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Anabolic Steroids: Types, Uses, And Risks

# Anabolic Steroids – A Comprehensive Overview

Anabolic steroids are synthetic derivatives of testosterone that promote muscle growth (anabolism) and, in some cases, enhance athletic performance. While they can be medically useful for certain conditions, their misuse has led to widespread health concerns and regulatory scrutiny.

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## 1. What Are Anabolic Steroids?

| Feature | Details |
|---------|--------|
| **Chemical Basis** | Synthetic analogues of the hormone testosterone (a steroidal androgen). |
| **Primary Action** | Bind to androgen receptors in muscle, bone, and other tissues → stimulate protein synthesis, reduce protein breakdown, and increase nitrogen retention. |
| **Secondary Effects** | May influence mood, aggression, libido, and can trigger a range of physiological side‑effects. |

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## 2. Medical Uses

- **Hormone Replacement Therapy**: Treat low testosterone in men (e.g., hypogonadism).
- **Cachexia Management**: Counteract muscle wasting in chronic illnesses such as HIV/AIDS, cancer.
- **Delayed Puberty or Growth Disorders**: Promote growth and development where hormone levels are deficient.
- **Anemia of Chronic Disease**: Occasionally used to stimulate erythropoiesis.

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## 3. Bodybuilding & Athletic Performance

### Intended Benefits
| Effect | Mechanism |
|--------|-----------|
| Muscle hypertrophy | ↑ protein synthesis, increased IGF‑1 |
| Strength gains | Improved neuromuscular recruitment |
| Reduced recovery time | Anti‑catabolic effects |

### Common Steroids Used
- **Anabolic steroids**: Testosterone esters (enanthate, cypionate), Dianabol (methandrostenolone), Trenbolone.
- **Steroid cycles**: Typically 8–12 weeks, followed by post‑cycle therapy.

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## 4. Adverse Effects

| System | Acute (hours–days) | Chronic (>months) |
|--------|--------------------|-------------------|
| **Endocrine** | Gynecomastia, testicular atrophy | Hypogonadism, infertility |
| **Cardiovascular** | Hypertension, tachycardia | Atherosclerosis, arrhythmias |
| **Hepatic** | Elevated liver enzymes (methanol, anabolic steroids) | Hepatotoxicity, cholestasis, hepatic adenoma |
| **Renal** | Acute kidney injury (rare with methanol) | Chronic nephropathy (steroids) |
| **Neurological** | Visual disturbances, headache | Cognitive impairment, stroke |
| **Psychiatric** | Irritability, depression | Psychosis (rare) |

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## 5. Preventive Strategies

| Category | Measures | Practical Implementation |
|----------|----------|---------------------------|
| **Pre‑hospital care** | Rapid decontamination; early antidote administration | Training EMTs in methanol protocols; pre‑filled kits with fomepizole, ethanol, and folinic acid |
| **In‑hospital protocols** | Standardized order sets for toxic alcohol ingestion; prompt labs (gas chromatography) | EMR alerts for "toxic alcohol" orders; automatic IV lines for fomepizole |
| **ICU monitoring** | Daily arterial blood gases; urine pH; lactate levels; renal function | Protocols to check every 4–6 h until stable |
| **Dialysis decisions** | Use of RRT criteria (acidosis, renal failure, electrolyte imbalance) | Clear guidelines: start dialysis if pH  5.5 with acidosis |
| **Post‑ICU follow‑up** | Neuropsychological assessment; audiology; endocrine panels | Referral to rehab services within 30 days post‑discharge |

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## 4. How This Applies to the Current Patient

| Situation | Recommendation |
|-----------|----------------|
| **Patient is in ICU, stable, no acidosis or renal failure** | Continue monitoring labs (BUN, creatinine, electrolytes). No dialysis indicated. |
| **If patient develops severe metabolic acidosis (pH  5.0 mmol/L** | Initiate CRRT; consult nephrology. |
| **If creatinine rises >2 mg/dL or oliguria (0.3 mg/dL)** | Check urine output, review fluids & nephrotoxic meds, consider stopping/adjusting offending drugs. |
| **Severe oliguria (

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