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Anabolic Androgenic Steroids (AAS)
AAS
Anabolic Androgenic Steroids, or Anabolic Steroids for short, are steroidal androgens.
They consist of natural androgens like testosterone, and synthetic androgens similar to steroid.
Androgens are one of three major sex hormones (the other two being estrogens and progestogens).
The Function of androgens are to increase cell proteins, especially in muscles, and to provide the characteristics of virilization.
In human males, that virililzation starts with the increase production of testosterone from the testes during puberty and results in:
- increase in size of muscle mass resulting in increase strength & joint repair
- increase in size of bones, changing the overall skeleton & heavier bones
- increase in body and facial hair, by conversion to DHT
- increase sweat glands
- increase of the larynx (Adam's apple) resulting in deepening of the voice
Apollo, the perfect man
Medical Treatment with Androgens
Medical conditions treated
Because of the properties of Anabolic Androgenic Steroids, androgens are used to treat a number of medical conditions:
- Testicular Hypogonadism
- Osteoporosis
- Joint repair
- Cachexia, maybe from some cancer, not CKD
Osteoporosis Treated
Testicular Hypogonadism
Low Testosterone or Male hypogonadism
Testicular hypogonadism or Testicular Hypofunction is a common condition in men. Articles have quoted that over 5 million men in the USA are affected, but only 5% are treated. One study noted the prevalence of hypogonadism was 38.7% in men aged ≥45 years presenting to primary care physician offices.
Male hypogonadism is characterized by:
- Low Testosterone serum or blood levels (total testosterone (TT) <300 ng/dl)
- Symptoms of Fatigue
- Erectile Dysfunction
- Mood changes
- Low libido
- Decreased volume of ejaculate
- Loss of body and facial hair
- Weakness
- Decreased bone density
- Decreased lean body mass
- Increased body fat
- Anemia
- Infertility
As we age, the decreased testosterone levels (and not just in men) become increasingly likely lead to worsening conditions of:
- Cardiovascular disease
- Depression
- Osteoporosis and fragility fractures
- Diabetes
Two types of Testicular Hypogonadism:
- Primary due to Testicular Failure, due to age, injury or insult, medical condition such as Klinefelter syndrome, undescended testes.
- Secondary due to Hypothalamus or Pituitary Failure, from Pituitary disorders, medicines, Diabetes, Age.
Treatment includes:
- exogenous Testosterone Replacement Therapy
- complementary endogenous using Human Chorionic Gonadotropin (hCG) and clomiphene (Clomid)
- use of complementary hormonal therapy, such as with Human Growth Hormone or Thyoid Replacement, as indicated
- use of complementary treatment with synthetic androgens
Testes Locations
Androgens and Sports
misperceptions
Unfortunately, the use of anabolic steroids in professional and Olympic athletes have brought a cloud of speculation and doubt regarding its use. Often classified as Performance Enhancing Drugs or PED's, it is felt that it gave an unfair advantage to a particular individual - because, it does; and thus violates the spirit of the sport. A list of the Gold Medalists and Champions that acknowledge using PEDs include: Arnold Schwarzenegger, baseball's Barry Bonds, 7-times Tour-winner Lance Armstrong, baseball's the Bash Brothers, golf's Vijay Singh, swimmer Christiane Knacke, Track's Marion Jones, and let's just say more than a few NFL players (a study quotes 10% of NFL players admit to it). Though these anabolic steroid medications are banned by numerous athletic associations such as the International Olympic Committee as well as the National Football and Basketball Associations and Major League Baseball, one cannot suspect the widespread use in professional sports. This ban unfortunately re-enforces the public perception that these medications should not be used under any circumstances. Indeed, a recent study on healthcare-provider attitudes towards anabolic androgenic steroids found that AAS users were viewed less favorably that cocaine abusers. These perceptions were enhanced by the passage of the Anabolic Steroid Control Act of 2004 that listed anabolic steroids as schedule III controlled substances—similar to ketamine, opiates and morphine. This policy mandated that a physician prescription was necessary to obtain the medication. As such, medical studies into alternatives to testosterone therapy have been slowed by societal stigma and perception. One must keep in mind that AAS and PEDs are beneficial, and why under medical supervision and proper indications, are invaluable in improving health and life.
