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Testosterone Supplementation - Fact & Fiction
There is bias in the media (and medicine); this results in polarity— one side strongly (and blindly) for an extreme position against a separate side just as vehement (and ignorant) with the opposite stance. Yet, revelations arise that eventually reach a critical mass wherein the media must begin acknowledging a contrarian position. Unfortunately, these apocalyptic messages tend to be voiced only after significant damage has occurred. One might think this relates to WikiLeaks revelations (if validated), fracking or overpriced medications— well, it does. But, consider also that anabolic-androgenic steroids (AAS) have been vilified for generations, portrayed as deadly and harmful drugs used only for unethical sports doping or to enhance a vain and shallow desire for beauty or power. Yet, during that time, not only have metabolic diseases erupted in prominence, but the environment seemingly has degraded man’s ability to generate testosterone in a manner equivalent with his father or grandfather.1 The reasons for this on a societal scale are legion, including: change in occupational and recreational lifestyle, dietary trends, exposure to pollutants and heavy metals, endocrine-disrupting chemicals present in our food and water supply, recreational drug use, metabolic changes related to chronic inflammation and obesity, trauma, etc.2
Testosterone Supplementation
Most men care little about their testosterone status, as long as they can develop an erection. Sad, but true. However, for the men who are physically active for recreational or occupational purposes, a noticeable decline in testosterone-related functions may be apparent during their 30s. This has inspired a growing number of clinical researchers to begin to publish articles, studies and reviews on the use and potential benefits of testosterone and related drugs (e.g., SERMs, aromatase inhibitors, gonadotropins, etc.). This is huge. Though still a minority opinion, this supports the credibility of recognizing and providing the potential benefits of testosterone and related drugs.
Certainly, many benefits have been reported with long-term testosterone supplementation therapy (TST). Despite the weekly presentation of bodybuilders in contests across the nation and globally, the medical literature is only now reporting that testosterone, even in the relatively modest dose schedules used in TST, aid in building lean mass and reducing fat mass.3 Despite these, and other benefits being glaringly obvious, there is still a strong lobby (for lack of a better word) against the use of testosterone in clinical medicine. Consider the publication of a 42-page review in the widely read journal PLOS ONE that concluded upon reviewing a large number of studies that there was no consistent benefit conferred by prescribing testosterone, and that its “known risks” preclude recommending its use.4 I assume the polar advocates of TST will leap in to contest this based on certain aspects of study design, lack of homogeneity in treatment, dosing, endpoints, etc. Interestingly, in nearly every category, a majority of studies showed benefit, though it was not universal. Further, the review only mentions benefit or no benefit— it did not describe adverse effects. This does not mean that there are no risks, but the review overstates the issue considerably.
Not Just for Jocks Anymore
Testosterone and AAS are not just drugs for young jocks only anymore. Though that may have been the case up until 20 years ago, it is evident that older men are capable of maintaining, and even developing, muscle mass and strength with the use of TST and/or AAS. Consider the performance of 52 year-old Kevin Levrone in the 2016 Mr. Olympia. Granted, Kevin did not place highly, but he returned to the competitive stage after a considerable time away. Many criticize that he did not belong onstage, having been granted a special invite rather than qualifying through competition. Objectively, Kevin’s physique was not Olympia-caliber, and he did not attain the elite condition and size he held when he was an active competitor years ago. Nonetheless, he did show that with proper support and dedication, a man his age is capable of attaining mass and condition that surpasses 99 percent of men in their prime.
An interesting trend is developing in the medical literature, in that topics are extending beyond testosterone. In fact, a number of interesting papers have come out covering the possible use of drugs that are staples in bodybuilding regimens as adjuncts to testosterone. Recall, AAS were developed to separate desired effects from overstimulating sex steroid-sensitive tissue such as the prostate or hair follicles. Clinicians and scientists are covering topics such as the use of nandrolone as a component of HRT (hormone replacement therapy), oxandrolone and even trenbolone.
