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Performance Enhancement Anabolic steroids And Other Ergogenic Agents
Written by: Dr. R Scruggs
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 judgement 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.
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