The Dangers of Surgery Under Anabolic Steroids

            Needless to say, many of the people who come to me for surgery are enjoying better living through chemistry, using anabolic steroids and other enhancing drugs.  Very often, it's the side effects of these substances, such as gynecomastia, that brought them to me in the first place. As a result, it has become necessary for me to become aquatinted with these medications and their physiologic effects on the body.

Some of these people are a veritable mobile pharmacy. They may be using a variety of anabolic steroids, human growth hormone, clenbuterol, thyroid medication, ephedrine, anti-inflammatories, diuretics and even narcotic agents. Some have been on these regimens for such an extended period of time that a weaning period is necessary.  It could actually be dangerous to stop everything all at once.

A Special Problem

First let's consider the anabolic steroids. There is a significant variety of anabolic agents, each with its own properties. To lump them all together would be like saying all antibiotics are the same. Basically, a division can be made between injectable and orals. The oral anabolics present a special problem since they pass through the liver and can effect liver chemistry and function. Since many anesthetic agents are detoxified through the liver, compromise of its function can cause serious problems with anesthesia. While the injectables have less effect on the liver, they share the attribute with orals of slowing blood clotting. On most anabolics, there will be increased bleeding and oozing during the surgical operation. This can lead to problems during the surgery and hematomas afterward. Some anabolics also cause fluid retention and increased blood pressure. Add hypertension to the decreased clotting and you can have a major bleeding situation.

The use of anti-inflammatories only makes the bleeding situation worse.

The metabolic stimulating agents, such as clenbuterol and ephedrine, can also increase blood pressure. In addition, they may sensitize the heart to go into abnormal rhythms when combined with some anesthetic agents. Diuretics can cause dehydration and abnormally low blood pressure. This can have effects on the heart and kidneys during an operation. Fluid balance is extremely important for the safety of the surgery. It is important to remember that the body is under unusual stresses during surgery and anesthesia. The use of anything that effects the body's ability to compensate can cause grievous consequences. A simple rule of thumb is to be off all cycles for at least six weeks before the surgery.

Judgment Withheld

So, it is important to let any surgeon know what you are taking. I know many are reluctant to mention to their doctors or dentists that they are using these agents. They don't want a lecture from someone they feel is not really informed about the substances they are taking. They don't want to be judged. However, you can see how important it is to be forthcoming. I am pleased that my patients know I will not be judgmental and that they can tell me fully what they may be cycling. I compete in bodybuilding myself and realize such cycles are part of the game. In this manner, I can safely bring them through the surgery and then let them resume their chosen lifestyles safely.