Genitourinary effects have included oligospermia and decreased ejaculatory volume. Elderly male patients may experience prostatic enlargement resulting in urinary obstruction. Priapism and excessive stimulation may develop. Female patients may experience virilization, including deepening voice, hirsutism, acne, clitomegaly (not reversible), and menstrual abnormalities. Discontinuation of anabolic steroids at signs of mild virilization may prevent irreversible virilization. Alterations in libido may occur (increased/decreased).[Ref]
Hepatic tumors associated with anabolic steroid use are more vascular than other hepatic tumors and may remain silent until the development of life-threatening abdominal hemorrhage. Peliosis hepatitis may present as mild liver dysfunction, but has resulted in liver failure.[Ref] Hepatic side effects have included life-threatening peliosis hepatitis and hepatic abnormalities such as hepatic neoplasms and hepatocellular carcinomas following prolonged therapy with high doses of anabolic steroids. Tumor regression did not occur in all cases following medication withdrawal. Cholestatic hepatitis, jaundice, and abnormal liver function tests can occur at relatively low dosages.
Compared with other steroid drugs, in moderate doses Oxandrolone lessens the production of its own testosterone and the axis of the hypothalamus-pituitary-testicle through a feedback mechanism. When the dosage of Anavar is high, the body reacts by reducing the production of gonadotropin, having reasons to believe that the endogenous level of testosterone is too much elevated. The lack of stimulation of Leydig cells leads to testicular atrophy. According to a study that was conducted by Grunfeld, Carl MD, PhD in 2006, Anavar at a dose of 80 mg per day reduced testosterone levels by 67% after 12 weeks of admission.
This two-day manual therapy seminar offers a new and simple approach in manual therapy which has been developed by Brian Mulligan, ., Dip. This course covers the application of mobilizations with movements (MWM's) for lower quadrant extremity and spinal joint dysfunction. The course is designed for health care professionals licensed to perform joint mobilizations who wish to broaden their existing manual therapy skills for use within their defined scope of practice.
This course will enable participants to learn the indications for this new and simple approach to manual therapy in clinical practice. Past Mulligan course feedback has indicated the need for a more detailed presentation of techniques along with the development of clinical reasoning skills. This seminar is designed to meet those needs. This course is one of four courses leading to qualifications as a Certified Mulligan Practitioner (CMP).