Adjuncts to Testosterone
Nandrolone provides the anabolic benefits of testosterone to tissues such as skeletal muscle, bone and blood without the negative effects of mood change or hair loss (in men), and estrogen conversion occurs to a much lesser degree (nandrolone is slightly active at the estrogen receptor).5 Nandrolone also aids in reducing joint pain, based on anecdotal reports. It is important to accept that nandrolone is not suitable as a direct substitute for testosterone, and should only be used to promote lean mass gains with a lesser “androgenic” response.
Oxandrolone is an oral steroid, best known by the former brand name Anavar. Oral steroids have a deserved reputation for being toxic to the liver due to their effect on certain enzyme systems and a buildup of bile that can lead to liver and kidney damage; a process that affects approximately 40 percent of oral AAS users. A number of supplements are purported to protect the liver from the hepatotoxic (liver-damaging) effects of oral steroids. The most exciting may be a bile acid metabolite called TUDCA.6 Additionally, n-acetyl cysteine (NAC) and milk thistle have shown promise for promoting liver health.
Trenbolone ranks highly among the most desired AAS by bodybuilders and powerlifters. Legendary for its ability to aid in creating a hard, dry look and renown for research reporting that trenbolone increases satellite cell fusion to muscle fibers, which is a limiting factor in raising the hypertrophy potential. An exciting study, admittedly using rats as subjects, confirmed trenbolone improved body composition without increasing mass.7 However, it was the improvement in metabolic factors and insulin sensitivity that makes trenbolone more appealing from a clinical standpoint. It is possible that trenbolone may be studied as an adjunct to TST, though progress will undoubtedly be slow.
Debunking the ‘More Is Better’ Mentality
The most relevant findings for the greatest number of readers is the realization that the “more is better” or “if you want to get stronger, up the dose” mentality is not correct for the general population, or one’s health. Instead, the collective experience of recreational and competitive users of AAS has arrived at the same dose range that was shown to be effective with minimal adverse effects, in the few studies that have looked at dose scaling. Weekly injections of 200 to 600 milligrams of testosterone ester seem to be the “sweet spot” for those who are willing to take on the risks (there remain some, and possibly some unknown with years-long exposure). However, it is important to assess beforehand the costs of long-term or lifelong treatment. One aspect that is not considered with sufficient review and importance is the potential to affect fertility. A small number of men have needed to seek the aid of a fertility medicine specialist to conceive (impregnate his wife/partner), and individual cases of men who suffered permanent infertility have been reported. A survey of men at a fertility clinic who used AAS very clearly indicated a lack of knowledge and regret when faced with this condition.8
Did 2016 introduce the perfectly safe mass-blaster AAS that chisels the torso like a hormonal Michelangelo? No. It did present a greater degree of clinical interest in researching and applying testosterone and related drugs to improving common and chronic health conditions, which is a welcome change.
References:
1. Travison TG, Araujo AB, et al. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab 2007;92:549-55.
2. Travison TG, Araujo AB, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab 2007;92:196-202.
3. Corona G, Giagulli VA, et al. THERAPY OF ENDOCRINE DISEASE: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 2015 Nov 4. pii: EJE-15-0262. [Epub, ahead of print]
4. Huo S, Scialli AR, et al. Treatment of Men for “Low Testosterone”: A Systematic Review. PLOS One 2016 Sep 21;11(9):e0162480 (42 pp).
5. Pan MM, Kovac JR. Beyond testosterone cypionate: evidence behind the use of nandrolone in male health and wellness. Transl Androl Urol 2016;5:213-9.
6. Benz C, Angermüller S, et al. Effect of tauroursodeoxycholic acid on bile acid-induced apoptosis and cytolysis in rat hepatocytes. J Hepatol 1998;28:99-106.
7. Donner DG, Beck BR, et al. Improvements in body composition, cardiometabolic risk factors and insulin sensitivity with trenbolone in normogonadic rats. Steroids 2015;94:60-9.
8. Kovac JR, Scovell J, et al. Men regret anabolic steroid use due to a lack of comprehension regarding the consequences on future fertility. Andrologia 2015;47:872-8.
