Anabolic steroid abuse A paradox of manliness

Reflections on “Anabolic steroid–induced hypogonadism: diagnosis and treatment” by Rahnema et al.

Ajay Nangia, M.B.B.S.

Volume 101, Issue 5, Page 1247

Reflections on “Anabolic steroid–induced hypogonadism: diagnosis and treatment” by Rahnema et al.

  • Jason Kovac

    We have recently published a rebuttal to this commentary focusing on the question whether AAS could actually have beneficial effects. Would be interested to hear what people think of this concept.

    Fertil Steril. 2014 Jul;102(1):e5. doi: 10.1016/j.fertnstert.2014.05.010. Epub 2014 Jun 4.
    A positive role for anabolic androgenic steroids: preventing metabolic syndrome and type 2 diabetes mellitus.
    Kovac JR1, Scovell J1, Kim ED2, Lipshultz LI3.

  • Michael Scally

    From the comment, “The dilemma that always exists for providers is whether treating such patients, and the sudden or later hypogonadism, is feeding into their abuse/dependent personality versus a liberal and nonjudgmental belief that these men need help with their physical symptoms and signs.”

    There is no more highly politicized class of drugs than Anabolic Androgenic Steroids (AAS). The nonprescription AAS user is often treated as pariah. Further, there is the problem that almost all physicians are not familiar with nonprescription AAS. The highly politicized topic of AAS halts all medical treatments and results in the unwarranted withholding of effective therapy, already essentially codified in the minds of many.

    This rings to mind the attitudes towards infectious disease, “Despite evidence that treatment for drug abuse is effective, many physicians view addicted patients as incurable and morally culpable. As with other `hateful’ patients, physicians may come to view drug users as manipulative, unmotivated, and undeserving of care. . . . Although the physicians’ frustration is understandable, such attitudes contribute to the unwarranted withholding of treatment and to mutually unsatisfactory patient–physician interactions.”

    Edlin BR, Seal KH, Lorvick J, et al. Is it justifiable to withhold treatment for hepatitis C from illicit-drug users? N Engl J Med 2001;345(3):211-5.

  • José Martínez-Jabaloyas

    Anabolic Steroid Induced Hypogonadism (ASIH) is a relative frequent cause of male infertility. One of the first problems is the usual negation of patients about steroid abuse
    (“I only take it one time…”) and some kind of psychological and/or physical
    dependence that difficult the withdrawal. I have seen
    patients with a depressive syndrome after androgen cessation in spite of
    recovering normal testosterone levels. I think that because of the increasing
    frequency of anabolic androgenic steroid users ASIH will be more and more
    frequent motive of consultation. It is necessary the implication of
    psychiatrists and/or psychologist for an adequate multidisciplinary treatment, as
    well as communication campaigns preventing about AAS abuse dangers.

  • Jason Kovac

    An excellent commentary that deserves a read by everyone interested in the topic. Watch for our “rebuttal” in an upcoming issue !

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