Monterey, CA 93940
Tel: 831.373.4406
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Get Lean, Burn Fat
Dr. K's Monterey Diet™
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This booklet deals with some of the current developments in medicine, pharmacology and endocrinology (the study of hormones) that bear on sexuality and steroids, a crucial life concern for most men and women using anabolic steroids. I have tried to organize and present the highly technical and scientific advances coming out of these medical disciplines in such a way as to help the ordinary man or woman who is trying to enhance his or her body image. If not managed properly, self-medicating with anabolic steroids can cause the loss of sexual function plus the attendant depression that goes along with it. The primary purpose of this short series is to clear up misconceptions and help gym-trained athletes to understand that they don't have to use steroids or accept what they consider to be the inevitable consequences of stopping their hormone supplements. Most bodybuilders believe that their doctors do not care or do not know much about hormone prescribing that is why they do not ask them for assistance. They therefore rationalize their self-medication. However a branch of endocrinology called andrology specializes in dealing with the study of hormones in men. Endocrinologists at university centers generally are the experts in hormone therapies. Some doctors may not have studied the field of endocrinology, but any doctor knows more than a gym coach or a steroid abuser. Andrologists do much of the research on the effects of steroids on humans. Many underground books and "Steroid Bibles" are used as guidelines for men who are self-prescribing hormones. Almost any anabolic steroid (AS) can be purchased on the Internet and used without medical supervision. But watch out! Many of these products are counterfeit! Well-developed muscles or a big penis do not necessarily go along with a good sex life. If you want both big muscles and a strong sex drive, the two might not be compatible if you try to achieve your goal using steroids. You might run out of testosterone sooner than you think for reasons you do not even suspect! Numerous men and women have not been treated for testosterone deficiency because they have usually been ignoring the problem. Low testosterone was considered a "dirty little secret" until Viagra® (Pfizer) was introduced in the late 1990's. Previously, men interpreted lack of sexual function as meaning they were not masculine anymore. It's time to change this notion. Viagra has brought sex "out of the closet" and into the media. The loss of sexuality should not be considered a normal part of aging any longer. No one with a willing partner should suffer with a low sex drive. Pharmaceutical companies make testosterone supplements available for the treatment of deficiency states with approval from the FDA. Only recently has the FDA had created an artificial generic testosterone shortage to discourage injectable testosterone use and regulate inventory. I hope that anyone who wants to make these fundamental improvements in their life can use this booklet as a guide to restore the balance of their sexual vitality, vigor and muscular strength, safely and sanely with their doctor's help. The following questions and answers will help give you, the reader a background to you to understand some of the body of knowledge about hormones and how they work.
Part 1- How Steroids Actually Work It has been estimated that 1 to 3 million male and female athletes in the United States have used androgens. (1) Androgens are the male hormones (andro, is Greek for man) and the primary hormones are testosterone and dihydrotestosterone or DHT. Androgenic effects, which are masculinizing, include a deeper voice for dominance, increased body and beard hair, a strong sexual drive or libido and the secretion of pheromones with sexual arousal that drive women crazy! Anabolic or bodybuilding effects include muscular development, increased strength of tendons and ligaments, increase in lean body mass over fat mass, high bone density and strengthening of heart muscle. Testosterone has equal anabolic and androgenic effects or an anabolic/androgenic ratio of 1 to1. All forms of testosterone, including Sustanon 250 have the same ratio. Nandralone decanoate or "deca" a non-aromatizeable anabolic steroid has an anabolic/androgenic (AA) ratio of 2.5 to1. Dihydrotestosterone, which is produced naturally, is four times as anabolic as testosterone (AA ratio of 4 to 1). Anabolic-androgenic steroid (AAS) use has been associated with serious side effects such as liver dysfunction, altered blood fat levels or high cholesterol, infertility, muscle-tendon injury, and psychological abnormalities including personality changes. Although AAS have been available to athletes for over 50 years, they have been used to excess by too many men. Irreversible side effects such as gynecomastia, roid-rages and aggression are related to conversion of excess testosterone to estrogen, but there is little evidence to show that steroid use will cause any long-term impairment when used in appropriate doses; furthermore, the use of moderate doses of anabolic steroids (less than 200 mg. per week of testosterone enanthate or Depo) results in side effects that are largely harmless and reversible. (2) Have you ever wondered how steroids actually work? Anabolic steroids shift the nitrogen balance to the positive side for better utilization of ingested protein and the increases the body's holding of nitrogen. This temporary effect requires a high-protein diet to help the body to build muscle tissue. The formation of a steroid-receptor complex in skeletal muscle stimulates the (RNA-polymerase) system, to increase protein formation in the cell. This may sound complicated but think of steroids as providing muscle cells with enough protein so that they can grow, doubling and tripling their size after adequate workouts. This is the more scientific explanation: muscle hormone receptors, the key that testosterone attaches to in order to exert is effects are of two types, either muscle building (anabolic) or muscle breakdown (catabolic), also called catabolism. Anabolic androgenic steroids work by preventing catabolism or muscle breakdown. The pain a bodybuilder gets in his muscles is a sign of this process (no pain, no gain principal). The accumulation