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.
---
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)
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.
---
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.
