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Steroid Nomenclature

Perhaps not obvious at first glance, there is a naming convention in place that was used to create identities for the various
anabolic/androgenic steroid hormones. This typically involves forming a root word to convey the structural base of the
steroid, and signifying other unique structural characteristics by including appropriate prefixes or suffixes. Below, we will
look at the common roots, prefixes; and suffixes used in steroid nomenclature, and identify them, as they are used in the
various commercial compound names. As you will see, the adoption of names like nandrolone, methandrostenolone, and
ethylestrenol were not as arbitrary as one might imagine. This section is also helpful if you wish to understand the deeper
chemical designations for the various substances that one might find in the medical literature, which involve the exclusive
use of this terminology (such as is the representation of methandrostenolone as 17b-hydroxy-17a-methylandrosta-1,
4-d ien-3-one).
Common prefixes and suffixes used in steroid naming:
Structural Property
Carbonyl (C=O)
Hydroxyl
Double Bnd ((=()
Methyl
Ethyl

Prefix
oxo-; keto
hydroxy

Suffix
-one

-01
-ene; -en

meth-; methyl
eth-; ethyl-

Co":,mon roots used in steroid naming:

Androstane
Androstene
Androstadiene
Estren; Estra
also: Norandrostene

Base
Base
Base
Base

carbon structure of dihydrotestosterone (no double-bond)

carbon structure of or similar to testosterone (one double-bond)

carbon structure similar to methandrostenolone (two double-bonds; di-ene)

structure of nandrolone (19-norandrostene) and estrogen

Common Commercial Compound Names:

Name
Boldenone
Ethylestrenol
Fluoxymesterone
Mesterolone
Methandienone
Methandrostenolone
Methenolone
Nandrolone
Norethandrolone
Oxandrolone
Oxymetholone
Stanozolol
Trenbolone

Taken From
[17b-ol, androstadiene, 3-one]
[17a ethyl, estren, 17b-ol]
[9-fluoro, 11 b-hydroxyl, 17a-methyl, testosterone, 3-one]
[l-methyl, dihydrotestosterone, 17b-ol, 3-one]
[17a-methyl, androstadiene, 3-one]
[17a-methyl, androstadiene, 17b-ol, 3-one]
[l-methyl, cl-2 double bond (en), 17b-ol, 3-one]
[norandrostene, 17b-ol, 3-one]
[19-nor, 17a-ethyl, (nor)androstene, 17b-ol, 3-one]
[2-oxy, androstane, 17b-ol, 2-one]
[2-hydroxymethylene, 17a-Methyl, 17b-ol, 3-one]
[Stanolone (androstanolone, DHT), 2-pyrazol, 17b-ol]
[tri-en, 17b-ol, 3-one]

26

Incorporated Into Name As

BOL DEN ONE
ETHYL ESTREN OL
FLU OXY ME STER ONE
ME STER OL ONE
METH ANDIEN ONE
METH ANDROSTEN OL ONE
METH EN OL ONE
NANDROLONE
NOR ETH ANDR OL ONE
OX ANDH OL ONE
OXY METH OL ONE
STANO ZOL OL
TREN BOL ONE

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Clinical Applications

Anabolic/androgenic steroids are approved for sale by

prescription in virtually every pharmaceutical market
around the world. Having been applied for many decades
to treat a variety of diseased states, today these drugs
have a number of well-established medical uses. They
have been used to treat most patient populations,
including men and women of almost all ages, ranging
from children to the elderly. In many instances
anabolic/androgenic steroids have proven to be life
saving medications, which is a fact easily overlooked with
all of the discussion about steroid abuse. This section
details some of the most common and accepted medical
applications for anabolic/androgenic steroids.

symptoms of low testosterone levels. To begin with,

raising testosterone levels above 350ng/dL (the very low
end of the normal range) will often restore normal sexual
function and libido in men with dysfunctions related to
hormone insufficiency. With regard to bone mineral
density, hormone replacement therapy is also
documented to have a significant positive effect. For
example, studies administering 250 mg of testosterone
enanthate every 21 days showed a 50/0 increase in bone
mineral density after six months. 51 Over time this may
prevent some loss of height and bone strength with
aging, and may also reduce the risk of fracture. Hormone
replacement therapy also increases red blood cell
concentrations (oxygen carrying capacity), improving
energy and sense of well-being. Therapy also supports the
retention of lean body mass, and improves muscle
strength and endurance.

