ANABOLIC STEROID ABUSE

Anabolic-androgenic steroids, usually referred to as “anabolic steroids”, are synthetic substances that mimic male sex hormones. These steroids stimulate male characteristics both in males and females, enhance skeletal muscle development, and boost red blood cell production. The anti-catabolic property of these substances prevents tissue breakdown linked with tremendous intensity activities. They are used to treat adolescent males with delayed puberty, hypogonadism, impotence, anaemia, osteoporosis, breast cancer and several other health problems caused by hormonal imbalance.

There are more than 100 kinds of anabolic steroids but only a few have been legally authorized for medical use. They may be administered internally through oral and intravenous routes or externally by applying cream or gel. These drugs are either prescribed or obtained illegally. People often use these steroids to gain more muscle mass in a short amount of time wherein high potential for abuse is possible. Doses consumed by persons who abuse these substances are 10 to 100 times higher than the approved dosage prescribed for those who have medical conditions.

SYMPTOMS

Medical signs of anabolic steroid abuse and symptoms include:

  • Severe chest pain
  • Elevated blood pressure
  • Tachycardia
  • Rapid weight gain
  • Peripheral edema
  • Acne on the face, back, and chest
  • Altered body composition (marked development of upper torso)
  • Muscular hypertrophy
  • Stretch marks on back, arms, and chest
  • Needle marks in large muscle groups
  • Development of baldness
  • Gynecomastia
  • Frequent bruising
  • Personality changes/steroid psychosis: rapid mood swings, sudden aggression, violent tendencies
  • Development of secondary male characteristics in females (deeper voice, excessive growth of facial and body hair, etc.)
  • Menstrual irregularities in females
  • Diarrhoea
  • Abdominal pain
  • Urinary tract infections 
  • Increased urine frequency
  • Bladder irritation
  • Insomnia 
  • Sleep apnea
  • Jaundice

Extreme depression which can lead to suicide, can result from anabolic steroid withdrawal.

There is a chance of delayed bone growth in the pediatric age group. Tendon and muscle strains are prevalent and will heal significantly slower than expected.

DIAGNOSIS

 

Urinalysis is the most popular method of screening anabolic steroid abuse, utilizing GC-MS, recognized as gas chromatography and mass spectrometry, which can identify a particular substance in a given sample. In human urine, gas chromatography (GC) along with mass spectrometry (MS) has widely been used to identify anabolic steroid metabolites and confirm anabolic steroid abuse.

Differential Diagnosis: Any young adult with an unexplained cause of chest pain, likely accompanied by dyspnea and high blood pressure without any clinical evidence of neuromusculoskeletal involvement, may indicate a history of anabolic steroid use.

 

TREATMENT

Medical Management: Medical management of anabolic steroid abuse is always coupled with behavioural psychotherapy and patient education. When patients experience withdrawal, medical intervention is administered, which may include prescription of anti-anxiety or antidepressants. 

Physical Therapy Management: Physical therapy management involves physical therapists to treat associated symptoms related to prolonged anabolic steroid abuse. 

Psychological Management: Abusers typically experience severe depression as a withdrawal symptom; cognitive psychotherapy is aimed to treat the depression and other detrimental behavioural patterns caused by anabolic steroid abuse.

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