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The use of anabolic and androgenic steroids in medicine

Even though anabolic and androgenic steroids are used in very large quantities by athletes, their primary role is to treat different diseases and conditions, being used in the medical field since they were invented. Here is a list of the main applications in medicine.
Anabolic and androgenic steroids are for sale in pharmacies, with prescription, in almost any country in the world. Being used for decades to treat certain diseases and conditions, anabolic steroids have some well-defined medical uses. They are used to treat men and women, children, young and old. In some situations, anabolic and androgenic steroids are drugs that can save patients' lives, a thing that is often overlooked because of discussions about steroid abuse and their use outside of medical settings. In this section we will detail the main medical uses of steroids, accepted by the vast majority of the medical community.
Hypogonadism / Hormone replacement therapy
Most often, anabolic and androgenic steroids are used in hormone replacement therapy, also known as testosterone replacement therapy. This involves supplementation with testosterone, the main male hormone, to alleviate the side effects of very low levels of the hormone (the medical term is hypogonadism). Patients may also be adolescents suffering from hypogonadism at puberty or other diseases that may disrupt the proper functioning of the hormonal balance, but most patients are men over the age of 30 years. Most of the time, natural testosterone levels have decreased due to aging.
Symptoms of low testosterone levels include decreased libido, erectile dysfunction, low energy levels, low muscle strength and endurance, reduced ability to play sports, emotional states oscillations, decreased height (reduced bone tissue), low work capacity, loss of work memory and decreased muscle tissue. When associated with aging, these symptoms are all passed under the umbrella of andropause. Clinically, this phenomenon is called late hypogonadism.
The total testosterone levels in adults are considered to be over 350 ng / dl, but some doctors consider them normal and those of 200 ng / dl. Unfortunately, hypogonadism is an undiagnosed condition for many. Hormone replacement therapy is only started if the patient also has symptoms associated with low testosterone levels.
Testosterone administration successfully removes most of the symptoms of hypogonadism. Increasing testosterone levels above 350 ng / dl will restore sex life and normal libido and remineralize bones. A study in which 250 mg of testosterone enanthenate was administered every 21 days resulted in a 5% increase in bone mineral density after 6 months. Over time, this can prevent bone tissue degradation and prevent fractures in the elderly. Hormone replacement therapy also increases the number of red cells (those that carry oxygen) improving energy and well-being. As expected, the therapeutic administration of steroids also leads to greater retention of muscle tissue and increased strength (at levels much lower than in the case of bodybuilders or athletes, who use overdoses and a more frequent administration).
Unlike steroid abuse and their use for purposes other than medical, their therapeutic administration can have positive effects on cardiovascular health. Testosterone therapy lowers LDL (bad cholesterol) and significantly increases HDL (good cholesterol). It also reduces fat around the waist and improves insulin sensitivity. These are important factors in the development of the metabolic syndrome, and the avoidance of this syndrome can also prevent the progression of atherosclerosis. Testosterone therapy also reduces inflammatory markers, which protects the artery walls.
The medical consensus today is that hormone replacement therapy in healthy men (whose only condition is hypogonadism caused by aging) has no side effects and may reduce the risk of heart disease.
Concerns about starting hormone replacement therapy arise when the patient's health is poor. Studies in patients over 65, who already had health problems such as heart disease or diabetes, have shown that the administration of androgen hormones can worsen things in some cases, so increased care and supervision is needed. Another effect that occurs in older patients, and does not occur in younger people, is prostate enlargement. These effects occur especially when administering superficial doses, and are lower when doses are medium.
 Treatment administration protocols
Transdermal: Transdermal applications (on the skin) are the most common method of testosterone supplementation, being the first approach in hormone replacement therapy. This method offers advantages to patients over injections. First of all, applying the gel on the skin is not painful so it increases the degree of comfort. Transdermal application maintains constant androgen levels in the blood, daily, without the fluctuations observed in injectable esters. The usual doses are between 2.5 mg and 10 mg / day (approximate dose absorbed).
The administration is done by applying a gel on the skin or a patch. Because of skin metabolism, this method increases dihydrotestosterone (DHT) levels more than injections. This can lead to increased androgen side effects during therapy, in which case it is passed through injections.
