Table 1 Summary of included studies
From: Treatments for people who use anabolic androgenic steroids: a scoping review
Reference no. | Country | Study design | Diagnosis | Treatment approach |
|---|---|---|---|---|
Psychiatric (n = 12) | ||||
[87] | USA | CS | Depression | Medical therapy |
[88] | USA | CR | Substance dependence | Drug treatment programme participation |
[89] | Canada | CR | Depressed mood with anxiety, paranoia, derealisation | Medical therapy, electroconvulsive treatment |
[90] | Greece | CR | Mood disorder with manic features | Medical therapy |
[91] | Germany | CR | Mania | Medical therapy |
[92] | USA | CR | Borderline personality disorder with antisocial traits | Medical therapy, education about AAS, psychotherapy |
[93] | India | CR | Substance dependence including opioids and AAS | Medical therapy for AAS and opioid withdrawal, psycho-education and relapse prevention |
[94] | Ireland | CR | Mixed psychotic disorder | Medical therapy |
[95] | USA | CR | Acute mania | Medical therapy |
[96] | UK | CR | Psychosis with low mood | Medical therapy |
[97] | USA | CR | AAS dependence | Drug treatment programme participation |
[98] | USA | CR | AAS dependence | Medical therapy |
Neuroendocrine (n = 11) | ||||
[99] | Netherlands | CR | Hypogonadotropic hypogonadism | Medical therapy |
[100] | USA | CR | Hypogonadism | Medical therapy |
[101] | Malaysia | CR | Complete azoospermia | Medical therapy |
[102] | UK | CR | Severe hypogonadotropic hypogonadism | Medical therapy |
[103] | UK | CS | Azoospermia | Advice to discontinue AAS |
[104] | USA | CR | Impotence—reduced testicular volume on both sides and gynaecomastia on both sides | Medical therapy |
[105] | USA | CR | Azoospermia | Discontinuation of all medications; medical therapy |
[106] | USA | RCR | Azoospermia | AAS cessation and medical therapy |
[107] | Italy | CR | Hypogonadotropic hypogonadism | Medical therapy following AAS discontinuation |
[108] | USA | CS | Hypogonadism | Medical therapy |
[109] | USA | CR | Azoospermia | Medical therapy |
Hepatic (n = 25) | ||||
[110] | USA | CR | Tumour haemorrhage in liver. On second presentation: tender hepatomegaly and haemorrhage, tachycardia | Surgery; instruction to discontinue AAS |
[111] | Mexico | CR | Liver toxicity, cholestasis | Medical therapy; AAS discontinued |
[112] | USA | CS | Hepatotoxicity | Medical therapy |
[113] | USA | CR | Liver toxicity | Medical therapy |
[114] | USA | CS | Hepatotoxicity. In one case, patient suffered from renal failure. | Medical therapy |
[115] | Spain | CS | 1) Hyperechogenic lesions in the liver; 2) Acute renal failure, muscular damage, metabolic alkalosis and hypernatraemia | 1) Instruction to discontinue AAS; inclusion in liver transplantation program; 2) Patient received haemodialysis; instruction to discontinue AAS. |
[116] | UK | CR | Hepatic rupture with cardiovascular collapse, sepsis and acute renal failure | Resuscitation, surgery |
[117] | Germany | CR | Hepatocellular carcinoma. Liver was enormously enlarged | Chemoembolization was declined by patient who was recommended for transplantation |
[118] | Australia | CR | Hepatocellular carcinoma | Surgery |
[119] | Lebanon | CR | Liver injury resulting in prolonged cholestasis and acute kidney injury | Advice to discontinue AAS, medical therapy, plasma exchange. Patient refused renal biopsy. |
[120] | China | CR | Dilated cardiomyopathy and acute hepatic injury | Medical therapy |
[121] | Poland | CR | Severe intrahepatic cholestasis that developed to severe liver failure | Medical therapy |
