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Drugs acting on the reproductive system
inhibition of testicular function, gynaecomastia, testic-
ular atrophy, priapism (a painful and continual erection
of the penis), baldness and change in libido (increased
or decreased). Women may experience hirsutism,
hoarseness, deepening of the voice, clitoral enlarge-
ment, baldness and menstrual irregularities. As with
the androgens, serum electrolyte changes, liver dysfunc-
tion (including life-threatening hepatitis), insomnia and
weight gain may occur. These drugs all have black box
warnings as alerts to the potentially serious effects of
liver tumours, hepatitis and blood lipid level changes
that might be associated with increased risk of coronary
artery disease. There is an increased risk of prostate
problems, especially in older people.
See the Critical thinking scenario for additional
information about treating a person experiencing adverse
effects of anabolic steroids.
Clinically important drug–drug interactions
Because the anabolic steroids affect the liver, there is a
potential for interaction with oral anticoagulants and
a potentially decreased need for hypoglycaemic agents,
which may not be metabolised normally. They may
alter lipid metabolism and cause a lack of effectiveness
for lipid-lowering agents. People should be monitored
closely and appropriate dose adjustments made. People
who are taking a prescribed androgen or anabolic
steroid for a medical condition should check with their
healthcare provider before taking any complementary
and alternative therapies because of a risk of adverse
effects (see Box 41.2).
With an increasing awareness of the risks associated
with anabolic steroid use and increasing pressures to
make it difficult to get these drugs even illegally, there
is an increased push in advertising of alternative or
“natural” products that are reported to enhance athletic
performance.
Bee pollen—Reported to contain amino acids and
other minerals and enzymes.There are no scientific
studies regarding its effectiveness. Serious allergic
reactions have been reported with the use of this
product. Random studies have found a wide variety of
ingredients in each product, depending on the season,
growing conditions and geographical area.
Creatine—Contains a substance that is found in muscle
and naturally occurs in red meats and other dietary
sources. No scientific data are available on its actual
effects on energy or athletic performance. It interacts
with many other drugs, including non-steroidal anti-
inflammatory drugs, cimetidine, probenecid and
trimethoprim, and can cause serious effects on kidney
functioning. Users should be advised to drink plenty of
fluids while taking this drug and to monitor for swelling,
muscle cramps and dizziness. Suggested only for short-
term use.
Damiana—Used to increase muscle strength, as an
aphrodisiac and to boost mental health. It can cause
liver toxicity. It interferes with antidiabetic agents and
causes elevated blood sugar concentrations. Users
should report muscle spasms or hallucinations.
Spirulina—Used to increase energy and boost metabolism.
It may contain toxic metals and can cause serious
reactions in children and pets. It interferes with vitamin
B12 absorption. No scientific studies validate the claims
of its effectiveness.
Wild yam—Found to have many oestrogen-like effects, this
herb is used to increase athletic performance because
it may contain a constituent of dehydroepiandrosterone
(DHEA) used to slow the ageing process and to
improve energy and stamina. Preparations interact with
disulfiram and metronidazole because they contain
alcohol. It is known to be toxic to the liver. Users may
experience oestrogen-like effects, including breast pain.
Users should be monitored closely and urged to report
any adverse effects.
Herbal and alternative therapies
BOX 41.2
Care considerations for
people receiving anabolic steroids
Assessment: History and examination
■
■
Assess for the following conditions,
which could be
cautions or contraindications to use of the drug
:
history of allergy to any androgens or anabolic
steroids; pregnancy or breastfeeding
because of
masculinisation of the neonate
; prostrate or breast
cancer; coronary disease; and hepatic dysfunction.
■
■
Perform a physical assessment
to determine
baseline status before beginning therapy and for
any potential adverse effects
.
■
■
Assess skin colour, lesions, texture and hair
distribution
to monitor for drug effects on the
body and potential adverse effects.
■
■
Monitor affect, orientation and peripheral
sensation
to assess CNS effects related to drug use.
■
■
Perform abdominal examination and serum
electrolytes, serum cholesterol and liver function
tests
to monitor for potential effects on liver
function.
■
■
Arrange for radiography of the long bones in
children
to assess for testosterone effects on
growth.
Implementation with rationale
■
■
Administer with food if GI effects are severe
to
relieve GI distress.