Androgen Replacement TherapyIHypogonadism

The most widely used medical application for
anabolic/androgenic steroids in the world is that of
androgen replacement therapy. Also referred to as
Hormone Replacement Therapy (HRT) or Testosterone
Replacement Therapy (TRT), this therapy involves the
supplementation of the primary male hormone
testosterone to alleviate symptoms of low hormone levels
(clinically referred to as hypogonadism). Patients may be
adolescent
males
suffering
from
childhood
hypogonadism or a specific disorder that causes
androgenic hormone disruption, although most of the
treated population consists of adult men over the age of
30. In most cases hormone levels have declined in these
men as a result of the normal aging process.

Unlike steroid abuse, hormone replacement therapy in

older men may also have benefits with regard to
cardiovascular disease risk. For example, studies tend to
show hormone replacement as having a positive effect on
serum lipids. This includes a reduction in LDL and total
cholesterol levels, combined with no significant change in
HDL (good) cholesterol levels. 52 53
Testosterone
supplementation also reduces midsection obesity, and
improves insulin sensitivity and glycemic control. 54 These
are important factors in metabolic syndrome, which may
also be involved in the progression of atherosclerosis.
Additionally, testosterone replacement therapy has been
shown to improve the profile of inflammatory markers
TNF, IL-1" and IL-10. 55 The reduced inflammation may
help protect arterial walls from degeneration by plaque
and scar tissue. The medical consensus today appears to
be that replacement therapy generally does not have a
negative effect on cardiovascular disease risk, and may
actually decrease certain risk factors for the disease in
some patients.

The most common complaints associated with low

testosterone in adult men include reduced libido, erectile
dysfunction, loss of energy, decreased strength and/or
endurance, reduced ability to play sports, mood
fluctuations, reduced height (bone loss), reduced work
performance, memory loss, and muscle IOSS.50 When
associated with aging, these symptoms are collectively
placed under the label of"andropause': In a clinical setting
this disorder is referred to as late-onset hypogonadism.
Blood testosterone levels below 350ng/dL are usually
regarded as clinically significant, although some
physicians will use a level as low as 200ng/dL as the
threshold for normal. Hypogonadism is, unfortunately, still
widely under-diagnosed. Most physicians will also not
recommend treatment for low testosterone unless a
patient is complaining about symptoms (symptomatic
androgen deficiency).

In addition to the normal list of potential side effects,

there are a few areas of caution with elderly patients. To
begin with, testosterone administration may increase
prostate volume and PSA values. 56 57 While this does not
appear to be of clinical significance with normal healthy
patients, benign prostate hypertrophy and prostate
cancer can be stimulated by testosterone. Men with
prostate cancer, high PSA values, or breast cancer are
generally not prescribed testosterone. Androgen
supplementation, has also been linked to sleep apnea,
which can interfere with the most restful (REM) phase of

Androgen replacement therapy effectively alleviates most

27

Vlllllillli LICWCIIYII I 1IIIIIDULllnl, Dill au.

sleep.58 The studies have produced conflicting data,

however, and the potential relationship remains the
subject of much debate. 59 Lastly, testosterone
replacement therapy has demonstrated negative,
positive, and neutral effects on cognitive functioning in
elderly men. 60 61 62 Studies do suggest that the dose can
dictate the level of response, with the most positive
effects noted when the androgen level reaches the mid
to upper-range of normal, not supraphysiological. 63
Elderly patients with preexisting deficits in cognitive
function should have their cognitive performance and
blood hormone levels monitored closely during hormone
replacement therapy.