of an acid called lactic acid, the result of hard work, causes this pain. Anabolic steroids compete for another receptor called the glucocorticoid receptors (GR), to exert their anti-catabolic effect. GR receptors cause muscle breakdown. During stressful activity such as lifting heavy weight, cortisol is released leading to this muscle destruction. By blocking the catabolism, which normally occurs after exercises from the glucocorticoid release, steroids not only build bigger muscles but they can also speed up the recovery. European athletes use far more anabolic steroids than Americans. The annual consumption of anabolic steroids by athletes in Denmark , for example, is estimated to be 2 million daily doses. (3) Beside the well-known side effects of anabolic steroids new problems and risks have occurred due to fake drugs counterfeited for sale on the black market. About forty "anabolic steroids" obtained from the black market were evaluated using gas chromatography analysis to evaluate the real pharmacological compounds. They found that fifteen (37.5%) of these so-called steroids contained different pharmacological compounds or nothing that was labeled. In other words they would say "Sustanon 250" but really contained cortisone or some veterinary testosterone for horses. The counterfeits were good. From the external packaging, a differentiation between original and the fake drugs was impossible. (4) Athletes will always continue to use steroids to help them win. Anabolic steroids were added to the International Olympic Committee's list of banned substances in 1975. Yet, these steroids have become increasingly popular among athletes even at the sub competitive or recreational level in spite of extensive doping tests, educational campaigns and lethal incidents. Steroid users will continue to hold the view that these drugs are effective and they are therefore unlikely to be persuaded to reduce their use. (5). III. Good and Bad Side Effects When sexual function becomes inadequate in a young man, or any man who is using illegal "steroids" or other such drugs, warning signs arise. This early stage is the time to act. Action will prevent further deterioration. Trying to improve one's body image is not bad. Self- improvements books prove very popular to the public. Diet books remain on the number one bestseller list. Sexual activity throughout life, all of life, should be equally as important as losing weight. In fact, we can safely say that where there is still life, there still ought to be sex. Hormone replacement is generally safe and effective. Testosterone, when used in a transdermal (across the skin) delivery system without cycling, is safe and free of any hazardous side effects. Cycling of anabolic steroids creates abuse potential and brain dysfunction due to off-and-on-again stimulation. Injectable hormones or "roids" are not the answer for replacement because the fluctuating levels of hormones are both dangerous and counter-productive. Testosterone has a very large safety margin and for that reason few bodybuilders actually die from regularly overdosing with testosterone. They think they just get bigger muscles but there are hidden features to testosterone abuse. Men can absorb high testosterone doses without any obvious negative effects over the short term. This observation encourages many bodybuilders to think that they are doing the "right stack" or combination. Testosterone supplementation definitely increases muscle size and strength in either sex so the results speak for themselves. It is definitely true that testosterone supplementation really does stimulate muscular growth, memory, erectile function and orgasmic ability. But can it improve your sex life beyond your wildest dreams? The side effects of anabolic steroids have been overstated. It has been estimated that 1 to 3 million male and female athletes in the United States have used androgens. Androgen use has been associated with liver dysfunction, altered blood lipids, infertility, musculotendinous injury, and psychological abnormalities. Although androgens have been available to athletes for over 50 years, there is little evidence to show that their use will cause any long-term detriment; furthermore, the use of moderate doses of androgens results in side effects that are largely benign and reversible. "It is our contention that the incidence of serious health problems associated with the use of androgens by athletes has been overstated". (7) Dr.K...... I'm still floundering around with the injectables I bought in Mexico without blood tests. I think I told you I double-dosed myself by accident, thinking that the concentration was 100mg/100 ml instead of 200 mg/100ml. Anyway, I had a series of tests from that injection of 600 mg, which were a complete waste of time; the readings were all sky-high, of course. My DHT thirty-six hours after the injection was 5023.7 on a normal adult male scale of 30 - 85, and the FT and TT were similarly off the charts. My doctor wants me to take 150 mg of Testosterone enanthate every ten days on the theory that at the end of the cycle my testicles will be forced to work a little bit. I've read several suggestions of taking 100 mg every 7 days, to avoid the ups and downs. I've never asked you about the problem of testicular atrophy. Right now I'm just concerned about the potential long-term effects of the peak part of the injection cycle on my liver. John, SF, CA Cycling, as referred to by John, is one of the worst offenders in causing increased side effects from anabolic steroids. The side effects of these drugs are overstated with acne and gynecomastia as the commonest side effect and an occasional difficulty in urinating seen in some older men. (2) Anabolic steroids have many beneficial effects and should be used more often by the medical establishment. However, some of the US regulatory agencies fear that men will become addicted to the anabolic effects of AAS. Users often experience a euphoric and feel more aggressive stimulating them to work out longer without fatigue and benefiting from the increase in recovery of muscle tissue. The use of excess anabolic steroids even increases the lean muscular mass. That is what most men strive for. It is wrong that doctors have told their patients that it is possible to develop the same amount of muscle tissue without steroids. However, we are always cautioned against use by the "side effects" of steroids.
