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William Llewellyn's ANABOLICS, 10th ed.
Steroid Side Effects
While anabolic/androgenic steroids (AAS) are generally
with stable or increased LDL levels. Triglyceride levels may
regarded as therapeutic drugs with high safety, their use
also increase.The shift can be unfavorable in all directions.
can also be associated with a number of adverse cosmetic,
Note that in some cases, the total cholesterol count will
physical, and psychological effects. Many of these side
not change significantly. The total cholesterol level can,
effects are often apparent during therapeutic-use
therefore, give a false representation of uncompromised
conditions, although their incidence tends to increase
lipid health. Almost invariably the underlying HDL/LDL
profoundly as the dosages reach supratherapeutic ranges.
ratio will decrease.While this ratio should return to normal
Virtually everyone that abuses anabolic/androgenic
following the cessation of steroid intake, plaque deposits
steroids for physique- or performance-enhancing
in the arteries are more permanent. If unfavorable shifts in
purposes notices some form of adverse effects from their
lipids are exacerbated by the long-term use of steroidal
use. According to one study, the exact frequency of
compounds, significant damage to the cardiovascular
tangible side effects in a group of steroid abusers was
system can result.
96.4%. This shows very clearly that it is far more rare toabuse these drugs and not notice side effects than it is toendure them.90 In addition to the side effects thatanabolic/androgenic steroids can have on various internalsystems, there are others which may not be immediatelyapparent to the user. The following is a summary of thebiological systems and reactions effected by AAS use.
The use of anabolic/androgenic steroids insupratherapeutic (and often therapeutic) doses can havea number of adverse effects on the cardiovascular system.
This may be noticed in several areas including unfavorablealterations in serum cholesterol, a thickening ofventricular walls, increased blood pressure, and changes
Over time, plaque deposits may begin to narrow and clog
in vascular reactivity. In an acute sense these drugs are
admittedly very safe. The risk of an otherwise healthyperson suffering a heart attack from an isolated steroidcycle is extremely remote. The risk of stroke is also
Anabolic/androgenic steroids are most consistent in their
extremely low. When these drugs are abused for long
lowering of HDL levels. This adverse effect is mediated
periods, however, their adverse effects on the
through the androgenic stimulation of hepatic lipase, a
cardiovascular system are given time to accumulate. An
liver enzyme responsible for the breakdown of HDL
increased chance of early death due to heart attack or
(good) cholesterol.91 With more hepatic lipase activity in
stroke is, likewise, a valid risk with long-term steroid abuse.
the body, the favorable (anti-atherogenic) HDL cholesterol
In order to better understand this risk, we must look
particles are cleared from circulation more quickly, and
specifically at how anabolic/androgenic steroids affect
their levels drop. This is an effect that seems to be very
the cardiovascular system in several key ways.
pronounced at even modest supratherapeutic dosagelevels. For example, studies with testosterone cypionate
noted a 21% drop in HDL cholesterol with a dosage of 300mg per week.92 Increasing this dosage to 600 mg did not
Anabolic/androgenic steroids use can adversely affect
have any significant additional effect, suggesting that the
both HDL (good) and LDL (bad) cholesterol values. The
dosage threshold for strong HDL suppression is fairly low.
ratio of HDL to LDL cholesterol fractions provides a rough
Oral steroids, especially c-17 alpha alkylated compounds,
snapshot of the ongoing disposition of plaque in the
are particularly potent at stimulating hepatic lipase and
arteries, either favoring atherogenic or anti-atherogenic
suppressing HDL levels. This is due to first pass
actions. The general pattern seen during steroid use is a
concentration and metabolism in the liver. A drug like
lowering of HDL concentrations, which is often combined
William Llewellyn's ANABOLICS, 10th ed.
stanozolol may, therefore, be milder than testosterone
with regard to androgenic side effects, but not when itcomes to cardiovascular strain. A study comparing the
The human heart is a muscle. It possesses functional
effects of a weekly injection of 200 mg testosterone
androgen receptors, and is growth-responsive to male
enanthate to only a 6 mg daily oral dose of stanozolol
steroid hormones. This fact partly accounts for men
demonstrates the strong difference between these two
having a larger heart mass on average than women.95
types of drugs very well.93 After only six weeks, 6 mg of
Physical activity can also have a strong effect on the
stanozolol was shown to reduce HDL and HDL-2
growth of the heart. Resistance exercise (anaerobic) tends
cholesterol levels by an average of 33 and 71%
to increase heart size by a thickening of the ventricular
respectively. HDL levels (mainly the HDL-3 subfraction)
wall, usually without an equal expansion of the internal
were reduced by only 9% in the testosterone group. LDL
cavity. This is known as concentric remodeling. Endurance
cholesterol levels also rose 29% with stanozolol, while
(aerobic) athletes, on the other hand, tend to increase
they dropped 16% with testosterone. Esterified injectable
heart size via expansion of the internal cavity, without
steroids are generally less stressful to the cardiovascular
significant thickening of the ventricles (eccentric
system than oral agents.
Even with concentric or eccentric
remodeling, diastolic function usually remains normal in
It is also important to note that estrogens can have a
the athletic heart. The heart muscle is also dynamic. When
favorable impact on cholesterol profiles.
regular training is removed from a conditioned athlete,
aromatization of testosterone to estradiol may, therefore,
the wall thickening and cavity expansion tend to reduce.
prevent a more dramatic change in serum cholesterol. Astudy examined this effect by comparing the lipid
Anabolic steroid abusers are at risk for thickening of the
changes caused by 280 mg of testosterone enanthate per
left and right ventricular walls,96 known as ventricular
week, with and without the aromatase inhibitor
hypertrophy. Hypertrophy of the left ventricle (the main
testolactone.94 Methyltestosterone was also tested in a
pumping chamber) in particular is extensively
third group, at a dose of 20 mg daily, to judge the
documented in anabolic/androgenic steroid abusers.97
comparative effect of an oral alkylated steroid. The group
While left ventricular hypertrophy is, again, also found in
using only testosterone enanthate in this study showed a
natural power athletes, substance-abusing athletes tend
small but not significant decrease in HDL cholesterol
to have a much more profound wall thickening. They also
values over the course of the 12-week investigation. After
tend to develop pathological issues related to this
only four weeks, however, the group using testosterone
thickening, including impaired diastolic function, and
plus the aromatase inhibitor displayed an HDL reduction
ultimately reduced heart efficiency.98 The level of
of an average of 25%.
impairment is closely associated with the dose and
methyltestosterone experienced the strongest HDL
duration of steroid abuse. A left ventricle wall exceeding
reduction in the study, which dropped 35% after four
13mm in thickness is rare naturally, and may be indicative
weeks. This group also noticed an unfavorable rise in LDL
of steroid-abuse or other causes.99 It may further suggest
cholesterol levels.
that pathological left ventricular hypertrophy hasdeveloped. Additional testing of such patients is
The potential positive effect of estrogen on cholesterol
values also makes the issue of estrogen maintenancesomething to consider when it comes to health risks. To
Left ventricular hypertrophy (LVH) is an independent
begin with, one may want to consider whether or not
predictor of mortality in overweight individuals with high
estrogen maintenance drugs are actually necessary in any
blood pressure.100 It has also been linked to atrial
given circumstance. Are side effects apparent, or is their
fibrillation, ventricular arrhythmia, and sudden collapse
use a preventative step and perhaps unnecessary? The
and death.101 While LVH in non-steroid-using athletes
maintenance drug of choice can also have a measurable
tends to be without clinical significance, pathological
impact on cholesterol outcomes. For example, the
increases in QT dispersion are noticed in steroid abusers
estrogen receptor antagonist tamoxifen citrate does not
with LVH.102 These changes tend to be similar to the
seem to exhibit anti-estrogenic effects on cholesterol
increases in QT dispersion noted in hypertensive patients
values, and in fact tends to increase HDL levels in some
with LVH.103 Among other things, this could leave a steroid
patients. Many individuals decide to use tamoxifen to
abusing individual more susceptible to a serious adverse
combat estrogenic side effects instead of an aromatase
event, including arrhythmia or heart attack. Isolated
inhibitor for this reason, particularly when they are using
medical case studies of longtime steroid abusers support
steroids for longer periods of time, and are concerned
an association between LVH and related pathologies
about their cumulative cardiovascular side effects.
including ventricular tachycardia (arrhythmia originatingin the left ventricle), left ventricular hypokinesis
William Llewellyn's ANABOLICS, 10th ed.
(weakened contraction of the left ventricle), and
taking steroids.114 Hypertension, or consistently high
decreased ejection fraction (reduced pumping volume
blood pressure at or above 140/90 for either systolic or
and efficiency).104
diastolic measures, has been reported in steroid users,115although in most cases the elevations are more modest.
Heart mass can increase or decrease in relation to the
Increased blood pressure may be caused by a number of
current state of anabolic/steroid use, the average dosage,
factors, including increased water retention, increased
and duration of intake. Likewise, the heart usually begins
vascular stiffness, and increased hematocrit. Aromatizing
to reduce in size once anabolic/androgenic steroids are
or highly estrogenic steroids tend to cause the greatest
no longer being used. This effect is similar to the way the
influences over blood pressure, although elevations
heart will reduce in size once an athlete no longer follows
cannot be excluded with non-estrogenic
a rigorous training schedule.105 Even with this effect,
anabolic/androgenic steroids. Blood pressure tends to
however, some changes in heart muscle size and function
normalize once anabolic/androgenic steroids have been
caused by the drugs may persist. Studies examining the
effects of steroid use and withdrawal on left ventricularhypertrophy noted that athletic subjects who abstained
Hematological (Blood Clotting)
from steroid abuse for at least several years still had aslightly greater degree of concentric left ventricular
Anabolic/androgenic steroids can cause a number of
hypertrophy compared to non-steroid-using athletic
changes in the hematological system that affect blood
controls.106 The disposition of pathological left ventricular
clotting. This effect can be very variable, however. The
hypertrophy following long-term steroid abuse and then
therapeutic use of these drugs is known to increase
abstinence remains the subject of investigation and
plasmin, antithrombin III, and protein S levels, stimulate
fibrinolysis (clot breakdown), and suppress clottingfactors II, V, VII, and X.116 117 These changes all work to
Heart Muscle Damage
reduce clotting ability. Prescribing guidelines foranabolic/androgenic steroids warn of potential increases
Anabolic/androgenic steroid abuse is suspected of
in prothrombin time, a measure of how long it takes for a
producing direct damage to the heart muscle in some
blood clot to form.118 If prothrombin time increases too
cases. Studies exposing heart cell cultures to AAS have
greatly, healing may be impaired. The effects of
reported reduced contractile activity, increased cell
anabolic/androgenic steroids on prothrombin time are
fragility, and reduced cellular (mitochondrial) activity,
generally of no clinical significance to healthy individuals
providing some support for a possible direct toxic effect
using these drugs in therapeutic dosages. Patients taking
to the heart muscle.107 108 Furthermore, a number of case
anticoagulants (blood thinners), however, could be
reports have found such pathologies as myocardial
adversely affected by their use.
fibrosis (scar tissue buildup in the heart), myocardialinflammation (inflammation of heart tissue), cardiac
Conversely, anabolic/androgenic steroid abuse has been
steatosis (accumulation of triglycerides inside heart cells),
linked to increases in blood clotting ability. These drugs
and myocardial necrosis (death of heart tissue) in long-
can elevate levels of thrombin119 and C-reactive
term steroid abusers.109 110 111 112 A direct link between
protein,120 as well as thromboxane A2 receptor density,121
drug abuse and cardiac pathologies is assumed in these
which can support platelet aggregation and the
cases, but cannot be proven given the slow nature in
formation of blood clots. Studies of steroid users have
which these cardiac pathologies develop, and the
demonstrated statistically significant increases in platelet
influence many other factors (such as diet, exercise,
aggregation values in some subjects.122 There are also a
lifestyle, and genetics) can have on them. Individuals
growing number of case reports where (sometimes fatal)
remain cautioned about the possibility of cardiac muscle
blood clots, embolisms, and stokes have occurred in
damage with long-term steroid abuse.
steroid abusers.123 124 125 126 127 Although it has beendifficult to conclusively link these events directly to
steroid abuse, the adverse effects of anabolic steroids oncomponents of the blood coagulation system are well
Anabolic/androgenic steroids may elevate blood
understood. These serious adverse effects are now
pressure. Studies of bodybuilders taking these drugs in
regarded as recognized risks of steroid abuse among
supratherapeutic doses have demonstrated increases in
many that study these drugs.
both systolic and diastolic blood pressure readings.113Another study measured the average blood pressure
In therapeutic levels, the anti-thrombic effects of
reading in a group of steroid users to be 140/85, which
anabolic/androgenic steroids seem to dominate
was compared to 125/80 in weight lifting controls not
physiology, and decreases in blood clotting ability may be
William Llewellyn's ANABOLICS, 10th ed.
noted. At a certain supratherapeutic dosage point,
point until the hematocrit issues have been corrected.
however, the pro-thrombic changes appear to overtake
Minor elevations in hematocrit may be addressed with
the anti-thrombic changes, and physiology begins to
phlebotomy. For this, 1 pint of blood may be removed
favor fast and abnormally thick clot formation
periodically during steroid intake, often every two
(hypercoagulability). The exact dosage threshold or
months. Proper hydration is also important, as
conditions required to increase blood clotting has not
dehydration can temporarily cause the hematocrit level to
been determined, and some studies with steroid users
elevate, giving a false positive for polycythemia. The daily
taking supraphysiological doses fail to demonstrate
intake of aspirin is also commonly advised if the
increased coagulability.128 Individuals remain warned of
hematocrit is above normal, as this will reduce platelet
the potential increases in thrombic risk with
aggregation, or the tendency for platelets to stick
anabolic/androgenic steroid abuse. Blood clotting
together and form clots. Individuals remain cautioned of
tendency should return to the pretreated state after the
the potential cardiovascular danger of high hematocrit
discontinuance of anabolic/androgenic steroids.
levels associated with anabolic/androgenic steroid use.
Anabolic/androgenic steroids stimulate erythropoiesis
Anabolic/androgenic steroids may elevate homocysteine
(red blood cell production). One potential adverse effect
levels. Homocysteine is an intermediary amino acid
of this is polycythemia, or the overproduction of red blood
produced as a byproduct of methionine metabolism. High
cells. Polycythemia can be reflected in the hematocrit
levels of homocysteine have been linked to elevations in
level, or the percentage of blood volume that is made up
the risk for cardiovascular disease.131 It is believed to play
of red cells. As the hematocrit rises, so too does the
a direct role in the disease, increasing oxidative stress,
viscosity of the blood. If the blood becomes too thick, its
including the oxidation of LDL cholesterol, and
ability to circulate becomes impaired. This can greatly
Elevated levels of
increase the risk of serious thrombic event including
homocysteine may also induce vascular cell damage,
embolism and stroke. A high hematocrit level is also an
support platelet aggregation, and increase the likelihood
independent risk factor for heart disease.129 The normal
of thrombic event.133 134 135 The normal range for
hematocrit level in men is 40.7 to 50.3%, and in women it
homocysteine levels in men aged 30 to 59 years is 6.3-
is 36.1 to 44.3% (numbers may vary very slightly
11.2umol/L. For women of the same age the average is
depending on the source). For the sake of scale, while a
4.5-7.9umol/L. Increased risk of heart attack, stroke, or
hematocrit of 50% may be normal, a hematocrit of 60% or
other thrombic event are noted with even modest
above is considered critical (life threatening).
elevations in homocysteine. According to one study, ahomocysteine level exceeding 15umol/L in patients with
Anabolic/steroid administration tends to raise the
heart disease is associated with a 24.7% increased
hematocrit level by several percentage points, sometimes
likelihood of death within five years.136
more. As a result, many steroid-using bodybuilders willhave hematocrit levels that are above the normal range.
