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P A R T 7  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, Herbal and alternative therapies BOX 41.2

Care considerations for people receiving anabolic steroids

Assessment: History and examination

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. ■ ■ 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.