IV. Bitch Tits, Breasts and Irritable Male Syndrome Today, there are far better delivery systems than pumping 3-5 ccs of peanut oil, deep into the buttock with a 2" thick gauge needle every 1-2 weeks for a lifetime. Since 1985, natural bioidentical testosterone has been incorporated into a transdermal (across the skin) delivery system called the T patch. This patch (Androderm®) effectively increases testosterone levels in males with inadequate levels of testosterone. Men who are deficient without any symptoms have used natural testosterone safely in small doses for almost 20 years. According to the FDA, T patches present no apparent health risks. Clinical trials have proven that plastic testosterone patches Androderm® ( Watson , Utah ) and Testoderm TTS® ( Alza , New Jersey ) are not only safe for testosterone replacement but they do not cause prostate cancer in deficient men of any age. The main problem with patches is that they are too weak. They only contain about 2.5-5% of testosterone. Sexually active men require about 5-10 mg of testosterone a day. Testosterone patches such as Testoderm TTS®, delivers 6 mg of testosterone daily and are applied to a shaved scrotum. Androderm®, ( Watson , Utah ) a very similar preparation, can be applied anywhere on the body. Hormone plastic patches are usually applied each morning and result in a surge of hormone within a few hours of application. This hormone level eventually drops down after 24 hours. Self-administration by this technique is effective but inadequate and often awkward causing severe skin reactions. Side effects related to testosterone use are minimal as are the beneficial effects. For an adequate effect most bodybuilders would need to wear about 4-6 patches. A very expensive, low dose new 1% testosterone product has been on the market since July 2000. AndroGel® (Unimed a subsidiary of Solvay) provides a safe delivery of natural testosterone in low physiologic doses of about 5-10 mg a day (the normal daily requirement for a man). One or two five-gram packets are required for adequate testosterone replacement by most men. A higher dose compounded testosterone cream containing 10% testosterone has been available by physician's prescription for over a decade. Generics for AndroGel® will be coming on the market over then next decade to decrease the costs. Gel delivery of testosterone is a brilliant marketing accomplishment by a foreign pharmaceutical company. A low dose dihydrotestosterone gel, AndactrimT ( Solvay , Belgium ) has been used in Europe for almost a decade and was recently accepted for evaluation by the FDA. The French have been using gel delivery testosterone for years. Testosterone transdermal compounded creams and gels are prescription items and come in various formulations across the country from small compounding pharmacies that still make up their own "medicines". These compounds, when applied properly on a daily basis provide a 24-hour duration of action that naturally mimics the rise and fall of testosterone throughout the day. It is this rhythm called the "circadian rhythm" which regulates the release of all the body's hormones without the need for cycling. Since 1985, testosterone has been incorporated into a transdermal (across the skin) delivery system effectively increasing testosterone levels in males with inadequate levels of testosterone. Natural testosterone is safe when used in small doses by men who are deficient. According to the FDA, testosterone patches present no apparent health risks. Clinical trials have proven that plastic testosterone patches Testoderm® ( Alza , New Jersey ) are not only safe for testosterone replacement but they do not cause prostate cancer in deficient men of any age. Sexually active men require about 5-10 mg of testosterone a day. Testosterone patches such as Testoderm®, deliver 4-6 mg of testosterone daily and are applied to the back, arm or shaved scrotum. Androderm®, a very similar preparation, can be applied anywhere on the body. Hormone patches are usually applied each morning and result in a surge of hormone within a few hours of application. Self-administration by this technique is effective but awkward and causes severe skin reactions. Side effects however are minimal as are the beneficial effects. Testosterone transdermals are prescription items and when applied daily provide a 24-hour duration of action. The hormone used in these systems is the same naturally derived testosterone and is identical to that secreted by the testicles. An oral testosterone preparation, Andriol®, is available in Canada as an anabolic steroid which is absorbed into the lymphatic system and does seem to have liver toxicity. The FDA is currently reviewing this form of testosterone undecanoate for release in the US . Suppression of the hypothalamus-pituitary-gonadal axis (HPGA) results in loss of sexual drive, erectile dysfunction and depression. This condition can occur years after steroid use has been discontinued. Basically what happens is that the testosterone supplementation suppresses the normal regulatory system and the amount of testosterone used can easily become excessive. Men who are shooting steroids more than once a week are abusing steroid effects and down the road they will suffer more harmful effects. The excess steroid is converted to estrogen, which does not belong in a male body in high doses. Estrogens stimulate male sexual function in some species. In men, most studies of androgen effects on behavior have used hypogonadal men as an experimental model; much less is known about the role of endogenous testosterone (T) or estradiol (E2) in the regulation of behavior in healthy, normal men (eugonadal) with average steroid production. A study temporarily induced chemical castration produced astonishing results. A statistically significant decrease in the frequency of sexual desire, sexual fantasies, and intercourse occurred at 4-6 weeks. These men also showed a strong trend towards decreased spontaneous erections after 4 and 6 weeks of treatment blocking testosterone action. A significant decrease in the frequency of masturbation was evident after 6 weeks. All measures returned to normal by post treatment week 3. There was a trend toward increased aggression in the hypogonadal men, but this disappeared with testosterone replacement. No changes in satisfaction or happiness with their partners were observed. (6)