Injections. Enhanced and cytopioned testosterone are the most prescribed anabolic and androgenic steroids in the world, in hormone replacement therapy. Then come testosterone mixtures, such as Sustanon 250 and Sustanon 100. An injection of such steroids will provide the required dose of androgens for 2-3 weeks. The most common protocol among doctors applying hormone replacement therapy is to inject 200 mg of testosterone every 2-3 weeks. It is important to remember that these testosterone esters will supply different levels of hormone each day. Levels will be higher in the first days after the injection and will gradually decrease as time passes. Doctors should closely monitor their patients to ensure that androgen supplementation maintains normal levels and relieves the symptoms of hypogonadism.
Another option, especially on the European market (and which is most often applied in Romania), is Nebido (testosterone undecanoate), which has a very long action, requiring 4-5 injections per year.
Oral. Oral testosterone (Undestor) is the only drug that provides testosterone by mouth. It is used mainly in Europe and Canada. The comfort is increased with this method of administration, and it is easy to follow, because it involves only ingesting a few pills daily. The usual doses for therapy are 120-160 mg / day, ie 3-4 capsules of 40 mg each. Daily doses are divided into two, during meals, usually for breakfast and dinner. Although this method of administration is very comfortable, blood testosterone levels can vary greatly from day to day. The amount of fat in the diet has a very large impact on the absorption of the hormone, and it is recommended meals that have at least 20 g of fat, for optimal absorption of the Undestor. And in the case of oral administration, DHT levels tend to increase more.
Hereditary angioedema
Anabolic and androgenic steroids are often prescribed for the treatment of hereditary angioedema, a rare and dangerous disease of the immune system. Hereditary angioedema is caused by the genetic mutation of blood coagulation factors, characterized by poor functioning of the C1 protein, which is inhibited by esterase. It plays a very important role in controlling inflammation. Symptoms of hereditary angioedema include intermittent but rapid swelling of the hands, arms, feet, eyes, tongue or throat. Swelling can also occur in the digestive tract, resulting in cramps, nausea or vomiting. In serious cases it can swell, blocking the airways.
Attacks start without a particular factor, but stress, trauma, surgery and dental work are frequently associated with hereditary angioedema.
C-17 alpha alkylated oral steroids are a useful preventative treatment, reducing the frequency and intensity of attacks. They are administered in small, long-term doses. The most commonly prescribed oral steroids for this condition are stanozolol and danocrin, but other oral steroids such as oxandrolone, methyltestosterone, oxymetolone, fluoxymesterone and metandrostenolone may also be used. The required doses vary depending on the individual, and are kept as low as possible to reduce the risk of side effects. For example, in the case of stanozolol the starting doses are 2 mg, given 3 times daily (total, 6 mg). The dose will be adjusted to a maintenance dose depending on the patient's response, usually 2 mg / day or once every two days.

Like the class of drugs, anabolic androgenic steroids stimulate erythropoietin synthesis in the kidneys, a hormone that supports the creation of new red cells. Thus, steroid administration tends to increase the number of red cells, favoring a viable treatment for some forms of anemia (a condition characterized by a small number of red cells).
The forms of anemia that respond positively to the treatment with anabolic and androgenic steroids are those caused by renal insufficiency, sciatica, refractory anemia such as aplastic anemia, myelofibrosis, myelosclerosis, agnogenic myeloid metaplasia and anemia caused by malignant diseases and drugs. Patients' response will be individual, depending on their body, method of therapy and form of anemia, but in many cases it will work.
The steroids prescribed for the treatment of severe anemia are oximetolone and nandrolone decanoate (Deca-durabolin). Oximetolone is given in doses of 1-2 mg / kg body weight per day, both in men and women, adults or children. The daily dose would be between 75 and 150 mg, for someone weighing 72 kg. Sometimes doses of 5 mg / kg / day are needed to see positive results.
Nandrolone decanoate is given in doses of 50-100 mg / week in women, and 100-200 mg in men. The doses for children (2-13 years) are 25-50 mg every 3-4 weeks.
In recent years, recombinant erythropoietin has brought about a change in the face of anemia. Even though anabolic and androgenic steroids are still useful and prescribed for this condition, they are regarded as secondary, and are used only if erythropoietin therapy does not work.
Usually erythropoietin results are better, and risks lower, especially for women and children.
