Veteran's; Consensus Statement on Medical/Psychiatric Contraindications of Anabolic Use

[archive_Bjaarki]

Brothers:

THIS IS A REVISED DRAFT, DATED 02-02-03.

This may be the final revision, the final draft, of this Consensus Statement. See what you think. If no one has any objections or corrections after a day or so, I think you should archive it, Ulter.

Bjaarki

--------------

Veterans' Consensus Statement on Medical/Psychiatric Contraindications of Anabolic Use.


Anabolic steroids have legitimate uses in the pursuit of important life goals, including physical strength, aesthetic appeal, psychological wellbeing, and longevity. However, few drugs have as broad and profound an impact on body chemistry as do anabolic steroids. These drugs can have unpredictable effects on all body systems, including the immune, circulatory, nervous, endocrine, and excretory systems (liver and kidney), as well as on the integument (skin and hairline) and on the joints and muscles that comprise the musculoskeletal system. The athlete contemplating the use of anabolic steroids must bear constantly in mind the idea that the point of their use is not to take drugs for drugs' sake, but rather to grow stronger and healthier and to live a more satisfying and long life, through the combination of anabolic steroids with proper diet, recuperation, and training practices.

But even the wisest and most conservative use of anabolic steroids is contraindicated by two main categories of pre-existing or concurrent problems - certain medical illnesses, and a small class of psychiatric disorders. The use of anabolics when these other conditions are present is unwise, and the user who moves ahead with a program of anabolic steroid use, despite the presence of these conditions, should be acutely aware of the risks taken.

1.) Medical conditions that contraindicate the use of anabolics by posing unacceptable levels of hazard to the prospective user include liver disease (hepatitis, jaundice, cirrhosis, which may be aggravated by 17-alpha-alkylated anabolics, though agents such as oxandrolone may have beneficial effects in some cases), kidney disease (which anecdotal reports suggest may be aggravated by such steroids as trenbolone), uncontrolled hypertension (blood pressure above 150/90, which may be boosted further by anabolics' effects on water retention and erythropoeisis, though it can be minimized through the wise use of certain ancillaries), cholesterol-dependent heart disease (steroids often precipitate a rise in serum cholesterol), morphologic abnormalities of the heart muscle such as hypertrophy of the ventricle's walls or irregular valve development (which can be exacerbated by androgens), a history of or significant risk for malignancy (because anabolics can accelerate tumor growth), and idiopathic endocrine disturbance including some irregularities of adrenal, thyroid, and hypothalamic function (though anabolics may be beneficial in some cases of endocrine insufficiency, such as hypogonadism). High but perhaps acceptable levels of hazard are present in prospective users with a history of severe acne (though some cases may benefit from non-testosterone based cycles or the use of certain ancillaries), male-pattern baldness, prostate disease and gynecomastia (all of which may be exacerbated by androgens), gastrointestinal disorders such as acid reflux disease (which may be aggravated by the use of some steroids), and joint and soft-tissue injury (which may be aggravated by steroid-induced strength gains, though Human Growth Hormone and nandrolone may be beneficial in some cases). The prospective user of anabolic steroids should also be aware that some ancillary drugs (such as Arimidex) have risk profiles of their own, and are not wholly benign simply because they combat unwanted side effects of anabolic agents.

2.) Psychiatric conditions that contraindicate the use of anabolics by posing unacceptable levels of hazard to the prospective user include presence or history of Bipolar Disorder or Hypomania (which can be exacerbated by anabolics), severe depression (which can be precipitated by the "post-cycle crash" though low-grade and abiding dysthymia may respond well to long-term low-dose programs of steroid use), psychosis (which can impair the judgment necessary to use anabolics responsibly), some disorders of impulse control such as Intermittent Explosive Disorder (which may be exacerbated by androgens), such conditions as Body Dysmporphic Disorder and severe, pathological narcissism (which may cause impaired control of anabolic use in order to achieve a physical effect that cannot, because of the distorted nature of the user's self-image, ever be achieved), and Antisocial Personality Disorder (which may cause impaired control of anabolic use, and may lead as well to misuse of the stength and size benefits of these agents). High but perhaps acceptable levels of hazard are present in prospective users with a history of Substance Use Disorder (which may lead to impaired control of anabolic use) or Panic Disorder and other debilitating anxiety disorders (which may be aggravated either "on-cycle" or "off-cycle" in certain cases).

