Lesson 1Evidence limits and uncertainty: interpreting low-quality/biased studies and clinician communication with patientsDem talk limits in anabolic studies, like pick bias, under-report, mix factors. Dem teach doctors to read weak data, talk uncertainty, help patient choices wey match dem 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 complicationsDem list early bad effects like too much blood cells, high pressure, pimples, mood change, liver hurt from pills, needle problems. Dem give steps for find, grade, handle.
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 evidenceDem see how anabolic hit fats, pressure, heart muscle, clotting. Dem review people and animal data on artery block, heart rhythm issues, sudden death, how to rank and cut heart risk.
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 syndromesDem cover fight mood, grumpiness, down feeling, worry, suicide links wid anabolic. Dem detail addiction, must-cycle, stop sickness, check, safety plans, send to mind health.
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 prescribeDem use harm cut when street use come out, no judge talk, safe dose ideas, stop germ, real goals. Dem clear law, right, clinic lines for no prescribe.
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 referralDem set follow-up for anabolic users, visit times, lab scan space, levels for dose change, stop, send. Dem stress see danger signs, write shared 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 femalesDem review how anabolic mess brain-gonad line, make low hormone, small testes, no baby, period mess, man features in women. Dem talk check, advice, heal 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 timeDem check bone muscle and body harms like tendon hurt, sugar resist, blood sugar mess, long body change. Dem talk screen, train load advice, risk cut ways.
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 indicatedDem detail start history, body check, tests before or in anabolic. Dem explain blood count, liver kidney, fats, hormones, PSA, heart trace, pressure, scans for risk rank and 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
