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Over the last thirty years the use of anabolic steroids, anti-catabolic agents, and more recently, Human Growth Hormone has tremendously accelerated. It has been estimated that more than three million male and female athletes have used these agents and more than one million are currently using them. This is in America alone. European athletes and trainers were the pioneers in the use of anabolic steroids. By far, the largest variety of anabolic substances are manufactured and sold outside of the United States. Once the province of elite competitive athletes, the use of anabolic steroids is growing explosively among recreational athletes and bodybuilders all over the world.
There is also a parallel increase in the use of anabolic steroids among adolescents in junior high and high school. This is not good. Unlike the hysterical and exaggerated claims of risk and damage often cited as a result of adult use of anabolic steroids, the perils of the use of such substances in adolescents are obvious, real, fairly well documented, and can be permanent.
These dangers include, but may not be limited to, early closure of the growth plates in long bones, precocious puberty, hypogonadism, cessation of the body's own production of anabolic steroids, which may be more often permanent in adolescents than in young adults using similar hormonal products.
Our discussion is limited to the use, effect, and side effects of anabolic steroids in young and older adults. First I want to say there is very little published in the medical literature about the use of anabolic steroids for any purpose and even less for the purpose of increasing muscle mass, strength, and athletic performance. The lack of scientific data has not deterred so-called medical experts, the media, and others from making unsupported and unsubstantiated claims about the damage and dangers of all anabolic steroid use. Even the small body of medical literature on this subject is strewn with unsupported assumptions and conclusions concerning bad side effects and politically correct condemnation of all use of anabolic steroids.
The literature is conflicting and contradictory. But, it is safe to say that the dangers of anabolic steroids have been exaggerated. There are a few published literature reviews, which supporters use in arguing for one position or the other; either harmful or benign result. There are both historical and the evidence of experience that anabolic steroid use is not the frightening nightmare portrayed in pop culture and by official medicine.
Anabolic steroids have been available to athletes for forty years. During that time, a few million athletes in this country alone have used them. If anabolic steroids were really dangerous and caused a broad range of permanent damage, physicians and researchers would have by this time seen and described an Athlete's Anabolic Steroid Syndrome. No such syndrome has emerged in the last thirty-to-forty years of anabolic steroids use.
Most athletes know this. In fact, many astute athletes and bodybuilders know more about anabolic steroids then most doctors. This situation has completely undermined the credibility of medical authorities who consistently and embarrassingly flout their own ignorance. This is unfortunate because there are dangers associated with these drugs. Problems with anabolic steroids occur because of several different reasons. Some specific anabolic agents are inherently unsafe and should be used very cautiously for short periods of time or avoided altogether. The use of massive doses of steroids may play a role in steroid related medical problems. Also, there is a highly individual response to anabolic steroids.
The term, massive doses, has no real quantitative meaning because there has been no clinical work done in human beings to determine where the line is between optimal dose for strength and muscle mass and the dangers associated with very large doses. What are these dangers? Again, this is hard to pin down because the studies simply have not been done. We don't even know if the incidence of many of these serious events, assumed to be related to steroid use, occur any more frequently in steroid users, massive doses or not, than in the general population.
At one time, it was widely thought that bodybuilders who used " massive doses" of anabolic steroids had a higher incidence of atherosclerosis resulting in a higher rate of heart attack and cardiac surgery. The consensus now is that this is not true. Bodybuilders do not have a higher incidence of heart attack than the general population. However, there are a few studies which indicate that heavy users over many years develop enlarged hearts in an anatomical pattern similar to that seen in cardiomyopathy, congestive heart failure, and hypertension. But, there is no convincing evidence, in fact no evidence at all, that even in this heavy user group, singled out by cardiac ultrasound and MRI, that the incidence rates of the actual disease states are any higher than in the general population. Only in a handful of case studies has the actual disease state been diagnosed, rather than a simple anatomical finding.
However, I do believe it prudent to accept worst case scenario for these very serious diseases and proceed with the assumption that there is a link between disease risk and the prolonged use of massive doses. But, again what are massive doses? We have to be somewhat arbitrary. The individual cases cited in the literature involved serious competitive bodybuilders who used far larger doses of anabolic steroids than other elite athletes. Therefore, one approach to defining a safe dosage range may be found by looking at the difference between the dose and the kinds of steroids used by serious bodybuilders and the rest of the athletic community.
