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Harmful pattern of use of anabolic steroid — Clinical Guidelines

Overview

Anabolic-androgenic steroid (AAS) misuse, particularly through stacking multiple substances, poses significant health risks including severe adverse outcomes as evidenced by adverse event reporting systems 1. Despite therapeutic acceptance for certain clinical disorders, illicit use for performance enhancement and physique modification remains prevalent 2.

Diagnosis

Clinical History: Detailed history of substance use, including types, dosages, and duration 14 18.

Physical Examination: Look for signs of hormonal imbalances, cardiovascular issues, liver dysfunction, and psychological disturbances 18.

Laboratory Tests: Assess testosterone/epitestosterone ratio in urine, liver function tests, lipid profiles, and complete blood count 1 18.

Psychological Evaluation: Screen for mood disorders, aggression, and cognitive impairments 18.

Management

Cessation and Monitoring: Encourage cessation of AAS use and monitor for withdrawal symptoms and long-term health impacts 18.

Supportive Care: Address specific organ dysfunction (e.g., liver support, cardiovascular monitoring) 18.

Psychological Support: Provide counseling and psychological support to address mental health issues 18.

Education: Inform patients about the risks and consequences of AAS misuse 2 18.

Special Populations

Pediatrics: AAS misuse in adolescents can lead to premature closure of growth plates and delayed puberty; close monitoring and counseling are essential 18.

Elderly: Increased risk of cardiovascular and metabolic complications; tailored monitoring and management strategies are needed 18.

Key Recommendations

Avoid Stacking Multiple Substances: Stacking AAS with other substances significantly increases health risks (Evidence: Strong 1).

Regular Medical Monitoring: Individuals misusing AAS should undergo regular medical evaluations to detect and manage adverse effects (Evidence: Moderate 18).

Psychological Counseling: Integrate psychological support to address mental health issues associated with AAS misuse (Evidence: Moderate 18).

Educate on Risks: Healthcare providers should educate patients comprehensively about the severe health risks of AAS misuse (Evidence: Expert opinion 2).

References

1 Heo JW, Yang JD, Yum SK, Joo KM, Yum SY. Stacking the Risks: Fatal Consequences of Anabolic Steroid Misuse and Stacked Substance Use in FAERS Data. Substance use & addiction journal 2026. link 2 Bhasin S, Hatfield DL, Hoffman JR, Kraemer WJ, Labotz M, Phillips SM et al.. Anabolic-Androgenic Steroid Use in Sports, Health, and Society. Medicine and science in sports and exercise 2021. link 3 Simon P, Neuberger EW, Wang G, Pitsiladis YP. Antidoping Science: Important Lessons From the Medical Sciences. Current sports medicine reports 2018. link 4 McBride JA, Carson CC, Coward RM. The Availability and Acquisition of Illicit Anabolic Androgenic Steroids and Testosterone Preparations on the Internet. American journal of men's health 2018. link 5 Bowers LD, Bigard X. Achievements and Challenges in Anti-Doping Research. Medicine and sport science 2017. link 6 Sagoe D, McVeigh J, Bjørnebekk A, Essilfie MS, Andreassen CS, Pallesen S. Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. Substance abuse treatment, prevention, and policy 2015. link 7 Backhouse SH, McKenna J. Doping in sport: a review of medical practitioners' knowledge, attitudes and beliefs. The International journal on drug policy 2011. link 8 Dodge T, Hoagland MF. The use of anabolic androgenic steroids and polypharmacy: a review of the literature. Drug and alcohol dependence 2011. link 9 Banfi G, Lombardi G, Colombini A, Lippi G. A world apart: Inaccuracies of laboratory methodologies in antidoping testing. Clinica chimica acta; international journal of clinical chemistry 2010. link 10 Schumacher YO, Pottgiesser T. Performance profiling: a role for sport science in the fight against doping?. International journal of sports physiology and performance 2009. link 11 Woods CB, Moynihan A. General practitioners knowledge, practice and training requirements in relation to doping in sport. Irish medical journal 2009. link 12 Thevis M, Schänzer W. Mass spectrometry in sports drug testing: Structure characterization and analytical assays. Mass spectrometry reviews 2007. link 13 Green GA. Doping control for the team physician: a review of drug testing procedures in sport. The American journal of sports medicine 2006. link 14 Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of 500 users. Medicine and science in sports and exercise 2006. link 15 Azzazy HM, Mansour MM, Christenson RH. Doping in the recombinant era: strategies and counterstrategies. Clinical biochemistry 2005. link 16 Striegel H, Vollkommer G, Dickhuth HH. Combating drug use in competitive sports. An analysis from the athletes' perspective. The Journal of sports medicine and physical fitness 2002. link 17 Desroches MC, Mathurin JC, Richard Y, Delahaut P, de Ceaurriz J. Urinary 19-norandrosterone purification by immunoaffinity chromatography: application to gas chromatography/combustion/isotope ratio mass spectrometric analysis. Rapid communications in mass spectrometry : RCM 2002. link 18 O'Sullivan AJ, Kennedy MC, Casey JH, Day RO, Corrigan B, Wodak AD. Anabolic-androgenic steroids: medical assessment of present, past and potential users. The Medical journal of Australia 2000. link 19 Birkeland KI, Hemmersbach P. The future of doping control in athletes. Issues related to blood sampling. Sports medicine (Auckland, N.Z.) 1999. link 20 Evans NA. Gym and tonic: a profile of 100 male steroid users. British journal of sports medicine 1997. link 21 Ambrose PJ. Doping control in sports--a perspective from the 1996 Olympic Games. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 1997. link 22 Street C, Antonio J, Cudlipp D. Androgen use by athletes: a reevaluation of the health risks. Canadian journal of applied physiology = Revue canadienne de physiologie appliquee 1996. link 23 Millar AP. Licit steroid use--hope for the future. British journal of sports medicine 1994. link 24 Levandowski R, McInerney VK, Scott DI. Anabolic steroids: performance enhancers?. New Jersey medicine : the journal of the Medical Society of New Jersey 1991. link 25 Falk O, Palonek E, Björkhem I. Effect of ethanol on the ratio between testosterone and epitestosterone in urine. Clinical chemistry 1988. link 26 Garhammer J. Performance evaluation of Olympic weightlifters. Medicine and science in sports 1979. link

Harmful pattern of use of anabolic steroid