A 23-year-old man has noted a yellow color to his sclerae for the past 2 weeks. On physical examination, he has generalized jaundice. He has the physique of a bodybuilder. Laboratory studies show serum total bilirubin, 5.6 mg/dL; ALT, 117 U/L; AST, 103 U/L; alkaline phosphatase, 148 U/L; albumin, 5.5 g/dL; and total protein, 7.9 g/dL. Which of the following substances is he most likely to be using?

Anabolic-androgenic steroids are injected for the purpose of increasing muscle mass to enhance athletic performance. Because performance is primarily correlated with skill and training, the potential gain from muscle mass is problematic, particularly in view of the deleterious effects, such as hepatic cholestatic hepatitis. Acetaminophen can produce hepatic necrosis, but icterus is less likely. Chlor- promazine is more likely to produce pure cholestasis as an idiosyncratic (unpredictable) reaction. Ethanol can produce steatosis, and in excess, the AST is often higher than the ALT. Isoniazid may produce hepatic necrosis in persons treated for tuberculosis.