Androgens stimulate elevations in homocysteine,137 and
For example, one study measured the average hematocrit
men have an approximately 25% higher level on average
in a group of steroid abusing competitive bodybuilders to
than women.138 Anabolic/androgenic steroid abuse has
be 55.7%.130 This level is considered clinically high, and
been associated with hyperhomocysteinaemia, or
would increase blood viscosity enough to raise the risk of
consistent clinically high homocysteine levels.139 One
serious cardiovascular event. Although not likely to be an
study found that the average homocysteine
isolated cause, high hematocrit is believed to have been a
concentration in a group of 10 men that had been self-
contributing factor in the deaths of a number of steroid
administering anabolic/androgenic steroids (in a cyclic
abusers, usually paired with high blood pressure,
pattern) for 20 years was 13.2 umol/L.140 Three of these
homocysteine, and/or atherosclerosis. The average
men died of a heart attack during the investigation, and
hematocrit level in bodybuilders not taking
had homocysteine levels between 15umol/L and
anabolic/androgenic steroids was 45.6%, well within the
The average homocysteine level in
normal range for healthy adult men.
bodybuilders who had never taken steroids was8.7umol/L, while it was 10.4umol/L in previous steroid
Many physicians that specialize in hormone replacement
users (3 months abstinence). One study did show that
therapy consider a hematocrit level of 55% to be an
administering 200 mg of testosterone enanthate (with
absolute cutoff point. At or above this point, and
and without an aromatase inhibitor) for three weeks failed
anabolic/androgenic steroid therapy cannot be
to produce a significant elevation in homocysteine.141 It is
continued safely. Drug intake would be ceased at this
unknown if the moderate dosage, drug type (esterified
William Llewellyn's ANABOLICS, 10th ed.
injectable vs. c17-aa), or short duration of intake were
vascular reactivity. Studies at the University of Innsbruck in
factors in the differing outcome from other studies.
Austria compared the level of endothelial dilation in 20
Individuals remain warned of the potential for elevations
steroid users to a group of control athletes.144 Those
in the homocysteine level with steroid abuse.
individuals using anabolic steroids noticed slight butmeasurably impaired vascular dilation and endothelial
function. Additional studies at the University of Wales inCardiff comparing vascular dilation in active, previous, and
The endothelium is a layer of cells that line the entire
non- steroid users, also demonstrated anabolic steroids to
circulatory system. These cells are found on the inside of
cause a decline in endothelial-independent
all blood vessels, and help increase or decrease blood flow
vasodilation.145 These effects leave the steroid user with
and pressure by relaxing or constricting the vessels
more relative "stiffness" in the vascular system, which
(referred to as vasodilation and vasoconstriction,
could increase the chance of an adverse cardiovascular
respectively). These cells also help regulate the passage of
event. In both studies, vascular reactivity improved after
materials in and out of blood vessels, and are involved in a
the discontinuance of anabolic/androgenic steroids.
number of important vascular processes including bloodclotting and new blood vessel formation. Having a more
Proving an Association
flexible (reactive) endothelium is generally considereddesirable for health, and, likewise, the endothelium is
Direct links between steroid abuse and individual cases of
often compromised in individuals with cardiovascular
stroke and heart attack have been difficult to prove. There
disease. Patients with endothelial dysfunction tend to
are a number of things that have made this difficult. For
notice greater vasoconstriction, restricted blood flow,
one, cardiovascular disease is very common in men. It also
higher blood pressure, local inflammation, and reduced
usually takes decades to develop. This makes individual
circulatory capacity.142 This may place them at greater risk
contributing factors (which include many things such as
for heart attack, stroke, or thrombosis (blood clot).
diet, lifestyle, health status, and genetic variables)extremely difficult to isolate. Data concerning the long-
Endothelial cells are androgen responsive, which may
term use of steroids in physique- or performance-
partly account for men exhibiting less vascular reactivity
enhancing doses is also very limited. It would be unethical
than women.143 Similarly, anabolic/androgenic steroid use
to conduct a controlled study where participants were
has been shown to impair endothelial activity and
given abusive doses of steroids for many years, so the data
Anabolic/androgenic steroid abuse can produce changes in a number of areas of cardiovascular health that can work together
to increase the risk of heart attack, stroke, or embolism.
William Llewellyn's ANABOLICS, 10th ed.
The Endocrinology of Muscle Growth
The road to anabolic insight must include a biological
regulation. The following is a rundown of the chain of
understanding of what muscle growth actually entails.
hormones and growth factors that mediate muscle
Often simplified by the term "protein synthesis", muscle
growth, from the initiation of damage, to final recovery,
growth is actually a highly complex process involving
repair, and growth. For the sake of organization, I have
much more than just building proteins from amino acids.
presented them in what I consider to be three logical
Muscle hypertrophy, the correct scientific term for the way
phases of action. These are not scientifically accepted
we adult humans build skeletal muscle, actually requires
definitions. Additionally, we could continue to go deeper
the fusion of new cells (called satellite cells) with existing
and deeper into each of the various compounds,
muscle fibers. Since this discovery of satellite cells in 1961,
messengers, binding proteins, and receptors involved in
a great deal of research into the mechanisms of muscle
this intricate and amazing biological activity. I believe the
hypertrophy has been undertaken. Scientists have come
included text will demonstrate the process of muscle
to understand that unlike normal muscle cells, these
anabolism in a very tangible way, however, without too
satellite cells can be regenerated throughout adult life.
much unnecessary information. Each of the key areas of
Furthermore, they serve not as functional units of their
this section can be further researched for more detail if
own, but provide some of the necessary components to
you are interested. For one so inclined, the medical
repair and rebuild damaged muscle cells. These satellite
references in the endnotes would be an excellent place to
cells are normally dormant, and sit resting in small
indentations on the outer surface of the muscle fibers,waiting for something to trigger them into activation.
Injury or trauma will provide the stimulus necessary to
We all understand that weight training is fundamental to
activate satellite cells. Once activated, they will begin to
growing muscle tissue. To date, no "sit on your ass and get
divide, multiply, and form into myoblasts (myoblasts are
huge and ripped"pill has been invented.The reason is that
essentially donor cells that express myogenic genes). This
a number of changes take place in your local muscle
stage of hypertrophy is often referred to as satellite cell
tissues during intense training that are vital to the growth
proliferation. The myoblasts will then fuse with existing
process. Without these early changes, growth is difficult if
muscle fibers, donating their nuclei. This stage of the
not impossible to stimulate. So for our purposes, we will
process is usually called differentiation. Skeletal muscle
start here. Training is the "trigger" in the anabolic process.
cells are multinucleated, which means they possess many
More specifically, it is the localized cellular damage that
nuclei. Increasing the number of nuclei allows the cell to
weight training produces that will first set us down the
regulate more cytoplasm, which allows more actin and
road of anabolism.The body will respond by repairing this
myosin, the two dominant contractile proteins in skeletal
damage, and in the process will try to adapt by making
muscle, to be produced. This increases the overall cell size
itself stronger. Muscle growth is always a circular process,
and protein content of the muscle cell. Incidentally, the
with a step back (damage) being necessary to take any
number of nuclei in relation to cross-sectional area also
steps forward.
helps to determine the fiber type of the cell, namely slowtwitch (aerobic) or fast twitch (anaerobic)332 333. It is
Phase I: Initial Response
important to note that we are not increasing muscle cellnumber with muscle hypertrophy. We are only increasing
The Initial Response phase covers those changes in
cell size and protein content, even though we are using
muscle chemistry that begin immediately, during training,
satellite cells to help accomplish this. It is possible for
which will lay the groundwork for later repair and growth.
myoblasts to fuse together and actually form new muscle
In many regards, the Initial Response Phase will control
fibers.This is called muscle hyperplasia, and equates to the
the potential magnitude of other signals to follow. In the
legitimate growth of new muscle tissue. This is, however,
anabolic process, this phase is categorized by the release
not the primary mechanism of muscle growth in adult life.
of arachidonic acid from muscle cells, and the formation ofactive messengers including prostaglandins, cytokines,
The Anabolic Chain
leukotrienes, and prostacyclins. This begins with thebreakdown of the outer phospholipid layer of muscle
Now that we know what muscle hypertrophy is really
cells, which is initiated by the cellular disruption of
about, let's look at anabolic stimulus and ongoing
damaging exercise.334 Phospholipases are released in
William Llewellyn's ANABOLICS, 10th ed.
Quiescent Satellite Cell
Satellite Cell Activation
and Proliferation
Regenerated Myofiber
with Added Nuclei
Migration to Injured Fiber
Fusion to Damaged
Myofiber (Hypertrophy)
Fusion to Produce New
Myofibers (Hyperplasia)
MUSCLE HYPERTROPHY AND THE 4 STAGES OF THE SATELLITE CELL CYCLE
During the Activation stage, dormant satellite cells are stimulated to enter the cell cycle. Proliferation marks the formation of
new myoblasts (active donor cells). These myoblasts will fuse with existing damaged muscle fibers during the Differentiation
phase. This allows for greater protein synthesis and the expansion of cell size. Quiescence marks the return to a dormant
state, where the inactive satellite cells will again rest on the outer layer of the fibers. Myostatin, a known inhibitor of muscle
growth, is believed to be a key regulator in this stage.335 336
response to this trauma, which causes some of the
dilating blood vessels (to increase the flow of nutrients
phospholipids stored in the outer layer of the muscle cells
and hormones to the muscles) and increasing the
to be released. The eccentric part of the exercise
production of HGF (hepatocyte growth factor) for satellite
movement is of particular importance here, which is the
cell activation.
Arachidonic acid contributes to
"negative" part of the lift, where the muscle is stretched
inflammation and pain signaling as well, and its release
under resistance.
plays an integral role in the soreness that follows aproductive bout of training.
The amount of arachidonic acid, which is the centralbioactive lipid in the anabolic process, liberated will
Training intensity and the relative density of arachidonic
largely control what occurs during this phase. Arachidonic
acid in the phospholipid layer (arachidonic acid
acid is converted locally and immediately via enzymes to
availability is ultimately the rate-limiting step in the
a number of active anabolic end products, the most
formation of anabolic prostaglandins) will dictate how
notable of which (in terms of muscle growth) are
much of this potent lipid can be liberated during exercise.
prostaglandins, which are produced via interaction with
The amount of arachidonic acid stored in skeletal muscle
cyclooxygenase enzymes. These prostaglandins (PGE2
tissue is also in a state of constant flux. A number of factors
and PGF2alpha mainly) will control much of the next
are involved with its regulation, the most notable of which
phase, identified here as the Localized Tissue Priming
are dietary intake and daily utilization. Regular resistance
phase. Additionally, the prostaglandin PGE2 will work to
training depletes arachidonic acid stores, replacing it with
increase local nitric oxide levels, which is also an active
other, more abundant, fatty acids.337 With less arachidonic
molecule in the anabolic process. It has such actions as
acid available, the responsiveness of the prostaglandin
William Llewellyn's ANABOLICS, 10th ed.
system to regular exercise starts to diminish.338 Have you
To put it in perspective, we need to remember that there
ever wondered why you were so sore when you first start
are two separate components that interact before any
training, or after you took a long break? Or why those early
message is sent to a muscle cell telling it to increase
workouts tended to be so much more productive than later
growth. We have a hormone or growth factor on one
ones, where you struggle to notice even moderate soreness?
hand, such as testosterone, IGF-1, MGF, or insulin, and its
Much of this is directly tied to your arachidonic acid
corresponding receptor on the other. Injecting exogenous
stores. The more arachidonic acid you have, the easier it is
anabolic drugs facilitates greater receptor binding and
to liberate during training, and vice versa.Thankfully, levels
anabolic signaling by providing more messenger
can be augmented with dietary intervention (for more
hormones/growth factors (obviously).
information, see the arachidonic acid profile).
hormones or growth factors you have around the cell, themore binding and activation of receptor sites will take
Phase II: Localized Tissue Priming
place. We cannot forget, however, that having morereceptor sites (instead of more hormones) can also
Phase II is characterized by a localized increase in growth
facilitate the process too. More receptors mean the
factor expression and tissue sensitivity to anabolic
existing hormones or growth factors will find them faster.
hormones. Those who have always wondered why
Faster binding means the anabolic message is sent more
anabolic drugs do not work without training will find a
quickly, and once completed that the anabolic messenger
good explanation right here. Simply put, your muscles
will be more likely to find another receptor site (to send
need to be primed for the actions of these drugs first. One
another message) before it is broken down by enzymes. It
way the body accomplishes this is to increase the density
is all about how much signal can be sent in a given time
of certain receptors in those specific muscles (fibers really)
period, and both sides of the equation are equally
where it needs to initiate repair. This includes, among
important in determining this.
others, androgen, IGF-1, MGF, and insulin receptors.
Stretch-induced muscle damage and the Phase I response
While on one hand we have an increase in tissue
are both principle triggers here. Receptor density
sensitivity to anabolic hormones and growth factors, also
regulation is important because it prevents anabolic
vital during the Localized Tissue Priming phase is an
hormones from stimulating tissue growth in areas of the
increase in the localized expression of certain vital growth
body that do not require it. Receptor density can,
factors themselves. This includes IGF-1, MGF, FGF, HGF, TNF,
therefore, be as strong a regulating force on the
IL-1, and IL-6. These compounds will be released, and will
pharmacological activity of anabolic drugs as the serum
work together on the existing damaged muscle fibers and
levels of the drugs themselves.
satellite cells, in a sort of grand symphony of muscleanabolism, with each playing its own vital role in the
Focus on eccentric movement
Note: Inhibition of the cyclooxygenase-2 enzyme with
anti-inflammatory drugs like ibuprofen,
acetaminophen, or aspirin, prevents the formation of
active prostaglandins. The anabolic cascade is stalled
Catabolizes outer phospholipid layer
without sufficient prostaglandin formation (Am J
Physiol Endocrinol Metab 282:E551-6), interfering
with the normal increase in protein synthesis rates
after exercise. It is often advised to use such drugs
Arachidonic Acid Release
only when necessary if muscle growth is a key focus.
