Lesson 1Evidence limits and uncertainty: interpreting low-quality/biased studies and clinician communication with patientsTalks gaps in anabolic studies like pick bias, under-report, mix-ups. Teaches docs to read weak data, share doubts, back smart choices matching patient 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 hurt from pills, jab issues. Gives real steps for spotting, rating, fixing.
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 evidenceChecks anabolic hits on fats, pressure, heart muscle, clotting. Reviews people/animal info on artery clog, heart rhythm probs, sudden stops, sorting and cutting 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 syndromesHandles anger, grumpiness, low mood, worry, self-harm links to anabolics. Details addiction, forced cycles, quit pains, checks, safety plans, mind health sends.
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 cut-harm for admitted street use, no-judging talk, safe dose ideas, germ stop, real goals. Clears law, right-wrong, doc lines for no-scripting.
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 regular follow-ups for users, visit times, test/scan gaps, levels for dose shifts, stops, sends. Stresses danger signs, note shared calls.
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 femalesReviews anabolic mess-up of hormone chain, low testes work, shrink, no babies, cycle mess, male traits in women. Covers checks, talks, 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 fuel harms like tendon snaps, sugar block, blood sugar mess, long body shifts. Screening, training load talks, risk cut tricks.
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 indicatedSpells start history, exam, aimed tests pre/during anabolic. How blood count, liver/kidney, fats, hormones, PSA, heart trace, pressure, scans sort risks, tailor checks.
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