Anabolic steroids are very powerful drugs. As you can appreciate from these examples, a complex interaction of diet, hormones and exercise plus testosterone anabolic effects causes muscles to grow. Androgenic anabolic steroids (AAS) affect many organ systems and should not be used without medical supervision. The question of steroid addiction is not yet confirmed. Some bodybuilders feel a need for steroids, or MORE steroids to grow bigger. However, anabolic steroids only increase protein metabolism and speed up recovery but testosterone itself does not create muscles. The effort involved in weight bearing exercise and the number of repetitions (though one set to failure is enough) induces existing muscle tissue to grow or hypertrophy. Muscle growth is exclusively a response to stimulation in the presence of adequate testosterone or the more anabolic DHT. Those guys are not that big - its possible they could be natural. It's amazing how big you can look with the right lighting, tanned and shaved. Hard to tell sometimes. I meant to ask you, do you patients stay on Testocreme year round? Do they cycle it? Do they need any kind of drug to restart natural testosterone production? You must have been thrilled to see the recent press coverage on testosterone supplementation. I would not be surprised if steroids were taken off the schedule 3 list in a couple of years. I would hope that if the mass audience gets interested in testosterone supplementation and people want it, lawmakers would reconsider and accept the wonderful benefits of test supplementation on appropriate dosages. What do you think? Steve The question of whether AAS addiction is rampant is not yet confirmed but a withdrawal state has been reported in Poland . (Medras M, Tworowska U. 2001) Some bodybuilders really feel a need for steroids, or even MORE steroids to grow bigger. They will use whatever they can get their hands on. However, although steroids do increase protein metabolism and speed up recovery, testosterone use by itself does not create muscles. The effort involved in weight bearing exercise and the number of repetitions (though one set to failure is enough) induces the existing muscle tissue to grow or hypertrophy. (Though one set to failure is enough once strength has been achieved). Muscular growth is exclusively a response to stimulation of the androgen receptor in the presence of adequate testosterone or its more anabolic metabolite, DHT. There are androgen receptors all over the body. The brain has multiple androgen and estrogen receptors. The total alteration in brain pattern and thinking with hormones indicates the potential power of these medications. There is evidence that steroid hormones induce "endorphins" which are similar to the brain's own morphine-like compounds as part of their action causing a "sense of well-being". These compounds can alter the perception of pain and pleasure and even sexual preference. Normally only opioid substances can affect these pain receptors but anabolic steroids (AAS) mimic some of these actions and possibly contribute to addiction by this mechanism. It was interesting to note that chronic opioid users have very low levels of testosterone. The changes in brain pattern and thinking with hormones indicate the potential power of these medications. There is evidence that steroid hormones can induce "endorphins" which are similar to the brain's own morphine-like compounds. These compounds can alter the perception of pain and pleasure. Normally only opioid substances can affect these pain receptors but anabolic steroids (AS) mimic some of these actions and possibly contribute to addiction by this mechanism. Deca Durabolin, a popular anabolic steroid (AAS) has been available for over twenty years in the gyms of American. Deca is very popular with bodybuilders who abuse anabolic steroids by using massive doses. Injections of Nandrolone Decanoate, or Nandralone a synthetic AS, presumably does not convert into estrogen, as do most of the anabolic steroid when used to excess. Unfortunately, Deca causes rapid loss of normal sexual drive due to its action on the pituitary gland in the brain. The feedback mechanism, which regulates testosterone production, is quickly thrown out of balance by injectable AAS. This email from a testosterone deficient man who is "legally" using AAS on prescription from his physician will give you an example of some of the problems. "I'm having a very frustrating experience (as usual) with this testosterone thing. My local doctor has insisted on giving me injections (testosterone cypionate), saying that they are less likely to cause aromatization. (T to E2). My first injection was 100 mg and I felt nothing. The second injection ten days later was 200 mg and I felt great, but my nipples enlarged a little and got sensitive, and three days later I felt my usual not-so-hot self. His idea was to give me 200 mg every 10 days for two episodes and then to check my blood levels 36 hours after the third 200 mg injection." Why do I feel so bad? Steven , LA. Why do men like Steve use AS? The use of anabolic hormones promotes increased muscle growth by the absorption of new amino acids, increased protein metabolism and growth or hypertrophy of the muscle. The muscle cells only grow bigger; they do not multiply in number. Anabolic (body building) steroids are used medically to treat several conditions besides replacement therapy in testosterone deficient males. Medically AS are used for treating breast cancer, severe anemia, osteoporosis and Alzheimer's disease. Amazingly little damage has been found in men who abuse these hormones even for extended periods of time ranging from 1-20 years. By cycling off and on testosterone according to guidelines in a large number of steroid bibles and instruction books written by bodybuilders, most men think that they will not have problems with their own testosterone production. Eventually, the abuse catches up to them. Bodybuilders have developed an entire subculture in this area of self-medication and AAS abuse. My husband went to the doctor because of lack of sex drive. He had his testosterone level checked and it was 171. He started