Lucas Caseri Câmara
Chronic diseases and aging often converge toward a shared biological phenotype characterized by loss of skeletal muscle mass, bone mass, strength, endurance, physical performance, and functional reserve. These changes are not merely secondary consequences of illness; in many patients, they become active determinants of frailty, disability, falls, fractures, reduced treatment tolerance, hospitalization, and mortality. We propose the term clinical anabolism as a conceptual framework to describe a medical, therapeutic, monitored, and functionally oriented approach aimed at preserving or restoring structurally and metabolically relevant tissues, particularly skeletal muscle and bone. This concept requires a clear distinction between testosterone replacement in documented androgen deficiency, therapeutic anabolic strategies in selected catabolic or rehabilitation-related conditions, and nonmedical anabolic-androgenic steroid use. Clinical anabolism should not be understood as cosmetic enhancement or indiscriminate pharmacological intervention, but as a multimodal strategy integrating resistance training, rehabilitation, nutrition, treatment of the underlying disease, and, in selected cases, pharmacological anabolic agents. Future studies should prioritize patient-centered outcomes such as strength, gait speed, falls, independence, hospitalization, treatment tolerance, and quality of life, rather than lean mass alone.