Anabolic Steroids: Types, Uses, And Risks

# What to Know About Anabolic Steroids

Anabolic steroids—synthetic compounds that mimic the hormone testosterone—are widely used in sports, bodybuilding, and sometimes for medical conditions such as delayed puberty or severe muscle wasting. While they can increase muscle mass and athletic performance, they also carry significant health risks and legal ramifications.

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## 1. What Are Anabolic Steroids?

| Category | Typical Examples | Primary Effects |
|----------|------------------|-----------------|
| **Medical** | Oxandrolone (Oxandrin), Metabolite of testosterone | Treats severe burns, AIDS‑related wasting, osteoporosis |
| **Performance‑Enhancing** | Testosterone enanthate, Trenbolone acetate, Nandrolone decanoate | Increase muscle protein synthesis, red blood cell production |
| **Illicit / Recreational** | Anabolic steroids sold online or via street dealers (often counterfeit) | Similar to above but with higher risk of toxicity |

*All are derivatives of testosterone; they can be orally active (e.g., stanozolol) or injectable.*

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## 3. Potential Side Effects

| Category | Examples | Mechanism / Notes |
|----------|----------|-------------------|
| **Endocrine** | Testosterone suppression, gynecomastia, infertility | Steroids down‑regulate HPG axis; aromatase converts to estrogen |
| **Hepatic** | Hepatitis, cholestasis, peliosis hepatis (especially with oral anabolic agents) | Liver metabolizes orally active steroids |
| **Cardiovascular** | Hypertension, dyslipidemia (↓ HDL, ↑ LDL), atherogenesis | Steroids alter lipid metabolism; increased sympathetic tone |
| **Dermatologic** | Acne, hirsutism, oily skin | Estrogenic/androgenic effects on sebaceous glands |
| **Musculoskeletal** | Tendon rupture, ligament laxity (especially with high doses) | Excess hormones can affect collagen synthesis |
| **Psychiatric** | Aggression ("roid rage"), anxiety, insomnia, mood swings, depression (upon cessation) | Neuromodulatory effects of steroids on CNS |

> **Key point:** These adverse events are dose‑dependent and often cumulative. Even "low" doses may precipitate problems if used chronically or combined with other medications that potentiate steroid action.

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## 3. Interaction With Other Medications (e.g., SSRIs)

### Pharmacodynamic Interactions

| Medication | Interaction with Low‑Dose Corticosteroids | Clinical Implication |
|------------|-------------------------------------------|----------------------|
| **SSRIs** (fluoxetine, sertraline, paroxetine) | Both can increase the risk of mood disturbances. Corticosteroids may worsen depressive or anxiety symptoms; SSRIs might blunt this effect but also potentially enhance steroid‑induced psychosis in susceptible individuals. | Monitor for new or worsening mood changes, especially early after starting steroids. |
| **CNS Depressants** (benzodiazepines, opioids) | Corticosteroids may potentiate CNS depression when combined with benzodiazepines, but not a major concern at low steroid doses. | Use caution if higher steroid doses are required; monitor sedation level. |
| **Anticholinergic Medications** | Steroids can cause increased sweating and cholinergic effects (e.g., tremor); anticholinergics may worsen dry mouth or constipation. | Monitor for GI side effects and adjust anticholinergic dosing if needed. |

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## 5. Practical Management Guidelines

| Parameter | Recommendation |
|-----------|----------------|
| **Baseline Assessment** | Document BP, HR, weight, fasting glucose, HbA1c (if available). Review current medications and dosage. |
| **Dose Titration** | Start at 10 mg daily. Reassess after 2–4 weeks; consider increase to 20 mg if needed. Avoid doses >30 mg/day in patients with uncontrolled hypertension or heart failure. |
| **Monitoring Schedule** | - BP & HR: first visit, then every 2–4 weeks until stable.
- Weight: monthly.
- Fasting glucose/HbA1c: baseline, then at 3 months and annually.
- Renal function (eGFR): baseline, 6 months, then yearly. |
| **Lifestyle Counseling** | Encourage low‑sodium diet, regular aerobic exercise, moderation of alcohol intake, weight management. |
| **Management of Adverse Effects** | - Hypertension: consider dose reduction or add antihypertensive.
- Fluid retention: diuretics (e.g., furosemide) if needed; monitor electrolytes.
- Hyperglycemia: dietary advice, possible metformin; refer to endocrinologist if HbA1c > 7%. |
| **Follow‑up Schedule** | • 4 weeks post‑initiation – assess BP, weight, labs.
• 12 weeks – review response and side effects.
• Every 3 months thereafter – continue monitoring. |

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### Key Points for the Patient

- **Start of therapy:** Expect an initial increase in blood pressure, swelling, or thirst; report any dizziness, chest pain, or severe headache immediately.
- **Daily routine:** Take medication exactly at the same time each day with a glass of water.
- **Lifestyle reminders:** Maintain a low‑salt diet, moderate physical activity (unless otherwise advised), and avoid excessive alcohol.
- **Follow‑up:** Keep all appointments; bring any new symptoms to the clinician’s attention promptly.

This plan balances efficacy for hypertension control with careful monitoring for potential side effects, ensuring safety and optimal patient outcomes.

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