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Older adults with cardiac problems or kidney disease are at increased risk for sodium and water retention when taking the androgens or anabolic steroids.

The nurse makes a daily comparison of the patient's preadministration weight with current weights. The nurse notes the presence of puffy eyelids and dependent swelling of the hands or feet (if the patient is ambulatory) or the sacral area (if the patient is nonambulatory) and reports any findings to the primary health care provider. The nurse monitors the daily fluid intake and output to calculate fluid balance.

With long-term administration, the female patient may experience mild to moderate masculine changes (virilization), namely facial hair, a deepening of the voice, and enlargement of the clitoris. Male pattern baldness, patchy hair loss, skin pigmentation, and acne may also be seen. Although these adverse effects are not life threatening, they often are distressing and only add to the patient's discomfort and anxiety. These problems may be easy to identify, but they are not always easy to solve. If hair loss occurs, the nurse can suggest the wearing of a wig. The nurse advises the patient that mild skin pigmentation may be covered with makeup, but severe and widespread pigmented areas and acne are often difficult to conceal. Each patient is different, and the emotional responses to these outward changes may range from severe depression to a positive attitude and acceptance. The nurse works with the patient as an individual, first identifying the problems, and then helping the patient, when possible, to deal with these changes.

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