decline to baseline over the following weeks. Physicians

are usually encouraged to monitor their patients closely
to ensure androgen supplementation is sustaining
hormone levels within the normal range (and alleviating
symptoms of hypogonadism) throughout the entire
therapeutic period. The longer acting injectable
testosterone
preparation
Nebido
(testosterone
undecanoate) is undergoing review in the U.S., and has
already been approved in other markets. This drug
requires only 4 to 5 injections per year for most patients.
Oral: Testosterone undecanoate (Andriol) is the only
prescription medication that delivers testosterone via an
oral capsule. This medication is not approved for sale in
the United States, but is a prescription drug in Canada and
many other markets around the world. Patient compliance
and comfort are high with this form of therapy, as there
are no special routines or requirements aside from taking
a few capsules each day with meals. Oral testosterone
undecanoate is usually given at an initial dosage of 120 to
160 mg per day, which equates to three to four 40 mg
capsules. This dosage may be reduced in subsequent .
weeks to 120 mg per day. The capsules are given in two
divided doses per day, which are usually taken with
breakfast and dinner. While this form of therapy is highly
convenient, serum hormone levels can fluctuate greatly
on a day-to-day basis. The amount of fat consumption has
a particularly strong impact on hormone bioavailability,
and meals providing at least 20 grams of fat are
recommended when taking the capsules for maximum
absorption. Note that as with transdermal testosterone,
oral testosterone undecanoate tends to increase serum
dihydrotestosterone (DHT) levels more profoundly than
testosterone injections.

Common Treatment Protocols:

Transdermal: Transdermal application is the most

commonly prescribed method for supplementing
testosterone in the United States and Canada, and is
generally the first course of therapy initiated with
androgen replacement therapy patients. This method of
drug delivery offers a number of advantages to the
patient when compared to injection. Since the
transdermal application is painless, patient compliance
and comfort is increased in comparison. Transdermal
application also provides stable day-to-day hormone
levels, and does not produce the broad fluctuations
usually noticed with injectable testosterone esters. The
most common protocol among hormone replacement
doctors is to prescribe a dosage of 2.5-10 mg of
testosterone per day (approximate absorbed dose). This is
applied as a rub-on gel or adhesive transdermal patch
that is replaced daily. Note that due to metabolism in the
skin, transdermal application of testosterone tends to
increase serum dihydrotestosterone (DHT) levels more
profoundly than testosterone injection. This may
exacerbate androgenic side effects during therapy in
some patients, causing some to seek out injectable forms
of testosterone as an alternative.

Angioedenla, Hereditary
Anabolic steroids are commonly prescribed for the'
treatment of hereditary angioedema, a rare and
potentially life-threatening disorder of the immune!
system. Hereditary angioedema is caused by genetic!
mutations of blood clotting factors, characterized by ai
decrease in the level or functioning of the protein Cl
esterase inhibitor. This protein controls Cl, which is a\
"complement system" protein that plays an important rolel
in the control of inflammation. Symptoms of hereditary
angioedema include an intermittent but rapid swelling of\
the hands, arms, legs, lips, eyes, ~ong~e, or throat. S~elli~g I
may also be noticed in the digestive. t.ract, resulting In\
abdominal cramping, nausea, or vomiting. In the most
serious cases, the patient may notice a swelling of the i
throat and a blockage of the airway passages, resulting in I,
asphyxiation and sydden death. Many attacks occur I
without a specific trigger, although stress, trauma, surgery, I
and dental work are commonly associated with i
l

Injection: Testosterone enanthate and testosterone

cypionate are the most widely prescribed injectable
testosterone drugs in the United States and Canada. In
many other markets the blended ester products Sustanon
100 and Sustanon 250 are also commonly prescribed.
Injection of one of these testosterone ester products will
provide the patient supplemental androgen levels for
approximately 2 to 3 weeks after each application. The
most common protocol among hormone replacement
doctors is to administer 200 mg of testosterone enanthate
or cypionate once every 2 to 3 weeks. It is important to
remember that testosterone esters will deliver varying
levels of testosterone to the body on a day-to-day basis
throughout each application window. Levels will be
highest the first several days after injection,and will slowly

I,:

28

- _

_,

'1M.

angioedema attacks.

to 4 weeks.