There is great variation in dose but generally, the elite athlete is looking for increases in strength and endurance rather than in muscle mass, without loss of speed, agility, and flexibility. Its' the other way round with bodybuilders where the main issues are size, contour and definition. Power lifters, of course are, concerned only with strength.
I have worked with all three. My primary interventions have centered on diet, treatment of side effects, mainly by dosage adjustment, changing protocols, or suggesting the addition of agents, which counter side effects.
Elite game playing athletes tend to use only one or two steroids at the same time. Examples would be Winstrol, oral or injectable, testosterone esters, usually cypionate, or enanthate. Sometimes these primary androgenic anabolic steroids are used in conjunction with the non-androgenic anabolic steroid nandrolone (Decca Durabolin).
A typical dose would be between 100-to-200 milligrams of testosterone and the same dose of nandrolone decoanate injected every four days. This is my favorite combination. Although I do prescribe doses both higher and lower than this 100-to-200 milligram range, it is more than adequate for athletes and all but the most serious hardcore bodybuilders. It is the ideal stack for the older athlete and bodybuilder because it has a long and safe history of use. Older men and women can take it for indefinite periods of time, without cycling, as part of their primary hormone replacement therapy. For women, small doses of nandrolone and testosterone are usually adequate. For maximal effect, this combination injection may be taken with a custom testosterone gel applied twice daily. The gel keeps a steady baseline level of testosterone, smoothing out the peak and valley effect produced by the injectables.
For that hardcore group of competitive bodybuilders, this drug and dosage schedule may not be enough. This group often uses many times the doses mentioned above of testosterone esters and nandrolone. It is not uncommon to see men injecting five or six c.c.s of testosterone enanthate, or mixed testosterone esters per week with 400 to 800 milligrams of nandrolone. These men often combine as many as four to six different injectable and oral anabolic steroids at once in complicated regimens. Often mixed-in are anti-catabolic drugs, beta adrenergic agents used to treat asthma such as clenbuterol, adrenal corticosteroid suppressants, like Cytadren, plus insulin, thyroid hormones, prostaglandins and a host of other seriously potent drugs and supplements in a complex program of biochemical tweaking.
Intuitively, this makes me a little uncomfortable. These men are twiddling with basic, powerful, and delicately balanced endocrine mechanisms. The pathophysiologic changes and the theoretical possibilities for trouble go far beyond the relatively simple and benign issues involved around the use of anabolic steroids only. The vast cascading array of changes in the endocrine, immune and neurological systems and in basic cellular mechanisms is complex, unknown, and unpredictable. No one understands what is actually happening or the implications on health risks.
I have no judgment on the men and women who utilize these radical approaches for increasing muscle mass and strength. But, I'm not sure if the rewards are worth the risks, which are largely unknown. Certainly, the competition in the upper echelons of national bodybuilding is as fierce as in any elite sport and the differences between top competitors is very small. I understand the pressure to do anything that will produce an edge. However, unless you are in this elite core of nationally competitive bodybuilders there is no reason to consider such massive dosage cycles and multiple agent mixtures.
It is doubtful that you will be willing to put in the equally massive amounts of gym time and effort to utilize such a complicated and heavy schedule of drug use. What bothers me is that if someone does get into trouble it is doubtful that anyone will be able help them because no one will understand what's going on.
The good news is that so far there has been remarkably little evidence of harm even with use of these mind-boggling protocols. But, it may be just a matter of time before physicians begin to see problems. However, I could be wrong. We just don't know, yet.
How much is too much? Well, power lifters appear to get very strong on regimens far smaller than those used by many of the most serious bodybuilders. Elite game-playing athletes use even less. I have never treated an elite athlete or power lifter for prolonged hypogonadism-loss of ability of the testicles to produce testosterone or, azoospermia-loss of sperm production resulting in sterility. I have treated both of these conditions in six different bodybuilders.
The only thing these bodybuilders had in common was the use of very large doses, five or six c.c.s injected per week, of multiple agents, plus oral anabolics. Four of these men were in their twenties when I first saw them and had been unproductive of their own testosterone and sperm for periods ranging from six months to two-and-a-half years. In only two of these men was normal hormonal out-put for age achieved. The other four had to go on permanent life-long testosterone replacement. I am the first to admit that my practice does not permit a large enough sampling to make broad sweeping generalizations. However, our collective experience is the only thing we have to guide us in the absence of credible research.