Unexpected symptoms should be discussed with a competent health or mental health professional. Laboratory testing is the only way in which certainty can be achieved in some cases. Before embarking on a course of anabolics, it is wise to get baseline readings of various systems – blood tests (comprehensive metabolic profile, CBC with differential), EKG, BP, PSA and physical exam. This permits the athlete and his/her healthcare provider to determine whether or not there are underlying conditions that preclude anabolic use, and allows comparison to subsequent tests if and when the athlete is re-examined due to the emergence of symptoms. In fact, ongoing testing of certain blood fractions (such as serum estradiol) is wise, in order to give the athlete a more accurate view of what ancillaries at what doses are needed, and what metabolic side effects are actually occuring.


In addition, certain universal precautions should be observed for the athlete and others' safety. A good liver metabolic including R-ALA, calcium-D-Glucurate, N-acetyl Cysteine or L-Glutathione (such as Tylers Detox) should be taken by anyone using oral anabolics. Plenty of water, protein, OMEGA 3, and vitamin supplementation should be standard, and the opportunity for both abundant sleep and physical rest should be included in the athlete's schedule.

The athlete using anabolics should, to a reasonable degree, avoid the use of nonessential pharmacueticals/drugs such as pain killers, alcohol, stimulants, sedatives, nicotine, and recreational drugs. These drugs add additional stress to the liver and kidneys, create unpredictable reactions in combination with anabolics, may mask injuries that should be given rest and medical attention, and may cause new injury due to intoxication effects. In addition, users must always be aware of synergistic drug effects. While most users are conscious of the negative impact on the liver of combining two 17aa steroids, most are not aware that there are many OTC drugs that affect the production of certain liver enzymes. These drugs do not always produce a negative impact on the liver when taken alone, but they can render the liver less capable of processing certain steroids. Users should familiarize themselves with the enzymes utilized to break down the more liver toxic steroids, as well as the OTC drugs that might have an impact on the specific enzymes in question.


For these reasons, the following Veterans' Consensus Statement on Medical/Psychiatric Contraindications of Anabolic Use is offered:

Physical illnesses that contraindicate the use of anabolics include liver disease, kidney disease, hypertension, heart disease, malignancy and endocrine disturbance. Psychiatric conditions that contraindicate the use of anabolics include severe depression and other mood disorder, psychosis, and marked disorders of impulse control. The use of anabolics when any of these conditions are present is unwise. Less but still measurable risk is borne by patients with severe acne, prostate disease, gynecomastia, male-pattern baldness, joint and soft-tissue injury, substance use disorder, or debilitating anxiety disorders such as panic. Unexpected symptoms should be discussed promptly with a qualified professional, and both laboratory testing and prophylactic use of detoxification agents is encouraged. The use of nonessential pharmaceuticals is discouraged in persons considering the use of anabolic steroids.

[This message was edited by Bjaarki on 01-30-2003 at 12:57 PM.]

[This message was edited by Bjaarki on 01-30-2003 at 01:21 PM.]

[This message was edited by Bjaarki on 02-02-2003 at 11:32 AM.]

[archive_therealj]

sounds good,lol...how the hell can I add anything intelligent to that

-----------------------------
when in doubt ask yourself "what would Munzer do?"

[Mister B.]

Wow! Great work guys!

I'm no veteran but:
Contraindication is the focus; how about mention of food intake (not a particular DIET so much as EAT!!) and how about ancilliaries? What to intake on-cycle is covered, how about after-cycling drugs such as clomid and/or nolvadex... hmmm... I can see that's opening a can of worms... maybe a reference to an upcoming Consensus Statement instead (such as: "As per CS on preventative measures" or something like that).

B

---------------------

Cycle? What's a cycle?

[Skaver]

Wow Bjaarki, you have entirely too much time on your hands to come up with such a thorough post. Very well said.

What about hairloss? If you're mentioning acne, you might as well throw in accelerated hairloss. They both have a social stigma attached and can lead to depression.


** Magnus Validus Formosus **

[nandi12]

I find it refreshing to see a board acknowledge that anabolic steroids are not without risk. I would only add a couple of points.

While it is generally sound to advise someone suffering from liver disease to avoid oral AAS,
oxandrolone has been used successfully in a number of trials to improve the nutritional status of patients suffering from alcoholic cirrhosis. While I doubt there are many board members afflicted with this, there are a number of other liver diseases such as hepatitis C which are rampant. An individual with such a diseasae way want to discuss the potential problems, as well as benefits of oxandrolone treatment with his/her physician. Note: I am not advocating that someone suffering from hepatitis C use oxandrolone unsupervised,

While not technically anabolics, other agents like T3 or T4, and aromatase inhibitors, are commonly used by bodybuilders and present possible risks, as well as offer therapeutic benefits. For example, thyroid hormone used in supraphysiological doses has been found to be an effective supplemental treatment in studies for refractory mood disorders.