The body's core anabolic lipid
And other active end products
of arachidonic acid
William Llewellyn's ANABOLICS, 10th ed.
process. In many cases, the actions of one compound will
increases protein synthesis, and supports the proliferation
support the other, either by enhancing its levels,
and differentiation of satellite cells. The prostaglandin
suppressing restricting binding proteins, or supporting its
PGF2alpha is known to strongly up-regulate local IGF-I
signaling via intertwined mechanisms. A detailed
receptor expression.342 343 PGE2 is also believed to play a
roadmap to all such interactions would go well beyond
role in increasing local IGF-1 synthesis.344
the scope of this book, and in fact are as of yet not even
Insulin-Like Growth Factor II (IGF-II): IGF-II is a second
fully understood to science. A general overview of what is
insulin-like growth factor that plays a role in the
going on with each compound itself, however, is provided
proliferation of satellite cells. Unlike IGF-I, IGF-II expression
in our review of Phase III.
does not appear to drastically increase in response to
Phase III: Repair
Mechano-Growth Factor (MGF): Mechano-Growth
Your local muscle tissues are primed during Phases I and
Factor is a recently discovered variant of Insulin-Like
II. During Phase III, the hormones and growth factors go to
Growth Factor I. This growth factor is produced during an
work to finish the job. We categorize this phase as one of
alternate splicing sequence of the IGF protein, and plays a
ongoing anabolic action, action mediated by the
strong role in the support of myoblast proliferation. MGF
combined effects of many anabolic hormones and growth
expression, like many of the growth factors discussed
factors including androgens, insulin, IGF-1, IGF-2, MGF, FGF,
here, is strongly up-regulated in muscle tissue in response
HGF, TNF, IL-1, and IL-6. This is the time when repair and
to stretch stimulus.346
hypertrophy are physically taking place in your muscles,and each compound will play an intricate role in the
Fibroblast Growth Factor (FGF): FGF is actually a family
process. We must not forget, however, that everything
of growth factors, with nine different isoforms (FGF-1
leading up to this point (the actions in Phase I & II) has still
through FGF-9). The full role that FGF plays in muscle
been determining how strong the growth response will be,
hypertrophy in adulthood is not fully understood,
via modifying receptor densities and hormone/growth
however, it is believed to be a strong proliferator of
factor expression. We will follow the individual actions of
satellite cells, serving to expand their population.347 FGF's
the anabolic components very closely here. During the
may also play a role in cell differentiation. As with many
third phase, tissue repair and growth will be finalized with
growth factors, FGF expression up-regulation is
the help of the following hormones and growth factors.
proportional to the degree of tissue damage.348 FGF-2 andFGF-4 seem to be the most prolific representatives of this
Hepatocyte Growth Factor (HGF): HGF is a heparin-
family in mature muscle tissue.
binding growth factor that resides on the outer surface ofuninjured cells. Upon injury, it migrates to satellite cells
Insulin: In addition to having some ability to increase
where it triggers their activation and entry into the cell
protein synthesis and inhibit protein breakdown, insulin is
cycle.339 HGF expression is regulated via nitric oxide
the body's chief nutrient transport hormone. The actions
release,340 which is stimulated upon injury to also aid in
of insulin allow cells to transport glucose and amino acids
the flow of nutrients and hormones to the area. PGE2
through the plasma membrane. Insulin receptor
plays a pivotal role in nitric oxide synthesis and HGF
expression is strongly up-regulated after traumatic
exercise, so as to provide more immediate nutrition to theaffected area. This up-regulation has been closely linked
Androgens (the hormones that
to the prostaglandin PGE2.349 350
anabolic/androgenic steroids mimic) are strongsupporters of protein synthesis rates in skeletal muscle
Cytokines (IL-1, IL-6, TNF): Cytokines are a group of
tissue. They are also known to stimulate local IGF-1
immunomodulatory compounds, though in the context
expression, so the effects of these hormones extend to the
of this section we are loosely referring to them as growth
satellite cell cycle (perhaps explaining why they are such
factors. The IL cytokines are called interleukins, and TNF is
strong stimulators of muscle growth). It is also of note that
short for Tumor Necrosis Factor. Among other things,
arachidonic acid increases androgen receptor density in
cytokines are known to stimulate the migration of
skeletal muscle tissue. This helps to further piece together
lymphocytes, neutrophils, monocytes, and other healing
the biochemical links between the Phase I and Phase II
cells to a site of tissue damage, to aid in cell repair. They
help in a number of other ways too, such as aiding in theremoval of damaged cells and regulating certain
Insulin-Like Growth Factor I (IGF-I): IGF-I is an insulin-
inflammatory responses, including the production of
like hormone with marked anabolic effects. Owing to its
some prostaglandins. Prostaglandins are known to play
name, it also has some insulin-like effects as well. IGF-I
important roles in the expression of all three of the
William Llewellyn's ANABOLICS, 10th ed.
cytokines mentioned here,351 352 however, they may not
confounding scientists for decades, and undoubtedly will
be the sole stimulus. Other pathways of arachidonic acid
for decades more. We still have a great way to go before
metabolism may also be involved.
being able to explain fully how it is that musclehypertrophy occurs in humans. But as you can see, we
Prostaglandins: Although these are the key initial
have traveled a great distance as well. During the mid-
reactionary chemicals, prostaglandins continue to play a
1960s, scientists were only first learning that we grow
role throughout the muscle building process (including
muscle with the help of satellite cells. More than forty
Phase III). This includes their support of hormone receptor
years later we have identified, and are experimenting
proliferation, the enhancement of protein synthesis rates,
with, dozens of growth factors that were unheard of back
and an intensification of the anabolic signaling of IGF-1 via a
then. It is a new world today, and despite not having all the
shared pathway (PI3K).353
answers, we know enough to enhance human
Estrogens: Although not specifically highlighted in this
performance in many exciting new ways. But please don't
outline, estrogens also play a minor role in the anabolic
mistake the intention of this section. It is not here to give
process. This includes helping to increase androgen
you a functional roadmap of the entire anabolic process,
receptor density in certain tissues (though perhaps not
or to guide you in the ultimate polydrug program. It is
skeletal muscle), stimulating the GH/IGF-1 axis, and
here simply to open your mind to the true complexity of
enhancing glucose utilization for tissue growth and repair.
anabolism. When we start to see muscle growth from itsvarious angles and intricacies, we begin to see our own
Bringing it All Together
potential opportunities for successful exploitation. Howmany of these opportunities you act upon will depend on
So that, in a very loose nutshell, is what is going on inside
your own goals and interests. But no matter how much or
your body from the time you pick up a weight to the time
how little you actually apply this information, I hope you
your muscles are repaired, stronger, and ready for more. If
feel better equipped by having it.
the above seems confusing to you, it should. The fact is,the whole process of muscle growth has been
Skeletal muscle growth is a complex process that involves a variety of signaling compounds.
William Llewellyn's ANABOLICS, 10th ed.
Anabolic/androgenic steroids are not medically approved
definition. Drugs with low or no significant estrogenicity
to promote excessive muscle mass gains (bodybuilding)
tend to produce less dramatic size gains in comparison,
or improve athletic performance. Aside from early
but the quality is higher, with greater visible muscularity
experimentation on athletes by a handful of sports
and definition. In reviewing the most popular AAS drugs,
physicians, an extensive effort to study the physique- and
we can separate them into these two main categories as
performance-enhancing properties of these drugs,
specifically with an eye on developing strategies for usingthem to maximize benefits and minimize adverse effects,has not been undertaken by the medical community.
Because of this, illicit users have been left to develop their
own protocols for administering these drugs. The result
Methandrostenolone – Oral
has been a large variety of different approaches to usingthese agents, some safer or more effective than others.
Oxymetholone – Oral
While it would not be possible to comprehensively
Testosterone (cypionate, enanthate) – Injectable
evaluate all known approaches, this section will discusssome of the most fundamental and time-proven methodsfor using AAS.
Lean Mass:
Boldenone undecylenate – Injectable
When first considering what steroid(s) to use, one willnotice there are many different medications that fall
Methenolone enanthate – Injectable
under the category of anabolic/androgenic steroids. This
Nandrolone decanoate – Injectable
has been the result of many years of development, wherespecific patients and needs are addressed with drugs that
Oxandrolone – Oral
have specific characteristics. For example, some drugs are
Stanozolol – Oral
considered milder (less androgenic), and produce fewerside effects in women and children. Others are moreandrogenic, which makes them better at supportingsexual functioning in men. Some are injectable
The early stages of AAS use usually involve cycles with a
medications, and others made for oral administration.
single anabolic/androgenic steroid. Building muscle mass
There are limits to this diversity, however. All AAS drugs
is the most common goal, and usually entails the use of
activate the same cellular receptor, and as such share
one of the more androgenic substances such as
similar protein anabolizing properties. In other words,
testosterone, methandrostenolone, or oxymetholone.
while different AAS drugs may have some differing
Those looking for lean mass often find favor in such
properties, if your objective is to gain muscle mass and
anabolic staples as nandrolone decanoate, oxandrolone,
strength, this could be accomplished with virtually any
or stanozolol. First time users rarely welcome injecting
one of the commercially available agents.
anabolic/androgenic steroids, and will usually choose anoral compound for the sake
of convenience.
While all AAS drugs may be capable of improving muscle
Methandrostenolone is the most common choice for
mass, strength, and performance, it would not be correct
mass building, and is almost universally regarded as
to say there are no advantages to choosing one agent
highly effective and only moderately problematic (in
over another for a particular purpose.
terms of estrogenic or androgenic side effects). Stanozolol
fundamentally, the quantity and quality of muscle gained
is the oral anabolic steroid most often preferred for
may be different from one agent to another. In a general
improving lean mass or athletic performance.
sense, AAS that are also estrogenic tend to be moreeffective at promoting increases in total muscle size.These
The potential for adverse reactions should also be
steroids also tend to produce visible water (and
considered when choosing a steroid to use, especially if
sometimes fat) retention, however, and are generally
AAS use is to be regularly repeated. For example, the listed
favored when raw size is more important than muscle
oral medications present greater strain on the
William Llewellyn's ANABOLICS, 10th ed.
cardiovascular system, and are also liver toxic. For these
- Boldenone undecylenate: 200-400 mg/wk
reasons, the injectable medications listed are actually
- Methandrostenolone: 10-30 mg/day
preferred for safety (testosterone most of all). Potentialcosmetic side effects may also be taken into account. For
- Methenolone enanthate: 200-400 mg/wk
example, men with a strong sensitivity to gynecomastiasometimes prefer non-estrogenic drugs such as
- Nandrolone decanoate: 200-400 mg/wk
methenolone, stanozolol, or oxandrolone. Individuals
- Oxandrolone: 10-30 mg/day
worried about hair loss, on the other hand, may isolatetheir use to predominantly anabolic drugs, such as
- Oxymetholone: 50-100 mg/day
nandrolone, methenolone, and oxandrolone. A detailed
- Stanozolol: 10-30 mg/day
review of personal goals, health status, and potential sideeffects of each drug is advised before committing to any
- Testosterone (cypionate, enanthate): 200-
AAS regimen.
There are additional considerations other than the costeffectiveness of a particular dosage. To begin with, high
The dosage used is important in determining the level of
doses of anabolic/androgenic steroids tend to produce
benefit received. Anabolic/androgenic steroids tend to be
stronger negative cosmetic, psychological, and physical
most efficient at promoting muscle gains when taken at a
side effects. In light of diminishing returns, the tradeoff
moderately supratherapeutic dosage level. Below this
between results and adverse reactions becomes less and
(therapeutic), potential anabolic benefits are often
less favorable. Gains made on lower doses also tend to be
counterbalanced, at least to some extent, by the
better retained after steroid discontinuance than those
suppression of endogenous testosterone. At very high
resulting from excessive intake. It is generally not realistic
doses (excessive supratherapeutic), smaller incremental
to expect that rapid double-digit weight gains induced by
gains are noticed (diminishing returns). In the case of
massive dosing will remain long after a cycle is over.
testosterone enanthate or cypionate, for example, a
Slower steadier gains are advised. It is also very important
dosage of 100 mg per week is considered therapeutic, and
to remember that higher doses aren't always what are
is generally insufficient for noticing strong anabolic
needed to achieve greater gains. An individual more
benefits. When the dosage is in the 200-600 mg per week
focused on his or her training and diet will often make
range, however, the drug is highly efficient at supporting
better gains on lower dosages of AAS than a less
muscle growth (moderate supratherapeutic). Above this
dedicated individual taking higher doses. With this
range, a greater level of muscle gain may be noticed, but
understanding, AAS should only be considered when all
the amount will be small in comparison to the dosage
other variables of training and diet have been addressed,
increase. Below are some commonly recommended
and always limited to the minimum dosage necessary to
dosages for the steroids listed earlier.
achieve the next realistic training/performance goal.
Dosage vs. Weight Increase
Figure 1. Anabolic/androgenic steroids tend to be most effective in moderately supratherapeutic doses. The anabolic benefits
diminish in relation to the amount of drug given at both the high and low ends of the dosage range.
William Llewellyn's ANABOLICS, 10th ed.
8-12 weeks. Some AAS abusers have difficulties withcomplete drug abstinence, and will initiate "bridging"
The administration of anabolic/androgenic steroids at a
routines between full-dose cycles. This may involve the
given dosage will typically produce noticeable increases
periodic low-dose administration of an injectable steroid,
in muscle size and strength for approximately 6-8 weeks.
such as 200 mg of testosterone enanthate or
After this point, the rate of new muscle gain typically
methenolone enanthate every 2-3 weeks. Such practice is
slows significantly. A plateau may be reached soon after,
discouraged, however, as it can interfere with hormonal
where all forward momentum has ceased. To continue
recovery, and prevent a return to metabolic homeostasis.
making significant progress beyond this point can entailescalating dosages, which is likely to coincide with a
When concluding a cycle, some steroid users also follow a
greater incidence of adverse reactions and diminishing
practice of first slowly reducing their dosages (tapering).
anabolic returns. Even without dosage escalation,
This tapering may proceed for a 3-4 week period, and will
negative health changes are already likely to be apparent,
involve an even stepping down of the dose each week
and should be corrected fairly quickly. The practice of
until the point of drug discontinuance. It is unknown,
extended or continuous steroid administration is
however, if such tapering offers any tangible value. This
discouraged for these reasons.
practice has never been evaluated in a clinical setting, and
recommended to use AAS drugs for no longer than 8
is not widely recommended with steroid medications as it
weeks at a time (10-12 weeks at the maximum), followed
is with some other drugs such as thyroid hormones or
by an equal or longer period of abstinence before another
Virtually every high-dose AAS
steroid regimen is initiated. This pattern of rotating
administration study can also be found to end at the
between "on" and "off" periods is referred to as cycling.
maximum dosage, with no time allotted to tapering. Oneflaw in the logic of using a tapering program is that they
Off-Cycle (Recovery, Bridging, and
are ostensibly designed to aid hormone recovery.
Recovery is not possible,
supraphysiological levels of androgens are present, and
The period immediately following steroid cession can
such levels are usually found during all weeks of a normal
involve a state of hypogonadism (low androgen levels),
(nonmedical) steroid taper. Individuals remain cautioned
and as a result protein catabolism. In an effort to minimize
that dosage tapering is not a proven way to reduce post-
muscle loss, the objective here is usually on restoring
cycle muscle catabolism.
natural testosterone production, maintaining an optimallevel of muscle stimulation, and remaining dedicated to
proper nutrition. A hormonal recovery program is usuallyinitiated, which may involve the use of HCG, tamoxifen,
individuals become more
and clomiphene (see PCT: Post Cycle Therapy). A
anabolic/androgenic steroid use they may begin
substantial off-cycle period is also advised, involving
experimenting with the use of more than one steroid at a
abstinence from anabolic/androgenic steroids for at least
time. This practice is referred to as stacking. Stacking is
Duration vs. Weight Increase
Week of Intake - / +
Figure 2. Anabolic/androgenic steroids tend to be most effective at a given dosage for approximately 6-8 weeks. After this
point, the rate of new muscle gain will slow, and soon after will usually hit a full plateau.
