For 11 years, a Massachusetts man had an alarming array of health problems, most notably that his heart kept failing. He landed in the hospital over and over again, needed life support at one point, spent years going to specialists, and underwent a barrage of tests along the way.

But through it all, he never revealed a key detail behind his ailments: He was taking powerful, illicit synthetic testosterone derivatives (aka anabolic-androgenic steroids, or AAS). One of the drugs he took was approved only for use in animals; it's primarily used to beef up cows.

Left in the dark, his doctors had to puzzle this out on their own. In a case report in this week's issue of the New England Journal of Medicine, they explain how they did it. They also offer a warning: These cases will only become more common, and clinicians need to know what they look like.

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