shots one week ago. It was a dose of 150. He is not scheduled to get another shot for 3 weeks. When will his sex drive return? He is only 41. Thanks. Worried Wife. Are you saying he's getting 150 mg of Testosterone Cypionate a month? That's not enough. He needs more like 100 mg per week or 200 mg every two weeks. Usually urologists or endocrinologists give the man a 200 mg shot and have them check back in two weeks. When I was on shots, I found 100 to 125 mg per week worked the best for me, because there's a roller-coaster effect as the shot wears off near the end of the 2-week period. If he has to wait a month on only 150 mg, he'll probably feel a little better for maybe a week and then he'll go downhill and feel worse than before the shot. And I wouldn't expect his sex drive to be noticeably better for months, and only on the higher dose. What kind of doctor is he going to? Some less informed doctors think you just give a little testosterone to make up for a shortfall, but what happens is his body will shut down it's production and he'll end up with too low of a T level. He needs to be on TOTAL REPLACEMENT or NOTHING, which was the 100-mg/week regimen (as a minimum) I mentioned. I began feeling better within several weeks, but it was probably 6 months to a year before the improvement was really noticeable. Alot depends on how long he's been deficient. Has he had a low sex drive for years? Months? All his life? Anyway, don't be too disappointed if there isn't an immediate, dramatic change. This is going to take time, and maybe a change of doctors several times. Millions of dollars are spent on supplements, steroids, shipping charges from Europe and customs confiscation by men with AAS dependence. As noted above, life-threatening withdrawal symptoms can occur. Naturally the FDA feels very chastised that they did not foresee this "abuse potential " when they first approved testosterone in 1935 as a "miraculous treatment for heart disease" and anemia.
VI. Anabolic Steroids as Black Market Drugs All anabolic steroids are based on testosterone. Their purpose is to increase tissue building and both appetite and weight. They are used medically in conditions related to wasting of muscle such as AIDS Wasting Syndrome (AWS) and sarcopenia, the loss of muscle associated with malnutrition and aging. Steroids accomplish this effect by their action on protein metabolism converting fat and carbohydrate metabolism to protein. If one increases protein intake (up to 1-2 grams of protein per pound of body weight) then more protein is converted to muscle mass. The shift towards protein accumulation and tissue growth is called anabolism as opposed to catabolism that occurs in tissue breakdown and weight loss. Weight loss is purely a matter of calories in versus calories out. It takes about 3500 calories to lose or gain one pound. There are 4 calories per gram of protein. The composition of the body (fat vs. lean muscle mass) is dependent on a balance of hormonal levels with testosterone predominance. Estrogens increase body fat; testosterone and its analogues decrease body fat. Increased cardiovascular activity or aerobics contributes to the burning of calories and loss of weight. Muscle size and strength were regularly improved by steroid use. Studies on the effects of anabolic steroids showed mixed results: half of them show no difference in muscle strength or size, on the other hand half indicate considerable improvement in muscle size and strength. A 1984 meta- analysis revealed that muscles grow under certain conditions including (a) a Maximum exertion of the muscle before, during, and after steroids use, (b) a high-protein-high-calorie diet, and © the use of repetitive exercise to maximum effort. New evidence supports the view that supraphysiological (higher than normal) doses of anabolic steroids do have a definite, positive effect on muscle size and muscle strength. Four major pharmaceutical companies currently manufacture the four major types of anabolic testosterone-based steroids: Organon, Upjohn, Solvay and Schering Plough. The income on sales of these compounds exceeds one billion dollars a year in the USA alone. Various compounds with numerous brand names are sold in Europe as well as South America . A) Testosterone Propionate (Androlan, Homogene-P, Malotrone-P, Neo-Hombreol, Oreton, Perandren, Testadenos, and Testonate) is short acting, half-life of 3-6 hours. This hormone is commonly abused in combination with other types of testosterone. Organon markets a product known as Sustanon 250, which claims to deliver 250 mg of testsoterone per milliliter or gram of oil. The highest concentration of testosterone, which can be kept in solution, is 200mg./ml. B) Testosterone Cypionate (Depo-Testosterone, Virilon IM) is intermediate acting (9-12 days). This form is most commonly abused as it contains 200 mg per milliliter of oil for injection. Often time doses of three to four cc's are used every few days. C) Testosterone Enanthate (Atlatest, Delatestryl, Dura-Testosterone,Testaval), is long acting ( 7-21 days). This preparation is used in combination with the previous two by bodybuilders. In standard clinical practice, enanthate is used for supplementation at doses of 1-2 ccs per month to 1-2 cc's per week. Those with only monthly shots experience a washout period of 10 days with resultant loss of effect of the testosterone. Unfortunately this may lead to subsequent withdrawal and dependence on more testosterone. D) Nandrolone Decanoate (Deca-Durabolin) is the most anabolic of the injectable testosterones. (3-7 days). Deca is referred to frequently in the gyms of America as the "best steroid for muscle growth" and the "worst for sexual function". Long-term use leads to ED and impotence. One injection of synthetic steroid can maintain normal serum levels of testosterone for up to 14-21 days. When used as a replacement therapy no apparent side effects are noticed. Nandrolone Decanoate is a synthetic testosterone that transforms to produce both high levels of testosterone and more anabolic steroids. Injectable synthetic steroids possess both androgenic and anabolic properties. Young male athletes have noticed testosterone stimulation of muscular development. Steroids allow the athlete to bulk up and recover faster. Oral androgens are not well metabolized into testosterone but act directly on androgen receptors. Because they cannot be bioconverted into DHT or estradiol, they are not as biologically active as injectable forms. Most are largely converted to inactive metabolites and only about one sixth of the hormone is available in the active form. All androgens appear to act on the same androgen receptors, but tissue sites vary in absorption and metabolism. Oral androgens are used medically for those patients with bleeding disorders or intolerant of injections. Oral anabolic steroids include the following:
