Lesson 1Evidence limits and uncertainty: interpreting low-quality/biased studies and clinician communication with patientsDiscusses gaps in anabolic studies, like bias, under-reporting, and mix-ups. Guides doctors on handling weak data, sharing doubts, and helping patients make informed choices based on values.
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: polycythemia, hypertension, acne, mood/behavior changes, hepatic injury (oral agents), injection complicationsLists early side effects like thick blood, high pressure, spots, mood swings, liver damage from pills, and jab issues. Gives steps for spotting, rating, and handling them.
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: dyslipidemia, myocardial hypertrophy, thrombosis, arrhythmia risk and available evidenceShows how anabolics affect fats, pressure, heart muscle, clotting. Reviews people and animal studies on artery hardening, irregular beats, sudden death, and ways to assess and cut heart risks.
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 neurobehavioral effects: aggression, mood disorders, dependence, and withdrawal syndromesCovers anger, grumpiness, low mood, worry, self-harm thoughts from anabolics. Details addiction, repeat cycles, withdrawal, and plans for checks, safety, mental health links.
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: minimizing acute harms, infection prevention, safer dosing concepts, and when to refuse to prescribeUses harm reduction for admitted non-medical use, with open talks, better dosing ideas, infection stops, goal setting. Sets legal, moral, care limits for not prescribing.
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 referralSets follow-up plans for anabolic users, visit times, lab/scan gaps, limits for dose shifts, stops, referrals. Stresses spotting danger signs and recording joint choices.
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, virilization in femalesExplains how anabolics mess up hormone control, causing low levels, shrinkage, no fertility, cycle changes. Covers female hair growth changes, checks, advice, recovery hopes.
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 timeLooks at muscle/bone and energy harms like tendon tears, sugar issues, body shape shifts. Gives screening, training advice, risk cut strategies.
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 start history, checks, tests before/during anabolics. Explains blood counts, liver/kidney tests, fats, hormones, PSA, heart traces, pressure, scans for risk 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