Oral c-17 alpha alkylated anabolic/androgenic steroids

have been shown to be a useful form of preventive
therapy, stabilizing complement system protein levels and
reducing the frequency and severity of angioedema
attacks. 64 They are usually administered in a low dose,
which is to be taken for long-term support of this disorder.
The anabolic steroids that have been most commonly
used in the United States for this purpose are stanozolol
and danocrine, although historically many other agents
have also been prescribed including oxandrolone,
methyltestosterone, oxymetholone, fluoxymesterone, and
methandrostenolone. The amount of steroid needed can
vary depending on the individual, and is usually
maintained at the lowest therapeutically effective dosage
in an effort to offset undesirable side effects. FDA
approved prescribing guidelines for stanozolol
recommended an initial dosage of 2 mg three times daily
(6 mg per day). This would be slowly adjusted downward
to a maintenance level after a positive response was
noted, usually to 2 mg given once every 1 to 2 days.

In recent years, the advent of recombinant erythropoietin

as a prescription drug has changed the face of anemia
treatment considerably. While anabolic/androgenic
steroids still offer therapeutic value here, and are still
marketed and sold to treat anemic patients, they are
presently regarded as adjunct or fallback medications for
use only when therapy with an erythropoietin alone has
failed to achieve a desired response. The hematocrit
increase from anabolic/androgenic steroids is generally
less predictable and positive than the newer
erythropoietins, and these drugs also tend to produce
very noticeable side effects when given in the levels
necessary to stimulate erythropoiesis, especially in
women and children. In many instances the risks to
therapy
strongly
outweigh
the
benefits
of
anabolic/androgenic steroids, given that there are newer
and directly targeted medications available with much
lower side effect potential.

Breast Cancer
Anabolic/androgenic steroids are sometimes prescribed
to treat beast cancer in postmenopausal women or
premenopausal women who have had their ovaries
removed. These drugs are of value when the cancer is
hormone responsive, which means that its growth can be
affected (positively or negatively) by hormonal
manipulation. Androgens and estrogens have opposing
actions on hormone-responsive tumors, with estrogens
supporting the growth of breast cancer tissue and
androgens inhibiting it 65 . The supplementation of an
anabolic/androgenic steroid can shift the androgen to
estrogen balance in a direction that favors a reduction in
tumor size, a therapy that has elicited a successful
response in a fair number of patients. The masculinizing
side effects of steroid therapy can be very pronounced in
women, however, so therapy is usually initiated with great
caution. An oral androgen such as fluoxymesterone is
usually preferred to a slower acting injectable steroid such
as nandrolone decanoate as well, as it can be abruptly
halted if undesirable side effects become too apparent.
Both primarily anabolic agents, however, have been
widely prescribed for this purpose.

Anemia
As a class of drugs, anabolic/androgenic steroids stimulate
the synthesis of erythropoietin in the kidneys, a hormone
that supports the manufacture of new red blood cells. By
doing this, the administration of steroids tends to increase
the red cell count and hematocrit level, making them of
tangible therapeutic value for treating certain forms of
anemia (a disease characterized by insufficient red blood
cell production). Forms of anemia likely to respond to
steroid therapy include anemias caused by renal
insufficiency, sickle cell anemia, refractory anemias
including aplastic anemia, myelofibrosis, myelosclerosis,
agnogenic myeloid metaplasia, and anemias caused by
malignancy or myelotoxic drugs. The level of response will
vary depending on the patient, type of therapy, and form
of anemia, but in many cases the management of a
normal hematocrit level can be achieved.
In the United States, both oxymetholone (Anadrol 50) and
nandrolone decanoate (Deca-Durabolin) are approved by
the FDA for the treatment of severe anemia. The
guidelines for using oxymetholone with both male and
female anemic patients (children and adults) recommend
a dosage of 1-2 mg/kg/per day. This would equate to a
daily dosage of 75-150 mg for an individual weighing
about 160 Ibs. Doses as high as 5 mg/kg/day are
sometimes necessary to achieve the desired therapeutic
response. The guidelines for nandrolone decanoate
recommend a dosage of 50-100 mg per week for women
and 100-200 mg per week for men. Children (2 to 13 years
of age) are recommended a dosage of 25- 50 mg every 3

In recent years the development of newer and more

targeted anti-estrogenic drugs such as selective estrogen
receptor modulators (SERMs) and aromatase inhibiting
drugs have almost completely eliminated the use of
anabolic/androgenic steroids for breast cancer treatment.
Medicative treatment for breast cancer today usually
consists of a SERM like Nolvadex (tamoxifen), which may
be used with a strong aromatase inhibitor such as
Arimidex (anastrozole) or Femara (exemestane).

