Summary
Definition
History and exam
Key diagnostic factors
- consumption of nutritional supplements
- use of other drugs to counteract adverse effects of steroids
- increased weight gain and muscular build
- increased appetite
- aggression and mood swings
- hirsutism
- voice pitch alterations
- clitoral hypertrophy
- disproportionate muscular development of upper torso
- testicular atrophy
Other diagnostic factors
- acne and/or oily skin
- temporal hairline recession/male pattern baldness
- striae or keloids
- menstrual irregularities
- changes in libido
- scrotal pain
- impotence
- infertility
- premature masculinization/feminization (adolescents)
- cognitive impairment
- GI upset
- short stature (adolescents)
- needle marks
- enlarged prostate
- gynecomastia
- narcissistic personality
Risk factors
- male gender
- participation in sports and athletics or bodybuilding
- hx of muscle dysmorphia or other body image disorder
- employment as nightclub bouncer, professional male dancer, professional wrestler, or law enforcement officer
- hx of childhood physical or sexual abuse
Diagnostic investigations
1st investigations to order
- urine toxicology testing
- testosterone to epitestosterone ratio
- serum LH and FSH
- CBC
- serum glucose
- serum electrolytes
- lipid panel
- LFTs
- CK
- hepatitis serology
- HIV serology
Emerging tests
- nuclear medicine cardiovascular imaging
Treatment algorithm
acute GI toxicity
chronic toxicity
refusal to cease taking steroids
Contributors
Authors
Marcel J. Casavant, MD, FACEP, FACMT, FAACT

Chief
Division of Toxicology
Nationwide Children's Hospital
Clinical Professor
The Ohio State University
Colleges of Medicine and Pharmacy
Columbus
OH
Disclosures
MJC declares that he has no competing interests.
Jill R. K. Griffith, BS, Pharm D
Clinical Assistant Professor
The Ohio State University
College of Pharmacy
Clinical Pharmacist
Mount Carmel Medical Center West
Columbus
OH
Disclosures
JRKG declares that she has no competing interests.
Peer reviewers
Fred Hartgens, MD, PhD
Department of Epidemiology
Maastricht University Medical Centre
Department of Surgery
Outpatient Clinic Sports Medicine
Maastricht
Netherlands
Disclosures
FH is an author of a reference cited in this monograph.
Harrison G. Pope Jr, MD, MPH
Professor of Psychiatry
Psychiatrist
Director
Biological Psychiatry Laboratory
McLean Hospital
Belmont
MA
Disclosures
HGP is an author of a number of references cited in this monograph.
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