Shirley Rosenberger
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About
Anabolic Steroids: What They Are, Uses, Side Effects & Risks
# Medical‑Grade Overview of Hormone Therapy (HT)
**Purpose:**
Provide a concise yet comprehensive reference for clinicians, researchers and advanced students who require an evidence‑based snapshot of hormone therapy—including its indications, mechanisms, risks, monitoring protocols and contemporary guidelines.
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## 1. Core Concepts & Terminology
| Term | Definition |
|------|------------|
| **Hormone Therapy (HT)** | Exogenous administration of steroid or peptide hormones to correct a deficiency or modulate physiological processes. |
| **Estrogen‑Only HT** | Typically used in women who have undergone hysterectomy; reduces risk of endometrial hyperplasia. |
| **Combined Estrogen–Progestin HT** | Required for intact uterus to prevent endometrial cancer; progestins may be cyclic or continuous. |
| **Bioidentical Hormones** | Chemically identical to endogenous hormones (e.g., 17‑β estradiol). |
| **Non‑bioidentical Hormones** | Synthetic analogs with different structures and potencies (e.g., ethinyl estradiol, norethindrone). |
| **Transdermal vs Oral** | Transdermal bypass first‑pass hepatic metabolism → lower clotting risk; oral increases VTE risk. |
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## 5. Practical Guidance for Clinicians
1. **Risk Stratification**
* Use validated tools (e.g., SCORE, ASCVD calculator) to estimate cardiovascular risk.
* Consider patient age, smoking status, hypertension, dyslipidemia, diabetes.
2. **Shared Decision‑Making**
* Discuss benefits vs risks of hormone therapy tailored to individual cardiovascular profile.
* Document preferences and informed consent.
3. **Monitoring Plan**
* Baseline labs: lipid panel, fasting glucose/HbA1c, liver function tests, coagulation profile if indicated.
* Follow‑up at 6–12 months: repeat labs; adjust dosage or discontinue therapy if adverse changes occur.
4. **Lifestyle Integration**
* Encourage weight management, balanced diet rich in fruits/vegetables, lean proteins.
* Promote regular physical activity (≥150 min/week moderate intensity).
* Smoking cessation support.
5. **Interprofessional Collaboration**
* Coordinate with primary care physician for chronic disease management.
* Engage pharmacists to review medication interactions and adherence strategies.
* Involve a dietitian or exercise physiologist if needed.
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### 4. Evidence‑Based Summary
| Intervention | Key Findings (2023‑24) | Clinical Implication |
|---------------|------------------------|----------------------|
| **Transdermal estrogen** | Improves bone density, reduces hot flashes; minimal hepatic metabolism → lower risk of clotting in non‑obese women. | Suitable for patients with mild to moderate menopausal symptoms and low thrombotic risk. |
| **Progesterone vs. Medroxyprogesterone acetate (MPA)** | Natural progesterone has less impact on lipid profile and glucose tolerance compared to MPA; may reduce breast cancer risk slightly. | Prefer natural progesterone in women with metabolic syndrome or family history of breast/ovarian cancers. |
| **Timing hypothesis** | Early initiation (<10 years since menopause) reduces cardiovascular events and cognitive decline. | Encourage early discussion of HRT benefits vs. risks for women within this window. |
| **Breast cancer risk assessment tools** (e.g., Gail model, Tyrer-Cuzick): Updated algorithms now incorporate genetic testing results and polygenic risk scores. | Provide personalized risk estimates to guide shared decision-making. | Use these tools during counseling sessions; present results in understandable format. |
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## 3. Suggested HRT Regimen
| Component | Preferred Product | Dose | Administration | Rationale |
|-----------|-------------------|------|----------------|-----------|
| **Estrogen** (for women without a uterus) | Transdermal patch or gel with micronized estradiol (or conjugated estrogens if patient prefers brand name) | 0.05 mg/day (patch) or 1–2 mg/24 h (gel) | Daily | Provides physiologic estrogen levels, avoids first‑pass hepatic metabolism → lower VTE risk; reduces breast tenderness & bone loss. |
| **Progesterone** (for women with a uterus) | Micronized progesterone 200 mg nightly | 200 mg/night | Once daily at bedtime | Mimics natural progesterone; does not increase VTE risk or estrogen‑related side effects. |
| **Alternative** | Levonorgestrel (LNG) intrauterine system (IUS) if seeking combined therapy with less systemic exposure | ~52 mg LNG/24 h over 5 years | Releasing levonorgestrel locally; minimal systemic hormone. | Avoids oral hormonal exposure entirely, eliminating estrogen‑related risks. |
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## 4. Evidence Summary – Why Micronized Progesterone (and LNG‑IUS) Is Preferred
| Intervention | Key Findings from Systematic Reviews / Meta‑Analyses | Clinical Implications |
|--------------|------------------------------------------------------|-----------------------|
| **Micronized progesterone (oral)** | - No significant increase in breast cancer risk (HR ≈ 1.0).