[/h]There is bias in the media (and medicine); this results in polarity— one side strongly (and blindly) for an extreme position against a separate side just as vehement (and ignorant) with the opposite stance. Yet, revelations arise that eventually reach a critical mass wherein the media must begin acknowledging a contrarian position. Unfortunately, these apocalyptic messages tend to be voiced only after significant damage has occurred. One might think this relates to WikiLeaks revelations (if validated), fracking or overpriced medications— well, it does. But, consider also that anabolic-androgenic steroids (AAS) have been vilified for generations, portrayed as deadly and harmful drugs used only for unethical sports doping or to enhance a vain and shallow desire for beauty or power. Yet, during that time, not only have metabolic diseases erupted in prominence, but the environment seemingly has degraded man’s ability to generate testosterone in a manner equivalent with his father or grandfather.1 The reasons for this on a societal scale are legion, including: change in occupational and recreational lifestyle, dietary trends, exposure to pollutants and heavy metals, endocrine-disrupting chemicals present in our food and water supply, recreational drug use, metabolic changes related to chronic inflammation and obesity, trauma, etc.2
Testosterone Supplementation
Most men care little about their testosterone status, as long as they can develop an erection. Sad, but true. However, for the men who are physically active for recreational or occupational purposes, a noticeable decline in testosterone-related functions may be apparent during their 30s. This has inspired a growing number of clinical researchers to begin to publish articles, studies and reviews on the use and potential benefits of testosterone and related drugs (e.g., SERMs, aromatase inhibitors, gonadotropins, etc.). This is huge. Though still a minority opinion, this supports the credibility of recognizing and providing the potential benefits of testosterone and related drugs.
Certainly, many benefits have been reported with long-term testosterone supplementation therapy (TST). Despite the weekly presentation of bodybuilders in contests across the nation and globally, the medical literature is only now reporting that testosterone, even in the relatively modest dose schedules used in TST, aid in building lean mass and reducing fat mass.3 Despite these, and other benefits being glaringly obvious, there is still a strong lobby (for lack of a better word) against the use of testosterone in clinical medicine. Consider the publication of a 42-page review in the widely read journal PLOS ONE that concluded upon reviewing a large number of studies that there was no consistent benefit conferred by prescribing testosterone, and that its “known risks” preclude recommending its use.4 I assume the polar advocates of TST will leap in to contest this based on certain aspects of study design, lack of homogeneity in treatment, dosing, endpoints, etc. Interestingly, in nearly every category, a majority of studies showed benefit, though it was not universal. Further, the review only mentions benefit or no benefit— it did not describe adverse effects. This does not mean that there are no risks, but the review overstates the issue considerably.
Not Just for Jocks Anymore
Testosterone and AAS are not just drugs for young jocks only anymore. Though that may have been the case up until 20 years ago, it is evident that older men are capable of maintaining, and even developing, muscle mass and strength with the use of TST and/or AAS. Consider the performance of 52 year-old Kevin Levrone in the 2016 Mr. Olympia. Granted, Kevin did not place highly, but he returned to the competitive stage after a considerable time away. Many criticize that he did not belong onstage, having been granted a special invite rather than qualifying through competition. Objectively, Kevin’s physique was not Olympia-caliber, and he did not attain the elite condition and size he held when he was an active competitor years ago. Nonetheless, he did show that with proper support and dedication, a man his age is capable of attaining mass and condition that surpasses 99 percent of men in their prime.
An interesting trend is developing in the medical literature, in that topics are extending beyond testosterone. In fact, a number of interesting papers have come out covering the possible use of drugs that are staples in bodybuilding regimens as adjuncts to testosterone. Recall, AAS were developed to separate desired effects from overstimulating sex steroid-sensitive tissue such as the prostate or hair follicles. Clinicians and scientists are covering topics such as the use of nandrolone as a component of HRT (hormone replacement therapy), oxandrolone and even trenbolone.
