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The severity of these complications correlates with the dosage, duration of use, and the potency of the steroid prescribed. While the incidence of steroid-induced myopathy does not appear to be directly related to the dosage of steroid prescribed nor the duration of use, it appears to be more prevalent with the use of steroids containing a 9-alpha fluorine configuration, such as triamcinolone (Aristocort®). The relationship between hypertensive side effects and the duration of therapy is also not very clear; steroids should be prescribed with greater caution in the elderly, in those individuals with known hypertension, and when compounds with greater mineralocorticoid properties are prescribed. As hyperglycemia is a well-known complication of corticosteroid use, oral steroids should be prescribed with caution in the diabetic population.

Laws and Penalties:  Concerns over growing illegal AAS abuse by teenagers, and many of the just discussed long-term effects, led Congress in 1991 to place the whole AAS class of drugs into Schedule III of the Controlled Substances Act (CSA).  Under this legislation, AAS are defined as any drug or hormonal substance, chemically and pharmacologically related to T (other than estrogens, progestins, and corticosteroids) that promotes muscle growth.  The possession or sale of AAS without a valid prescription is illegal.  Since 1991, simple possession of illegally obtained AAS carry a maximum penalty of one year in prison and a minimum $1,000 fine if this is an individual’s first drug offense.  The maximum penalty for trafficking (selling or possessing enough to be suspected of selling) is five years in prison and a fine of $250,000 if this is the individual’s first felony drug offense.  If this is the second felony drug offense, the maximum period of imprisonment and the maximum fine both double.  While the above listed penalties are for federal offenses, individual states have also implemented fines and penalties for illegal use of AAS.  State executive offices have also recognized the seriousness of AAS abuse and other drugs of abuse in schools. For example, the State of Virginia enacted a law that will allow student drug testing as a legitimate school drug prevention program (48, 49).

Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone-containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 10%, varying between individuals) and these treatments tend to be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non-medical purposes. [45]

The side effects of Nebido can include those of an androgenic nature. The androgenic side effects of Nebido are, however, highly dependent on genetic predispositions and will not affect all men. The possible androgenic side effects of Nebido include accelerated hair loss in those predisposed to male pattern baldness, acne in sensitive individuals and body hair growth.

While by no means always necessary, some men may find the use of a 5-alpha reductase inhibitor to be useful. The testosterone hormone is metabolized by the 5-alpha reductase enzyme, which reduces the testosterone hormone to dihydrotestosterone (DHT). The DHT is what leads to the androgenic related effects. By incorporating a 5-alpha reductase inhibitor, you will reduce the hormones androgenicity. It will not be a complete reduction, but it will be significant. However, such inhibitors are not always recommended and should only be used as needed as they can hinder the potency of the testosterone hormone.

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The side effects of Nebido can include those of an androgenic nature. The androgenic side effects of Nebido are, however, highly dependent on genetic predispositions and will not affect all men. The possible androgenic side effects of Nebido include accelerated hair loss in those predisposed to male pattern baldness, acne in sensitive individuals and body hair growth.

While by no means always necessary, some men may find the use of a 5-alpha reductase inhibitor to be useful. The testosterone hormone is metabolized by the 5-alpha reductase enzyme, which reduces the testosterone hormone to dihydrotestosterone (DHT). The DHT is what leads to the androgenic related effects. By incorporating a 5-alpha reductase inhibitor, you will reduce the hormones androgenicity. It will not be a complete reduction, but it will be significant. However, such inhibitors are not always recommended and should only be used as needed as they can hinder the potency of the testosterone hormone.

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