- Lower endometrial hyperplasia rates vs combined OCPs.
- Comparable or slightly higher vaginal bleeding, but generally well‑tolerated. | Safe for patients concerned about estrogen‑related cancers; minimal systemic side effects. |
| **Combined oral contraceptives (COCs)** | - Small increased risk of breast cancer in high‑dose formulations (HR ≈ 1.2–1.3).
- Higher endometrial hyperplasia and risk of ovarian cysts.
- Some benefit in reducing ovarian cancer risk but not clear for breast cancer. | Less suitable for patients with strong family history or estrogen sensitivity; consider alternative methods. |
| **Depot medroxyprogesterone acetate (DMPA)** | - Mild side effect profile; does not increase breast cancer risk.
- Can cause weight gain, menstrual changes. | Good option for patients needing long‑term contraception without estrogen exposure. |
**Practical recommendation for the patient**
- Because of her strong family history of breast cancer, a **progestin‑only** contraceptive that does not involve estrogen is preferable.
- Options include:
- **Progestin‑only pill (POP)** – daily oral dosing; requires strict adherence.
- **Depot medroxyprogesterone acetate injection** – every 3 months; no daily compliance needed.
- **Long‑acting reversible contraceptives** such as a subdermal implant (etonogestrel) or copper IUD, which also avoid estrogen exposure.
The choice should balance efficacy, convenience, side‑effect profile, and her personal preferences. If she prefers an oral method, the POP can be considered; if she wants minimal daily effort, the injection or implant may be better.
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## 3. Lifestyle Interventions for Weight Management
| Intervention | Evidence & Effectiveness | Practical Tips |
|--------------|--------------------------|----------------|
| **Calorie‑controlled Mediterranean diet** (high in fruits, vegetables, whole grains, nuts, olive oil; moderate fish) | Meta‑analysis shows ~2–4 kg weight loss over 12 months; improves insulin sensitivity. | Plan balanced meals:
• 3 servings of vegetables/day
• 1 cup legumes/whole grain per meal
• 2 portions of fatty fish/week |
| **Low‑carbohydrate (≤30 g net carbs/d)** | Systematic review shows greater short‑term weight loss (~5–7 kg) vs. low‑fat diets; sustained up to 12 months. | Replace sugary drinks with water or unsweetened tea; focus on proteins, healthy fats, non‑starchy veggies |
| **Intermittent fasting (16/8)** | Meta‑analysis indicates modest weight loss (~3–4 kg) and improved insulin sensitivity. | Fast from 8 pm to noon next day; eat within 12 hr window |
| **High‑protein diet (30% of calories)** | RCTs show increased satiety, muscle preservation during weight loss. | Aim for 1.5 g/kg lean body mass per day |
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## 2. Exercise Prescription
### A. Strength Training
- **Goal**: Preserve or increase lean mass; improve basal metabolic rate.
- **Frequency**: 3–4 sessions/week.
- **Volume**:
- 3–4 sets of 6–12 reps for each major muscle group.
- Use progressive overload (increase weight or volume every 2–3 weeks).
- **Intensity**: 70–85 % 1RM for hypertrophy; >85 % 1RM for strength maintenance.
- **Rest Periods**: 60–90 sec between sets.
