I've been approached only once that I can recall by a patient asking for anabolic steroids. A thirtyish, single stockbroker or financial advisor-type guy who went to a gym like a lot of people and was fit but not anything like Arnold, said "I want to get as big as I can get" and was a bit peeved when I explained it was illegal and not a good idea health-wise for me to prescribe steroids for that reason and that I wouldn't do it. eldy, pego, bambam, etc., any of you ever have patients ask for steroids?
In the same vein (or similar, at least), have any of you had patients who asked that you monitor their use? In other words, check LFTs/FLPs, prescribe something like Clomid for coming off cycles, etc. A doctor I work with has had at least one patient in the 15 years he's been out of residency (he's CAQSM and works with a lot of athletes . . . usually at the high school/college level though) who came to him and was open about his use. He was adamant about continuing the use, despite counseling otherwise from the doc. Knowing full well that he was going to go ahead and use anyway, the doc had an agreement to check labs regularly to make sure he wasn't ruining his liver. Apparently this was ~10 years ago.
I'd be interested to know how often this might happen, and what others' views on this practice is.
Related to this, I'll add my opinion that I see nothing wrong in people who are not competing professionally using steroids, hgh or other "banned" substances. It is only immoral when used to gain a competitive advantage.
BisonHurdler wrote:Edit: Sorry, didn't mean to hijack the thread.
No, no, that adds an interesting twist to it. I haven't seen anyone with that story and request. If I did, I think I would not want to be a part of it. I'm no expert in steroid use, but it seems that just because some lab work is normal along the way doesn't mean someone isn't doing themselves some harm. I'm not sure what the athlete means by "monitoring" since I don't know that there is a good body of medical literature that says "here is how to overuse anabolic steroids in a way that is safe long-term."
Seeksreal wrote:Related to this, I'll add my opinion that I see nothing wrong in people who are not competing professionally using steroids, hgh or other "banned" substances. It is only immoral when used to gain a competitive advantage.
Other than the fact that, at least with regard to anabolic steroids, it's illegal to use them for some sort of performance enhancement (they are controlled substances) and there's no evidence that it's medically safe or beneficial to do so. Use away, at your own risk.
There are all sorts of 'competitive' games going on, including the one that the one individual wanted steroids for. The standards for 'looking buss' go up when some are using steroids and that pushes others to do so. Is this different? It is not good for the people, and a docs oath includes 'do no harm'.
I don't know about other schools, but the day before the main graduation we had a Hippocratic Oath ceremony. I think it was non-binding (kind of like the Olympic Oath, "... respecting and abiding by the rules that govern them, in the true spirit of sportsmanship...". )
SQUACKEE wrote:Doc what do you day to the 50-60-70 year old runner who is thinking of a tiny little bit of HGH and testosterone-only to levels he had in his 30's? Its not me , its a friend of mine.
Some doc in an NPR story about the use of HGH and/or testosterone in men in that age group compared it to the use of estrogen replacement in post-menopausal women. Starting in the 1970s (or maybe early 1980s?) it became pretty much the norm to put post-menopausal women on hormone replacement therapy (HRT). It made intuitive sense--just like the use of testosterone in older men might--and some seemingly reasonable studies showed benefit in reduction of cardiovascular disease in women on HRT. Well, finally a huge study was done, the Women's Health Initiative Study (published about four years ago), and this showed a slight increase in cardiovascular and breast cancer risk in women on HRT (out of 10,000 women on estrogen and progesterone, per year there were something like 7 more strokes, 8 more heart attacks, 8 more breast cancers, 18 more deep vein clots or pulmonary emboli, 6 fewer colon cancers, and 5 fewer hip fractures). So what was being done for years, in part becasue it seemed to make sense, was actually causing harm. The doc on NPR cautioned against jumping on the testosterone or HGH bandwagon, just because it seems to make sense, before we have good data from large, well-designed randomized studies, about the long-term medical risks and benefits.
That said, there are other reasons to consider estrogen replacement in women, namely hot flashes and emotional lability, but we should use the lowest dose that helps and try stopping it every year or two (75% of women will have their hot flashed resolve, eventually).
It is interesting, that in virtually all the men in whom I've checked testosterone levels because of a complaint about erectile dysfunction or unexplained fatigue, the level has generally been low-normal, maybe 9.5 or 10 or 12, normal range being about 9 to 30. If it's lower than normal, we talk about and often start testosterone. But what should we do if a guy has those symptoms and it's 10? Is that the cause? I can't say I check it in 60 year olds who are (allegedly) still getting it on with their wife five days a week. Maybe in that group the average level is 20. Should we use a low dose and get it up to 15 or 20? I don't know, and a la the estrogen issue, I'm hesitant to do that without studies saying it's the right thing to do.
DrJay wrote:I don't know about other schools, but the day before the main graduation we had a Hippocratic Oath ceremony. I think it was non-binding (kind of like the Olympic Oath, "... respecting and abiding by the rules that govern them, in the true spirit of sportsmanship...". )
now i figured it !
i failed my finals, so i obviously don't know if there was an oath or not, because i wasn't elgible to attend !
6/12 later, after passing resits ( no big deal - you got 5 goes at them ), i had no idea if they did a 2nd oath for us 10 out of 200 who failed the 1st time round - i rushed down the pub for a whole week the moment after seeing my pass on the notice-board, so i'm no authority on the "oath" issue
Dr. Jay, as I remember reading recently, regarding estrogen, there were errors in the estrogen study. I cannot remember exactly what they were except that we now know that estrogen for those without wombs was not measured correctly and that there are good stats up to about age 60 and no bad stats after that.