29

Anabolic/androgenic steroids are still made available in

the United States and many other nations for treating
breast cancer, and are sometimes still applied. They are
very much regarded as adjunct or fallback medications,
however, for use only when therapy with anti-estrogenic
drugs alone has failed to achieve a desired response.

hormone deficiency. These agents have been shown to

have positive effects on both muscle and bone mass.
When they are administered before the ends of the long
bones (epiphysis) have fused and further linear growth
has been halted, their anabo'lic effects on bone may
support an increase in height.?' This can occur both
through direct anabolic action of the steroid on bone
cells, and indirectly via the stimulation of growth
hormone and IGF-1 release.7 2 An anabolic steroid that is
non-aromatizable and non-estrogenic is typically used for
this purpose, as estrogen is known to cause an
acceleration of growth arrest. Anabolic steroid therapy
must always be u~ed with caution in pediatric patients,
however. In addition to the possibility of common adverse
effects, even non-aromatizable steroids may accelerate
the rate of epiphysis closure.7 3

Decreased Fibrinolytic Activity

Anabolic steroids may be prescribed to treat conditions
associated with decreased fibrinolytic activity. Fibrinolysis
is the process in which a blood clot is broken down and
metabolized by the body. It represents a counter to blood
coagulation, with the two systems working together to
maintain the hemostatic balance. Disorders of the
fibrinolytic system are rare, although can be very serious
in nature when they do occur. Decreased fibrinolytic
activity can result in a shift in blood clotting factors that
greatly favor coagulation (hypercoagulability), increasing
the risk of a serious cardiovascular event such as
thromboembolism, heart attack, or stroke. Oral (-17 alpha
alkylated anabolic steroids are recognized to increase
fibrinolytic activity, and as a result have been beneficial in
many patients suffering from decreased fibrinolytic
activity linked to Antithrombin III deficiency or fibrinogen
excess. 6667 Stanozolol has been most commonly used in
the United States for this treatment, although similar
therapeutic benefits can be seen with many other
anabolic steroids. The maintenance dose is tailored to the
individual, and is determined with close monitoring of
both side effects and changes to blood coagulation
parameters. Esterified injectables and oral non-alkylated
steroids do not produce the same fibrinolytic response. 68

In the United States, oxandrolone is the anabolic steroid

most widely prescribed for the treatment of growth
failure. It is usually given as a supportive medication, used
to augment the anabolic effects of human growth
hormone therapy.The drug is typically taken for periods of
6-12 months at a time, in an effort to accelerate the
growth rate without substantially affecting the rate of
epiphysis fusion. A dosage of 2.5 mg per day is often used
for this purpose, although this may be adjusted upwards
or downwards depending on the patient's sex, age,
bodyweight, and sensitivity to adverse effects. When used
under optimal conditions, the result may be an
enhancement of the growth rate and an increase in total
height compared to not initiating therapy.This benefit has .
been difficult to achieve consistently in clinical studies,
however. A number of trials with oxandrolone have failed
to produce a statistically significant effect on total height,
questioning its ultimate value.7 4 The short-term benefits
of anabolic steroids on the growth rate, however, remain
well supported.
I

Infertility (Male)
In a small percentage of cases, anabolic/androgenic
steroids may be prescribed for the treatment of male
infertility. When the cause of infertility is low sperm
concentration due to Leydig-cell secretion deficiencies, an
androgen might be able to alleviate the condition. In such
cases the steroid may increase the sperm count, sperm
quality and the fructose concentration,69 70 which can
increase the chance of conception. The oral androgen
mesterolone (Proviron) is most commonly prescribed for
this purpose, although has not been granted FDA
approval for sale in the United States. Note that
anabolic/androgenic steroids usually reduce male fertility,
so the potential for these agents to successfully treat male
fertility is limited.

