Complications
Depressive symptoms are primarily associated with withdrawal and are considered part of the anabolic-androgenic steroid withdrawal syndrome.
Reassurance should be offered to patients experiencing depressive mood during withdrawal.
Collaboration with a psychiatrist for major mood disorders is advised.[53]
Pharmacologic treatment or admission to the hospital may be indicated.[33]
Frequent follow-up and carefully inquiring about these symptoms are important.
Anabolic-androgenic steroid (AAS) use increases scores on the Young Mania Rating Scale.
Hypomania and mania are possible while using high-dose AAS.[1]
Supportive therapy may be indicated.
These changes are believed to be reversible on discontinuation.
Symptoms include excessive worry and tension.
Some users may already be self-treating with anxiolytics.
Supportive therapy may be indicated.
These changes are felt to be reversible on discontinuation.
Symptoms include hallucinations and delusions (grandiose and/or paranoid).[63]
Supportive therapy may be indicated.
These changes are believed to be reversible on discontinuation.
Associated with needle use.
Treated with oral or intravenous antibiotics with coverage for skin flora including MRSA (e.g., trimethoprim/sulfamethoxazole or clindamycin).
Tetanus immunization should be updated if needed. Because an injection site abscess is a tetanus-prone wound, tetanus immunoglobulin is used for patients without a clear history of having a complete tetanus immunization series.
Hypersensitivity reactions to the oils (e.g., sesame, cottonseed) used as diluents in some intramuscular products may occur.
May occur after a single dose.
Allergic reactions, depending on severity, can be treated with oral or parenteral diphenhydramine, subcutaneous epinephrine, and oral/parenteral glucocorticoids.
Height that is significantly below the average height for a person's given age/sex.
Use of anabolic-androgenic steroids during adolescence leads to premature closure of the epiphyseal plates.[21] This is a permanent effect.
Anabolic-androgenic steroid (AAS) use enhances vascular resistance and blood pressure and the proinflammatory biomarker profile; alters serum lipoproteins; and produces direct myocardial toxicity.[23] Cardiac complications are the major cause of sudden and premature death associated with AAS use.[2]
Decreased HDL and increased LDL are noted.
These changes are reversible on discontinuation.[64]
Anabolic-androgenic steroid (AAS) use enhances vascular resistance and blood pressure and the proinflammatory biomarker profile; alters serum lipoproteins; and produces direct myocardial toxicity.[23] Cardiac complications are the major cause of sudden and premature death associated with AAS use.[2]
Hypertension is reversible with cessation of use (within months).
Dietary and lifestyle modifications should be considered before antihypertensive medication treatment.
Anabolic-androgenic steroid (AAS) use enhances vascular resistance and blood pressure and the proinflammatory biomarker profile; alters serum lipoproteins; and produces direct myocardial toxicity.[23]
Cardiac complications are the major cause of sudden and premature death associated with AAS use.[2]
Cardiomyopathy can result from remodeling after myocyte injury.
Cardiac hypertrophy occurs in part as adaptation to the user’s increased body size and muscle mass, but in part is a direct effect of AAS use.[65]
Treatment is directed at the type of cardiomyopathy identified.
Anabolic-androgenic steroid (AAS) use enhances vascular resistance and blood pressure and the proinflammatory biomarker profile; alters serum lipoproteins; and produces direct myocardial toxicity.[23] Cardiac complications are the major cause of sudden and premature death associated with AAS use.[2]
Long-term AAS use appears to be associated with myocardial dysfunction and accelerated coronary atherosclerosis.[44]
Although atherogenic changes are believed to be reversible on discontinuing AAS use, users are at risk for myocardial infarction from plaque formation and intracoronary thrombus formation. Users are also at risk of myocardial infarction due to coronary vessel reactivity.[64]
Cardiac complications are the major cause of sudden and premature death associated with anabolic-androgenic steroids.[2]
Atrial fibrillation is usually accompanied by rapid and irregular heart rates. Medication, lifestyle changes, and surgery are treatment options.
Stroke disrupts blood supply to the brain caused by either blockade or hemorrhage. Stroke tends to be embolic in users of performance enhancing drugs; anabolic-androgenic steroids may have a direct effect on the coagulation/fibrinolytic system to increase coagulation factors, and other substances, such as erythropoietin, may be used.[42]
Thrombolytics may be used for treatment.
Anabolic-androgenic steroids are believed to promote a hypercoagulable state.[64] Anticoagulant therapy is the usual treatment.
Anabolic-androgenic steroids are believed to promote a hypercoagulable state.[64] Anticoagulant therapy is the usual treatment.
Desiring fertility is a major reason for men to want to give up use of anabolic-androgenic steroids (AAS). Secondary hypogonadism can be confirmed with early morning serum testosterone and gonadotropin levels. All other causes of secondary hypogonadism should be excluded.
Evidence suggests that with an AAS exposure of ≤1 year, serum gonadotropin and testosterone levels recover to normal concentrations in 3-6 months and 6 months, respectively, after cessation of AAS use. AAS exposure for >1 year will result in symptomatic hypogonadism and serum testosterone concentrations below normal for years after discontinuation of AAS use.[1] In these cases, after discontinuation of AAS use, initiation of clomiphene or gonadotropin therapy is likely to increase spermatogenesis and restore fertility.
Gynecomastia results from an imbalance of androgenic and estrogenic action on breast tissue.[18] Aromatizable androgens, particularly at high doses, and human chorionic gonadotropin therapy (that stimulates aromatase) can cause tender gynecomastia.[6] Many anabolic-androgenic steroid (AAS) users will take aromatase inhibitors to prevent or treat this adverse effect.[1][6]
Gynecomastia may persist after stopping AASs.[11] Surgical repair may be the only option for irreversible gynecomastia.
More common, particularly with the 17-alpha-alkyl steroids, and is reversible on cessation of anabolic-androgenic steroids.[22]
Associated with 17-alpha-alkyl steroid use.[22]
Both benign and malignant tumors have been linked to taking anabolic-androgenic steroids.
Tumor may regress on discontinuation.
Treatment decisions are based on the tumor type identified.
A rare form of hepatitis characterized by formation of multiple blood-filled cysts within the liver, which can be life-threatening.
Treatment is usually directed at managing the underlying cause.
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