C H A P T E R 4 1
Drugs affecting the male reproductive system
633
■■
Anabolic steroids are testosterone analogues with
more anabolic or protein-building effects than
androgenic effects.
■■
Deadly effects may result from the abuse of anabolic
steroids by athletes trying to build muscle mass and
improve performance.
KEY POINTS
■
■
Monitor endocrine function, hepatic function and
serum electrolytes before and periodically during
therapy
so that dose can be adjusted appropriately
and severe adverse effects can be avoided.
■
■
Arrange for radiography of the long bones of
children every 3 to 6 months
so that the drug can
be discontinued if bone growth reaches the norm
for the child’s age.
■
■
Provide thorough teaching, including measures
to avoid adverse effects and warning signs
of problems, as well as the need for regular
evaluation, including blood tests,
to enhance
knowledge about drug therapy and to promote
compliance with the drug regimen.
Evaluation
■
■
Monitor response to the drug (increase in
haematocrit, protein anabolism).
■
■
Monitor for adverse effects (androgenic effects,
serum electrolyte disturbances, epiphyseal closure,
hepatic dysfunction, personality changes, cardiac
effects).
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects to
watch for and specific measures to avoid them).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
CRITICAL THINKING SCENARIO
Adverse effects of anabolic steroids
THE SITUATION
Senior nursing student K.S. recently became engaged.
Her fiancé is a university senior who is training as a javelin
thrower in hopes of competing in the Olympics. K.S.
noticed that her fiancé had been suffering from GI upset
for the last 3 weeks and more recently had developed
tremors and muscle cramps. K.S. first suspected that he was
suffering from a viral infection, but when the symptoms
did not resolve, she became concerned. K.S. tried to get
her fiancé to see a doctor, but he refused. Eventually, he
admitted that he had begun using anabolic steroids to
develop his muscles and improve his athletic prowess. He
said that the friend who gave him the drugs told him that
stomach upset was normal. He refuses to see a doctor
because he knows that the use of these drugs is illegal. He
believes that using the anabolic steroids for a while will put
him closer to his goal. K.S. accepts his explanation but is
upset about the use of anabolic steroids. She consults with
her clinical instructor about the effects of these drugs.
CRITICAL THINKING
What does K.S. need to know?
Think about the systemic
effects of anabolic steroids and the possible long-term
effects from their abuse.
What implications do these effects have for the athlete?
Consider the concern that K.S. must be experiencing. Suggest
ways for K.S. to share the information about the actual
effects of anabolic steroids with her fiancé and still cope with
her own feelings and concerns.
What are the ethical and legal issues involved when a
heathcare provider knows about illegal drug use and
abuse?
Outline a plan for helping K.S. and her fiancé cope
with this issue and its implications for their futures.
DISCUSSION
Use of anabolic steroids is illegal in almost all organised
athletic contests. Random drug testing is done to rule out
use of these and other drugs. Not surprisingly, K.S. feels
insecure about her fiancé’s decision. She needs to know
that her discussion will be confidential and that she will
receive support for her concerns and her fears. K.S. needs
to review the effects of anabolic steroids. Although they do
promote muscle development, there has never been any
evidence that they actually improve athletic performance.
The potential adverse effects of these drugs can be deadly,
especially if K.S.’s fiancé is receiving the drugs from a friend
and has no medical evaluation or dosage guidance to reduce
the risk. Personality changes, cardiomyopathy, liver cancer
and impotence are just a few of the possible adverse effects.
K.S. is in a precarious position. She does not want to
interfere with her fiancé’s dreams or cause problems in
their relationship. She should be encouraged to explain
the adverse effects of the drugs to her fiancé, pointing
out that he is already experiencing some of them. Adverse
effects associated with the drugs can ultimately interfere
with, not enhance, his athletic performance. She might be
encouraged to practise what she will tell her fiancé and to
seek other support as needed.
