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What Are The Side Effects Of Metandienone?

### 1 – Overview of Anabolic‑Steroid Use in Athletes
| **Aspect** | **Key Points** |
|------------|----------------|
| **Indications** | Performance‑enhancing muscle hypertrophy, increased strength, reduced recovery time. |
| **Common Regimens** | "Stacking" of testosterone analogues (e.g., nandrolone, oxandrolone) with aromatase inhibitors or selective estrogen receptor modulators to control estrogenic side effects. Cycles typically last 6–12 weeks, followed by post‑cycle therapy (PCT). |
| **Detection** | Urine and blood screening (GC‑MS, LC‑MS/MS); long‑term monitoring of steroid metabolites and endocrine biomarkers. |

### 2.2 Potential Complications in a Male Athlete

| System | Key Complications | Mechanisms | Clinical Indicators |
|--------|-------------------|------------|---------------------|
| **Endocrine** | - Hypogonadotropic hypogonadism
- Gynecomastia (estrogenic effect)
- Hypertriglyceridemia | Exogenous steroids suppress LH/FSH → ↓ testicular testosterone; aromatase converts androgens to estradiol. | Low serum T, high LH/FSH, elevated estradiol, enlarged breasts. |
| **Cardiovascular** | - Hypertension
- Dyslipidemia (↑ LDL, ↓ HDL)
- Atherosclerosis risk | Steroids alter lipid metabolism; increased VLDL and LDL. | Elevated BP readings, abnormal lipid panel. |
| **Metabolic** | - Insulin resistance
- Type 2 diabetes onset | Steroids impair insulin signaling in muscle/visceral tissue. | Fasting glucose >126 mg/dL, HbA1c >6.5%. |
| **Renal** | - Proteinuria (early sign)
- Chronic kidney disease progression | Steroid-induced glomerular hyperfiltration and damage. | Urinalysis shows albumin excretion rate >30 mg/day. |

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### 4. **Key Clinical Indicators & Monitoring**

| Parameter | Typical Thresholds | Frequency |
|-----------|-------------------|-----------|
| Blood Pressure | ≥140/90 mmHg | Every visit (≥3× per year) |
| Serum Creatinine / eGFR | eGFR 15% decline | Every 6–12 months |
| Urine Albumin-to-Creatinine Ratio (UACR) | ≥30 mg/g | Annually (or more if abnormal) |
| Lipid Profile | LDL ≥130 mg/dL, TG ≥150 mg/dL | Annually |
| HbA1c (if diabetic) | >7% | Every 3–6 months |

### 2.5 Medication Management

- **ACEI/ARB**: Initiate at low dose; titrate to max tolerated or target dose.
- **Statin**: High-intensity if LDL ≥190 mg/dL or ASCVD risk ≥7.5%.
- **Antihypertensive**: Prefer thiazide diuretics, calcium channel blockers, ACEI/ARB for renal protection.
- **Diabetes**: Metformin first-line; consider SGLT2 inhibitors for CKD if tolerated.

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## 3. Risk Prediction Model (Risk Score)

A simplified risk score based on the above predictors can be implemented in a clinical decision support tool.

| Variable | Points |
|----------|--------|
| Age ≥60 | +1 |
| Male sex | +1 |
| Diabetes mellitus | +2 |
| Hypertension | +2 |
| History of CVD (HF, CAD) | +3 |
| Baseline eGFR 0.5 g/day | +4 |

**Total score interpretation:**

- 0–3 points: Low risk (~15% progression).
- 4–7 points: Moderate risk (~30% progression).
- ≥8 points: High risk (>45% progression).

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### 3. Clinical Recommendations for Risk Mitigation

| **Intervention** | **Targeted Population** | **Evidence/Guideline Basis** |
|------------------|-------------------------|-----------------------------|
| **Optimal Glycemic Control (HbA1c