There isn't space enough to list all the anabolic agents which one should be careful using because of liver toxicity. Most of these risky steroids, but not all, fall into the oral rather than the injectable category. Some steroids can be taken in either injectable or oral forms. It is always the oral forms which are potentially more toxic. This is because of what is known as "first hepatic pass" phenomenon. Certain oral drugs are shunted from the intestines directly into the liver to be metabolized before they are absorbed systemically. No matter, the drug, first hepatic pass puts great stress on the liver.
Even testosterone, when methylated for oral use, becomes a dangerous drug to the liver and can cause chemical hepatitis, hemorrhagic liver cysts, and even liver cancer. This picture of possible liver damage is true for almost all oral steroids with the chemical structure that includes what is known as an alpha alkyklated carbon at the 17 carbon position.
The most toxic of these 17-alpha alkylated steroids are Anadrol, methyltestosterone, and Halotestin in that order. These three mass building steroids are highly prized by bodybuilders for the incredible and immediate increases in muscle size and strength produced by these very androgenic and highly anabolic steroids.
Anadrol is the most toxic and dangerous of the three. Grossly noticeable jaundice, yellow eyeballs and skin indicating liver damage can occur with only three to six weeks of use depending on dose.
If you must use one of these, three make it Halotestin. It is the least toxic of the three. Halotestin produces exceptional muscle hardness and definition with very little conversion to estrogen and virtually no water retention. It is a favorite of athletes who play burst energy sports like football and boxing because of the aggressive confidence it supposedly induces. Also, Halotestin can be obtained legally in this country, while Anadrol can be purchased only on the black market.
Oxandrolone, also legally available in the USA, is an outstanding oral steroid because of its low side effect profile and the ability to produce great strength gains and a hard ripped look. It is not liver toxic. It will not convert to estrogen at any dose, does not suppress the body's own production of testosterone and is only weakly androgenic-meaning it causes little or no hair loss, acne or large increase in libido. For these reasons, oxandrolone is also a good choice for women in small doses. At appropriate doses, there is no virilization such as acne, increased hair growth on face and body, clitoral enlargement, or deepening of the voice.
Oxandrolone is also a good choice to stack with other steroids. I know. I said I didn't like using multiple steroids except for testosterone and nandrolone. But, clearly, there are large numbers of people who perceive the need to stack. So, if you must stack, stack oxandrolone with nandrolone, testosterone esters, and Winstrol, or even Halotestin, for outstanding results. Nandrolone and oxandrolone together make an extremely effective combination for increasing both mass and making strong, hard, well-defined and ripped muscles while promoting virtually no side effects.
Although oxandrolone and Primobolan are often put forward as an ideal stack for women, Primobolan is not legally available. Nandrolone is also a good choice for women to stack with oxandrolone. Four to six tablets of oxandrolone daily plus 50-to-100mg of nandrolone weekly should be enough for serious female bodybuilders. Athletic women who just want to look good and be strong can obtain gratifying results with half this dose or even less. Some dedicated female bodybuilders use steroids with more androgenic properties for at least part of their training cycle. The choice for a woman to use more androgenic hormones often depends on her choice of how much masculinization she is willing to risk.
The real negative aspect of oxandrolone is it's cost. At about four to four-and-a half-dollars per pill and the need for 8-to-12 pills per day in men, 2-to-6 in women, oxandrolone is expensive. But, there is nothing on the legal market to compete with it, which gives the manufacturers the power to charge whatever they want.
Anabolic/androgenic agents can be safely used to increase muscle mass and strength. The upper tiers of competitive sports and bodybuilding may lead the contestant into medically uncharted territory in the search for that small edge that is the difference between winning and losing. There are certain monitoring and defensive measures to reduce the possibility of liver damage and other side effects anyone using anabolic agents should consider.
First, you should have regular monitoring with blood panels, at least once or twice per year, more frequently if indicated. This is primarily for liver function, red cell number and mass, blood lipids, estrogen levels and Prostate Specific Antigen. Although testosterone and other androgenic agents are supposed to lower cholesterol and triglycerides, clinically, the finding of elevated levels is not infrequent.
