Performance-enhancing substances in young athletes — formative SAQs

SAQ 1 — The boy who gained nine kilograms (10 marks)

Stem: A fifteen-year-old boy presents with a sore shoulder. Alone in the consultation, he discloses that he has gained nine kilograms of lean mass over a term and has been injecting testosterone and an oral steroid bought online for four months. On examination he has severe cystic acne over his back and shoulders, gynaecomastia, and small testes for his pubertal stage. ^{[6] [1]}

a) Name the most likely class of substance and explain why the aromatisation of excess androgen is of specific concern in this adolescent. (2 marks) ^{[4] [6]}

b) List the physical stigmata that support the diagnosis and the baseline investigations you would arrange to quantify the harm. (3 marks) ^[6]

c) Explain why the cessation of androgens must be slow and supported, and what psychiatric risk an abrupt withdrawal carries. (3 marks) ^{[4] [6]}

d) Outline the five steps of the counselling pathway and the prevention evidence you would cite to the family. (2 marks) ^{[5] [6]}