Question on Anabolic Steroids. Can you answer?
A 16 year-old male came to your office for the evaluation of a rash on his back and an abscess on his right thigh. He is also feeling frustrated, irritable and lost interest in activities he once enjoyed. His vital signs were Temp = 98.2 F, Blood pressure = 150/90 mm Hg, Pulse = 95/minute, RR = 24/minute. In the physical examination, you noticed severe acne on his face, several pustules of hair follicles on his back and a 5 cm by 5 cm size abscess with surrounding erythema on the lateral surface of right thigh. There is tenderness to palpation in the right upper quadrant. On further questioning, the patient admits that he takes some oral and injection steroid supplements to increase his muscle mass and ‘sexual energy’. He would like to build his body like his favorite movie star.
Regarding his use of performance-enhancing steroids, which of the following is the best advice you can give to this patient?
- Continue at current doses with regular checkups of liver enzymes to prevent liver dysfunction
- Use only oral preparations because injection use is associated with skin infections and abscesses like the one he got on his right thigh
- Stop all steroid supplements because they are injurious to his health
- Continue steroid supplements at lower doses than current doses
Correct Answer is C. Anabolic-androgen steroids (AASs) are performance-enhancing substances used by adolescents. They are synthetic modifications of testosterone. They include nandrolone decanoate, dimethandrolone, testosterone propionate, or testosterone enanthate.Their use is illegal. Despite their ban, 3-10% of adolescents have used anabolic steroids to build muscles and augment athletic performance. High doses of anabolic steroids can cause cholestatic liver injury, jaundice, elevation of liver enzyme levels, hepatocellular adenomas, acne vulgaris, folliculitis (like in this patient), premature androgenic alopecia, gynecomastia, testicular atrophy, infertility, precocious puberty, growth stunting, hypertension (like in this patient), lipid abnormalities,skin striae, increased tendencies toward violent behavior, high risk personal health behaviors such as tobacco use, excessive alcohol consumption, opioid abuse, and clinical depression (‘feeling frustrated, irritable, and lost interest in activities he once enjoyed’).
A is incorrect because use of anabolic steroids even with regular checkups of liver enzymes is illegal and unhealthy
B is is incorrect because oral preparations are no less harmful than injectables
D is incorrect anabolic steroid use is illegal irrespective of their dose and frequency