The side effects of any anabolic steroid depend on the extent to which receptors on target cells are stimulated. There are receptors on sebaceous glands, hair follicles, and muscle tissue and brain tissue. Therefore the side effects include increased acne, increased body hair growth and increased male pattern baldness, in addition to increased muscle mass. Physicians are well advised to monitor liver function biannually, even if oral steroids are not being used, and to withdraw the hormone or decrease the dosage if enzyme levels increase. Testosterone has both androgenic or male characteristic and anabolic or bodybuilding actions as mentioned previously. The ratio of anabolic /androgenic effects is 1/1 for testosterone. Some anabolic steroids such as Deca Durabolin have a ratio of 2.5/1. Anabolic/androgenic steroids, in the presence of an adequate diet, can contribute to increases in body weight in the lean mass compartment through the activation of protein metabolism. The gains in muscular strength achieved through high intensity exercise and proper diet can be increased by the use of anabolic/androgenic steroids in many individuals. Androgen use is very prevalent in American society. The quest for the 'perfect body' and a 'six pack' by both men and women had created a huge market for steroid abuse. Much of this is due to androgen abuse among athletes and bodybuilders, where black market androgen abuse has reached epidemic proportions. Indeed, in various studies of high school boys, it has been found that 4-12% had used androgens at least once (JAMA 27O: 12l7, 1993). Current polls indicating use of testosterone replacement, illegally by the following: 96% Professional Football Players; 80-99% Male Body Builders; 11% high school Football Players; and 6 -10% high school Senior Males. What can a physician do however, when a young man (under 30) complains of being unable to build up muscle despite spending hours at the gym lifting heavy weights, eating a high protein diet and using all the muscle building aids available over the counter? Most physicians usually tell the individual to lift more weights or that it is just their body type or genetic makeup. Worse yet, to tell a man that he will never be to develop muscles naturally, regardless of what he does forces him to consider the use of black market steroids from the gyms. He wants to be just like other musclemen he sees in the gym who use anabolic steroids. The prescription and use of steroids is legal in the United States . The Anabolic Steroid Control Act of 1990, which criminalized the sale, clouds the issue and possession of any anabolic steroid intended for non-medical use (such as bodybuilding). Misuse of steroids in the sports world has led to stigmatization of their legitimate medical uses; however, some care must nonetheless be exercised in prescribing steroids. The best protection for a physician is to carefully document symptoms and test results and not to over prescribe any replacement therapy. The need for testosterone replacement in both sexes is found in multiple conditions from loss of libido, sexual dysfunction, and chronic fatigue to early neuronal degeneration as in Alzheimer's Syndrome. Watson/Proctor and Gamble are on the horizon in the form of testosterone patches for women developing a new treatment jointly. The development of the newer transdermal testosterones and estrogens has opened the floodgates for the treatment of sexual problems in the new millennium. Just as women needed estrogen to feel feminine , men need testosterone to be motivated in business, to exercise, to feel manly and to develop firm, long lasting erections. Too many doctors are still reluctant to prescribe testosterone even though it has been FDA approved for over 60 years in one form or another. Due to the fact that testosterone can be made from progesterone in the female, testosterone has been used successfully as a female sexual stimulant in tiny doses for women with decreased sex drive due to menopause. The anabolic effects of steroids are those that have a direct effect on the production of muscle mass. There is an increase in muscular strength and faster recovery from injury or stress. Androgenic effects of steroids include the development or increase of facial hair, the deepening of the voice, stimulation of sebaceous glands and some as yet ill-defined effects on brain tissue. These brain effects are becoming more and more important as diseases such as depression, Alzheimer's Dementia, and decrease of verbal and spatial orientation skills occur due to testosterone deficiency. Black market steroid sales are worth $300-400 million annually. Unfortunately, half of the anabolic sold are counterfeit. Labels often claim legal importation despite the fact that many are either watered down or totally bogus products. There is no regulation or control of illegal steroids. Organon, a Dutch company is a major steroid producer in the world and sells many of their injectable testosterone products in Europe . These are then purchased and resold on-line through illegal outlets. Purity is questionable for the non-branded testosterone products. Then too, labels can be counterfeit as well as the contents and the outrageous prices, for which they are sold, make it seem that they are legitimate. Many Internet bodybuilding sites cater to this group of individuals, known as roid users or juicers . By providing shipments at a very high price without any guarantee of delivery due to customs confiscation, the mail insurance business is generating profits as an offshoot of the steroid trade. These anabolic steroids are being imported from Europe, Mexico and Russia at an alarmingly increasing rate.
