Can I discharge a patient on anabolic steroids?

Discharging a Patient on Anabolic Steroids

Patients on anabolic steroids should not be discharged without a thorough cardiovascular assessment and patient education about the risks of continued use, as these substances are associated with significant cardiovascular complications including hypertension and cardiomyopathy.

Risks of Anabolic Steroid Use

• Anabolic-androgenic steroids (AAS) are associated with multiple serious adverse effects including cardiovascular disease, which may remain undetected for years 1

• Cardiovascular risks include:

  • Hypertension and heart failure with reduced ejection fraction 1
  • Severe depression of high-density lipoprotein levels and increased low-density lipoprotein/cholesterol levels 2
  • Increased risk of stroke, even in young athletes 2
  • Alterations of the cardiovascular system that may be severe with prolonged use at high doses 3

• Other significant health concerns include:

  • Hepatic alterations ranging from abnormal liver function tests to life-threatening liver tumors, especially with 17-alpha-alkylated steroids 4
  • Endocrine side effects including reproductive dysfunction in both sexes 4
  • Psychological and behavioral disturbances, potentially including dependence with excessive doses 4, 3

Pre-Discharge Assessment

• Before discharge, patients on anabolic steroids should be evaluated for:

  • Signs of heart failure or reduced ejection fraction 1
  • Hypertension requiring management 1
  • Liver function abnormalities 4
  • Psychological disturbances that may affect follow-up compliance 3

• Laboratory evaluation should include:

  • Lipid profile to assess cardiovascular risk 2
  • Liver function tests to detect hepatotoxicity 4
  • Complete blood count to check for polycythemia 4

Discharge Considerations

• If the patient has developed complications from anabolic steroid use:

  • Initiate appropriate medical management for conditions like hypertension or heart failure before discharge 1
  • Consider cardiology consultation if there are signs of cardiomyopathy or significant cardiovascular risk 1

• For patients with severe complications:

  • Hospital admission may be necessary for patients with significant cardiac dysfunction, uncontrolled hypertension, or acute hepatic injury 1, 4
  • Patients with psychological disturbances requiring immediate intervention should not be discharged until stabilized 3

Patient Education and Follow-up

• Provide clear education about:

  • The documented risks of continued anabolic steroid use 1, 4, 2, 3, 5
  • The importance of discontinuing steroid use to prevent further health complications 1
  • The need for regular follow-up to monitor for developing complications 4

• Establish a follow-up plan:

  • Schedule appropriate follow-up appointments with primary care and relevant specialists based on identified complications 1
  • Consider referral to addiction services if there are signs of dependence 3

Special Considerations

• Athletes and bodybuilders may be resistant to discontinuing use due to performance concerns 5
• Patients may experience mild withdrawal effects upon discontinuation, though the dependence liability is relatively low compared to other substances 3
• Patients using anabolic steroids in combination with alcohol have an increased risk of violence and aggression, which may affect discharge safety planning 3

Conclusion

The decision to discharge a patient on anabolic steroids should be based on a thorough assessment of cardiovascular, hepatic, and psychological status. If significant complications are present, these should be addressed before discharge. All patients should receive education about the risks of continued use and appropriate follow-up care.