On the other hand, in animal studies, aromatase inhibitors have been shown to greatly accelerate the development of atherosclerotic plaques by blocking the local aromatization of testosterone to estrogen in the vascular endothelium.

So some drugs that are often considered dangerous, like T3, have legitimate medical uses in supraphysiological doses, while other drugs that are generally considered benign, like aromatase inhibitors, could potentially be dangerous.

[Billy_Bathgate]

Wow that is good.

Only thing I would add is maybe adviory for those with high risk of prostate problems such as cancer. Also stomach/GI problems. I can attest to that one personally.

[archive_Mr. Nobody]

As all of Bjaarkis posts it is well written and well researched. However, if I may add the following suggestion:
Why not do a list of anabolics, ancillaries and other adjuncts (exluding fat burners) and their respective side effects? To me this is too general. Why not split it up?

Disclaimer:
Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner.
The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advice.

[DaMan]

<BLOCKQUOTE class="**-ubbcode-quote"><font size="-1">quote:</font><HR>Originally posted by Mr. Nobody:
As all of Bjaarkis posts it is well written and well researched. However, if I may add the following suggestion:
Why not do a list of anabolics, ancillaries and other adjuncts (exluding fat burners) and their respective side effects? To me this is too general. Why not split it up?

_Disclaimer:
Mr. Nobody is presenting fictitious opinions and does in no way, shape or form encourage, use nor condone the use of any illegal substances or the use of legal substances in an illegal manner.
The information discussed is strictly for entertainment purposes only and shall not take the place of qualified medical advice._<HR></BLOCKQUOTE>

My thoughts exactly.

Also, it's spelled "aesthetic"

BTW what's "psychic" wellbeing? Do you mean psychological? (sorry, just a bit confusing.)

[archive_Bjaarki]

Mr B, your idea is a good one. We'll include it in a revised version, which we'll post in a few days.

Skaver, we could include hairloss as a case of "high but perhaps acceptable levels of hazard." I've been bald so long, and have never had a problem with that, that it never occured to me that it could be a contraindicating problem for gear use. That's why we post these things, to get input.

Excellent points all, nandi. Macro had suggested some of the same things, but I didn't include them. We could certainly add something on the therapeutic effects of ox, and a warning about ant-e's. Could you post specifics? I don't want to touch T3 or cutting drugs in this CS.

Billy, I think we have notes in there about prostate probs and malignancies. What is the issue with GI complaints? Give me some specifics, and I'll see about incorporating them.

Mr. N, your suggestion for a list of drugs and their sides just goes beyond the scope of this CS. We want it to be short enough to be accessible to the average reader, and we really want it to focus on contraindicating medical and psychiatric conditions, not gear itself.

DaMan, I could change "psychic" to "psychological," no problem. Esthetic is a variant that is more widely used in modern English than aesthetic, so I chose the former term.

Thanks much, gentlemen. Keep typing.

Bjaarki

[BrahmaBull]

It's old hat that Bjaarki is thoughtful and intelligent, so I won't say that.
Why not a list of all anabolics and ancillaries, and their side effects?

Well, that list might be interesting, but the lead-off really takes a different line. It's not about what specific harm you might suffer from a course of anabolics. It's about classes of people who should not (in the "consensus" opinion) be doing anabolics AT ALL.

Which leads me to my second point. The laws, the mass media, and public perceptions all say with a loud voice that NOBODY should be using anabolic steroids without a doctor's prescription. So do we think that coming out with a consensus statement like this is going to stop anybody from using steroids? If the guy with liver disease or bipolar disorder is contemplating this course, ignoring all the prohibitions society has put out there, do we think our consensus statement is going to keep him off?

BrahmaBull

[This message was edited by therealj on 01-24-2003 at 01:10 PM.]

[archive_Bjaarki]

What we're trying to do, Brahma, is just state the consensual opinion of the members of the board, about important aspects of anabolic use. then, when questions come up, we can just refer to the Consensus Statement. This happened a day or two ago when a young guy with 1 y of lifting wrote asking for advice on a first cycle. J just referred him to the CS on "Age of Initiation," and the matter was settled.

These statements won't prevent anyone from doing what they are hell-bent on doing, but they can serve some deterrent function and they will, over time, gain authority if they are well researched and consensually developed.

Good to see you BTW, Brahma.

Thanks, J.

Bjaarki

[This message was edited by Bjaarki on 01-24-2003 at 01:23 PM.]

[This message was edited by Bjaarki on 01-24-2003 at 01:24 PM.]

[Fukkenshredded]

"Level of hazard that warrants increased consideration."

The suggestion that mental disorders are anything beyond the above tier (which I re-worded for clarity) is, in my opinion, overkill.

