Performance and image enhancing drugs PIEDs Beng Eu Prahran Market Clinic Performance and image enhancing Drugs PIEDs AAS Anabolicandrogenic steroids Testosterone Nandrolone deca Boldenone eq equipoise ID: 935880
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Slide1
Pennington Institute Seminar
Performance and image enhancing drugs (PIEDs)
Beng
Eu
Prahran Market Clinic
Slide2Performance and image enhancing Drugs- PIEDs
AAS (Anabolic-androgenic steroids)
Testosterone
Nandrolone (deca)
Boldenone (eq, equipoise)
Stanazolol
Methenolone
Trenbolone (
tren
)
Anavar
80-90% of all PIEDs
Hormones
HGH
HGH-likeSARMs (Ligandrol, testolone)IGF-1
Peptides
Insulin
Post-cycle therapy
Clomiphene
Tamoxifen
HCG
Anastrozole
Slide3Slide4Mostly IM injections,
gluts >thigh> delt
Some oral (especially PCT)
Insulin,
aas
- s/c
In cycles 3/12 on and off
Blast and cruise
Continuous
Stacking
Post-cycle therapy (PCT)
How are PIEDs used?
Slide5PCT
The use of agents to attempt to stimulate natural testosterone after and during use of AAS, prevent depletion or treat AEs
Common agents- tamoxifen, clomiphene, HCG, cyclofenil, anastrozole, (SARMS)
Often used after a cycle as well as during the cycle
Complex dosing schedules (online)
Sometimes used by endocrinologists in testosterone deficiency
Slide6How big is the problem of PIEDs use in Australia?
Slide7Australian Criminal Intelligence Commission -
Illicit Drug Data Report 2018-2019
Slide82018-2019 – 4,643 PIED detections
68% AAS
32% hormones (GH,HCG,EPO
etc
)
21.3 kg AAS seized
Australian Criminal Intelligence Commission -
Illicit Drug Data Report
AAS
68%
21.3 kg
Slide9Using testosterone enanthate as an example: 1
dose = 250mg
Hormone replacement dosing
:
2 weeks
Non-medical use
21.3 kg of AAS seized in a year
21.3 kg represents
85,200 doses
Est. 2 doses/per week, 24 weeks/year
Supply for 1,775 people
Slide10The Australian Needle and Syringe Program Survey (ANSPS) collects self-report information and capillary blood samples annually to monitor blood borne viral infections, the proportion of respondents reporting PIEDs
as the drug last injected in the last decade fluctuated, from 2 per cent in 2009 to 7 per cent in 2012, 2013 and 2014. This proportion decreased from 5 per cent in 2017 to 4 per cent in 2018 (Iversen & Maher 2015; Heard et al. 2019
)
Slide1120,000 sample size
12-17 yo
Performance enhancing drugs
Only 2-3% of all students had ever used these kinds of drugs without a prescription to improve sporting ability, increase muscle size, or improve appearance. 1% reported use in the past month.
3% = 48,000
1% = 16,000
Likely approx. 30,000
Total population- ? 200,000
Slide12Where are AAS coming from?
By number,
China
(including Hong Kong) was the primary embarkation point for PIED detections in 2018–19. Other key embarkation points by number this reporting period include the
United States (US), the United Kingdom (UK), India, Singapore, Thailand, Turkey, the Philippines, Poland and Greece.
Slide13How does it get here?
The international mail stream accounted for 76 per cent of the number of PIED detections in 2018–19, followed by air cargo (20 per cent), air passenger/crew
(4 per cent) and sea cargo (<1 per cent).
Slide14Why do people use AAS?
Improved performance , training and recovery– sports
Muscle gains – image, muscle comp.
Anti-ageing, wellness, more energy
Testosterone replacement
Slide15End of part 1
Slide16Reandron
(testosterone undecanoate) PI
Common (1/10 – 1/100) in bold
Uncommon (1/100 – 1/1000)
Case reports/anecdotes with non-prescribed AAS –
in italics
What do we know about the adverse effects of AAS?
Slide17Appearance
Acne
Balding
Gynaecomastia
Testicular shrinkage
Slide18CVS/metabolic effects
Polycythemia
Hypertension
Hyperlipidaemia
( Chol + TG)
Increased HBA1c
Cardiomyopathy
Myocardial Infarction,
CVA,thrombosis
, Conduction Abnormalities
Cardiac Death
Slide19Slide20Neuro endocrine system
Testicular pain
Suppression of HPG axis-?duration
Cognitive defects
Ongoing testosterone suppression
Infertility
Slide21Mental Health
Depression (during and after)
Emotional disorder
Insomnia
Restlessness
Aggression
Irritability
Pre-, during and after AAS
Slide22Other adverse effects
Injecting site reactions
Liver toxicity (oral > IM), adenomas
Injecting risks- BBV,
haematoma
, abscesses
Muscle, joint pains, CK increase
Pulmonary micro-embolism
Slide23Additional AES in women
Clitoral growth
Deepening of voice
Loss of breast tissue
Disruption of menstrual cycles
Slide24Barriers to finding out adverse effects of PIEDs use
Many substances not approved for human use
Doses used are not those done in trials
Often used in combination – different combos for different time periods- multiple variables
Supplies vary in quality and content
Limited data collection
eg.
at hospital presentation (stigma)
Limited background information about population
Slide25Barriers for health care provision
Available healthcare providers who have knowledge and are willing
Harm reduction is only acceptable model
Medicolegal matters
State health laws about prescribing (PCT)
Medicare rules about ordering tests
If private testing- ? medicolegal
Slide26STIGMA
self
Peers
Healthcare providers
Family
friends
Healthcare
Advice
Monitoring
Testing
Harm reduction
DRUG CHEATS
Criminality
Slide27How real are the barriers for accessing health care?
Slide28Slide29thejuice.org.au
Slide30Case Studies
Male, 36
yo
on oral and IM AAS, 3
rd
cycle in last 12 months, ½ way into cycle, presents for routine screening. Significantly abnormal liver function- AST, ALT >2x ULN. Lipids, Hb, renal function were normal.
Advised to at least cease oral AAS
At review at 1 month, LFTs were normal
Slide31Case Studies
Male, 28yo, presents- on IM AAS- 2
nd
cycle for screening.
LFTs, U + E- normal, normal BP
Hb 190 ( 130-180)
Elevated Hb is known side effect of testosterone and other AAS, but other causes need to be considered
Discussed the likelihood of AAS causing this and the potential cardiac risk this poses. Either to have venesection or cease AAS.
He decided to cease AAS
Slide32Case Studies
Male 52
yo
, Had been several times on AAS cycle and had normal blood test results. Presented for the first time for a pre-cycle screening.
Normal BP, normal Hb, LFTs, U + E. Testosterone 14
High PSA
Discussed risk of testosterone use with prostate cancer.
Referred to urologist – diagnosed and treated for prostate cancer
6 months post- treatment- had some questions about using AAS
Slide33Impact of harm reduction
- BBV, injecting risks reduced
- adverse events monitored and managed
- health advice discussed
- mental health aspects discussed
- referrals as appropriate-
eg.
endocrinologist, psychologist
- discussion about withdrawals,
etc
Slide34THE PUSH! AUDIT COLLABORATION
Data collection of 150+ people who use PIEDs
Sponsors:
Slide35Where to from here?
Slide36Ways to reduce harm that can be caused PIEDs
Increase appropriate health care providers by educating health care providers about this issue
Encourage this population to engage with healthcare -education and promotion
Create pathways for referrals and treatment if required
Slide37