Lesson 1Evidence limits and uncertainty: interpreting low-quality/biased studies and clinician communication with patientsCovers gaps in anabolic studies, like bias, under-reports, mix-ups. Teaches reading weak data, sharing doubts, and aiding patient 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, jab issues. Gives steps for spotting, rating, handling.
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 anabolic effects on fats, pressure, heart muscle, clotting. Reviews people/animal data on artery hardening, irregular beats, sudden death, and risk sorting/mitigation.
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 syndromesHandles anger, grumpiness, low mood, worry, self-harm links to anabolics. Covers addiction, repeat cycles, quit symptoms, checks, safety plans, 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 cuts for non-medical users, with fair talk, safe dosing ideas, germ prevention, goal setting. Sets legal, moral, care limits for saying no to scripts.
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 users, visit times, lab/scan gaps, limits for dose shifts, stops, links. Stresses danger signs and shared choice records.
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 femalesShows how anabolics mess gland axis, causing low hormones, shrunken testes, no fertility, cycle changes. Covers female hair/deep voice, 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 timeChecks bone/muscle and body harms like tendon snaps, sugar issues, long shape shifts. Gives screens, training advice, risk cuts.
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 indicatedPlans start history, exam, tests pre/during anabolics. Uses blood counts, liver/kidney, fats, hormones, PSA, heart trace, 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
