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, gitea.cncfstack.com 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