Veterans' Consensus Statement on Medical/Psychiatric Contraindications of Anabolic Use.
 

Anabolic steroids have legitimate uses in the pursuit of important life goals, including physical strength, aesthetic appeal, psychological wellbeing, and longevity. However, few drugs have as broad and profound an impact on body chemistry as do anabolic steroids. These drugs can have unpredictable effects on all body systems, including the immune, circulatory, nervous, endocrine, and excretory systems (liver and kidney), as well as on the integument (skin and hairline) and on the joints and muscles that comprise the musculoskeletal system. The athlete contemplating the use of anabolic steroids must bear constantly in mind the idea that the point of their use is not to take drugs for drugs' sake, but rather to grow stronger and healthier and to live a more satisfying and long life, through the combination of anabolic steroids with proper diet, recuperation, and training practices.

But even the wisest and most conservative use of anabolic steroids is contraindicated by two main categories of pre-existing or concurrent problems - certain medical illnesses, and a small class of psychiatric disorders. The use of anabolics when these other conditions are present is unwise, and the user who moves ahead with a program of anabolic steroid use, despite the presence of these conditions, should be acutely aware of the risks taken.

1.) Medical conditions that contraindicate the use of anabolics by posing unacceptable levels of hazard to the prospective user include liver disease (hepatitis, jaundice, cirrhosis, which may be aggravated by 17-alpha-alkylated anabolics, though agents such as oxandrolone may have beneficial effects in some cases), kidney disease (which anecdotal reports suggest may be aggravated by such steroids as trenbolone), uncontrolled hypertension (blood pressure above 150/90, which may be boosted further by anabolics' effects on water retention and erythropoeisis, though it can be minimized through the wise use of certain ancillaries), cholesterol-dependent heart disease (steroids often precipitate a rise in serum cholesterol), morphologic abnormalities of the heart muscle such as hypertrophy of the ventricle's walls or irregular valve development (which can be exacerbated by androgens), a history of or significant risk for malignancy (because anabolics can accelerate tumor growth), and idiopathic endocrine disturbance including some irregularities of adrenal, thyroid, and hypothalamic function (though anabolics may be beneficial in some cases of endocrine insufficiency, such as hypogonadism). High but perhaps acceptable levels of hazard are present in prospective users with a history of severe acne (though some cases may benefit from non-testosterone based cycles or the use of certain ancillaries), male-pattern baldness, prostate disease and gynecomastia (all of which may be exacerbated by androgens), gastrointestinal disorders such as acid reflux disease (which may be aggravated by the use of some steroids), and joint and soft-tissue injury (which may be aggravated by steroid-induced strength gains, though Human Growth Hormone and nandrolone may be beneficial in some cases). The prospective user of anabolic steroids should also be aware that some ancillary drugs (such as Arimidex) have risk profiles of their own, and are not wholly benign simply because they combat unwanted side effects of anabolic agents.

2.) Psychiatric conditions that contraindicate the use of anabolics by posing unacceptable levels of hazard to the prospective user include presence or history of Bipolar Disorder or Hypomania (which can be exacerbated by anabolics), severe depression (which can be precipitated by the "post-cycle crash" though low-grade and abiding dysthymia may respond well to long-term low-dose programs of steroid use), psychosis (which can impair the judgment necessary to use anabolics responsibly), some disorders of impulse control such as Intermittent Explosive Disorder (which may be exacerbated by androgens), such conditions as Body Dysmporphic Disorder and severe, pathological narcissism (which may cause impaired control of anabolic use in order to achieve a physical effect that cannot, because of the distorted nature of the user's self-image, ever be achieved), and Antisocial Personality Disorder (which may cause impaired control of anabolic use, and may lead as well to misuse of the strength and size benefits of these agents). High but perhaps acceptable levels of hazard are present in prospective users with a history of Substance Use Disorder (which may lead to impaired control of anabolic use) or Panic Disorder and other debilitating anxiety disorders (which may be aggravated either "on-cycle" or "off-cycle" in certain cases).

Unexpected symptoms should be discussed with a competent health or mental health professional. Laboratory testing is the only way in which certainty can be achieved in some cases. Before embarking on a course of anabolics, it is wise to get baseline readings of various systems – blood tests (comprehensive metabolic profile, CBC with differential), EKG, BP, PSA and physical exam. This permits the athlete and his/her healthcare provider to determine whether or not there are underlying conditions that preclude anabolic use, and allows comparison to subsequent tests if and when the athlete is re-examined due to the emergence of symptoms. In fact, ongoing testing of certain blood fractions (such as serum estradiol) is wise, in order to give the athlete a more accurate view of what ancillaries at what doses are needed, and what metabolic side effects are actually occurring.


In addition, certain universal precautions should be observed for the athlete and others' safety. A good liver metabolic including R-ALA, calcium-D-Glucurate, N-acetyl Cysteine or L-Glutathione (such as Tylers Detox) should be taken by anyone using oral anabolics. Plenty of water, protein, OMEGA 3, and vitamin supplementation should be standard, and the opportunity for both abundant sleep and physical rest should be included in the athlete's schedule.

The athlete using anabolics should, to a reasonable degree, avoid the use of nonessential pharmacueticals/drugs such as pain killers, alcohol, stimulants, sedatives, nicotine, and recreational drugs. These drugs add additional stress to the liver and kidneys, create unpredictable reactions in combination with anabolics, may mask injuries that should be given rest and medical attention, and may cause new injury due to intoxication effects. In addition, users must always be aware of synergistic drug effects. While most users are conscious of the negative impact on the liver of combining two 17aa steroids, most are not aware that there are many OTC drugs that affect the production of certain liver enzymes. These drugs do not always produce a negative impact on the liver when taken alone, but they can render the liver less capable of processing certain steroids. Users should familiarize themselves with the enzymes utilized to break down the more liver toxic steroids, as well as the OTC drugs that might have an impact on the specific enzymes in question.


For these reasons, the following Veterans' Consensus Statement on Medical/Psychiatric Contraindications of Anabolic Use is offered:

Physical illnesses that contraindicate the use of anabolics include liver disease, kidney disease, hypertension, heart disease, malignancy and endocrine disturbance. Psychiatric conditions that contraindicate the use of anabolics include severe depression and other mood disorder, psychosis, and marked disorders of impulse control. The use of anabolics when any of these conditions are present is unwise. Less but still measurable risk is borne by patients with severe acne, prostate disease, gynecomastia, male-pattern baldness, joint and soft-tissue injury, substance use disorder, or debilitating anxiety disorders such as panic. Unexpected symptoms should be discussed promptly with a qualified professional, and both laboratory testing and prophylactic use of detoxification agents is encouraged. The use of nonessential pharmaceuticals is discouraged in persons considering the use of anabolic steroids.