Olympic sports and PEDs
Nandrolone
DECA
A synthetic anabolic steroid that has been available for decades and has been investigated to some degree is 19-nortestosterone (or nandrolone, deca-durabolin). Early investigations of nandrolone focused on its potential uses in the treatment of osteoporosis for both men and women. It increased gastrointestinal and renal tubular absorption of calcium and decreased bone reabsorption. Because of viriliztion, it has been replaced by newer and more effective therapies to treat osteoperosis (i.e., bisphosphonates)
Nandrolone also had the beneficial effects of stimulating the formation of extra-osseous collagen and soft tissue.
Researchers have suggested its use in:
- anemia
- muscle wasting secondary to hemodialysis and/or HIV
- COPD
The only major difference between Testosterone and Deca is a single methyl group. Like Testosterone, Deca-durabolin is given injection IM.
Nandrolone binds to androgen receptors with a greater affinity than testosterone and with an increased anabolic or myotrophic activity (versus androgenic activity). The myotrophic-androgenic ratio can be used to compare testosterone to nandrolone - approximately 1 to 11, with regards to the ability to stimulate muscle growth compared to virilization.
While testosterone in the prostate or in the hair follicles, testosterone is converted to dihydrotestosterone (DHT) by 5 alpha-reductase (5AR). This 5AR activity is undetectable in skeletal muscle. In prostatic tissues and hair follicles, testosterone is converted to DHT by 5AR and is thus responsible for the known side effects of testosterone replacement therapy (TRT) on prostate growth and alopecia..
On the other hand, while 5AR can also act on nandrolone (19-nortestosterone) to produce 5α-dihydro-19-nortestosterone, it has a significantly decreased binding affinity for the androgen receptor. As such, in prostatic tissues results in a significantly decreased ability of nandrolone to bind androgen receptors. Theoretically, this could mean a decrease in prostatic growth with a possible decreased effect on lower urinary tract symptoms such as those developed as a result of benign prostatic hyperplasia (BPH). A potential decrease in the rates of alopecia could also be observed . Furthermore, the lack of 5AR in skeletal muscle allows nandrolone to bind strongly to androgen receptors in the muscle and stimulate growth, contributing to its high myotrophic:androgenic ratio.
Thus, nandrolone may be an option for treating hypogonadal men concerned about alopecia or hair loss. Androgenic alopecia, or male pattern hair loss, typically occurs in 20% of 20-year-old men and then increases by approximately 10% every 10 years. While finasteride which was approved for the treatment of alopecia in 1997 at a dose of 1 mg daily (propecia®) has been used for male pattern baldness, it has noteworthy side efects of persistent sexual side effects and anxiety/depressive symptoms.
The ability of nandrolone to preferentially stimulate muscle growth formed the basis of its use in the treatment of anorexia and cachexia in patients with chronic medical conditions including chronic renal failure and HIV.
Hypogonadism has been shown to be associated with dyslipidemia, atherosclerosis, cardiovascular disease, metabolic syndrome, and diabetes). Testosterone supplementation in hypogonadal men improves these risk factors leading, in some patients, to complete resolution of their metabolic syndrome. By improving the muscle mass with nandrolone, it could improve body composition and augment testosterone’s effects in preventing and reversing metabolic syndrome and the risk of type 2 diabetes in hypogonadal men.
One potential side effect comes from patients, who have previously used nandrolonesuggests a relationship with the use of nandrolone (alone, not in combination with testosterone) and ED. Nandrolone may contribute to the development of ED through two mechanisms: (1) the suppression of testosterone/DHT via negative feedback and (2) the buildup of estrogens.
DECA or Nandrolone
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