Odgovor Če dec 13, 2018 20:42

Outpatient clinic for users of anabolic androgenic steroids:

INTRODUCTION

AAS abuse in the Netherlands
In the Netherlands approximately 160,000 people use performance enhancing drugs (PED), of which 20,000 anabolic androgen steroids (AAS).1 Production and trading of AAS without a license is prohibited in the Netherlands, yet AAS can be easily acquired illegally through local dealers or the internet. The majority of users do not engage in organised sporting events.1
AAS is most often used intermittently, i.e. in cycles, and users’ knowledge is based on information from acquaintances, trainers or the internet.2 Among users, cycles differ greatly with respect to length, dosage as well as the number of different AAS used simultaneously or consecutively.3 An earlier report showed that in about 50% of illegally obtained AAS the contents do not match the description on the label.4 Therefore, it is difficult to attribute side effects to specific AAS or dosages.

Health concerns about AAS abuse
The Health Council of the Netherlands stated that AAS are harmful but data are lacking as to precisely how harmful they are.5 Among physicians, there is low awareness of the possibility of AAS abuse by patients, and patients tend to be secretive about their use and do not rely on the physician’s knowledge of AAS.6 Knowledge of the unwanted somatic and psychological effects of AAS is limited because clinical research in the field of AAS is scarce. Prospective clinical trials among AAS users are hampered by ethical issues due to the fact that there is no registered indication for the use of supraphysiological doses of androgens, the products are mainly illegally obtained and most anabolic steroids are not registered for, nor extensively studied in, humans. As a result, most knowledge about the harmful effects of AAS is based on low level evidence, such as expert opinion, case reports or small observational studies.

Outpatient AAS clinic
An outpatient clinic for past and current users of AAS, the ‘Anabolenpoli’ or AAS clinic, was established in the Spaarne Gasthuis, Haarlem in 2011, in an attempt to gain more insight into the characteristics of AAS users, the methods of AAS use and the health risks associated with AAS abuse in the Netherlands. To our knowledge, it is the only clinic worldwide that focuses primarily on helping patients with health problems related to AAS. Patients need a referral to the clinic from their general practitioner or a medical specialist and the healthcare provided is fully covered by Dutch healthcare insurance. Haarlem is located centrally in the Netherlands with a maximum distance of 250 km to all country borders and is therefore readily reached by patients throughout the country.

The AAS clinic has now been running for five years. This study provides an overview of all patients who were referred to the clinic and generates novel data regarding recreational AAS use in the Netherlands and related health issues.

Concluding remarks
This review of 180 patients referred to the AAS clinic suggests that AAS abuse does not structurally lead to severe health problems and critical side effects are limited to incidental cases as reported in literature. However, the incidence of side effects with a substantial symptom burden, reduced fertility, substance abuse dependence and potentially harmful concomitant use of other PED and medications among AAS users is high. Considering the large number of users in the community, AAS abuse may be an important public health problem.13 A prospective study with a systematic approach is required to provide more reliable data regarding short- and long-term health risks of AAS abuse. Moreover, we need clinical trials to study the efficacy and long-term effects of treatment.
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