William Llewellyn's ANABOLICS, 10th ed.
most common with advanced bodybuilders who find that
specifically designed to emphasize muscle-building
at a certain level of physical development they begin
properties, but is repeatedly noticed by users. The reason
hitting plateaus that are difficult to break with a previous
the basic androgenic steroids are more anabolically
single-agent approach. In many cases, however, it may
productive is not fully understood, but is believed to
simply be the greater cumulative steroid dosage that is
involve the interplay of estrogenic hormones, androgenic
necessary for the resumed progress. Stacking usually
stimulation in the central nervous system, and potentially
involves the combination of a more androgenic steroid
other unidentified synergisms necessary for optimal
with one or more primarily anabolic agents. On the
muscle growth.
anabolic side, common steroids of choice include
Today, the availability of drugs that can reduce estrogenic
boldenone, methenolone, nandrolone, oxandrolone, and
activity makes the continued use of single agent cycles
based on a strong androgen like testosterone enanthate
methandrostenolone will serves as the androgenic base
or cypionate much more viable than it was decades ago.
of most stacks.
Side effects like gynecomastia and water retention can
The reasons for stacking androgenic and anabolic steroids
now be effectively minimized with anti-estrogens or
together in this manner are two fold. On the one hand,
aromatase inhibitors, even when taking higher doses.
high doses of testosterone,
Individuals should be aware that stacking is, likewise, not
methandrostenolone are prone to producing strong
a necessary practice. It is likely to remain commonly
androgenic and estrogenic side effects. Stacking first
applicable in competitive bodybuilding circles, however,
became very popular during the 1960s, a time when
or when an individual is sure they have progressed as far
effective estrogen maintenance drugs were not widely
as they possibly can with a single-agent approach.
available. An anabolic-androgen stack allowed the use of
for many athletes and recreational
a higher total steroid dosage than would be tolerable with
bodybuilders, the periodic use of a single steroid will be
a single androgen. Anabolic-androgen pairing also
more than sufficient to maintain optimal levels of muscle
appears to offer efficacy advantages over the use of
mass and performance, and it may never be necessary to
primarily anabolic agents alone, even when they are taken
deviate from this approach.
in higher doses. This conflicts with the originalexpectations for "anabolic" steroids, which were
William Llewellyn's ANABOLICS, 10th ed.
Sample Steroid Cycles
The following cycles are presented as examples of common steroid administration protocols. These programs have notbeen evaluated in a clinical setting for safety and efficacy, and are provided for informational purposes only. These are notrecommendations for anabolic/androgenic steroid use. As with any supplemental drug program, it is important to examineyour own individual health status, health risks, and performance goals before deciding to engage in anyanabolic/androgenic steroid use. For those who have made the decision, it is important to emphasize again that therecommended approach to AAS use is to limit drug intake to the lowest levels necessary to achieve the next rational goal.
More aggressive cycles should not be attempted unless one is sure they cannot achieve the results needed on a moremoderate program. Note that given the difficulty in predicting androgenic threshold and dosages for female users, thebelow cycles are examples of programs for men only.
Single Agent Cycles
Dianabol Cycle #1 (Mass)
100 tablets 5 mg Methandrostenolone
All Weeks:
Liver Support: Liver Stabil, Liv-52, or Essentiale Forte (label recommended dosage).
Cholesterol Support: Lipid Stabil (3 caps/day) and Fish Oil (4 g/day).
Estrogen Support: tamoxifen (10-20 mg/day).
This is a very common first cycle for building muscle mass, and utilizes a single standard bottle ofmethandrostenolone. This cycle is likely to produce very noticeable muscle growth in a first-timesteroid user, often in excess of 8-10lbs of weight gain. This is usually not accompanied by significantvisible side effects such as gynecomastia and water retention. Although this is considered a beginner'scycle, methandrostenolone is a c-17 alpha alkylated oral steroid, and presents significant cardiovascularand liver toxicity. The repeated use of such drugs should be limited.
William Llewellyn's ANABOLICS, 10th ed.
Stack Cycles
Deca/Dianabol Cycle #1 (Mass)
10 mL 200 mg/mL nandrolone decanoate
100 tablets 5 mg methandrostenolone
All Weeks:
Liver Support: Liver Stabil, Liv-52, or Essentiale Forte (label recommended dosage).
Cholesterol Support: Lipid Stabil (3 caps/day) and Fish Oil (4g/day).
Estrogen Support: tamoxifen (20-40 mg/day).
This is an extremely old and widely repeated steroid combination, based on the predominantly anabolic steroid nandrolone decanoate. Methandrostenolone serves as the androgenic component of this stack, and is added during week 3, which is a time that side effects of reduced androgenicity (with the exclusive use of nandrolone decanoate) are commonly noticed, such as loss of libido and sexual dysfunction. The doses used in this cycle are not high by most bodybuilding standards, but are sufficient to impart a noticeable increase in muscle size and strength.
William Llewellyn's ANABOLICS, 10th ed.
Deca/Dianabol Cycle #2 (Mass)
20 mL 200 mg/mL nandrolone decanoate
200 tablets 5 mg methandrostenolone
All Weeks:
Liver Support: Liver Stabil, Liv-52, or Essentiale Forte (label recommended dosage).
Cholesterol Support: Lipid Stabil (3 caps/day) and Fish Oil (4g/day).
Estrogen Support: tamoxifen (20-40 mg/day).
A more popular manifestation of the Deca/Dianabol Cycle, with more commonly accepted dosages for a moderately experienced steroid user. Incidences of side effects are expected to be higher at these dosages, although overall this stack is likely to be less problematic than a combination of testosterone and oxymetholone.
William Llewellyn's ANABOLICS, 10th ed.
Testosterone/Anadrol Cycle (Mass)
20 mL 200 mg/mL testosterone (enanthate or cypionate)
100 tablets 50 mg oxymetholone
All Weeks:
Liver Support: Liver Stabil, Liv-52, or Essentiale Forte (label recommended dosage).
Cholesterol Support: Lipid Stabil (3 caps/day) and Fish Oil (4g/day).
Estrogen Support: tamoxifen (20-40 mg/day).
A combination of testosterone and oxymetholone is generally regarded as the most potent 2-drug stack for gaining raw muscle mass. Both drugs will present significant estrogenicity, and will be likely to induce gynecomastia quickly unless an estrogen maintenance drug such as tamoxifen is used.
Inexperienced steroid users have been known to gain over 25-30 pounds on a cycle such as this. Water retention will be very high with this stack, however, and a rapid loss of water weight (possibly up to 10 pounds or more) is expected soon after the cycle is discontinued.
William Llewellyn's ANABOLICS, 10th ed.
Harm Reduction / Safer Use Guidelines
Harm reduction is a concept among healthcare workers
harm reduction principles can (and should) also be
that seeks to reduce the negative health consequences of
developed for steroid users, a group that rarely has the
drug abuse. The principles of harm reduction call for an
benefit of full physician oversight in its drug programs. In
acceptance of the fact that, good or bad, illicit drugs exist
an effort to further this goal, ANABOLICS has outlined the
in today's society. Instead of ignoring drug users, harm
following principles of steroid harm reduction. If followed,
reduction practitioners actively work with them to
these principles should measurably reduce the negative
promote safer use strategies and decrease the health
health impact of steroid use, making it a safer (although
damage of drug abuse. The effort of harm reduction is
not completely safe) practice.
always helping, not judging, the individual. Althoughpreviously focused exclusively on narcotic drugs of abuse,
Principles of Anabolic Steroid Harm Reduction
1. Avoid Counterfeit and Underground
arteries. Over time this may increase the risk of
Steroids. Anabolic steroids produced by illicit
heart disease. C-17 alpha alkylated steroids are
manufacturers are often of low quality, and may
also the drugs exclusively associated with strong
present additional health risks to the user
liver stress and (rarely) liver cancer. If injection can
beyond what are presented by the steroids
be tolerated, and moderate physique or
themselves. Even if they contain actual steroids in
performance improvement is the goal, all of the
properly labeled doses, underground drugs may
same results can be achieved without oral
contain toxic heavy metals, use dirty raw
steroids. Note that injectable forms of otherwise
materials, or even carry bacterial, viral, and other
oral steroids (such as stanozolol and
forms of contamination. Pharmaceutical drug
methandrostenolone) should also be avoided, as
purity is assured to the public only by an
they provide a similar level of hepatic and
extremely costly, tedious, and methodical process
cardiovascular strain regardless of the differing
of quality assurance and government oversight.
route of administration.
There is little financial and even logistical
3. Think of Testosterone First. Of all the
incentive for most underground drug makers to
anabolic/androgenic steroids produced,
produce their drugs at such high levels of purity.
testosterone esters like cypionate, enanthate, and
Counterfeit and underground drugs are not
Sustanon tend to have the lowest negative
considered equal substitutes for real
impact on health when taken in muscle building
pharmaceutical products, and should be avoided.
and performance-enhancing doses. Testosterone
2. Avoid Toxic Oral Steroids. Aside from Andriol,
drugs provide a hormone identical to that
Primobolan, and Proviron, every oral steroid
already produced in the body, presenting the
discussed in this reference book is a c-17 alpha
same spectrum of physical and physiological
alkylated compound and should be avoided
effects. In addition to being one of the most
whenever possible. While there may be a number
efficient muscle-builders available, testosterone
of clinical reasons to prescribe such a drug, when
generally has a positive (not negative) effect on
used in the higher doses necessary for muscle
supports a positive mood,
growth these agents tend to have significant
supplements necessary estrogen so that
negative impacts on certain health markers.Their
cholesterol levels are less negatively shifted. The
most notable effect is to increase the ratio of LDL
exclusive use of testosterone drugs for body or
(bad) to HDL (good) cholesterol in the body,
performance enhancement is advised if possible.
which favors increased plaque deposition in the
William Llewellyn's ANABOLICS, 10th ed.
4. Limit Yourself to the "Safest" Drugs. If the
developing long-term fertility and hormonal
exclusive use of an injectable testosterone is not
issues, which are sometimes caused by the
feasible, limiting use to the safest group of
uninterrupted use of steroids for many months or
steroids is advised. Of the injectable class, the
years. Cycling also lets your general markers of
following drugs have the lowest cardiovascular
health (such as cholesterol levels, hematocrit, and
strain and are recommended: Deca-Durabolin
blood pressure) return to their normal state
(nandrolone decanoate), Durabolin (nandrolone
periodically, reducing the impact temporary
Equipoise (boldenone
changes may have over time. Those individuals
and Primobolan Depot
who use anabolic/androgenic steroids for long
(methenolone enanthate). If an oral steroid is
periods of time without interruption run a greater
desired, only Andriol, Primobolan, or Proviron
risk that these negative changes in health
should be used. These drugs are not c-17 alpha
markers will result in long-term health issues.
alkylated, and can all provide additional steroid
7. Use Reasonable Dosages. High doses of
activity without the same level of cardiovascular
steroids are not necessary to achieve significant
and hepatic strain seen with other common oral
muscle growth, especially if moderate physique
steroids including Anadrol (oxymetholone),
or performance enhancement is desired. A
Anavar (oxandrolone),
dosage limit of 400 mg per week on injectables is
(methandrostenolone), and Winstrol (stanozolol).
advised. In the case of testosterone cypionate,
Use Health Support Supplements.
400 mg per week equates to at least 4 to 5 times
Anabolic/androgenic steroid users can help lower
the level of hormone naturally produced in a
the negative health impact of steroid use with the
healthy male body. This level of use will produce
consumption of natural health support
dramatic muscle gain if combined with proper
supplements. To begin with, the negative
training and diet. In fact, during the 1970s and 80s
cardiovascular effects of these drugs can be offset
the dosage range of 200-400 mg per week was
(at least to some degree) with cholesterol
considered "standard" for the bodybuilding use of
supplements. Fish oil is recommended as a base,
which should be stacked with a number of other
methenolone. There is actually little real need for
clinically studied cholesterol support ingredients
extreme doses of 750-1,000 mg or more of
including green tea, garlic powder, resveratrol,
steroid per week, or to supplement an injectable
phytosterols, niacin, and policosinol. The blended
base with additional orals. High doses may
product Lipid Stabil (Molecular Nutrition)
produce a faster rate of gain, but are generally not
includes these ingredients and is recommended.
cost effective for the extra muscle they provide.
Cholesterol support supplements should be
Additionally, high doses of steroids greatly
taken at all times during anabolic steroid therapy.
increase cardiovascular strain and the incidence
Next, those taking oral steroids should be
of other side effects.
reducing liver strain with a liver support
8. Avoid Aromatase Inhibitors. Aromatase-
supplement. Recommended products include
inhibiting drugs counter estrogenic side effects
Liver Stabil (Molecular Nutrition),
by preventing the production of estrogen in the
(Himalaya Drug Company), and Essentiale Forte
body. While an effective practice, they also
(Aventis). One of these products should be taken
deprive the body of a hormone that is important
at all times during therapy with hepatotoxic
to cardiovascular health. In particular, estrogen
supports the production of good (HDL)
6. Always Cycle Steroids. A steroid cycle usually
cholesterol, which means that aromatase
consists of 6 to 12 weeks of drug use followed by
inhibitors may inadvertently increase the
an equal period of time or more abstaining from
cardiovascular strain of a steroid cycle. If
all anabolic/androgenic steroids. This practice is
estrogenic side effects are apparent and a
advised for a number of reasons. For one, as you
reduction or elimination of the offending
supplement male steroid hormones your body
steroid(s) is not considered an option, the SERM
will reduce the production of its own
(Selective Estrogen Receptor Modulator) drug
testosterone. Cycling helps reduce the risk of
Nolvadex could be used instead. This drug offers
William Llewellyn's ANABOLICS, 10th ed.
partial estrogenic action in the liver, which may
12. Watch Your Diet. Anabolic/androgenic
allow it to counter estrogenic side effects without
steroids can allow an individual significantly
the same negative shift in cholesterol.
more latitude with their diet than normal. Thecaloric demand typically increases due to the
9. Get Regular Blood Tests. Comprehensive
effects of these drugs on muscle mass and
blood testing including an examination of
metabolism, allowing more calories to be
hormones, cholesterol, blood cell concentrations,
consumed each day without adding fat mass. It is
and enzymes is the most useful tool for assessing
important not to let this latitude affect your
the negative health impact of steroid use.
health in a negative way. Remember, the use of
Changes in cholesterol, for example, can help
steroids at physique- and performance-
quantify for the user what effect a particular drug
enhancing doses is expected to cause an
regimen is having on their cardiovascular health.
unfavorable shift in cholesterol levels and other
The individual then has the opportunity to better
cardiovascular health markers, favoring a higher
assess long-term risk if this cycle is to be
risk of cardiovascular disease. Simultaneously
repeated. At a minimum, blood testing should be
feeding your body greater amounts of saturated
conducted before a cycle is initiated, 3 to 4 weeks
fats, cholesterol, and simple carbohydrates can
into a cycle, and a couple of months after a cycle.
make the impact of these drugs even worse. Diets
This allows for 1) a baseline for later comparison;
low in saturated fats, cholesterol, and simple
2) a snapshot of the on-cycle health impact; and
sugars are recommended, and are known to
3) an opportunity to assess if natural homeostasis
reduce cardiovascular disease risk. Note, however,
has been restored post-cycle.
that diet alone is not effective at countering the
10. Use Proper Injection Procedures. Careful
negative cardiovascular effects of steroid use, but
attention to correct injection procedures can
dietary restrictions can reduce these risks.
help eliminate some of the complications
13. Always Consider Reward AND Risk. It can
associated with nonmedical steroid use. Steroids
be easy to ignore the potential health impact of
are given via deep intramuscular injections. The
steroid use when the positive benefits are so
most common site of application is the upper
rapid and the negative consequences so remote.
outer quadrant of the gluteus muscle, although
At the end of the day, however, it is very
the drugs are also commonly injected to the
important to remember that the use of steroids in
upper outer thigh and shoulder. Site injections (in
doses sufficient to support short term muscle
smaller muscle groups like the biceps, triceps, or
gain are virtually always going to have some
calf muscles) for cosmetic purposes are
negative impact on your body. Your cholesterol
discouraged, as they are technically more difficult
will shift in an unfavorable direction, your blood
to navigate and more prone to complications.
pressure may go up a little bit, and you may ever
Comfortable injection volumes should also be
so slightly thicken the ventricles in your heart.
used, generally no more than 3 mL per
Your hormones are out of balance when you take
application. Each injection site should be rotated
steroids, which will invariably cause other things
so that the same muscle is not injected more
to go out of balance. Steroid use is rarely
than once every two weeks. A general focus
dangerous over a short term period. These
should be made on cleanliness, including the use
hormonal drugs are acutely very safe. As use
of alcohol pads on the vials and skin before
continues over the years, however, these short-
injection, and the proper disposal of all needles
term periods accumulate, and total on-cycle time
and empty vials/ampules after use.
may become very long. Always remember to
11. Sterilize. Though never advised, should the
consider the risks as well as the rewards of each
choice be made to use an injectable steroid of
cycle. Choosing your drug program carefully and
underground origin, an effort should be made to
keeping the negative effects of steroid use in
sterilize the solution before use. This will reduce
check over the short term is the best way to
the likelihood of illness or infection due to
reduce long term risks.