Perhaps a hazard gradient, such as A, B, and C, with C being the least and A being unacceptable, is appropriate.

The singling out of GHB as a hazard is peculiar, and from a medical standpoint, unwarranted altogether. Their are many patients currently being treated for narcolepsy with GHB, and eventually Congress will get over the hysteria surrounding this simple carbohydrate. While GHB is not a substance to be taken lightly, it certainly cannot be ranked with many of the fatburners that are commonly used in bodybuilding. The only reason to actually single out this compound is to remind people of the disproportionately harsh penalties associated with its possession, which for most of us is sufficient motivation to part with it.

[archive_macrophage69alpha]

in agreement with FS with respect to GHB.

However, with respect to 1,4 absolutely opposed to its use. The addiction potential of 1,4 and its less than satisfactory effectiveness as either a sleep agent or mood enhancer makes this drug completely unnaceptable.

caveat: responsible use of GHB is far safer than other euphorics with little if any impact on health. In fact there are many positive health aspects to GHB. Though given its current legal status cannot in reccomend it as the penalties for use outwiegh the benefits.

MP

[Billy_Bathgate]

Bj, I was thinking the bold at the bottom was the actuall statement and I didnt see prostate mentioned their specifically, I saw it above though.

GI problems, well first off, I have acid reflux disease. So, my stomach is very sensitive so to speak. While on AS it acts up much more and I can tell a defniate change while on. Not just heartburn, but upset stomach and vomitting. I have had it looked into many times, and there isnt anything detectably wrong there except the acid reflux. AS just seems to magnify it. I manage it ok, but I wonder about those who arent as obvious to stomach conditions as I am.

Just a thought from a personal experience really.

[SteelPreacher]

What's up B~

What about adding Sociopaths (since they are not technically covered under "disorders" and rather have this as a personality trait, Sufferers of Post Traumatic Stress Syndrome, and oppossitional defiant disorder. Thanks

Fukken~
I think GHB is mentioned specifically because many in the BB world are still using this crap. Also if one is using it to treat narcolepsy I feel that that person should think twice about AS anyway. We should add that too. Narcolepsy.


and if they approach us..I..I..I bury those cockroaches!

[Zyglamail]

Excellent work, not much to add really. Depression is the most common mental illness I think we face and while looking at it it should be obvious, perhaps specifically stating depression may not be a bad idea.

[archive_HULK1550]

Bj, you make a great point about being able to point people to this thread (the young man with 1yr lifting). This thread, and the other one are written very intricately. This concerns me however, if we are going to point people in the directions of these consensus statements. A teen for example may not understand half the terms used in them. I understand the need to sound like we know what we are talking about (which this board does)but not sure everyone reading it will comprehend it all. (also many foreign readers) But it is a great piece of work and thanks for taking the time to write it so well.

1stRule: Show Up!
2nd Rule: Squat!

[Zyglamail]

Good point hulk, but my thoughts on the subject are if you cant understand the verbage then AAS is likely beyond your current education level as well. Far to many people just want an outline of what needs to be done and get on the fast track, but I am a firm beleiver that a person should not go by an outlined course, at least not until they have the underlying knowledge to understand all the aspects of the outline they have been given.

[archive_Ulter]

I don't think GHB should be singled out like it is as a rec drug. I would guess better than half the people here use alcohol. Obviously alcohol is abused much more than GHB and there is no mention of alcohol as a rec drug, and don’t give me that medicinal purposes BS. Insomnia is a real problem while cycling and GHB helps a lot of people through that without complication. I think we should leave it out.


We discussed the vernacular that would be used in the CS and it was our decision that we should write it just as you would any intelligent post. We actually considered taking out the word contraindications from the title. My position was that it’s on the insert of every drug in the world, in there respective languages of course. If someone doesn’t know what it is then they need to leave the premises immediately.
Zyg is right. If someone can’t understand what these things are after they are given an explanation then they have no business using AAS.
I would like to point to nandi12’s post because this is exemplary of what we are referring to here.
He uses terms that many people are not familiar with. But his post is exactly what we would want in terms of an idea thoroughly explained. If you don’t know some the terms then do what your grade school teacher told you. Look it up. I understand that many people want things explained to them like they were 8 years old. So do I sometimes when I am talking to Macrophage. But we can’t drop the intelligence level on the boards to accommodate those who won’t read up a little.

[SteelPreacher]

Ulter alcohol is listed with painkillers etc. Fuken said that GHB is used to treat Narcolepsy not insomnia. I don't think anyone that is passing out all the time needs to be on AS. Plus GHB, Alcohol, painkillers,etc. are no doubt bad for everyone all the time not just while on AS.


and if they approach us..I..I..I bury those cockroaches!