CFM, finally, fits who prescribes pump – 01/05/2023 – Bruno Gualano

In reaction to a joint note from eight medical Societies and Federations, the Federal Council of Medicine, this time, aligned itself with science by vetoing hormone therapies for aesthetic and sports performance purposes (resolution nº 2,333/23). Just what this columnist asked for here.

And more: the restriction advances to “carrying out courses, events and advertising with the aim of encouraging the use or supporting the possible benefits of androgen therapies for aesthetic purposes, muscle mass gain or improvement in sports performance”.

The therapeutic indication of steroids remains justified in conditions such as hypogonadism, neonatal micropenis, delayed puberty, cachexia and gender dysphoria.

Although late, the regulation is right, as it halts the momentum of greedy charlatans who make their fortune risking the lives of patients.

But as the writer and social activist Upton Sinclair (1878 – 1968) teaches us –a lesson that must have assimilated more from his political than literary endeavors–, it is hard to make a man understand something when his salary depends, above all, that don’t understand it.

Dissatisfied with the atrophy of the golden chicken, pump prescribers turned to their bubbles to inflate them against the CFM resolution.

The main argument is that the prohibition of cosmetic prescription of steroids would represent the abandonment of the user, who, without “professional care”, would end up exposed to heavier drugs and without control of origin.

Balela. First, because pump prescribers play with the illusion that they are able to prevent –or, as they like to say, “manage”– adverse events. It turns out that there is not a single scientific study that teaches how to do it.

Second, because the argument maliciously suggests that the harm reduction strategy is prohibited by the resolution.

And, on this, it is worth spending a few lines. Harm reduction is a consecrated therapeutic practice, which includes several actions focused on the defense of life, aimed at reducing personal risks and social, economic and health damages for people who do not want or are unable to stop using drugs.

In the context of steroid abuse, part of harm reduction is:

• welcoming the user, without stigmatization, judgment or prejudice;
• education about adverse events;
• the identification of risk factors that aggravate them; information on safer modes of use (non-sharing of syringes, less toxic drugs, commonly used doses, etc.);
• advice on how to optimize aesthetic or performance results with “natural” interventions (physical training and nutrition);
• clinical monitoring of the user and, when applicable, referral to services specialized in psychiatric disorders and addiction.

It is not part of harm reduction: the distortion of scientific evidence in order to minimize the risks of steroid abuse; conducting slot machine courses that boast pseudoscientific information on the subject; the cosmetic prescription of steroids veiled by marketing adornments (hormonal modulation, beauty chip, anti-aging, bioidentical). These actions go by the name of misconduct, which, now typified, becomes punishable.

The indiscriminate use of steroids is a complex public health problem. It is essential that the SUS –from primary to specialized care– be instrumentalized in welcoming users, in light of the principles of harm reduction.

Professional training, educational campaigns, repression of clandestine laboratories and traffickers, and funding of scientific studies on the subject are additional measures that can cool down the crisis.

The prohibition against apology and abusive prescription of steroids is part of this preventive role. There is not a single medical or scientific entity that discredits the decision. The pump prescriber alliance – that one! – vigorously disagrees.

Sinclair has the explanation.

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