VII. Risk of Using Anabolic Androgenic Steroids We do not live in a perfect world. Steroid abusers sharing needles run the risk of hepatitis, HIV infection, abscesses, cellulitis and death. Even this threat does not stop men from using up their gym buddy's "hormone stack". Potential steroid users should be aware that even buying a known counterfeit steroid is a felony, as is buying a non-FDA approved steroid. The Internet makes steroid purchases simple and apparently legal. In 2002, the FDA attempted to remove generic steroids from the market, so that they were better able to regulate the "lost inventory" of the steroid producing pharmaceutical companies. They thought that they could police a smaller number of companies more efficiently. Unfortunately, this zealous regulation of injectable brand name steroids only contributed to the problem and did raised prices. The "war on drugs" is a victimless war that will never end and there is no "winner". What happens is that demand is only increased by the apparent unavailability of product? The main effect is to raise the price, restrict availability and encourage counterfeiting. Many men who feel they have a deficiency will avoid injectable and stick to over-the-counter supplements. Dr. Kanayama and his associate psychiatrists at Harvard found that many individuals attempting to gain muscle or lose fat, used dietary supplements that are actually potent drugs such as androstenedione and ephedrine. They estimated that possibly 1.5 million American gymnasium clients have used adrenal hormones and 2.8 million have used ephedrine within during the prior 3 years of the survey. Despite their known adverse effects, unknown long-term risks, and possible potential for causing abuse or dependence, men and women abuse these hormones. (Kanayama G, 2001) Steroid abusers sharing needles run the risk of hepatitis, HIV infection, abscesses, cellulitis and death. Potential steroid users should be aware that buying a known counterfeit steroid is a felony, as is buying a non-FDA approved steroid. Recently generic steroids have been removed from the market, so that the FDA is better able to regulate the inventory of the steroid producing pharmaceutical companies. Unfortunately, this zealous regulation of injectable brand name steroids is only contributing to the problem and not solving it. The war on drugs is a victimless war, which will never end as demand is only increased by the apparent unavailability of products. The main effect is to raise the price and encourage counterfeiting. If more physicians were willing to test men with complaints of possible hormone deficiency then legal steroids would quickly replace the black market versions. However the conflict occurs when these men first try to contact a physician and ask for some help or an evaluation. Most are treated as drug abusers and referred to psychiatrists or told to end their pursuit of a better body. Many are turned down flat since the use of anabolic steroids for bodybuilding or physical enhancement is not medically approved. This prejudice against helping men who may actually be hypogonadal drives them underground to the black market for illegal steroids. "Despite the prevalence of legal and illegal androgen use, the science of androgen effects has greatly lagged behind the understanding of biological effects of estrogen and indications for estrogen replacement therapy. Female oral contraceptives have been in use for many years, but only recently have we seen studies regarding hormone contraceptive agents in men. " Dr. Dana Ohl, from the University of Michigan , stated at the onset of his lecture on Androgen Therapy in men in 1999. The reported incidence of acute life-threatening events associated with AAS abuse is low and the exact incidence is unknown. Dr. Frederick Wu, who has studied the endocrine aspects of anabolic steroids (1997) reports that most of the adverse effects of the androgenic-anabolic steroids (AAS) are reversible but some are permanent, particularly in women and children. Direct toxicity is unknown in men, however in women, testosterone does cause rapid masculinization and facial hair growth, which can be permanent. espite the problems in women, men who use AAS under medical supervision, such as athletes, movie stars and aging bodybuilders, seem to have very few side effects and tolerate them quite well. Even bodybuilders who self-medicate have few serious side effects but long-term effects can result in impotence. According to a Canadian study the use of moderate doses of androgens results in side effects that are largely benign and reversible. The incidence of serious health problems associated with the use of androgens by athletes has been overstated. This is one reason that bodybuilders do not trust doctors. If these AAS were as bad as they were told, they would be dropping dead or having serious side effects.
