Lesson 1Evidence limits and uncertainty: interpreting low-quality/biased studies and clinician communication with patientsDiscusses limitations of existing anabolic research, including selection bias, underreporting, and confounding. Teaches clinicians to interpret weak or conflicting data, communicate uncertainty, and support informed, values-based patient decisions.
Common biases in anabolic researchInterpreting observational and case dataHandling conflicting or absent evidenceExplaining uncertainty to patientsShared decision-making under ambiguityDocumenting risk discussions clearlyLesson 2Acute and subacute adverse effects: polycythaemia, hypertension, acne, mood/behaviour changes, hepatic injury (oral agents), injection complicationsOutlines common early adverse effects of anabolic use, including polycythaemia, hypertension, acne, mood shifts, hepatic injury from oral agents, and injection complications. Provides practical algorithms for detection, grading, and management.
Polycythemia detection and managementBlood pressure elevation and treatmentDermatologic effects and acne careHepatic injury from oral agentsInjection-site and infectious issuesWhen acute effects require cessationLesson 3Cardiovascular risks: dyslipidaemia, myocardial hypertrophy, thrombosis, arrhythmia risk and available evidenceExplores how anabolic agents affect lipids, blood pressure, myocardium, and coagulation. Reviews human and animal data on atherosclerosis, arrhythmias, and sudden death, and explains how to stratify and mitigate cardiovascular risk in users.
Mechanisms of dyslipidemia and hypertensionMyocardial hypertrophy and remodelingThrombosis and coagulation abnormalitiesArrhythmias and sudden cardiac death riskImaging and functional cardiac assessmentRisk stratification and mitigation stepsLesson 4Psychiatric and neurobehavioural effects: aggression, mood disorders, dependence, and withdrawal syndromesCovers aggression, irritability, depression, anxiety, and suicidality associated with anabolic use. Details dependence, compulsive cycling, and withdrawal syndromes, and outlines assessment, safety planning, and referral to mental health services.
Aggression, irritability, and violence riskMood disorders and suicidalityCognitive and impulse-control changesDependence, craving, and compulsive useWithdrawal syndromes and taperingCollaboration with mental health servicesLesson 5Harm reduction principles when non-medical use is disclosed: minimising acute harms, infection prevention, safer dosing concepts, and when to refuse to prescribeApplies harm reduction when non-medical use is disclosed, focusing on nonjudgmental engagement, safer dosing concepts, infection prevention, and realistic goal setting. Clarifies legal, ethical, and clinical boundaries for refusing prescriptions.
Nonjudgmental assessment and rapportSafer dosing and cycle design conceptsInjection hygiene and infection preventionOverdose and acute crisis planningWhen to decline prescribing or supportReferral pathways and community resourcesLesson 6Ongoing monitoring protocols: frequency and thresholds for intervention, red flags for urgent cessation and referralDefines structured follow-up for anabolic users, including visit timing, lab and imaging intervals, and thresholds that trigger dose changes, cessation, or referral. Emphasises recognising red flags and documenting shared decisions.
Visit frequency by risk categoryRoutine lab and imaging intervalsAction thresholds for key lab changesClinical signs requiring urgent cessationCriteria for specialist referralDocumentation and follow-up planningLesson 7Reproductive and endocrine sequelae: hypogonadism, testicular atrophy, infertility, menstrual disturbances, virilisation in femalesReviews how anabolic use disrupts the hypothalamic–pituitary–gonadal axis, causing hypogonadism, testicular atrophy, infertility, and menstrual changes. Addresses virilisation in females and outlines evaluation, counselling, and recovery expectations.
HPG axis suppression mechanismsMale hypogonadism and testicular atrophyMale and female fertility impairmentMenstrual disruption in female usersVirilization signs and reversibilityEndocrine recovery and PCT limitsLesson 8Musculoskeletal and metabolic harms: tendon injury risk, insulin resistance, and body composition changes over timeExamines musculoskeletal and metabolic harms, including tendon injury, altered collagen, insulin resistance, dysglycaemia, and long-term body composition changes. Describes screening, counselling on training loads, and strategies to reduce risk.
Tendon structure and rupture riskJoint stress and injury patternsInsulin resistance and glucose controlVisceral fat and body composition shiftsScreening for metabolic syndromeTraining and rehab modificationsLesson 9Screening and baseline evaluation to mitigate risk: CBC, CMP/LFTs, lipid panel, testosterone/hormone profile, PSA, ECG, blood pressure and targeted imaging when indicatedDetails baseline history, physical exam, and targeted testing before or during anabolic exposure. Explains how CBC, CMP, lipids, hormones, PSA, ECG, blood pressure, and imaging guide risk stratification and individualised monitoring plans.
Key history and physical exam elementsCBC and CMP/LFT interpretationLipid panel and cardiovascular markersHormone profile, PSA, and gonadal testsECG, blood pressure, and ambulatory dataWhen to order echocardiogram or imaging