[122] | UK | CS | Cholestasis | Medical therapy |
[123] | Spain | CR | Severe cholestatic jaundice | Unclear |
[124] | USA | CS | Severe hepatotoxicity, cholestasis | Medical therapy |
[125] | Netherlands | CR | Mild jaundice; cholestatic hepatitis identified through liver biopsy | Medical therapy |
[126] | UK | CR | Three grade II oesophageal varices | Blood transfusion and sclerotherapy |
[127] | Australia | CR | Intrahepatic cholestasis | Medical therapy |
[128] | USA | CR | Severe cholestasis and renal failure. Re-admitted with pruritus | Medical therapy |
[129] | Spain | CR | Hepatic rupture, liver failure. Hematoma of the liver | Surgery |
[130] | USA | CR | Acute, nonobstructive, intrahepatic cholestatic hepatitis | Medical therapy; advice to avoid other medications |
[131] | USA | CR | Severe jaundice, bile acid nephropathy | Medical therapy, blood transfusion, AAS discontinued |
[132] | Spain | CS | Severe cholestasis, hepatotoxicity | Medical therapy followed by MARS therapy |
[133] | Brazil | CR | Giant hepatic adenoma | Surgery |
[134] | Germany | CR | Hepatocellular carcinoma | Surgery |
Kidney (n = 6) | ||||
[135] | USA | CR | Initial diagnosis of hepatic adenomatosis (2004). On third admission, diagnosed with chronic kidney disease and coronary artery disease (2013) | Advice given to discontinue AAS initially. Surgery at later presentation. |
[136] | Spain | CR | Severe acute kidney failure with high blood pressure, anaemia and thrombocytopenia | Medical therapy |
[137] | Iran | CR | Acute renal failure; muscle injury and rhabdomyolysis | Medical therapy |
[138] | Brazil | CS | Acute kidney injury in both cases | Medical therapy. |
[139] | USA | CR | Recurrent renal infarction | Medical therapy, AAS counselling |
[140] | Lebanon | CR | Acute pancreatitis, acute renal failure and hypercalcemia. | Medical therapy |
Cardiovascular (n = 26) | ||||
[141] | Japan | CR | Cardioembolic stroke | Medical therapy, AAS use discontinued |
[142] | Sweden | CR | Intraparenchymal haemorrhage in right parietal lobe; right cortical venous thrombosis | Anticoagulation therapy |
[143] | UK | CR | Acute myocardial infarction | Surgery |
[144] | Egypt | CR | Severe toxic cardiomyopathy. | Medical therapy |
[145] | Canada | CR | Cardiomyopathy | Incubation, medical therapy, resuscitation, dialysis and device implantation, addiction counselling referral |
[146] | Argentina | CR | Posterior territory ischemic stroke. | Intubation and ventilation; rehabilitation |
[147] | Sweden | CR | Severe hypertension | Aggressive treatment with intravenous drugs; AAS cessation |
[148] | Turkey | CR | Acute coronary syndrome | Medical therapy |
[149] | Sweden | CS | i) Occlusion of all major arteries of the leg. ii) Arterial thrombosis: | i) Surgery ii) Thrombolysis attempted with no improvement. Surgery performed. |
[150] | Canada | CR | Stroke. Upon readmission 3 years later, diffused distal arterial thrombosis | Medical therapy |
[151] | Kuwait | CR | Cardiomyopathy, stroke and peripheral vascular disease | Medical therapy |
[152] | Portugal | CR | Severe toxic cardiomyopathy. | Medical therapy |
[153] | USA | CR | Myocardial infarction | Medical therapy |
[154] | Turkey | CR | Myocardial infarction | Medical therapy |
[155] | Greece | CR | Myocardial infarction | Medical therapy |
[156] | USA | CR | Acute myocardial infarction and polycythaemia | Surgery, medical therapy, phlebotomy. |
[157] | Portugal | CR | Myocardial infarction | Medical therapy. |
