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Episode of harmful use of anabolic steroid — Clinical Guidelines

Overview

An episode of harmful use of anabolic-androgenic steroids (AAS) involves the misuse of synthetic testosterone derivatives to enhance muscle mass and performance, leading to significant adverse health effects across multiple organ systems including cardiovascular, hepatic, endocrine, musculoskeletal, and psychiatric domains 1 2 4 9 12.

Diagnosis

Clinical Presentation: Symptoms may include mood swings, aggression, acne, testicular atrophy, gynecomastia, and cardiovascular abnormalities 1 9.

Laboratory Tests: Indirect markers such as low HDL cholesterol, elevated liver enzymes, and hormonal imbalances (e.g., suppressed endogenous testosterone) can indicate AAS abuse 3.

Physical Examination: Signs like gynecomastia, acne, and testicular atrophy are indicative 14.

History: Detailed history of substance use, including patterns and dosages, is crucial 2 12.

Management

Discontinuation: Gradual tapering of AAS under medical supervision to manage withdrawal symptoms 9.

Symptom-Specific Treatment: Address psychiatric symptoms with appropriate psychotherapeutic interventions; manage cardiovascular risks with lifestyle modifications and medication if necessary 1 9.

Monitoring: Regular follow-up to monitor liver function, lipid profiles, and hormonal levels 3 4.

Supportive Care: Nutritional counseling and psychological support to address body image issues and mental health concerns 6 9.

Special Populations

Pediatrics: Early intervention and education on risks crucial due to developmental impacts 10.

Adolescents: Focus on anticipatory guidance and addressing misuse of ergogenic aids during preparticipation exams 16.

Comorbidities: Tailored management considering existing health conditions, particularly cardiovascular and liver health 4 12.

Key Recommendations

Gradual Tapering for Withdrawal Management: Gradually reduce AAS dosage under medical supervision to mitigate withdrawal symptoms (Evidence: Moderate 9).

Comprehensive Monitoring Post-Discontinuation: Regular clinical and laboratory monitoring for cardiovascular, hepatic, and endocrine complications (Evidence: Moderate 3 4).

Psychological Support: Provide psychological counseling to address mental health issues such as depression and aggression associated with AAS use (Evidence: Moderate 9).

Education and Prevention: Educate athletes and healthcare providers about the risks and detection methods of AAS abuse (Evidence: Expert opinion 6).

Heightened Suspicion in Dermatological Presentations: Consider AAS abuse in patients presenting with skin manifestations like acne or hirsutism (Evidence: Expert opinion 14).

References

1 Mingxing L, Yanfei Y. Adverse Effects of Anabolic Androgenic Steroid Abuse in Athletes and Physically Active Individuals: A Systematic Review and Meta-Analysis. Substance use & misuse 2025. link 2 Smit DL, Buijs MM, de Hon O, den Heijer M, de Ronde W. Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100 men. Scandinavian journal of medicine & science in sports 2021. link 3 Christou GA, Christou MA, Žiberna L, Christou KA. Indirect clinical markers for the detection of anabolic steroid abuse beyond the conventional doping control in athletes. European journal of sport science 2019. link 4 Horwitz H, Andersen JT, Dalhoff KP. Health consequences of androgenic anabolic steroid use. Journal of internal medicine 2019. link 5 Dikic N, McNamee M, Günter H, Markovic SS, Vajgic B. Sports physicians, ethics and antidoping governance: between assistance and negligence. British journal of sports medicine 2013. link 6 Kersey RD, Elliot DL, Goldberg L, Kanayama G, Leone JE, Pavlovich M et al.. National Athletic Trainers' Association position statement: anabolic-androgenic steroids. Journal of athletic training 2012. link 7 . ACOG Committee Opinion No. 484: Performance enhancing anabolic steroid abuse in women. Obstetrics and gynecology 2011. link 8 Stirling AE. Definition and constituents of maltreatment in sport: establishing a conceptual framework for research practitioners. British journal of sports medicine 2009. link 9 Talih F, Fattal O, Malone D. Anabolic steroid abuse: psychiatric and physical costs. Cleveland Clinic journal of medicine 2007. link 10 Kerr JM, Congeni JA. Anabolic-androgenic steroids: use and abuse in pediatric patients. Pediatric clinics of North America 2007. link 11 Maughan RJ. Contamination of dietary supplements and positive drug tests in sport. Journal of sports sciences 2005. link 12 Hall RC, Hall RC. Abuse of supraphysiologic doses of anabolic steroids. Southern medical journal 2005. link 13 Kouri EM, Pope HG, Katz DL, Oliva P. Fat-free mass index in users and nonusers of anabolic-androgenic steroids. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 1995. link 14 Scott MJ, Scott MJ. Dermatologists and anabolic-androgenic drug abuse. Cutis 1989. link 15 Farjam A, de Jong GJ, Frei RW, Brinkman UA, Haasnoot W, Hamers AR et al.. Immunoaffinity pre-column for selective on-line sample pre-treatment in high-performance liquid chromatography determination of 19-nortestosterone. Journal of chromatography 1988. link81465-5) 16 Dyment PG. The adolescent athlete and ergogenic aids. Journal of adolescent health care : official publication of the Society for Adolescent Medicine 1987. link90247-6) 17 Alén M, Reinilä M, Vihko R. Response of serum hormones to androgen administration in power athletes. Medicine and science in sports and exercise 1985. link

Episode of harmful use of anabolic steroid