VIII. Steroids Enhance Athletic Performance An average teen-age girl naturally produces somewhere around half a milligram of testosterone a day. The East German sports authorities routinely prescribed steroids to young adolescent girls in doses of up to thirty-five milligrams a day. As the investigation progressed, former female athletes, who still had masculinized physiques and voices, came forward with tales of deformed babies, inexplicable tumors, liver dysfunction, internal bleeding, and depression. Today, coaches no longer have to coerce athletes into taking drugs. Athletes take them willingly. The drugs themselves are used in smaller doses and in resourceful combinations, leaving few telltale physical signs. It is virtually impossible to catch all the cheaters, or to do much more than guess when cheating is taking place. Among the athletes, "Competitive sport begins where healthy sport ends." The drug issue was brought to the public when Ben Johnson, the Canadian sprinter won the one hundred meters at the Seoul Olympics, in 1988. Johnson set a new world record, then failed a post-race drug test and was promptly stripped of his gold medal and suspended from international competition. In the sprints, individual improvements are usually measured in hundredths of a second; athletes, once they have reached their early twenties, typically improve their performance in small, steady increments, as experience and strength increase. Among world-class athletes, the lure of steroids is not that they magically transform performance-no drug can do that-but that they make it possible to train harder. An aging baseball star, for instance, may realize that what he needs to hit a lot more home runs is to double the intensity of his weight training. Ordinarily, this might actually hurt his performance. When an athlete is under that kind of physical stress, his or her body releases corticosteroids, which block testosterone-corticosteroids are catabolic: they break down muscle. Using testosterone supplements counteracts the impact of corticosteroids and helps the body bounce back faster. If that home-run hitter were taking testosterone or an anabolic steroid, he'd have a better chance of handling the extra weight training. Going into the Seoul Olympics, then, Johnson was a walking pharmacy. This is the great irony of his case-none of the drugs that were part of his formal pharmaceutical protocol resulted in his failed drug test. He had already reaped the benefit of the steroids in intense workouts leading up to the games, and had stopped testosterone long enough in advance that all traces of both supplements should have disappeared from his system by the time of his race. Johnson should have been clean It has been suggested that Johnson's urine sample might have been deliberately contaminated by a rival, a charge that is less preposterous than it sounds. Documents from the East German archive show, for example, that in international competitions security was so lax that urine samples were sometimes switched, stolen from a "clean" athlete, or simply "borrowed" from a noncompetitor. The pure urine would either be infused by a catheter into the competitor's bladder (a rather painful procedure) or be held in condoms until it was time to give a specimen to the drug control lab. It is also possible that Johnson's test was simply botched. We may never know what really happened with Johnson's assay, and perhaps it doesn't much matter. Very clearly this was something less than a victory for drug enforcement. . It is hard to believe that Johnson was the only prominent athlete caught for drug use in Seoul . Johnson's suspension cost him an estimated twenty-five million dollars in lost endorsements. The real lesson of the Seoul Olympics may simply have been that Johnson was a very unlucky man
IX. Drug Testing at the Olympics The International Olympic Committee banned anabolic steroids in 1975; almost a decade after the East Germans started using them. In 1996, at the Atlanta Olympics, five athletes tested positive for a Russian-made psycho-stimulant. Human growth hormone, meanwhile, has been available for twenty years, and the drug testing community has just figured out how to detect it. Erythropoietin (EPO) a blood boosting natural hormone secreted by the kidney is now detected in professional athletes. The best example of the difficulties of drug testing is testosterone abuse detection. As mentioned earlier, testosterone has been used by athletes to enhance performance since the 1950's in one form or another. The International Olympic Committee (IOC) announced that it would finally crack down on testosterone supplements in the early 1980's. This didn't mean that the they were going to test for testosterone directly because the testosterone that athletes were getting was largely indistinguishable from the testosterone they produced naturally. What was proposed was to compare the level of testosterone in urine with the level of another hormone, epitestosterone, to determine what's called the T/E ratio. Under normal circumstances, that ratio is 1:1, and so the theory was that if testers found a lot more testosterone than epitestosterone it would be a sign that the athlete was cheating. Since a small number of athletes have naturally higher levels of testosterone, the I.O.C. avoided the embarrassment of falsely accusing anyone by setting the legal T/E ratio limit at 6:1 for both men and women. (Cowan, 1991) Major sports organizations conduct their drug testing certain special competitions. Athletes using testosterone would simply taper off their use in the days or weeks prior to these events. When authorities began randomly showing up at athletes' houses or training sites and demanding urine samples, AAS abusing athletes responded by taking an extra doses of epitestosterone with their testosterone, so their T/E would stay below detection. To counteract this subterfuge, multiple urine samples, measuring an athlete's T/E ratio over several weeks were requested. Normally elevated T/E ratio has fairly consistent ratios from week to week. An abuser will have telltale spikes-immediately after using AAS when the level of the hormone peaks rapidly. The FDA provided a perfect solution to this problem. Athletes in 1985 switched from injection to transdermal testosterone patches, which administer a continuous low-level of the hormone, smoothing out incriminating spikes. The patch has another advantage: once removed, the testosterone level will drop rapidly, returning to normal, in as little as a few hours. If an athlete knew how long it took for his blood level of testosterone to get back under the legal limit, he could stall the test for that period and probably pass the test. For those athletes who did not want to risk detection, keeping their testosterone below the 6:1 ration provided an enormous performance benefit. The attitude today is that only careless and stupid people ever get caught in drug tests. The rich professional athletes can who hire top medical people to make sure nothing bad happens, and to help them continue to avoid detection and win their events. Charles Poliquin, an athletic trainer, feels that men who want to achieve prominence among athletes must have fairly high testosterone levels to become successful. Increased strength, faster recovery, improved coordination and memory are definite advantages in the world of sports. Although many athletes are looking toward enhancing performance by proper training, some look to biochemical aids for a "quick fix". I believe that strength athletes should have 800 ng/dl or higher to optimize strength gains, speed recovery, and to have the aggressive drive to compete. Unfortunately, the average drug-free athlete is probably somewhere around 500 ng/dl, which is obviously way too low. So, if you live in North America , and you're a male between the ages of 20 and 45, odds are you have way too low testosterone levels for optimal strength gains ... Charles Poliquin Strength Coach and Trainer
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