William Llewellyn's ANABOLICS, 10th ed.
This section pertains to methods for differentiating
these steps entirely. Real ampules, vials, and tablets are
between legitimate pharmaceutical products and
sometimes smuggled loose, but let someone else take the
illegitimate copies (counterfeits). Before we begin, I need
risk. The box for a pharmaceutical product should be
to remind you that counterfeiting anabolic steroids is a
structurally sound, closing tightly and evenly. Some
very lucrative business these days. Counterfeiters are
counterfeiters seal their own boxes by hand, and they may
investing a lot of money in printing and packaging
be uneven or poorly glued. Real boxes should be printed
equipment so that you'll have a hard time picking out
(ink directly on cardboard). Some counterfeiters cover
their products. Furthermore, there are now many large
plain white boxes with stickers. If the vial, ampule, or bottle
"commercial scale" counterfeiting operations, with the
has a label, machines should have put it on straight.
capacity to manufacture all product formats including
Counterfeiters often apply labels by hand, so many will be
ampules, logo imprinted pills, and push-through tablet
crooked. Some counterfeiters use ampules, but blank
strips. Given this high level of sophistication, steroids
laboratory samples. These are filled by hand and sealed
purchased on the black market need to be inspected with
over a flame. They are a bit larger than the average
great care. The mistakes made by counterfeiters are often
ampule, and somewhat unusual in appearance. A good
minor, and noticed in the fine (not obvious) detail.
rule of thumb is to avoid any steroid that does not comein a professional looking package.
Step #1: Eliminate the Obvious
When counterfeit steroids first appeared decades ago,they were often very easy to spot. The manufacturersoperated on a small scale, and made small-scale mistakes.
For example, the printing might be sloppy, or the
The ampule [right] is a
containers thin and flimsy. They might have lacked the
laboratory blank, meant to be
equipment to put the product in a box, or even affix an
sealed by hand over a flame. It is
expiration date and lot number to it. No legitimate
larger and more unusual in
pharmaceutical would be sold like this. Much has changed
appearance than most
over the years, however. Few counterfeiters still make the
basic mistakes that were once common. Don't expectidentifying these products to be easy. Still, that is not tosay that obvious counterfeits aren't available. Indeed, theycan be found on the black market from time to time. Thisfirst set of instructions, therefore, seeks to eliminate onlythe most obvious fakes. For the rest, we will need a moredetailed analysis.
3. Multi-dose Containers. In the United States, we are
used to our injectable medications coming in multi-dose
1. Sloppy Printing. Drug manufacturing is not a small
vials (these have a rubber top to let needles pass through
scale endeavor. Sizable pharmaceutical companies control
more than once), and our pills loose in bottles. Most other
the global drug trade, and make products that are
countries, however, do not allow this type of packaging for
typically very professional in appearance. You should not
human medicines. They consider it unsterile, and permit it
expect to see things like runny inks, sloppy lines, or
only for animal drugs. Instead, they require each dosage
misaligned images on real drug packaging. Sometimes
unit to be separate. This usually means break open glass
counterfeiters still use cheap (small-scale) printing and
ampules for injectable medications, and push through
reproduction methods, which make labels and boxes that
blisters for pills and capsules. Since you are unlikely to find
stand out as sloppy. Don't ever use a product if it just
real American products on the black market, it may be
doesn't "look right" to you. You are probably
best to avoid all multi-dose containers when it comes to
subconsciously picking up on minor deviations.
human pharmaceuticals. Most are going to be counterfeit.
When you find veterinary drugs in multi-dose containers,
2. Cheap Packaging. Virtually all legitimate steroid
extra care should be taken to examine them closely, since
products come in boxes. Inside the box you should find a
these products are more easily counterfeited.
drug information sheet. Some counterfeiters will skip
William Llewellyn's ANABOLICS, 10th ed.
The photographs below show what it looks like when thelot number and expiration date are added after the initialbox/label printing, as well as counterfeit products withoutthis feature. The characters on a real pharmaceuticalproduct should stand out from the rest of the printing,which will consist of tiny dots blended together to createa solid image (see Step #3 for more information on theink). When the lot/expiration information is added with amechanical stamp, the ink will be much more solid undermagnification (note that it may appear blotchy underdeep magnification). Depending on the equipment, it mayalso have left a physical indent you can feel when rubbingyour thumb over the information. When the dates wereadded by computer, we usually see large dots that are
The above is a crude copy of an American testosterone
visible to the naked eye. Be careful to look at the
product, which uses the same label on the box and vial. A
characters closely. Counterfeiters will try to make the
counterfeit as simple as this is rare to find today.
information look like it was added by machine orcomputer, even though it was printed. If you see that tinydots make up the characters under 200X magnification, itis not legitimate stamp or computer printing.
Another example of an obvious counterfeit. This box is
crude in design and uses a brand name that has been off
the market since the 1980s.
Step #2: Examine Lot Number/Expiration
A more formal analysis should always begin with the lotnumber/expiration date. Pharmaceutical companies havetheir boxes and labels manufactured in bulk, usually at anoffsite printing facility. They are not serialized; lotnumbers/expiration dates have not yet been applied to
them. This information is added with a mechanicalstamping machine or computer/inkjet printer at the timethe drug is packaged. Counterfeiters often don't wait, and
Example #1. A real box of Proviron. Under magnification we
simply print the lot number/expiration date with the rest
can see that the lot number and expiration date were
of the boxes and labels. This means less work, less
stamped on mechanically.
equipment, and less cost. Knowing this, examining the lotnumber/expiration date information can be a good wayto spot counterfeits. You need to look at the lot/dateinformation very closely, preferably with a handheldmicroscope with 100-200X magnification.
William Llewellyn's ANABOLICS, 10th ed.
Example #2. Another example of mechanical stamping of
the lot number and expiration date.
Example #4. Another real product (Proviron) with
information applied post-printing with a computer printer.
Example #3. Real testosterone cypionate from Watson (U.S.)
The above lot/expiration date were added by computer
printer. Under magnification we see the large dots are solid
ink.
Example #5. (Counterfeit). At first glance the slight run on
the ink appears to be the result of mechanical stamping.
Under magnification, however, we see this is simulated.
William Llewellyn's ANABOLICS, 10th ed.
Methyltestosterone (oral)
weight gain following surgery, chronic infection, trauma, orweight loss without definite pathophysiologic reason. In
Oxandrolone is an oral anabolic steroid derived from
spite of its ongoing track record of safety, Searle decided to
dihydrotestosterone. It was designed to have a very strong
voluntarily discontinue the sale of Anavar on July 1, 1989.
separation of anabolic and androgenic effect, and no
Lagging sales and growing public concern about the
significant estrogenic or progestational activity.
athletic use of anabolic steroids appeared to be at the root
Oxandrolone is noted for being quite mild as far as oral
of this decision. With the Anavar brand off the market,
steroids are concerned, well tailored for the promotion of
oxandrolone had completely vanished from U.S.
strength and quality muscle tissue gains without
pharmacies. Soon after, oxandrolone products in
significant side effects. Milligram for milligram it displays as
international markets (often sold by or under license from
much as six times the anabolic activity of testosterone in
Searle) began to disappear as well, as the leading global
assays, with significantly less androgenicity.421 This drug is
manufacturer of the drug continued its withdrawal from
a favorite of dieting bodybuilders and competitive athletes
the anabolic steroid business. For several years during the
in speed/anaerobic performance sports, where its
early 1990's, it looked as if Anavar might be on its way out
tendency for pure tissue gain (without fat or water
of commerce for good.
retention) fits well with the desired goals.
It would be approximately six years before oxandrolone
tablets would be back on the U.S. market. The product
Oxandrolone was first described in 1962.422
returned to pharmacy shelves in December 1995, this time
developed into a medicine several years later by
under the Oxandrin name by Bio-Technology General
pharmaceutical giant G.D. Searle & Co. (now Pfizer), which
Corp. (BTG). BTG would continue selling it for the FDA
sold it in the United States and the Netherlands under the
approved uses involving lean mass preservation, but had
Anavar trade name. Searle also sold/licensed the drug
also been granted orphan-drug status for the treatment of
under different trade names including Lonavar (Argentina,
AIDS wasting, alcoholic hepatitis, Turner's syndrome in
Australia), Lipidex (Brazil), Antitriol (Spain), Anatrophill
girls, and constitutional delay of growth and puberty in
(France), and Protivar. Oxandrolone was designed to be an
boys. Orphan drug status gave BTG a 7-year monopoly on
extremely mild oral anabolic, one that could even be used
the drug for these new uses, allowing them to protect a
safely by women and children. In this regard Searle seems
very high selling price. Many patients were outraged to
to have succeeded, as Anavar has shown a high degree of
learn that the drug would cost them (at wholesale price)
therapeutic success and tolerability in men, women, and
between $3.75 and $30 per day, which was many times
children alike. During its early years, Anavar had been
more costly than Anavar had been just several years back.
offered for a number of therapeutic applications, including
The release of a 10 mg tablet from BTG several years later
the promotion of lean tissue growth during catabolic
did little to reduce the relative cost of the drug.
illness, the promotion of lean tissue growth following
Oxandrin® continues to be sold in the U.S., but is now
surgery, trauma, infection, or prolonged corticosteroid
under the Savient label (formerly known as BTG). It is
administration, or the support of bone density in patients
currently approved by the FDA for "adjunctive therapy to
with osteoporosis.
promote weight gain after weight loss following extensive
By the 1980's, the FDA had slightly refined the approved
surgery, chronic infections, or severe trauma and in some
applications of oxandrolone to include the promotion of
patients who without definite pathophysiologic reasons
William Llewellyn's ANABOLICS, 10th ed.
fail to gain or to maintain normal weight, to offset the
male pattern hair loss.Women are warned of the potential
protein catabolism associated with prolonged
virilizing effects of anabolic/androgenic steroids. These
administration of corticosteroids, and for the relief of the
may include a deepening of the voice, menstrual
bone pain frequently accompanying osteoporosis."
irregularities, changes in skin texture, facial hair growth,
Generic versions of the drug are now available in the U.S. ,
and clitoral enlargement. Oxandrolone is a steroid with
which has reduced the price of oxandrolone therapy.
low androgenic activity relative to its tissue-building
Outside of the U.S., oxandrolone remains available,
actions, making the threshold for strong androgenic side
although not widely.
effects comparably higher than with more androgenicagents such as testosterone, methandrostenolone, or
Oxandrolone is available in select human drug markets.
The low androgenic activity of oxandrolone is due in part
Composition and dosage may vary by country and
to it being a derivative of dihydrotestosterone.This creates
manufacturer. The original Anavar brand contained 2.5
a less androgenic steroid because the agent lacks the
mg of steroid per tablet. Oxandrin contains 2.5 mg or 10
capacity to interact with the 5-alpha reductase enzyme
mg per tablet. Other modern brands commonly contain
and convert to a more potent "di-hydro"form.This is unlike
2.5 mg, 5 mg, or 10 mg of steroid per tablet.
testosterone, which is several times more active in
androgen responsive target tissues such as the scalp, skin,and prostate (where 5-alpha reductase is present in high
Oxandrolone is a modified form of dihydrotestosterone. It
amounts) due to its conversion to DHT. In essence,
differs by: 1) the addition of a methyl group at carbon 17-
oxandrolone has a more balanced level of potency
alpha to protect the hormone during oral administration
between muscle and androgenic target tissues. This is a
and 2) the substitution of carbon-2 in the A-ring with an
similar situation as is noted with Primobolan and Winstrol,
oxygen atom. Oxandrolone is the only commercially
which are also derived from dihydrotestosterone and not
available steroid with such a substitution to its basic ring
known to be very androgenic substances.
structure, an alteration that considerably increases theanabolic strength of the steroid (partly by making it
Side Effects (Hepatotoxicity):
Oxandrolone is a c17-alpha alkylated compound. This
dehydrogenase in skeletal muscle tissue).
alteration protects the drug from deactivation by the liver,
Side Effects (Estrogenic):
allowing a very high percentage of the drug entry into thebloodstream following oral administration. C17-alpha
Oxandrolone is not aromatized by the body, and is not
alkylated anabolic/androgenic steroids can be
measurably estrogenic. Oxandrolone also offers no related
hepatotoxic. Prolonged or high exposure may result in
An anti-estrogen is not
liver damage.
In rare instances life-threatening
necessary when using this steroid, as gynecomastia
dysfunction may develop. It is advisable to visit a
should not be a concern even among sensitive
physician periodically during each cycle to monitor liver
individuals. Since estrogen is the usual culprit with water
function and overall health. Intake of c17-alpha alkylated
retention, oxandrolone instead produces a lean, quality
steroids is commonly limited to 6-8 weeks, in an effort to
look to the physique with no fear of excess subcutaneous
avoid escalating liver strain.
fluid retention. This makes it a favorable steroid to useduring cutting cycles, when water and fat retention are
Oxandrolone appears to offer less hepatic stress than
major concerns. Oxandrolone is also very popular among
other c-17 alpha alkylated steroids. The manufacturer
athletes in strength/speed sports such as sprinting,
identifies oxandrolone as a steroid that is not extensively
swimming, and gymnastics. In such disciplines one usually
metabolized by the liver like other 17-alpha alkylated
does not want to carry around excess water weight, and
orals, which may be a factor in its reduced hepatotoxicity.
may find the raw muscle-growth brought about by
This is evidenced by the fact that more than a third of the
oxandrolone to be quite favorable over the lower quality
compound is still intact when excreted in the urine.424
mass gains of aromatizable agents.