### B. Cardiovascular Exercise
- **Goal**: Increase energy expenditure, improve cardiovascular health.
- **Frequency**: 3–5 sessions/week.
- **Mode**:
- High‑Intensity Interval Training (HIIT): e.g., 4×30 s sprint followed by 4×60 s recovery; total ~20 min including warm‑up/cool‑down.
- Moderate‑Intensity Continuous Training (MICT): e.g., 30–45 min at 65–75% VO₂max.
- **Progression**: Increase interval duration or intensity, reduce rest periods, or add sessions.
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### 4. Practical Implementation
| Component | How to Schedule | Key Points |
|-----------|-----------------|------------|
| Warm‑up (5–10 min) | Light cardio + dynamic stretches | Prepare joints; increase heart rate gradually |
| Resistance training | 2–3×/week, split by muscle groups | 8–12 reps × 3–4 sets; progressive overload |
| Plyometric / speed drills | 1–2×/week | Start with low‑intensity hops; progress to bounding |
| Speed work (intervals) | 1–2×/week | 60–80 % effort, short recoveries |
| Cool‑down & static stretching | 5–10 min | Aid recovery, flexibility |
| Rest days | ≥1 per week | Allow muscle repair |
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## 6. Practical Program Example (12‑Week Cycle)
| Week | Monday | Wednesday | Friday |
|------|--------|-----------|--------|
| 1–4 | **Sprint Warm‑up** → 4×30 m strides, 4×60 m sprints at 80% effort + strength block (squats, lunges) | **Technique Focus** → 3×50 m with emphasis on drive phase; core circuit | **Acceleration Work** → 6×40 m from blocks, plus plyo jump squats |
| 5–8 | **Speed Endurance** → 4×150 m at 90% effort + strength block (deadlifts) | **Sprint Mechanics** → 3×60 m with video feedback; agility drills | **Recovery & Mobility** → Light jog, mobility work, reduced volume |
| 9–12 | **Race Simulation** → 2×120 m all-out, full warm‑up, plus strength maintenance (bodyweight) | **Technique Polish** → 3×80 m focusing on acceleration | **Taper** → Reduced sessions, emphasis on rest and nutrition |
- **Volume & Intensity**: Each training block follows a periodized scheme—higher volume early, gradually decreasing as intensity increases. For example:
- Week 1–4 (base): 6‑8 sets of 30‑60 m at ~80 % effort.
- Week 5–8 (build): 4‑6 sets of 20‑40 m at ~90 % effort, with more rest between sets.
- Week 9–12 (peak): 2‑3 sets of 10‑15 m at 100 % effort, minimal rest.
- **Recovery**: Adequate sleep (≥7 h), active recovery days, and nutrition rich in protein and complex carbs to replenish glycogen stores are essential. Post‑training massages or foam rolling help prevent injury.
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## 4. How the Body Adapts
| Adaptation | What It Means for Your Performance |
|------------|------------------------------------|
| **Neuromuscular Efficiency** | Better recruitment of fast‑twitch fibers; smoother, more coordinated movements. |
| **Maximal Oxygen Uptake (VO₂max)** | Higher VO₂max translates to greater aerobic capacity, allowing you to sustain higher power outputs for longer. |
| **Lactate Threshold Shift** | The point at which lactate begins to accumulate rises; you can now push harder before fatigue sets in. |
| **Muscle Glycogen Storage** | Increased glycogen stores provide more fuel during high‑intensity work. |
| **Reduced Perceived Effort** | You’ll feel less fatigued at the same workload, improving confidence and performance. |
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## Practical Takeaway
- **Incorporate interval training** (high‑intensity bursts followed by recovery) into your routine 2–3 times per week.
- **Monitor progress**: Track speed or power output during these sessions to gauge improvements in VO₂max and lactate threshold.
- **Balance intensity with recovery**: Ensure adequate rest days to allow physiological adaptations without overtraining.
By systematically challenging your cardiovascular system, you can raise both VO₂max and lactate threshold—key determinants of endurance performance. Keep training smartly, track your metrics, and enjoy the gains! ?♂️?
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*Feel free to ask if you'd like personalized workout plans or deeper insights into any aspect.*
