The bodybuilding supplement Estro Suppress has been found to contain traces of a breast cancer drug, but is the discovery old news?

Some may already be familiar with the meme-friendly factoid that entertainer Dwayne “The Rock” Johnson has purportedly undergone liposuction for something called gynecomastia –– a benign enlargement of male breast tissue resulting from metabolic disorder, side-effects from medication, or natural drops in testosterone levels. Or anabolic steroid use. It follows that, in the bodybuilding community, this unnerving syndrome is relatively common –– so much so that many have traditionally taken to self-medication to keep their pecks in check.

Here, unfortunately, is where tamoxifen enters the picture. A high-shelf, prescription-based pharmacological agent, this drug antagonizes the body’s estrogen receptors, lowering the level of the hormone in the body. For women (or men) with estrogen receptor-positive breast cancers, a lower amount of estrogen inhibits the tumor growth. For bodybuilders on a program of shady supplements, it helps offset biological responses that would otherwise result in “moobs.” The use is pervasive and has been going on for about 30 years.

This Is A Problem

For some time, the supplement Esto Suppress has been thrown around in bodybuilding circles as a legal, natural supplement that does more or less the same thing as these pharmacological hormone suppressors. However, clichés notwithstanding, bodybuilders are no idiots –– and aside from the unbelievably sketchy label, many have also been tipped off by the chemical designation (Z)-1-(p-dimethylaminoethoxyphenyl)-1,2-diphenyl-1-butene. The systematic name for tamoxifen is (Z)-2-(4-(1,2-diphenylbut-1-en-1-yl)phenoxy)-N,N-dimethylethan-1-amine. Let it suffice to say that these two are very similar. The bodybuilding forum “Bodybuilding Forum” has more.

“It's straight tamoxifen (just an odd nomenclature), assuming what's on the label is in the bottle,” writes one user, whose handle “THEHUGE –– Just call me Lucifer” admittedly belies an eye for formal IUPAC terminology.

But for a matter like this to be brought to the scientific and regulatory eye, you often need the intervention of scientists and regulators. Now, in a letter to the journal BMJ, a team led by Dr. Michael Evans-Brown of Liverpool John Moores University in the UK outline their own investigation of the supplement. Not surprisingly, the results confirm the suspicion of those who use Esto Suppress on a daily basis.

“Four samples were purchased at different times between late 2011 and early 2012 and were analysed using reference standards and gas chromatography coupled with flame ionisation and mass spectrometry detectors,” the team writes, adding that tamoxifen was found in three out of the four samples. “The product label suggested a dosage of two capsules a day, which in the case of sample 1 may have provided 7.6 mg of tamoxifen.”

Why This Is A Problem

Now, since higher doses of tamoxifen are actually used to treat gynecomastia, it may take some parsing to figure out what the issue really is. Because, if an at-risk part of the population self-medicates for a condition it would otherwise not report to health authorities, isn’t that better than letting people suffer? The answer goes to the core of a broader issue that is currently keeping experts across the public health spectrum sleepless.

Last week, I wrote about a so-called diagnostic inflation, a troubling development by which the rate of diagnosis and prescription is artificially increased. Though less obvious, something very similar appears to be at play here: By marketing pharmacologically active substances as something else, companies like Estro Suppress’ developer Pharma Lab and other “natural” suppliers are turning users into unwitting pill poppers. Granted, some seek out the drug precisely because they are pill poppers obsessed with striking the perfect supplement balance –– but that doesn’t justify the developer’s attempt to plunge them into an even steeper downward spiral under the guise of “holistic” or “natural” intervention.

This problem also fits into a larger issue concerning the use of stimulants and other illicit practices in noncompliant corners of the supplement industry. Last year, for example, the substance “OxyElite Pro” was implicated in a string of hepatitis infections and liver failures after a probe by the Food and Drug Administration (FDA). The supplement, which supposedly targets fat cells that are “holding your body fat hostage,” was subsequently shown to contain aegeline, a substance the FDA classifies as an adulterant. The Texas-based manufacturer, USPlabs LLC, was advised to recall the supplement and destroy inventory valued at $22 million.

"As soon as we suspected a possible link between OxyElite Pro products and cases of liver failure and non-viral hepatitis in Hawaii, we warned the public and immediately launched an investigation with state officials and the Centers for Disease Control and Prevention (CDC)," Daniel Fabricant, director of the Division of Dietary Supplement Programs at the FDA, said in a statement released after the agency’s probe in 2013. "Our mandate to protect the public was fulfilled by ensuring the swift removal of the product from the marketplace."

Evans-Brown and colleagues share the concerns of FDA officials. In their letter, they urge all physicians to question patients on supplements, as some ills may be side effects of pharmaceutical drugs they themselves have no idea they’re taking. “These include anabolic steroids, erectogenics, stimulants, appetite suppressants, and anxiolytics,” they write. “Some of these substances have been withdrawn from use in medicines owing to safety concerns, others have never been tested in humans...Most users will be unaware that they are taking these substances.”

Read the label one more time, and throw the bottle in the trash.

Source: Evans-Brown M, Kimergård A, McVeigh J, Chandler M, Brandt SD. Is The Breast Cancer Drug Tamoxifen Being Sold As A Body Building Dietary Supplement? BMJ. 2014.