Especially important, and most often disturbed, are HDL and LDL levels. HDL is the good cholesterol and LDL the bad cholesterol. HDL should be high and LDL should be low. With some steroid users, the reverse happens. An accepted measure of heart disease risk is the ratio between total cholesterol and HDL cholesterol, CHOL/HDLC. The average risk-ratio is 4.98. Anything above this represents significantly increased risk. I see CHOL/HDL ratios in steroid users that are above 7.25, about three times the average risk.
This particular combination of low HDL and elevated LDL is also found in patients with liver damage. So, even in the face of normal liver studies, low HDL and high LDL with an elevated CHOL/HDLC ratio should be considered a sign not only of increased risk for atherosclerosis but also of liver damage. Both can be easily reversed if caught early and prevented from recurring.
Elevated lipid levels and bad HDL and LDL numbers can be easily treated with many different herbs and supplements. In fact, there are too many choices. I have my favorites in terms and ease of use. Reversal of mild liver damage can also be easily achieved with natural substances. The risk of liver damage can be greatly reduced by the use of phase one and phase two liver detoxification factors.
Red blood cell number and mass should also be followed, particularly with either heavy steroid cycles or prolonged use. Anabolic steroids increase red blood cell formation in the bone marrow. The result can be a condition called polycythemia. This just means a whole lot of red blood cells. This condition can cause sludging even clogging of small arteries. Everyone appears to have a different potential for acquiring this condition.
There are competitive bodybuilders on huge stacks who don't over produce red cells and there are older men and women taking only small replacement doses of testosterone who do over produce red blood cells. This points to the importance of at least occasional blood testing. Donating a unit of blood on a regular schedule is the best way to treat this condition. In giving blood, you not only lower your risk of thrombosis but, you also get to help another human being,
It is extremely important to determine estrogen blood levels. Everyone knows that testosterone is converted to estrogen. But, you fellows, don't let the formation of breast buds be the first sign that you've been making too much estrogen. It's worth periodic investment of money in blood testing to determine what level of estrogen you produce when taking what level and combination of which aromatizing substances.
Estrogen levels can be misleading. Many hormones taken internally can confuse the estrogen lab assay producing a falsely high result. This occurs with any standard estrogen assay from any laboratory. If this phenomenon is suspected a special epitope assay must be used to validate or invalidate the first result.
High estrogen levels are not good for men and the wrong estrogen metabolites are unhealthy for both men and women. They may increase the risk of prostate cancer, even at high normal levels. Balanced estrogen metabolism is extremely important to the health of all adults. Everyone's livers are stressed with the detoxification of so-called xenoestrogens-industrial compounds that also have estrogen-like activities. These estrogen-like pollutants are responsible for the tremendous increase in breast cancer in women and testicular cancer in men.
This increasing burden must be carried in addition to the normal liver activities of clearing natural estrogen metabolites which increase with age. The biochemical processes, which break down estrogen into beneficial metabolites, are also responsible for detoxifying a broad range of carcinogens noted to increase the risk of hormonal cancers such as cervical, ovarian, endometrial, breast and prostate.
Anything that coaxes the body into making the right estrogens is of benefit. There has been a lot of publicity and product advertising lately in bodybuilding publications for I3C, or indol-3-carbinol, one of several extracts of cruciferous vegetables having this property of normalizing estrogen chemistry. It is known that a better product to take is diindolemethane, or DIM. DIM is safer than I3C. I3C must be converted to DIM for biologic activity. During this process, I3C may stimulate liver cytochrome P450 enzymes to produce liver toxic reactive intermediates. I3C is also unstable both in storage and during digestion. DIM is one of the few products that appear to be beneficial for adults of all ages to take. Available evidence indicates that this is especially true for adults on hormone replacement or enhancement programs.
A number of issues surrounding performance enhancement, the necessity for informed use of agents and how to reduce some of the known deleterious side effects have been discussed. I think this small taste will give the reader a better sense of what NewHopeMed can do for you. You're invited to take the next step in protecting and maintaining your health during hormone replacement or enhancement therapy. You can make either a full new patient consultation appointment, or a fifteen-minute $55.00 First Look Appointment to determine if we have what you want. The First Look Appointment charge will be credited to the cost of a new patient consultation, should you care to proceed with NewHopeMed.
Written by: Dr. R Scruggs.