Adjuncts to Testosterone
Nandrolone provides the anabolic benefits of testosterone to tissues such as skeletal muscle, bone and blood without the negative effects of mood change or hair loss (in men), and estrogen conversion occurs to a much lesser degree (nandrolone is slightly active at the estrogen receptor).5 Nandrolone also aids in reducing joint pain, based on anecdotal reports. It is important to accept that nandrolone is not suitable as a direct substitute for testosterone, and should only be used to promote lean mass gains with a lesser “androgenic” response.
Oxandrolone is an oral steroid, best known by the former brand name Anavar. Oral steroids have a deserved reputation for being toxic to the liver due to their effect on certain enzyme systems and a buildup of bile that can lead to liver and kidney damage; a process that affects approximately 40 percent of oral AAS users. A number of supplements are purported to protect the liver from the hepatotoxic (liver-damaging) effects of oral steroids. The most exciting may be a bile acid metabolite called TUDCA.6 Additionally, n-acetyl cysteine (NAC) and milk thistle have shown promise for promoting liver health.
Trenbolone ranks highly among the most desired AAS by bodybuilders and powerlifters. Legendary for its ability to aid in creating a hard, dry look and renown for research reporting that trenbolone increases satellite cell fusion to muscle fibers, which is a limiting factor in raising the hypertrophy potential. An exciting study, admittedly using rats as subjects, confirmed trenbolone improved body composition without increasing mass.7 However, it was the improvement in metabolic factors and insulin sensitivity that makes trenbolone more appealing from a clinical standpoint. It is possible that trenbolone may be studied as an adjunct to TST, though progress will undoubtedly be slow.
Debunking the ‘More Is Better’ Mentality
The most relevant findings for the greatest number of readers is the realization that the “more is better” or “if you want to get stronger, up the dose” mentality is not correct for the general population, or one’s health. Instead, the collective experience of recreational and competitive users of AAS has arrived at the same dose range that was shown to be effective with minimal adverse effects, in the few studies that have looked at dose scaling. Weekly injections of 200 to 600 milligrams of testosterone ester seem to be the “sweet spot” for those who are willing to take on the risks (there remain some, and possibly some unknown with years-long exposure). However, it is important to assess beforehand the costs of long-term or lifelong treatment. One aspect that is not considered with sufficient review and importance is the potential to affect fertility. A small number of men have needed to seek the aid of a fertility medicine specialist to conceive (impregnate his wife/partner), and individual cases of men who suffered permanent infertility have been reported. A survey of men at a fertility clinic who used AAS very clearly indicated a lack of knowledge and regret when faced with this condition.8
Did 2016 introduce the perfectly safe mass-blaster AAS that chisels the torso like a hormonal Michelangelo? No. It did present a greater degree of clinical interest in researching and applying testosterone and related drugs to improving common and chronic health conditions, which is a welcome change.
References:
1. Travison TG, Araujo AB, et al. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab 2007;92:549-55.
2. Travison TG, Araujo AB, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab 2007;92:196-202.
3. Corona G, Giagulli VA, et al. THERAPY OF ENDOCRINE DISEASE: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 2015 Nov 4. pii: EJE-15-0262. [Epub, ahead of print]
4. Huo S, Scialli AR, et al. Treatment of Men for “Low Testosterone”: A Systematic Review. PLOS One 2016 Sep 21;11(9):e0162480 (42 pp).
5. Pan MM, Kovac JR. Beyond testosterone cypionate: evidence behind the use of nandrolone in male health and wellness. Transl Androl Urol 2016;5:213-9.
6. Benz C, Angermüller S, et al. Effect of tauroursodeoxycholic acid on bile acid-induced apoptosis and cytolysis in rat hepatocytes. J Hepatol 1998;28:99-106.
7. Donner DG, Beck BR, et al. Improvements in body composition, cardiometabolic risk factors and insulin sensitivity with trenbolone in normogonadic rats. Steroids 2015;94:60-9.
8. Kovac JR, Scovell J, et al. Men regret anabolic steroid use due to a lack of comprehension regarding the consequences on future fertility. Andrologia 2015;47:872-8.