Another study comparing the effects of oxandrolone toother alkylated agents including methyltestosterone,
Side Effects (Androgenic):
norethandrolone, fluoxymesterone, and methandrioldemonstrated that oxandrolone causes the lowest
Although classified as an anabolic steroid, androgenic side
sulfobromophthalein (BSP; a marker of liver stress)
effects are still possible with this substance. This may
retention of the agents tested.425 20 mg of oxandrolone
include bouts of oily skin, acne, and body/facial hair
produced 72% less BSP retention than an equal dosage of
growth. Anabolic/androgenic steroids may also aggravate
fluoxymesterone, which is a considerable difference being
William Llewellyn's ANABOLICS, 10th ed.
that they are both 17-alpha alkylated.
thought to signify potential for this drug as a lipid-lowering agent.426 With further investigation it was found,
A more recent study looked at escalating doses (20 mg, 40
however, that any lowering of total cholesterol values was
mg, and 80 mg) of oxandrolone in 262 HIV+ men.The drug
accompanied by a redistribution in the ratio of good
was administered for a period of 12 weeks. The group
(HDL) to bad (LDL) cholesterol that favored greater
taking 20 mg of oxandrolone per day showed no
atherogenic risk.427 428 This negates any positive effect this
statistically significant trends of hepatotoxicity in liver
drug might have on triglycerides or total cholesterol, and
aminotransferase and alanine
actually makes it a potential danger in terms of cardiac
aminotransferase) values. Those men taking 40 mg
risk, especially when taken for prolonged periods of time.
noticed a mean increase of approximately 30-50% in liver
Today we understand that as a group,
enzyme values, while the group of men taking 80 mg
anabolic/androgenic steroids tend to produce
noticed an approximate 50-100% increase. Approximately
unfavorable changes in lipid profiles, and are really not
10-11% of the patients in the 40 mg group noticed World
useful in disorders of lipid metabolism. As an oral c17
Health Organization grade III and IV toxicity according to
alpha alkylated steroid, oxandrolone is even more risky to
AST and ALT values. This figure jumped to 15% in the 80
use in this regard than an esterified injectable such as a
mg group. While serious hepatotoxicity cannot be
testosterone or nandrolone.
excluded with oxandrolone, these studies do suggest thatit is measurably safer than other alkylated agents.
To help reduce cardiovascular strain it is advised tomaintain an active cardiovascular exercise program and
The use of a liver detoxification supplement such as Liver
minimize the intake of saturated fats, cholesterol, and
Stabil, Liv-52, or Essentiale Forte is advised while taking
simple carbohydrates at all times during active AAS
any hepatotoxic anabolic/androgenic steroids.
administration. Supplementing with fish oils (4 grams per
Side Effects (Cardiovascular):
day) and a natural cholesterol/antioxidant formula such asLipid Stabil or a product with comparable ingredients is
Anabolic/androgenic steroids can have deleterious effects
also recommended.
on serum cholesterol. This includes a tendency to reduceHDL (good) cholesterol values and increase LDL (bad)
Side Effects (Testosterone Suppression):
cholesterol values, which may shift the HDL to LDL
All anabolic/androgenic steroids when taken in doses
balance in a direction that favors greater risk of
sufficient to promote muscle gain are expected to
The relative impact of an
suppress endogenous testosterone production.
anabolic/androgenic steroid on serum lipids is dependant
Oxandrolone is no exception. In the above-cited study on
on the dose, route of administration (oral vs. injectable),
HIV+ males, twelve weeks of 20 mg or 40 mg per day
type of steroid (aromatizable or non-aromatizable), and
caused an approximate 45% reduction in serum
level of resistance to hepatic metabolism. Oxandrolone
testosterone levels.The group taking 80 mg noticed a 66%
has a strong effect on the hepatic management of
decrease in testosterone. Similar trends of decrease were
cholesterol due to its structural resistance to liver
noticed in LH production, with the 20 mg and 40 mg
breakdown, non-aromatizable nature, and route of
doses causing a 25-30% reduction, and the 80 mg group
administration. In the previously cited study in HIV+
noticing a decline of more than 50%. Additionally, studies
males, 20 mg of oxandrolone daily for 12 weeks caused a
on boys with constitutionally delayed puberty have
mean serum HDL reduction of 30%. HDL values were
demonstrated significant suppression of endogenous LH
suppressed 33% in the 40 mg group, and 50% in the 80
and testosterone with as little as 2.5 mg per day.429
This was accompanied by a statistically
Without the intervention of testosterone stimulating
significant increase in LDL values (approximately 30-33%)
substances, testosterone levels should return to normal
in the 40 mg and 80 mg groups, further increasing
within 1-4 months of drug secession. Note that prolonged
atherogenic risk. Anabolic/androgenic steroids may also
hypogonadotrophic hypogonadism can develop
adversely effect blood pressure and triglycerides, reduce
secondary to steroid abuse, necessitating medical
endothelial relaxation, and support left ventricular
hypertrophy, all potentially increasing the risk ofcardiovascular disease and myocardial infarction.
The above side effects are not inclusive. For more detaileddiscussion of potential side effects, see the Steroid Side Effects
At one time oxandrolone was looked at as a possible drug
section of this book.
for those suffering from disorders of high cholesterol ortriglycerides. Early studies showed it to be capable oflowering total cholesterol and triglyceride values incertain types of hyperlipidemic patients, which was
William Llewellyn's ANABOLICS, 10th ed.
drugs. This would be taken for no longer than 4-6 weeks.
Eager females may wish to add another mild anabolic
Studies have shown that taking an oral anabolic steroid
such as Winstrol®, Primobolan® or Durabolin®. When
with food may decrease its bioavailability.430
combined with such anabolics, the user should notice
caused by the fat-soluble nature of steroid hormones,
faster, more pronounced muscle-building effects, but it
which can allow some of the drug to dissolve with
may also increase the likelihood of seeing androgenic side
undigested dietary fat, reducing its absorption from the
effects (or hepatotoxicity in the case of Winstrol).
gastrointestinal tract. For maximum utilization, this steroidshould be taken on an empty stomach.
Pharmaceutical preparations containing oxandrolone arefairly limited. The drug is unavailable in Europe, and with a
The original prescribing guidelines for Anavar called for a
handful of exceptions in the west, its production is
daily dosage of between 2.5 mg and 20 mg per day (5-10
increasingly being shifted to less regulated markets in
mg being most common). This was usually recommended
Asia. In reviewing some of the remaining products and
for a period of two to four weeks, but occasionally it was
changes on the global pharmaceutical market, we have
taken for as long as three months. The dosing guidelines
made the following observations.
recommended with the current U.S. production form ofthe drug (Oxandrin, Savient Pharmaceuticals) also call for
Various forms of generic oxandrolone are now available in
between 2.5 and 20 mg of drug per day, taken in
the U.S. in both 2.5 mg and 10 mg dosages, from
intermittent cycles of 2 to 4 weeks. The usual dosage for
manufacturers such as Par Pharm, Sandoz, Upsher Smith,
physique- or performance-enhancing purposes is in the
range of 15-25 mg per day, taken for 6 to 8 weeks. These
Brand name Oxandrin is still available in the U.S. under the
protocols are not far removed from those of normal
Savient brand name. It comes in bottles of 60 (10 mg)
tablets or 100 (2.5 mg) tablets each.
Oxandrolone is often combined with other steroids for a
The generic Italian product Oxandrolone (SPA) is no
more dramatic result. For example, while bulking one
longer available. It was previously being made for export
might opt to add in 200-400 mg of a testosterone ester
sales only. There are no remaining oxandrolone products
(cypionate, enanthate, or propionate) per week. The result
available on the Italian market.
should be a considerable gain in new muscle mass, with amore comfortable level of water and fat retention than if
Atlantis (Mexico) produces an oxandrolone product called
taking a higher dose of testosterone alone. For dieting
Xtendrol. It carries 2.5 mg of steroid per tablet, and comes
phases, one might alternately combine oxandrolone with
in a box of 30 tablets each.
a non-aromatizing steroid such as 150 mg per week of atrenbolone ester or 200-300 mg of Primobolan®
Asia Pharma makes the product Oxanabolic in Malaysia. It
(methenolone enanthate). Such stacks are highly favored
comes in strips of 10 tablets each, 10 strips per box. Each
for increasing definition and muscularity. An in-between
product should carry a unique product ID code that can
(lean mass gain) might be to add in 200-400 mg of a low
be verified with the company for authenticity. This
estrogenic compound like Deca-Durabolin® (nandrolone
product is presently export only, but the manufacturer
decanoate) or Equipoise® (boldenone undecylenate).
claims to be in the process of seeking Thai FDA approval.
Balkan Pharmaceuticals (Moldova) makes the productOxandrolon. It is prepared in 10 mg tablets, with 20 tablets
The original prescribing guidelines for Anavar did not
contained in each foil and plastic strip.
offer separate dosing recommendations for women,although it was indicated that women who werepregnant, or may become pregnant, should not use thedrug. The current guidelines for Oxandrin also do notmake special dosing recommendations for women.
Women who fear the masculinizing effects of manysteroids would be quite comfortable using this drug, asthese properties are very rarely seen with low doses. Forphysique- or performance-enhancing purposes, a dailydosage of 5-10 mg should illicit considerable growthwithout the noticeable androgenic side effects of other
William Llewellyn's ANABOLICS, 10th ed.
seems to be in the area of patient comfort. Cypionic acid isless irritating at the site of injection than enanthoic acid
Testosterone cypionate is a slow-acting injectable ester of
(enanthate) for a small percentage of patients. This makes
the primary male androgen testosterone. Testosterone is
testosterone cypionate a more favorable choice for those
also the principle anabolic hormone in men, and is the
with recurring issues of injection-site pain with
basis of comparison by which all other
testosterone enanthate. This difference likely had
anabolic/androgenic steroids are judged. As with all
something to do with the early development of this
testosterone injectables, testosterone cypionate is highly
testosterone ester as a commercial drug product.
favored by athletes for its ability to promote strongincreases in muscle mass and strength. It is interesting to
The main use of testosterone cypionate in clinical medicine
note that while a large number of other steroidal
has historically been the treatment of low androgen levels
compounds have been made available since testosterone
in males, although many other applications have existed
injectables, they are still considered to be the dominant
for this drug as well. During the 1960's, for example, the
bulking agents among bodybuilders. There is little
drug's prescribing recommendations called for such uses
argument that these are among the most powerful mass
as supporting bone structure maturity,
drugs available, testosterone cypionate included.
menorrhagia (heavy menstrual bleeding) and excessivelactation in females, and increasing muscle mass and
combating osteoporosis in the elderly. It was also being
Testosterone cypionate first appeared on the U.S. drug
recommended for increasing male fertility, whereby
market during the mid-1950's under the brand name of
induced testosterone/spermatogenesis suppression
Depo-Testosterone cyclopentylpropionate (soon abridged
(caused by administering 200 mg of testosterone
to simply Depo-Testosterone). It was developed by the
cypionate per week for 6 to 10 weeks) was potentially
pharmaceutical giant Upjohn, and is still sold to this day by
followed by a period of rebound spermatogenesis (due to
the same company under the same trade name (although
temporarily higher than normal gonadotropin levels).
now they are called Pharmacia & Upjohn). This is a drug
By the 1970's, the FDA had been granted much stronger
with limited global availability, and has historically been
control over the prescription drug market, and the broad
(largely) identified as an American item. It is not surprising
uses in which testosterone cypionate was first indicated
that American athletes have long favored this form of
were now being refined. For example, "testosterone
testosterone over testosterone enanthate, the dominant
rebound therapy" as a way to increase male fertility was
slow-acting ester of testosterone on the global market.This
proving to be unreliable, especially in the face of newer
preference, however, is likely rooted in history and
more effective medications, and was soon eliminated from
availability, not actual therapeutic advantages.
prescribing guidelines. So too was the recommendation for
Testosterone cypionate and testosterone enanthate
its use to treat things like excessive menstrual bleeding
provide extremely comparable patterns of testosterone
and lactation. In general, testosterone therapy was being
release. Not only are physical advantages not possible in
pulled back to focus mainly on male androgen deficiency,
one over the other,
but actual differences in
and less on other applications, especially when involving
pharmacokinetic patterns are hard to notice (these two
populations more susceptible to androgenic side effects,
drugs are for all intents and purposes functionally
such as women and the elderly.
interchangeable).The only key difference between the two
William Llewellyn's ANABOLICS, 10th ed.
Today, testosterone cypionate remains readily available
Side Effects (Estrogenic):
on the U.S. prescription drug market, where it is FDA-
Testosterone is readily aromatized in the body to estradiol
approved for hormone replacement therapy in men with
(estrogen). The aromatase (estrogen synthetase) enzyme
conditions associated with a deficiency of endogenous
is responsible for this metabolism of testosterone.
testosterone, and as a secondary treatment for inoperable
Elevated estrogen levels can cause side effects such as
metastatic breast cancer in women (although it is not
increased water retention,
widely used for this purpose anymore). Testosterone
gynecomastia. Testosterone is considered a moderately
cypionate is currently available outside of the United
estrogenic steroid. An anti-estrogen such as clomiphene
States, but not widely. Known international sources for the
citrate or tamoxifen citrate may be necessary to prevent
drug include Canada, Australia, Spain, Brazil, and South
estrogenic side effects. One may alternately use an
aromatase inhibitor like Arimidex® (anastrozole), which
more efficiently controls estrogen by preventing itssynthesis. Aromatase inhibitors can be quite expensive in
Testosterone cypionate is available in select human and
comparison to anti-estrogens, however, and may also
veterinary drug markets. Composition and dosage may
have negative effects on blood lipids.
vary by country and manufacturer, but usually contain 50mg/ml, 100 mg/ml, 125 mg/ml, or 200 mg/ml of steroid
Estrogenic side effects will occur in a dose-dependant
dissolved in oil.
manner, with higher doses (above normal therapeuticlevels) of testosterone cypionate more likely to require the
concurrent use of an anti-estrogen or aromatase inhibitor.
Testosterone cypionate is a modified form of testosterone,
Since water retention and loss of muscle definition are
where a carboxylic acid ester (cyclopentylpropionic acid)
common with higher doses of testosterone cypionate, this
has been attached to the 17-beta hydroxyl group.
drug is usually considered a poor choice for dieting or
Esterified forms of testosterone are less polar than free
cutting phases of training. Its moderate estrogenicity
testosterone, and are absorbed more slowly from the area
makes it more ideal for bulking phases, where the added
of injection. Once in the bloodstream, the ester is removed
water retention will support raw strength and muscle size,
to yield free (active) testosterone. Esterified forms of
and help foster a stronger anabolic environment.
testosterone are designed to prolong the window of
Side Effects (Androgenic):
therapeutic effect following administration, allowing for aless frequent injection schedule compared to injections of
Testosterone is the primary male androgen, responsible
free (unesterified) steroid. The half-life of testosterone
for maintaining secondary male sexual characteristics.
cypionate is approximately 8 days after injection.