Breast cancer ..
Anabolic and androgenic steroids are sometimes prescribed to treat breast cancer in women whose eggs have been removed. Steroids are useful when cancer responds to hormones, meaning its progression can be controlled by hormone manipulation. Androgens and estrogens have opposite actions on responsive tumors, estrogen supporting the advancement of breast cancer and androgens inhibiting it. The administration of anabolic steroids and androgens can tilt the androgen balance, reducing the size of the tumor, a treatment method that has been successful in many patients. Unfortunately, the side effects of virilization can be strong in women, which is why these therapies are done with great care.
An oral steroid such as fluoxymesterone is usually preferred over a slow-acting injectable such as nandrolone decanoate, because it can be stopped quickly if the side effects of virilization are too pronounced.
Since the emergence of strong estrogen inhibitors and aromatics, the use of steroids to treat breast cancer has been almost completely eliminated. Today, such treatments combine antiestrogens such as Nolvadex with aromatherapy inhibitors such as Arimidex or Femera. Anabolic steroids are still prescribed for the treatment of breast cancer, but more than the safe method, when anti-estrogen therapy does not work.

Low fibrinolytic activity
Anabolic and androgenic steroids can be used to treat conditions associated with decreased fibrinolytic activity. Fibrinolysis is the enzymatic process by which a blood clot is broken down and metabolized. It is an antagonist of coagulation, the two mechanisms maintaining homeostatic balance. Fibrinolytic disorders are rare, but very serious when they occur.
Low fibrinolytic activity can lead to the formation of blood clots that can cause thromboembolism, stroke and crime. C-17 alpha alkylated oral steroids are known to increase fibrinolytic activity, being useful for many patients suffering from antithrombin III deficiency or fibrinogen excess. Stanozolol is most commonly used, but other oral steroids may be used. The doses are set individually, taking into account the positive results and the side effects. Esterified or non-alkylated oral injectable steroids do not have the same fibrinolytic effects.
Infertility (men).
In a very small proportion of cases, anabolic and androgenic steroids may be prescribed for the treatment of infertility in men. When the cause of infertility is low sperm concentration due to secretion deficiencies of Leydig cells, an androgen may improve the situation. In these cases, the steroid may increase sperm count, sperm quality and fructose concentration, increasing the chances of conception. Oral androgen mesterelon (Proviron) is most often prescribed for this purpose.
It should be said that in general anabolic and androgenic steroids reduce fertility in men, this being the only exception.
Growth problems.
Anabolic steroids can be prescribed to children suffering from growth defects, both with and without hormonal deficiencies. They have positive effects on both muscles and bones. If they are administered before the long ends of the bones (the epiphyses) are welded and the linear growths have stopped, their anabolic effects on the bones can support the increases in height. This can happen either through the direct action of steroids on bone cells, or indirect action through stimulation of growth hormone and IGF-1.
Steroids that are not flavored and have no estrogen activity are usually used, because estrogen causes the growth to stop. In children, the use of anabolic and androgenic steroids should be done with great care and caution. In addition to side effects, even non-flavored steroids can accelerate the closure of epiphyses (the ends of long bones).
Oxandrolone is commonly used, along with human growth hormone. It is taken for periods of 6-12 months, at doses of 2.5 mg / day; doses can be adjusted according to the patient (sex, weight, sensitivity). When the treatment is done in good conditions, it increases the overall growth rate and in height, compatible with the initiation of therapy. However, the tests carried out over long periods of time did not bring enough data to support the usefulness of oxandrolone in this situation.
Libido (women).
Methyltestosterone is used to increase libido in menopausal women. Low doses of the steroid are included in drugs that also have estrogen, combinations designed to combat menopausal symptoms, including lack of libido. The doses used are small, compared to other medical applications of methyltestosterone, being of maximum 2 mg / day.
Osteoporosis ..
Anabolic and androgenic steroids increase bone density, and may be prescribed for the treatment of osteoporosis. The main benefits are to stimulate the growth of new bone tissue, to prevent the breakdown of the bone tissue, and to increase the absorption rate of the calculation. Steroids can also reduce pain caused by osteoporosis. Osteoporosis occurs mainly in women who have undergone menopause, being caused by hormonal changes. But, the disease manifests itself in older people of both sexes. Osteoporosis may also be caused by prolonged administration of corticosteroids.