The steroid methyltestosterone is approved fori

prescription sale in the United States and many otherl
markets to improve libido in female menopause patients.11
Small doses of the drug are typically included in products
that als? supplement estrogens, the combination aimed'l'
at treating the full spectrum of menopause symptoms,
including reduced female libido. The dosage used is low
compared to those of other clinical applications for
methyltestosterone, and will usually amount to no more
than 2mg per day.

Growth Failure

Osteoporosis

Anabolic steroids may be prescribed to treat growth

failure in children, both with and without growth

Anabolic steroids increase bone mineral density, and may

be prescribed for the treatment of osteoporosis. Benefits

Libido (Female)

I
I

30

of therapy include the stimulation of new bone formation,

inhibition of bone resorption (breakdown), and
enhancement of calcium absorption/5 76 These drugs
have additionally been shown to reduce bone pain
associated with osteoporosis 77, a frequent complication
with elderly patients suffering from the condition.
Osteoporosis is most common in postmenopausal
women, and is usually linked to the changes in hormonal
chemistry that are noted later in life. This disorder does
occur to a high degree in the elderly of both sexes,
however. Osteoporosis can also be caused by the
prolonged administration of corticosteroids, which can
directly stimulate bone resorption and inhibit new bone
growth. This is identified as steroid- or glucocorticoid
induced osteoporosis.

II

u uu,

U'I'

uu.

genetic conditions, most commonly Turner's syndrome in

females and Klinefelter's syndrome in males. Both are
chromosomal disorders characterized by deviations from
the normal XX/XV pairing. They result in (among other
health issues) abnormalities in growth, sexual
development, and ongoing sexual functioning. Males with
Klinefelter's syndrome are sterile, and typically have a
rounder (less muscular) physique.They also develop small
testicles (microorchidism), and may suffer with
gynecomastia. In these patients the supplementation of
testosterone (in a similar fashion to that used for
androgen replacement therapy) is common, and can help
alleviate some of the issues with sexual functioning and
body composition. Females with Turner's syndrome will
be of short stature, and develop other physical
abnormalities including a broad chest, low hairline, low
set ears, and webbed neck. Low doses of a primarily
anabolic steroid may be used in adolescent patients as an
adjunct to growth hormone therapy to support the linear
growth rate. Oxandrolone is the steroid most commonly
used in the United States for this purpose, and has been
clinically successful at increasing final height when used
in dosage of .05-.1 mg/kg per day.82

Nandrolone decanoate is the anabolic steroid most

commonly prescribed for the treatment of osteoporosis.
The drug tends to offer measurable benefits with regard
to bone density, and may reduce the likelihood of bone
fracture in patients.?8 79 The dosage used to treat
postmenopausal women is usually 50 mg once every 3 to
4 weeks. Adverse reactions are common with therapy,
however, including virilization symptoms (hoarseness and
body/facial hair growth)80 and unfavorable alterations in
serum cholesterol. 81 Therapy appears to be better
tolerated in patients above the age of 65, who as a group
seem to notice lower adverse effects. Male patients are
given a nandrolone decanoate dosage of 50 mg once
every 1 to 2 weeks. Therapy for both sexes is usually
conducted for at least six months, and may last for one
year or longer if necessary.The long therapeutic window is
usually required in order to give the drug ~nough time to
measurably effect bone strength.

Weight Loss/Muscle Wasting

Anabolic steroids may be administered for the treatment
of clinically significant weight loss. Common causes
include prolonged corticosteroid therapy, extensive
surgery, chronic infections or severe trauma. In a general
sense, these agents can be highly useful when a patient is
subject to a long hospital stay or period of bed rest, when
normal daily muscle stimulation is not present and a
significant loss of muscle mass is noticed. Severe burn
injuries may also call for the supportive application of
anabolic steroids, as this is a type of injury also associated
with secondary muscle loss. Anabolic steroids may
additionally be prescribed to individuals with weight loss
not associated with any known cause. The failure to
maintain a healthy (normal) level of body weight for ones'
height, and an inability of diet and exercise alone to
correct weight loss, are usually the determining factors in
recommending such treatment.