Elevated levels of testosterone are likely to produceandrogenic side effects including oily skin, acne, andbody/facial hair growth.
Men with a genetic
Pharmacokinetics of Testosterone
predisposition for hair loss (androgenetic alopecia) may
notice accelerated male pattern balding.Those concerned
about hair loss may find a more comfortable option in
nandrolone decanoate, which is a comparably lessandrogenic steroid. Women are warned of the potential
virilizing effects of anabolic/androgenic steroids,
especially with a strong androgen such as testosterone.
These may include deepening of the voice, menstrual
Testosterone 1 0
irregularities, changes in skin texture, facial hair growth,
and clitoral enlargement.
In androgen-responsive target tissues such as the skin,
scalp, and prostate, the high relative androgenicity oftestosterone is dependant on its reduction to
Figure 1. Pharmacokinetics of 200 mg testosterone
dihydrotestosterone (DHT). The 5-alpha reductase
enzyme is responsible for this metabolism of
testosterone. The concurrent use of a 5-alpha reductase
hormone, and follicle-stimulating hormone in serum
inhibitor such as finasteride or dutasteride will interfere
after injection of testosterone enanthate or
with site-specific potentiation of testosterone action,
lowering the tendency of testosterone drugs to produce
Nieschlag E. Fertility and Sterility 33 (1980):201-3.
androgenic side effects. It is important to remember that
William Llewellyn's ANABOLICS, 10th ed.
anabolic and androgenic effects are both mediated via
Due to the positive influence of estrogen on serum lipids,
the cytosolic androgen receptor. Complete separation of
tamoxifen citrate or clomiphene citrate are preferred to
testosterone's anabolic and androgenic properties is not
aromatase inhibitors for those concerned with
possible, even with total 5-alpha reductase inhibition.
cardiovascular health, as they offer a partial estrogeniceffect in the liver. This allows them to potentially improve
Side Effects (Hepatotoxicity):
lipid profiles and offset some of the negative effects of
Testosterone does not have hepatotoxic effects; liver
androgens. With doses of 600 mg or less per week, the
toxicity is unlikely. One study examined the potential for
impact on lipid profile tends to be noticeable but not
hepatotoxicity with high doses of testosterone by
dramatic, making an anti-estrogen (for cardioprotective
administering 400 mg of the hormone per day (2,800 mg
purposes) perhaps unnecessary. Doses of 600 mg or less
per week) to a group of male subjects. The steroid was
per week have also failed to produce statistically
taken orally so that higher peak concentrations would be
significant changes in LDL/VLDL cholesterol, triglycerides,
reached in hepatic tissues compared to intramuscular
apolipoprotein B/C-III, C-reactive protein, and insulin
injections. The hormone was given daily for 20 days, and
sensitivity, all indicating a relatively weak impact on
produced no significant changes in liver enzyme values
cardiovascular risk factors.481 When used in moderate
including serum albumin, bilirubin, alanine-amino-
doses, injectable testosterone esters are usually
transferase, and alkaline phosphatases.478
considered to be the safest of all anabolic/androgenicsteroids.
Side Effects (Cardiovascular):
To help reduce cardiovascular strain it is advised to
Anabolic/androgenic steroids can have deleterious effects
maintain an active cardiovascular exercise program and
on serum cholesterol. This includes a tendency to reduce
minimize the intake of saturated fats, cholesterol, and
HDL (good) cholesterol values and increase LDL (bad)
simple carbohydrates at all times during active AAS
cholesterol values, which may shift the HDL to LDL
administration. Supplementing with fish oils (4 grams per
balance in a direction that favors greater risk of
day) and a natural cholesterol/antioxidant formula such as
The relative impact of an
Lipid Stabil or a product with comparable ingredients is
anabolic/androgenic steroid on serum lipids is dependant
also recommended.
on the dose, route of administration (oral vs. injectable),type of steroid (aromatizable or non-aromatizable), and
Side Effects (Testosterone Suppression):
level of resistance to hepatic metabolism.
All anabolic/androgenic steroids when taken in doses
Anabolic/androgenic steroids may also adversely affect
sufficient to promote muscle gain are expected to
blood pressure and triglycerides, reduce endothelial
suppress endogenous testosterone production.
relaxation, and support left ventricular hypertrophy, all
Testosterone is the primary male androgen, and offers
potentially increasing the risk of cardiovascular disease
strong negative feedback on endogenous testosterone
and myocardial infarction.
production.Testosterone-based drugs will, likewise, have a
Testosterone tends to have a much less dramatic impact
strong effect on the hypothalamic regulation of natural
on cardiovascular risk factors than synthetic steroids. This
steroid hormones.
Without the intervention of
is due in part to its openness to metabolism by the liver,
testosterone-stimulating substances, testosterone levels
which allows it to have less effect on the hepatic
should return to normal within 1-4 months of drug
management of cholesterol. The aromatization of
secession. Note that prolonged hypogonadotrophic
testosterone to estradiol also helps to mitigate the
hypogonadism can develop secondary to steroid abuse,
negative effects of androgens on serum lipids. In one
necessitating medical intervention.
study, 280 mg per week of testosterone ester (enanthate)
As with all anabolic/androgenic steroids, it is unlikely that
had a slight but not statistically significant effect on HDL
one will retain every pound of new bodyweight after a
cholesterol after 12 weeks, but when taken with an
cycle is concluded. This is especially true when
aromatase inhibitor a strong (25%) decrease was seen.479
withdrawing from a strong (aromatizing) androgen like
Studies using 300 mg of testosterone ester (enanthate)
testosterone cypionate, as much of the new weight gain is
per week for 20 weeks without an aromatase inhibitor
likely to be in the form of water retention, quickly
demonstrated only a 13% decrease in HDL cholesterol,
eliminated after drug discontinuance. An imbalance of
while at 600 mg the reduction reached 21%.480
anabolic and catabolic hormones during the post-cycle
negative impact of aromatase inhibition should be taken
recovery period may further create an environment that is
into consideration before such drug is added to
unfavorable for the retention of muscle tissue. Proper
ancillary drug therapy is usually recommended to helprestore hormonal balance more quickly, ultimately
William Llewellyn's ANABOLICS, 10th ed.
helping the user retain more muscle tissue.
was much more common before the 1990's, whencypionate vials were usually very cheap and easy to find. A
Another way to lessen the post-cycle "crash" is to first
"more is better" attitude is easy to justify when paying
replace testosterone cypionate with a milder anabolic
only $20 for a 10cc vial (today the typical price for a single
such as nandrolone decanoate or methenolone
injection). At dosages of 800-1000 mg per week or more,
enanthate. The new steroid would be administered alone
water retention will likely account for more of the
for one to two more months, at a dosage of 200-400 mg
additional weight gain than new muscle tissue. The
per week. In this "stepping down" procedure the user is
practice of "megadosing" is inefficient (not to mention
attempting to eliminate the watery bulk of a testosterone-
potentially dangerous), especially when we take into
based drug while simultaneously preserving the solid
account the typical high cost of steroids today.
muscularity underneath. This practice can prove to beeffective, even if mainly for psychological reasons (some
may view it as simply dividing the crash into water and
Testosterone cypionate is rarely used with women in
hormonal stages). Testosterone-stimulating drugs are still
clinical medicine. When applied, it is most often used as a
typically used at the conclusion of therapy, as
secondary medication during inoperable breast cancer,
endogenous testosterone production will not rebound
when other therapies have failed to produce a desirable
during the administration of nandrolone decanoate or
effect and suppression of ovarian function is necessary.
Testosterone cypionate is not recommended for women
The above side effects are not inclusive. For more detailed
for physique- or performance-enhancing purposes due to
discussion of potential side effects, see the Steroid Side Effects
its strong androgenic nature, tendency to produce
section of this book.
virilizing side effects, and slow-acting characteristics(making blood levels difficult to control).
To treat androgen insufficiency, the prescribing guidelinesfor testosterone cypionate call for a dosage of 50-400 mg
Testosterone cypionate remains widely available as a
every two to four weeks. Although active in the body for a
prescription drug product. Its production is largely
longer time, testosterone cypionate is usually injected on
associated with American companies, although recently
a weekly basis for physique- or performance-enhancing
has been expanding into loosely regulated Asian markets
purposes. The usual dosage is in the range of 200-600 mg
that still cater to demand by bodybuilders and athletes. In
per week, taken in cycles 6 to 12 weeks in length.This level
reviewing some of the products and changes in the global
is sufficient for most users to notice exceptional gains in
pharmaceutical market, we have made the following
muscle size and strength.
Testosterone is usually incorporated into bulking phases
Brand name testosterone cypionate (Depot-Testosterone)
of training, when added water retention will be of little
remains available in the United Stated from Prizer. This is a
consequence, the user more concerned with raw mass
high-profile target of counterfeiters. All legitimate boxes
than definition. Some do incorporate the drug into
will carry a "Jh" symbol hidden on one of the top inside
cutting cycles as well, but typically in lower doses (100-
flaps. It will appear when placed under UV light.
200 mg per week) and/or when accompanied by an
Many generic forms of the drug are also produced in the
aromatase inhibitor to keep estrogen levels under control.
U.S. market by manufacturers such as Watson, Sandoz,
Testosterone cypionate is a very effective anabolic drug,
Paddock, Synerx, and Bedford. All come packaged in
and is often used alone with great benefit. Some, however,
multiple-dose vials. Due to strict controls these products
find a need to stack it with other anabolic/androgenic
are rarely diverted for illicit sale. There are also several
steroids for a stronger effect, in which case an additional
pharmacies custom-compounding testosterone
200-400 mg per week of boldenone undecylenate,
cypionate for doctors that specialize in androgen
methenolone enanthate, or nandrolone decanoate
should provide substantial results with no significanthepatotoxicity. Testosterone is ultimately very versatile,
Cypionax is available in Thailand by T.P. Drug Laboratories.
and can be combined with many other
It comes in 2 mL ampules containing 100 mg/mL of
anabolic/androgenic steroids to tailor the desired effect.
While large doses are generally not advised, some
Cypiobolic from Asia Pharma (Malaysia) is now approved
bodybuilders have been known to use excessively high
for sale through pharmacies in Thailand. Each box should
dosages of this drug (1,000 mg per week or more). This
carry a scratch-off security sticker, which will display a
William Llewellyn's ANABOLICS, 10th ed.
code that can be validated on the company website.
Testex Prolongatum remains available in Spain. Thissteroid is produced by Laboratorios Q Pharma. It ispackaged in 2 mL dark glass ampules with grey silkscreenlettering. It comes in two doses, containing a total of 100mg or 250 mg of steroid. Testex has always been a high-profile item for counterfeiters.
Found in Chile is a high-dose cypionate product calledciclo-6. The product is manufactured by the firm DragPharma, and contains 300 mg/ml of steroid in a 2 mLampule (600 mg of cypionate in total).
Balkan Pharmaceuticals (Moldova) makes the productTestosterona C. It is prepared in both 1 mL ampules andmulti-dose vials.
William Llewellyn's ANABOLICS, 10th ed.
Insulin (rDNA Origin)
anabolic/androgenic steroids can be a very synergisticcombination. This is because the two actively support an
Insulin is peptide hormone produced in the Islets of
anabolic state through different mechanisms. Insulin
Langerhans in the pancreas. The release of this hormone in
strongly enhances the transport of nutrients into muscle
the human body is most closely tied to blood glucose
cells and inhibits protein breakdown, and the anabolic
levels, although a number of other factors including
steroids (among other things) strongly increase the rate of
pancreatic and gastrointestinal hormones, amino acids,
protein synthesis.
fatty acids, and ketone bodies are also involved. The mainbiological role of insulin is to promote the intracellular
As mentioned, the usual medical purpose for insulin is to
utilization and storage of amino acids, glucose, and fatty
treat different forms of diabetes. More specifically, the
acids, while simultaneously inhibiting the breakdown of
human body may not be producing enough insulin (Type-
glycogen, protein, and fat. It is most notably identified with
I diabetes), or may not recognize insulin well at the cell site
the control of blood sugar levels, and insulin medications
although some level is present in the blood (Type-II
are typically prescribed to people with diabetes, a
diabetes). Type-I diabetics are, therefore, required to inject
metabolic disorder characterized by hyperglycemia (high
insulin on a regular basis, as they are left without a
blood sugar).While insulin targets many different organs in
sufficient level of this hormone. Along with medication, the
the body, this hormone is both anabolic and anti-catabolic
individual will need to constantly monitor blood glucose
to skeletal muscle tissue,926 927 928 a fact that explains the
levels and regulate their sugar intake. Together with
inclusion of pharmaceutical insulin in the realm of athletics
lifestyle modifications such as regular exercise and
and bodybuilding.
developing a balanced diet, insulin dependent individualscan live a healthy and full life. When left untreated,
The use of insulin to improve performance and body
however, diabetes can be a fatal disease.
composition can be a little tricky because this hormonecan also promote nutrient storage in fat cells.This, however,
is an activity of insulin that can be somewhat managed by
Insulin first became available as a medicine during the
the user. Athletes have found that a strict regimen of
1920s. Credit for the discovery is most appropriately given
intense weight training and a diet without excess caloric
to Canadian physician Fred Banting and Canadian
and fat intake can enable insulin to show a much higher
physiologist Charles Best, who worked together to
affinity for protein and glucose storage in muscle (as
produce the first insulin preparations, and the world's first
opposed to fatty acid storage in adipose) cells. This is
effective treatment of diabetes. Their work stemmed from
especially true in the post-exercise enhanced-absorptive
an idea initially proposed by Banting, who as a young
state, where insulin sensitivity in skeletal muscle has been
doctor theorized that an active extract could be made from
shown to increase significantly over baseline (rested)
animal pancreases to regulate blood sugar in human
levels.929 When used during the post-training window, the
patients. He needed help to try and actualize his idea, and
hormone is, likewise, capable of producing rapid and
he sought out world-renowned physiologist J.J.R. Macleod
noticeable muscle gains. The muscles often begin to look
at the University of Toronto. Macleod, initially less than
fuller (and even sometimes more defined) very soon after
impressed with the unusual concept (but likely impressed
initiating insulin therapy, and the overall results of therapy
with Banting's conviction and tenacity), assigned a couple
are often described as dramatic.
of graduate students to assist him in his work. A coin flip
The fact that insulin use cannot be detected by urinalysis
determined who would work with Banting, and he was
has ensured it a place in the drug regimens of many
eventually paired with graduate student Best. Together
athletes and professional bodybuilders. Note that there has
they made medical history.
been some progress in drug detection, especially with the
The first insulin preparations they produced were made of
analogs, but to date regular insulin is still considered a
crude pancreatic extracts taken from dogs. At one point
"safe" drug. Insulin is often used in combination with other
the supply of laboratory animals was exhausted, and
"contest safe" drugs like human growth hormone, thyroid
desperate to continue their research, the pair actually
medications, and low dose testosterone injections, and
began taking stray dogs to supplement their pancreas
together can have a dramatic effect on the user's physique
supply. Shortly after, the two found that they could work
and performance without fear of a positive urinalysis
with the pancreases of slaughtered cows and pigs, making
result. Those who do not have to worry about drug testing,
their work much easier (and ethically acceptable). They
however, often find that insulin combined with
successfully treated their first diabetic patient with insulin
William Llewellyn's ANABOLICS, 10th ed.
