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3 Best Steroids For Beginners Plus 3 To Avoid

Below is a concise, evidence‑based overview of the health risks associated with the use of anabolic–androgenic steroids (AAS) such as testosterone and its analogues. The information is drawn from peer‑reviewed literature, official agency reports, and established medical guidelines. It is intended for educational purposes only; it does **not** provide dosing instructions or substitute for individualized medical advice.

| System | Typical Adverse Effect(s) | Key Evidence Sources |
|--------|---------------------------|----------------------|
| **Cardiovascular** | • Elevated blood pressure (hypertension)
• Dyslipidemia: ↑ LDL, ↓ HDL
• Myocardial hypertrophy, arrhythmias, increased risk of coronary artery disease | 1. *J Clin Endocrinol Metab*. 2004;89(12):5935‑5943.
2. *Circulation*. 2010;122(7): 719‑728. |
| **Hepatobiliary** | • Elevated transaminases, cholestasis
• Hepatic adenoma, peliosis hepatis (rare) | 1. *J Hepatol*. 2009;50(5): 1002‑1008.
2. *World J Gastroenterol*. 2014;20(12): 3630‑3640. |
| **Cardiovascular** | • Hypertension, tachycardia
• Rarely arrhythmias or congestive heart failure | 1. *Circulation*. 2006;114(7): 741‑748.
2. *JACC*. 2013;62(10): 1019‑1028. |
| **Renal** | • Mild proteinuria
• Rare acute tubular necrosis | 1. *Kidney Int*. 2004;65(5): 1727‑1736.
2. *Nephrology (Carlton)*. 2010;15(3): 167‑174. |
| **Other** | • No significant increase in hepatic, pulmonary or cardiac toxicity observed | 1. *Clin Pharmacol Ther*. 2005;78(4): 470‑476.
2. *Drug Saf*. 2009;32(9): 783‑795. |

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## Summary of Findings

| Aspect | Key Points |
|--------|------------|
| **Overall Effectiveness** | 13/14 RCTs reported significant improvements in pain and function with tramadol plus standard therapy versus conventional treatment alone or placebo. 12/15 RCTs also showed superior outcomes compared to NSAIDs, acetaminophen, or paracetamol. |
| **Pain Reduction** | Statistically significant reductions observed at multiple time points (4–24 weeks). |
| **Functional Improvement** | Significant improvements in WOMAC function subscale and other functional measures. |
| **Adverse Events** | Common side effects: nausea/vomiting, constipation, dizziness. Rare but serious events include seizures and serotonin syndrome; however, incidence was low across studies. |
| **Safety Considerations** | Tramadol is a weak opioid with potential for abuse. Use caution in patients with seizure disorders or on serotonergic agents. |
| **Clinical Implication** | Tramadol can be considered as an alternative analgesic for knee OA when NSAIDs are contraindicated, but benefits must be weighed against risks of opioid-related side effects and dependence. |

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## 2. Systematic Review Protocol (PRISMA-P)

### Title
Effectiveness and safety of tramadol in the treatment of pain associated with osteoarthritis: a systematic review.

### Registration
Protocol to be registered on PROSPERO (CRD420XXXXXX).

### Objectives
- To determine whether tramadol improves pain control compared with placebo or active comparators in patients with knee/hip OA.
- To quantify adverse events, particularly opioid‑related side effects and dependence.

### Eligibility Criteria

| Domain | Inclusion | Exclusion |
|--------|-----------|-----------|
| Population | Adults ≥18 years diagnosed with osteoarthritis of any joint (knee, hip, hand, spine). | Non‑OA joint pain; pediatric population. |
| Intervention | Oral tramadol (any dose or formulation) administered for ≥2 weeks. | Tramadol used as part of multimodal therapy but not primary analgesic. |
| Comparator | Placebo, no treatment, NSAIDs, paracetamol, opioids other than tramadol. | Comparators not specified. |
| Outcomes | Pain intensity (VAS/NRS), function scores (WOMAC, Lequesne, DASH), adverse events. | No pain or functional outcomes reported. |
| Study design | RCTs, cluster‑RCTs, crossover trials. | Observational studies excluded. |

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### 3 Risk of bias assessment

The risk of bias was evaluated for each included study using the revised Cochrane RoB‑2 tool.
Across all trials:

- **Randomisation process** – *low* in 12/16 (75 %) and *some concerns* in 4/16 (25 %).
- **Deviations from intended interventions** – *low* in 11/16 (69 %) and *some concerns* in 5/16 (31 %).
- **Missing outcome data** – *low* in 10/16 (63 %) and *some concerns* in 6/16 (38 %).
- **Measurement of the outcome** – *low* in 13/16 (81 %) and *some concerns* in 3/16 (19 %).
- **Selection of reported results** – *low* in all 16 studies (100 %).

Overall, each study’s risk-of-bias judgment was "low" for the primary outcome.
The authors explicitly state that the risk-of-bias assessment was performed according to the Cochrane Handbook and is presented in their tables.

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## Search Strategy Used

The systematic review was conducted using a **hand‑search strategy** that involved:

1. **Searching reference lists** of all included studies (backward citation searching) – 1,011 records screened.
2. **Forward citation searches** on Google Scholar for each included study to find any subsequent publications citing it – 7 records identified and assessed.

No electronic database search (e.g., MEDLINE, Embase) was performed; the authors relied solely on citation‑based methods to locate studies.

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## Other Relevant Information

* The review’s **PRISMA diagram** shows that 1,021 records were screened in total: 1,011 from backward searching and 7 from forward searching (plus 3 additional records identified during initial screening of included papers).
* The authors explicitly state that they used Google Scholar for the forward citation search, which is an appropriate tool for such a task.

These details collectively demonstrate how the systematic review was conducted, why Google Scholar was chosen, and what information was omitted in the provided summary.

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