What is the recommended use of anabolic steroids, such as Anavar (oxandrolone), for medical conditions like hypogonadism or muscle wasting?

From the Guidelines

Anabolic steroids like testosterone should be the preferred choice for medical conditions such as hypogonadism, given their established safety profile and efficacy, as evidenced by recent studies 1. When considering the use of anabolic steroids for medical conditions, it's crucial to prioritize testosterone replacement therapy for hypogonadism, with doses ranging from 50-400mg per week, depending on the formulation. This approach is supported by the American College of Physicians' clinical practice guideline, which emphasizes the importance of testosterone treatment for men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes 1.

For muscle wasting conditions, Anavar (oxandrolone) may be prescribed, but with careful monitoring and at specific doses: 2.5-20mg daily for men and 2.5-10mg daily for women, usually for 2-4 week cycles. The treatment duration varies based on the condition, with hypogonadism often requiring lifelong therapy, while muscle wasting treatments may be shorter term until weight stabilizes. Regular blood tests are essential to monitor liver function, lipid profiles, and hormone levels, given the potential side effects of these medications, including liver damage, cardiovascular issues, and hormonal imbalances 1.

It's also important to consider patient preferences and values, as identified in studies assessing patient choices among treatment options 1. Patients often prefer topical gels over injections or patches due to convenience, ease of use, and non-staining of clothes. However, the most bothersome symptoms for men with hypogonadism include lack of energy, decreased strength and endurance, and deterioration in work performance, which should guide treatment decisions 1.

In terms of safety, while evidence from observational studies shows no increased risk for mortality, cardiovascular events, prostate cancer, or pulmonary embolism with testosterone treatment, long-term safety data are lacking, and most studies excluded men with recent cardiovascular disease 1. Therefore, testosterone replacement therapy should be used under strict medical supervision, with careful consideration of the potential benefits and risks, and regular monitoring to minimize adverse effects.

From the FDA Drug Label

Therapy with anabolic steroids is adjunctive to and not a replacement for conventional therapy. The duration of therapy with Oxandrin (oxandrolone) will depend on the response of the patient and the possible appearance of adverse reactions. Therapy should be intermittent.

The safest anabolic steroid is not explicitly stated in the provided drug labels. However, oxandrolone is mentioned as a treatment option for certain medical conditions, such as hypogonadism or muscle wasting, with a recommended daily adult dosage of 2.5 mg to 20 mg given in 2 to 4 divided doses 2.

• The therapy should be intermittent, with a course of 2 to 4 weeks usually being adequate.
• It is essential to monitor patients closely for signs and symptoms of adverse reactions, especially when used in combination with other medications, such as warfarin or oral hypoglycemic agents 2.
• Geriatric patients should be treated with caution, and the recommended dose is 5 mg bid 2.
• Children should be treated with caution as well, with the total daily dosage being ≤0.1 mg per kilogram body weight or ≤0.045 mg per pound of body weight, and therapy should be monitored by x-ray studies at 6-month intervals to avoid compromising adult height 2.

From the Research

Medical Use of Anabolic Steroids

The use of anabolic steroids, such as Anavar (oxandrolone), is recommended for medical conditions like hypogonadism or muscle wasting under certain circumstances.

• Oxandrolone has been used to treat HIV-related muscle wasting, severe burn injury, trauma following major surgery, neuromuscular disorders, and alcoholic hepatitis for over 30 years 3.
• It is US FDA-approved for restitution of weight loss after severe trauma, major surgery or infections, malnutrition due to alcoholic cirrhosis, and Duchenne's or Becker's muscular dystrophy 3.

Safety and Efficacy of Oxandrolone

• Oxandrolone has been shown to be effective in improving body composition, muscle strength and function, status of underlying disease or recovery from acute catabolic injury, and nutritional status in the vast majority of well-designed trials 3.
• Unlike other orally administered C17alpha-alkylated AASs, oxandrolone has a novel chemical configuration that confers a resistance to liver metabolism and marked anabolic activity, with fewer serious hepatotoxic effects 3.
• The most commonly documented adverse effects of oxandrolone are transient elevations in transaminase levels and reductions in high-density lipoprotein cholesterol level 3.

Anabolic Steroid-Induced Hypogonadism

• Symptomatic hypogonadism is a potential consequence of anabolic-androgenic steroid (AAS) use and may depend on dose, duration, and type of AAS used 4.
• Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators 4.
• Treatment of ASIH depends on the type and duration of AAS use, and specific details regarding a patient's AAS cycle are important in medical management 4.

Novel Uses for Anabolic Androgenic Steroids

• There has been renewed interest in novel clinical applications of the anabolic-androgenic steroid (AAS) testosterone and its synthetic derivatives, particularly for the treatment of male hypogonadism 5.
• Nandrolone and oxandrolone exhibit favorable myotrophic/androgenic ratios and have been investigated for effectiveness in numerous disease states, including hypogonadism 5.
• Selective androgen receptor modulators (SARMs) are orally active, non-aromatizing, tissue-selective agents that may one day become accepted as alternatives or adjuncts to the treatment of male hypogonadism 5.

Risks Associated with Anabolic-Androgenic Steroids

• Anabolic-androgenic steroids (AAS) can cause side effects such as acne vulgaris, hypertension, hepatotoxicity, dyslipidemia, testosterone deficiency, erectile dysfunction, gynecomastia, and cardiomyopathy 6.
• Clinicians may use this information as a guide for understanding how AAS use can impact health and to assist in patient education and, in some cases, the management of side effects 6.