[158] | Turkey | CR | Acute inferior myocardial infarction, renal infarction | Medical therapy, surgery |
[159] | USA | CR | Acute myocardial infarction | Medical therapy, rehabilitation |
[160] | USA | CR | Myocardial infarction | Medical therapy |
[161] | Australia | CR | Persistent atrial fibrillation | Electrical cardioversion, medical therapy. |
[162] | Germany | CR | Severe coronary heart disease | Surgery, medical therapy |
[163] | UK | CR | Coronary thrombus | Medical therapy |
[164] | USA | CR | Cardiomyopathy, severe systolic dysfunction and Class IV heart failure. | Medical therapy and device implementation until discharge. |
[165] | USA | CR | Cardiomyopathy, acute systolic heart failure. | Medical therapy, instruction not to use AAS. |
[166] | Finland | CS | Cardiac hypertrophy | Surgery, medical therapy. In one case, no treatment was reported |
Musculoskeletal (n = 13) | ||||
[167] | USA | CR | Tear in the midsubstance of the triceps tendon. | Surgery, immobilisation |
[168] | Israel | CR | Massive rhabdomyolysis | Medical therapy |
[169] | Ireland | CR | Quadriceps tendon rupture, patella tendon rupture, distal femur fracture, patella dislocation in both legs | Surgery, immobilisation, physiotherapy |
[170] | Iran | CR | Quadriceps tendon rupture in both knees and partial rupture of triceps tendon. | Surgery, immobilisation, physiotherapy |
[171] | UK | CR | Bilateral rupture of the quadriceps tendon | Surgery, immobilisation |
[172] | Denmark | CR | Complete rupture of the extensor pollicis longus tendon. | Surgery, immobilisation |
[173] | Finland | CR | Complete bilateral quadriceps tendon rupture in both legs | Surgery, immobilisation |
[174] | UK | CR | Rupture of both quadriceps tendons | Surgery, immobilisation, physiotherapy |
[175] | Finland | CR | Bilateral distal biceps tendon avulsions | Surgery, immobilisation, physiotherapy |
[176] | UK | CR | Complete rupture of the anterior cruciate ligament | Physiotherapy |
[177] | UK | CR | Rhabdomyolysis. Initially diagnosed with musculoskeletal pain. | Medical therapy |
[178] | UK | CR | Bilateral simultaneous traumatic upper arm compartment syndromes | Surgery |
[179] | Italy | CR | Complete tear of quadriceps tendon | Surgery, immobilisation, rehabilitation |
Infectious (n = 7) | ||||
[180] | USA | CR | Abscess. | Medical therapy; AAS counselling |
[181] | Israel | CR | Full thickness skin and subcutaneous tissue necrosis | Surgery |
[182] | USA | CR | Pyomyositis | Medical therapy, surgery |
[183] | UK | CS | Injection injury | Surgery, medical therapy |
[184] | Turkey | CR | Spontaneous corpus cavernosum abscess | Surgery |
[185] | UK | CR | Necrotizing myositis | Surgery, medical therapy |
[186] | UK | CR | Abscess | Surgery, medical therapy |
Other (n = 8) | ||||
[187] | UK | CR | Chronic laryngitis | Medical therapy followed by laser treatments |
[188] | UK | CR | Hypokalaemia and metabolic alkalosis. | Fluid provision |
[189] | UK | CR | Abnormal lipid profile | Advice to stop using AAS |
[190] | UK | CR | Acute respiratory distress syndrome | Intubation and ventilation; rehabilitation. |
[191] | USA | CR | Multiple organ dysfunction syndrome, acute kidney injury and refractory supraventricular tachycardia | Resuscitation, medical therapy, ventilation, haemodialysis and electrical cardioversion for different symptoms. |
[192] | USA | CR | New onset of diabetes | Medical therapy, AAS advice |
[193] | Lebanon | CS | Spontaneous subdural haematoma | Surgery |
[194] | UK | CR | Bilateral internal laryngocoeles | Medical therapy |