In the United States, however, the use of an anabolic

steroid such as nandrolone decanoate for the direct
treatment of osteoporosis is presently viewed as
controversial. In spite of substantial clinical data and
history supporting the use of steroids for this purpose in
the United States, many medical organizations hold the
opinion that the potential side effects of steroid therapy
are too substantial to justify their benefits with
osteoporosis. No agent is presently FDA approved for this
purpose. Oxandrolone does remain FDA approved for
osteoporosis patients, but for the specific purpose of
alleviating bone pain associated with the disease, not for
augmenting bone mineral density. Anabolic steroids
remain in use for osteoporosis in many other nations,
however, and are still prescribed to varying patient
populations including men, women, and the elderly.

The significant loss of lean body mass can present its own
set of health issues. Individuals that are chronically
underweight may suffer from low energy and a reduced
sense of wellness, and are at greater risk of mortality.83
Severe weight loss during recovery from surgery or illness
may also measurably delay or complicate the recovery
phase. 84 In the most severe cases, an ability of the patient
to maintain acceptable lean body mass can be the key
determining factor in recovery. The ability of anabolic
steroids to increase protein synthesis makes them among
the most accepted agents for the treatment of clinically

Turner's and Klinefelter's Syndrome

Anabolic/androgenic steroids may be used to treat certain

31

................. v ...... v

__ ,

__

significant weight loss, provided the patient does not

have a health condition or is taking any other medicine
that would exclude them from using these drugs. They
can positively affect both muscle and bone as well,
making them very versatile anabolic agents.

however, the discontinuance of nandrolone decanoate on

the pharmaceutical market and a perceived higher
patient comfort profile in oxandrolone has made
oxandrolone the preferred agent for HIV cachexia. The
dosage of oxandrolone used may range from 20 mg to 80
mg per day. The most consistent clinical benefits have
been seen with a 40 mg and 80 mg daily dose.8?

In the United States, oxandrolone is the agent most

frequently prescribed for most kinds of clinically
significant weight 10ss.The dosage used for this purpose is
typically 10 mg given twice per day (20 mg total),
although lower doses may be given in some female,
elderly, or younger patients in an effort to avoid
undesirable androgenic side effects. The drug is
commonly administered for a period of 3 to 4 weeks
during the early stages of recovery, although may be
given for a longer duration if necessary. Given that the
support of constructive protein metabolism is a trait
shared by virtually all anabolic steroids, many agents
other then oxandrolone are clinically useful for this
purpose. In many other regions, agents with a high
anabolic-to-androgenic activity ratio are predominantly
used for this purpose including stanozolol, nandrolone,
methenolone, and methandrostenolone.
Anabolic steroids may also be prescribed to treat more
severe cases of muscle wasting. This is a condition
characterized by strong ongoing protein catabolism,
which means that muscle protein is being predominantly
broken down (as opposed to synthesized) in the body,and
a progressive loss of weight, strength, and energy is
noticed. In a medical setting, severe muscle wasting is
referred to as cachexia. Cachexia is not associated with
insufficient food intake (dietary malnutrition), but has a
metabolic cause than cannot be alleviated with changes
in diet. This cause is also usually identified when
discussing the condition (ie, cancer cachexia, HIV related
cachexia). HIV related muscle wasting is the most
common form of cachexia treated with anabolic steroids.
The use of these drugs as supportive therapy for cancer
cachexia has not been well established, however, and
currently the subject of ongoing investigation.
Nandrolone decanoate, oxandrolone, and oxymetholone
have been the anabolic steroids most commonly used in
the U.S. to treat muscle wasting specifically associated
with HIV infection. Although no specific FDA
recommendations have been adopted, studies with
nandrolone decanoate have shown a dosage of 150 mg
every 14 days to have a similar anabolic benefit, and a
significantly lower incidence of side effects, as 6 mg (18 IU)
of human growth hormone per day.8s In 2003,
oxymetholone was the subject of successful Phase III
clinical trials for HIV wasting. 86 The dosage of this study
(100-150 mg per day) mirrors those that are most
commonly prescribed by physicians. In recent years,

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