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Anabolic Steroids: Uses, Abuse, And Side Effects

Anabolic Steroids – A Comprehensive Overview

Anabolic steroids are synthetic derivatives of the naturally occurring hormone testosterone. They possess anabolic (muscle‑building) and androgenic (male sex‑characteristic‑enhancing) properties, making them useful for certain medical conditions but also highly sought after by athletes, bodybuilders, and some non‑athletes seeking rapid physique changes.

Below is a structured guide covering their therapeutic uses, side‑effect profile, contraindications, drug interactions, monitoring strategies, and key references.

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1. Medical Indications

Category Specific Conditions

Endocrine & Metabolic

Hypogonadism (primary or secondary) in men

Musculoskeletal

Cushing’s disease with muscle wasting

Osteoporosis (rarely, as a steroid)

Gastrointestinal

Severe chronic inflammatory bowel disease (e.g., Crohn’s) when other therapies fail

Immunology & Hematology

Autoimmune diseases refractory to standard therapy (rarely)

Sickle cell disease pain crises (experimental)

Nephrology & Cardiology

Renal transplant rejection prophylaxis (experimental)

Cardiac allograft vasculopathy prevention (experimental)

Note: Many of these indications are experimental and not recommended outside clinical trials.

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5. Potential Side Effects

System Common/Expected Adverse Events

Endocrine Weight gain, hyperglycemia, hypertension, dyslipidemia, acne, hirsutism (women).

Metabolic Increased insulin resistance, elevated fasting glucose, new-onset type 2 diabetes.

Cardiovascular Elevated blood pressure; possible increased risk of heart failure or arrhythmias in susceptible individuals.

Dermatologic Acneiform eruptions, rash, hypertrichosis.

Hepatic Mild transaminase elevations (rare).

Gastrointestinal Nausea, abdominal discomfort; rarely, severe GI side effects.

Ophthalmologic Rare cases of ocular hypertension; monitor intraocular pressure in patients with glaucoma risk factors.

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4. Contraindications & Precautions

Category Specific Concerns / Actions

Pregnancy / Lactation No clinical data support safety. Avoid use unless absolutely necessary.

Hypersensitivity to Progestins Complete contraindication.

Severe Liver Disease Reduced metabolism → increased exposure; avoid or monitor closely.

Uncontrolled Hypertension, Diabetes Mellitus Progesterone analogues may worsen control; evaluate risk-benefit.

Active Malignancy (Breast, Endometrial) Potential estrogenic effect; use with caution.

History of Deep Vein Thrombosis / Pulmonary Embolism Progestins can increase clotting risk; avoid unless no alternatives.

Pregnancy / Breastfeeding Use only if clearly indicated; monitor infant for suppression of adrenal function.

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6. Clinical Summary

Purpose:

- Primarily: Replacement therapy in congenital adrenal hyperplasia (CAH) and other steroid‑deficiency disorders.

- Secondary: Adjunctive therapy to correct cortisol deficiency when hydrocortisone is insufficient or impractical.

Key Points for Practice:

Dose & Frequency – 2–3 mg/kg/day, divided into 3–4 doses; adjust based on weight changes and clinical response.

Monitoring – Weight gain, growth curves, blood pressure, serum electrolytes (Na⁺/K⁺), fasting glucose/HbA1c, liver enzymes; consider cortisol levels when necessary.

Safety Precautions – Educate caregivers on signs of adrenal crisis; maintain emergency hydrocortisone injection kit and educate on stress dosing.

Drug Interactions – Avoid co‑administration with rifampicin/phenobarbital; review all medications for CYP450 interactions.

Tapering & Withdrawal – Only after at least 6 months of therapy, under specialist supervision.

Conclusion

The dosing regimen and safety monitoring plan above should be implemented in the patient’s care pathway to ensure effective adrenal insufficiency treatment while minimizing adverse events. Regular follow‑up visits with endocrine assessment and laboratory testing are essential for early detection of potential complications and for timely adjustment of therapy.
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