The most prescribed anabolic steroid for the treatment of osteoporosis is nandrolone decanoate. It offers a significant increase in bone density and can prevent bills. The doses for women are 50 mg once every 3-4 weeks. But this treatment also comes with side effects, most often virilization and increased bad cholesterol. Treatment is better tolerated by patients over 65 years of age, who report far fewer side effects. The doses for men are 50 mg once every 1-2 weeks. The duration of treatment in both sexes lasts at least 6 months, usually a year or even longer. This large interval is needed to allow the nandrolone to act on bone density.

Turner syndrome and Klinefelter syndrome.
Anabolic and androgenic steroids can be used to treat certain genetic conditions, such as Turner syndrome in women and Klinefelter syndrome in men. Both are chromosomal disorders, characterized by chromosome deviations from the normal sequence XX / XY. The result (among other health problems): growing imbalances and poor sexual development. Men with Klinefelter syndrome are sterile, and have a round body, without a muscular appearance. They have small testes and can suffer from gynecomastia. In these patients, it is common to supplement with testosterone (in a manner similar to hormone replacement therapy) and may help to solve the problems of sexual functioning and physical appearance.
Women with Turner syndrome are short and have abnormal features such as a broad chest, low hairline, low ear position and very wide neck. Small doses of a mainly anabolic steroid, used in adolescence along with growth hormone, can correct these mistakes. Oxandrolone is most commonly used at doses of 0.5 - 1 g / kg body / day.
Weight Loss / Muscle Atrophy.
Anabolic steroids can be given when significant weight loss occurs in a clinical setting. The causes can be multiple, such as prolonged administration of corticosteroids, surgery, chronic infections or severe trauma. Steroids are usually useful when the patient stays in bed or immobilized for a long time, and the usual muscular functions do not occur, resulting in muscle atrophy.
Severe burns may also require the administration of anabolic steroids. It can also be used in patients who lose a lot of weight, without a known cause. The inability to maintain a normal weight, proportional to height, and the inability of diet and exercise to correct the problem, may require treatment with anabolic and androgenic steroids.
Losing a significant proportion of lean muscle mass can be a risk factor in itself. Those with a very low weight have no energy, feel constant sickness and have a high risk of mortality. Light weight after surgery or illness can adversely affect the convalescent period. The ability of steroids to increase protein synthesis makes them the most accepted agents for treating clinical weight loss, provided the patient does not have a disease or use drugs that would not be compatible with steroids.
Again, in most cases oxandrolone is most often used. The doses used are 10 mg twice daily (a total of 20 mg), but lower doses can be used in women, the elderly and children. Treatment lasts 3-4 weeks, in the early stages of recovery, but may be prolonged. But other steroids are used for this purpose, in sepcaial steroids that have a proportion in favor of anabolism, compared to the androgenic component, such as: stanozolol, nandrolone, methenolone and metandrostenolone.
Anabolic steroids can also be prescribed to treat very severe cases of muscle atrophy. These are the cases when the catabolism is pronounced, that is, the muscle proteins are broken down at a very fast rate, which leads to drastic weight loss and lack of energy. In medical terms, the phenomenon is called the casexia. Casexia is not linked to insufficient food intake, but has a metabolic cause that cannot be corrected by nutrition. It is usually caused by carcinogenic diseases, HIV, etc. Casexia caused by HIV is most often treated with anabolic and androgenic steroids. Casexia caused by cancer and steroid use has not yet been fully documented, and research is underway.
Muscular atrophies caused by HIV are most often treated with nandrolone decanoate, oxandrolone, and oximetolone. Some studies have shown that a dose of 150 mg of nandrolone decanoate, made at 14 weeks, has the same effects in HIV patients as the daily administration of 6 mg (18 IU) of somatotropin growth hormone, but with much more side effects. small. In 2003, the optimum dose in oximetolone patients, ie 100-150 mg / day, was determined by laboratory tests.
In recent years, declining production of decanted nandrolone worldwide and increased comfort for oxandrolone patients have made oxandrolone the preferred case for HIV-induced casexia. The doses of oxandrolone range from 20 to 80 mg / day. Clinical tests have shown that the best results are obtained at doses of 40-80mg / day.