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Such substances have not undergone the kind of large-scale trials the FDA would normally require to establish safety and efficacy

In addition, high-dose or prolonged anabolic steroid use has been linked to hepatic abnormalities, including rare cases of benign liver tumors or hepatic peliosis, and even malignant liver tumors, although such effects are uncommon with the doses used in therapeutic testosterone replacement

Obtaining injections outside regulated NHS settings may involve inappropriate dosing, lack of monitoring, non-sterile technique, and unnecessary financial cost without clinical benefit

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