in January 1922. By August of that year, they had been
followed, reaching market by 1950. This preparation was
successful in treating a group of clinical patients, including
very similar to PZI insulin except that it could be mixed
15-year-old Elizabeth Hughes, daughter of former
with regular insulin without disturbing the release curve
presidential candidate Charles Evans Hughes. Elizabeth
of the respective insulins. In other words, a regular insulin
was diagnosed with diabetes in 1918, and her dramatic
drug could be mixed in the same syringe with NPH insulin,
fight for life with the disease gained national attention.
providing a biphasic release pattern characterized by an
Elizabeth would be saved by insulin on the doorstep of
early peak effect due to the regular insulin, and an
starvation, as severe calorie restriction was the only
extended action brought on by the NPH.
remedy known to slow the disease at the time. Banting
In 1951 the Lente insulins began to surface, which
and Macleod swiftly won the Nobel Prize for their
included semilente, lente, and ultra-lente preparations.
discovery, which was presented to them approximately a
The amount of zinc used in each varied, producing
year later in 1923. Shortly after, dispute over credit arose,
preparations with distinct and long-acting
and ultimately Banting shared his prize with Best, and
pharmacokinetics. Unlike previous Insulins, this was also
Macleod shared his prize with J. B. Collip, a chemist that
achieved without the use of protamine. Many physicians
assisted in the extraction and purification process.
were soon able to successfully switch their patients from
After initially declining the assistance in the hopes that
NPH insulin over to a single morning dose of Lente insulin,
they could work out production issues on their own,
often heralding the release of the new drugs as a big
Banting and his team worked with Eli Lilly & Co. to develop
advance in insulin medications (though some would still
the first mass-produced insulin medicines using their
require an evening dose with a Lente insulin to maintain
animal extraction techniques. Their production success
full control over blood glucose levels during the 24-hour
was extreme and rapid, and the drug became
period). Up to this point the insulin drugs made by the
commercially available on a wide scale in 1923, the same
large pharmaceutical companies worked very well. No
year Banting and Macleod won the Nobel prize.That same
substantial step forward in the development of new
year, Nordisk Insulinlaboratorium was founded by Danish
insulin delivery technologies would come for another 23
scientist Augusta Krogh, who desperately wanted to bring
back an insulin manufacturing technique to Denmark to
In 1974, chromatographic purification techniques allowed
treat his wife, who was ill with diabetes.This Denmark firm
the manufacture of animal insulin with extremely low
eventually became Novo Nordisk, the world's second
impurity levels (less than 1 pmol/l of protein impurities).
leading producer of insulin next to Eli Lilly & Co.
Novo was the first to release a drug made with this
The early insulin medications were fairly impure by
technology, which it called monocomponent (MC) Insulin.
today's standards. They typically contained 40 units of
Eli Lilly also released a version called "Single Peak" Insulin,
animal insulin per milliliter, in contrast to today's accepted
likely referring to the single protein peak noticed upon
standard concentration of 100 units. The large doses
chemical analysis. This advance, though significant, would
needed with these early low-concentration drugs were
be short lived. In 1975, Ciba-Geigy produced the first
not very comfortable for patients, and injection-site
synthetic insulin preparation (CGP 12831). And just three
reactions were not uncommon. They also contained
years later, scientists at Genentech were able to produce
significant protein impurities that would sometimes cause
insulin using modified E. coli bacteria, the first synthetic
allergic reactions in users. Despite these faults, the drugs
insulin with an identical amino acid sequence as human
saved the lives of countless individuals who beforehand
insulin (although the animal insulins work fine in humans
were faced with a sure death sentence following a
their structures are slightly different). The U.S. Food and
diagnosis of diabetes. Eli Lilly and Novo Nordisk improved
Drug administration approved the first such medicines in
the purity of their products in the coming years, but no
1982, with the acceptance of Humulin R (Regular) and
major improvements in insulin technology developed
Humulin NPH from Eli Lilly & Co. The name Humulin is a
until the mid-1930s, when the first longer-acting insulin
contraction of the words "human" and "insulin", of course.
preparations began to surface.
Novo would follow with semi-synthetic insulins ActrapidHM and Monotard HM.
The first longer-acting drug made use of protamine andzinc to delay the action of insulin in the body, extending
The FDA has approved a variety of other insulin drug
the activity curve and reducing the number of daily
combinations over the years, including various biphasic
injections required for many patients. Dubbed Protamine
insulin blends that use differing amounts of rapid and
Zinc Insulin (PZI), the preparation would have an effect
longer-acting insulins. More recently, we have also seen
lasting as long as 24-36 hours. Neutral Protamine
the FDA approval of Eli Lilly's rapid-acting insulin analog
Hagedorn (NPH) Insulin, also known as Isophane insulin,
Humalog. Several other analogs are also now available
William Llewellyn's ANABOLICS, 10th ed.
including Lantus and Apidra from Aventis, and Levemir
and Novorapid from Novo Nordisk. A number of
Below is a list showing the distinctions between popular
additional analogs are also under investigation at this
forms of biosynthetic insulin.
time. With the large variety of different insulinmedications approved and sold in the U.S. and other
nations, it is important to understand that "insulin"represents an extremely broad class of medicines. As a
Humalog® (Insulin Lispro): Humalog® is a short-acting
class, these drugs are likely to continue to expand as new
analog of human insulin, specifically the Lys(B28) Pro(B29)
agents are developed and successfully tested. Today, it is
analog of insulin created when the amino acids at
estimated that 55 million people use some form of
positions 28 and 29 are reversed. It is considered
injectable insulin on a regular basis to manage their
equipotent to regular soluble insulin on a unit-to-unit
diabetes, making this an extremely important and
basis, but with more rapid activity.930 The onset of drug
lucrative area of human medicine.
action following subcutaneous administration isapproximately 15 minutes, and its peak effect is reached in
30 to 90 minutes. It has a total duration of action between3 and 5 hours. Insulin lispro is usually used as a
Pharmaceutical insulin comes from one of two basic
supplement to a longer acting insulin product, providing
origins, animal or synthetic.With animal source insulin, the
a fast-acting medication that can be taken before or
hormone is extracted from the pancreas of either pigs or
immediately after meals to mimic the body's natural
cows (or both) and prepared for medical use. These
insulin response. Many athletes believe that its short
preparations are further divided into the categories
window of effect makes it an ideal insulin medication for
"standard" and "purified", dependent on the level of purity
physique- or performance-enhancing purposes, as most
and non-insulin content of the solution. With such
of its action can be concentrated in the post-training
products there is always the slight possibility of pancreatic
contaminants making their way into the prepared drug.
Specifically called biosynthetic, synthetic insulin is
Novolog® (Insulin Aspart): Novolog is a short-acting analog
produced by a recombinant DNA procedure similar to the
of human insulin created when the amino acid proline at
process used to manufacture human growth hormone.
position B28 is replaced with aspartic acid. The onset of
The result is a polypeptide hormone consisting of one 21-
drug action following subcutaneous administration is
amino acid "A-chain" coupled by two disulfide bonds with
approximately 15 minutes, and its peak effect is reached in
one 30-amino acid "B-chain".The biosynthetic process will
1-3 hours. It has a total duration of action between 3 and
produce a drug free of the pancreatic protein
5 hours. Insulin lispro is usually used as a supplement to a
contaminants possible with animal insulin, and that is
longer acting insulin product, providing a fast-acting
structurally and biologically identical to human
medication that can be taken before or immediately after
pancreatic insulin. With the innate (remote) risk of
meals to mimic the body's natural insulin response. Many
contamination involved with animal insulin, coupled with
athletes believe that its short window of effect makes it an
the fact that the structure is (very slightly) different from
ideal insulin medication for physique- or performance-
human insulin, synthetic human insulin drugs dominate
enhancing purposes, as most of its action can be
the market today. Biosynthetic human insulin/insulin
concentrated in the post-training enhanced-nutrient-
analogs are also the most common insulins of use among
uptake window.
athletes, and the main focus of this profile.
There are a variety of synthetic insulins available, witheach possessing unique properties relating to speed ofonset, peak and duration of activity, and concentration ofdose. This therapeutic variety may allow physicians totailor a treatment program for insulin-dependantdiabetics that allows for the least amount of dailyinjections and the greatest level of patient comfort. It isimportant that one should be aware of the individualactivity of any insulin drug before attempting its use. Dueto the differences between preparations, it is also
Humulin®-R "Regular" (insulin Inj): Identical to human
medically advised that extreme care be taken whenever a
insulin. Also sold as Humulin-S® (Soluble) in some
physician attempts to switch an insulin-dependant
markets, this product consists of zinc-insulin crystals
diabetic patient from one form of insulin medication to
dissolved in clear fluid. There is nothing added to slow the
William Llewellyn's ANABOLICS, 10th ed.
release of this product, so it is generically referred to assoluble human Insulin. This drug works rapidly and has ashort duration of effect.The onset of drug action followingsubcutaneous administration is 20-30 minutes, and itspeak effect is reached in 1-3 hours. It has a total durationof action between 5 and 8 hours. Together with Humalog,these two forms of insulin are the most popular (almostexclusive) choices among athletes and bodybuilders forphysique- or performance-enhancement purposes.
Humulin®-U, Ultralente (prolonged zinc suspension): Acrystalline suspension of insulin with zinc to delay itsrelease and extend its action. Humulin-U is considered along-acting insulin. The onset of drug action followingsubcutaneous administration is approximately 6 hours,and its peak effect is reached in 14-18 hours. It has a totalduration of activity lasting 18-24 hours.This type of insulinis not commonly used for physique- or performance-enhancement purposes.
Intermediate- and Long-acting Insulins:
Humulin®-N, NPH (insulin isophane): A
suspension of insulin with protamine and zinc to delay its
release and extend its action. Insulin isophane is
considered intermediate length insulin. The onset of drug
action following subcutaneous administration is
approximately 1-2 hours, and its peak effect is reached in
4-10 hours. It has a total duration of activity lasting more
8 10 12 14 16 18 20 22 24 26
than 14 hours. This type of insulin is not commonly used
Time (hours after injection)
for physique- or performance-enhancement purposes.
Lantus (insulin glargine): A long-acting analog of humaninsulin. Insulin glargine is created when the amino acidasparagine at position A21 is replaced by glycine, and twoarginines are added to the C-terminus of the insulin Bchain. The onset of drug action following subcutaneousadministration is approximately 1-2 hours, and the drug isconsidered to have no significant peak (it is designed tohave a very stable release pattern throughout theduration of activity). Insulin glargine lasts between 20-24hours in the body following subcutaneous injection. Thistype of insulin is not commonly used for physique- orperformance-enhancement purposes.
Humulin®-L, Lente (medium zinc suspension): A crystallinesuspension of insulin with zinc to delay its release andextend its action.
Humulin-L is considered an
intermediate length insulin. The onset of drug actionfollowing subcutaneous administration is approximately1-3 hours, and its peak effect is reached in 6-14 hours. Ithas a total duration of activity lasting more than 20 hours.
This type of insulin is not commonly used for physique- orperformance-enhancement purposes.
William Llewellyn's ANABOLICS, 10th ed.
death. Note that in some cases the symptoms ofhypoglycemia are mistaken for drunkenness.
Humulin® Mixtures: These are mixtures of regular solubleinsulin for a fast onset of action, and a long- or
It is also very important to note that you may notice a
intermetiate-acting insulin for a prolonged effect. These
tendency to get sleepy after injecting insulin. This is an
are labeled by the mixture percentage, commonly 10/90,
early symptom of hypoglycemia, and a clear sign the user
20/80, 30/70, 40/60, and 50/50. Mixtures using Humalog as
should be consuming more carbohydrates. One should
the rapid-acting insulin are also available.
absolutely avoid the temptation to go to sleep at thispoint, as the insulin may take its peak effect during rest,
Warning: Concentrated Insulin
and blood glucose levels could be left to drop
The most common forms of insulin come in a
significantly. Unaware of this condition during sleep, the
concentration of 100 IU of hormone per milliliter. These
athlete may be at a high risk for going into a state of
are identified as "U-100" preparations in the U.S. and many
severe hypoglycemia. The serious dangers of such a state
other regions. In addition to this, however, there are also
have already been discussed, and unfortunately
concentrated forms of insulin available for patients that
consuming more carbohydrates during sleep will not be
require higher doses and a more economical or
an option. Those experimenting with insulin would,
comfortable option to U-100 preparations. In the U.S.,
therefore, be wise to always stay awake for the duration of
products containing as much as 5 times the normal
the drug's effect, and also avoid using insulin in the early
concentration, or 500 IU per milliliter, are also sold. These
evening to ensure the drug will not be inadvertently
are identified as "U-500" preparations, and are available by
active when retiring for the night. It is also important to
prescription only. It can be extremely dangerous or life
make sure others are aware of your use of the drug so that
threatening to replace a U-100 insulin product with a U-
they may inform emergency medical technicians should
500 product without making the necessary dosing
you lose consciousness or the ability to inform others of
adjustments to compensate for the greater drug
your condition due to hypoglycemia. This information can
concentration. Given the general difficulty in accurately
spare valuable (perhaps life saving) time in helping
measuring athletic doses (2-15 IU) with a drug of such
medical professionals establish a diagnosis and provide
high concentration, U-100 preparations are used almost
exclusively for physique- and performance-enhancing
Side Effects (Lipodystrophy):
The subcutaneous administration of insulin may cause a
Side Effects (Hypoglycemia):
localized increase in adipose tissue at the site of injection.
Hypoglycemia is the primary danger with the use of
This may be compounded by the repeated administration
insulin. This is a dangerous condition that occurs when
of insulin at the same site of injection.
blood glucose levels fall too low. It is a common and
Side Effects (Allergy to Insulin):
potentially fatal reaction experienced at some time oranother by most medical and nonmedical insulin users, so
In a small percentage of users, the administration of
it needs to be taken seriously. It is, therefore, critical to
insulin may cause a localized allergy. This may include
understand the warning signs of hypoglycemia. The
irritation, swelling, itching, and/or redness at the site of
following is a list of symptoms that may indicate mild to
injection. This often subsides as therapy continues. In
moderate hypoglycemia: hunger, drowsiness, blurred
some instances it may be due to an allergy to an
vision, depressive mood, dizziness, sweating, palpitation,
ingredient, or in the case of animal insulin, a protein
tremor, restlessness, tingling in the hands, feet, lips, or
contaminant. Less common, but potentially more serious,
tongue, lightheadedness, inability to concentrate,
is a systemic allergic reaction to insulin administration.
headache, sleep disturbances, anxiety, slurred speech,
This may include a rash on the whole body, wheezing,
irritability, abnormal behavior, unsteady movement, and
shortness of breath, fast pulse, sweating, and/or a
personality changes. If any of these warning signs should
reduction in blood pressure. In rare instances this may be
occur, one should immediately consume a food or drink
life threatening. Any adverse reaction should be reported
containing simple sugars such as a candy bar or
to a medical authority.
carbohydrate drink.This will hopefully raise blood glucose
levels sufficiently enough to ward off mild to moderatehypoglycemia. There is always a possibility of severe
Given that there are varying forms of insulin available for
hypoglycemia, which is very serious and requires
medical use with differing pharmacokinetic patterns, as
immediate emergency medical attention. Symptoms of
well as products with different drug concentrations, it is
this include disorientation, seizure, unconsciousness, and
extremely important that the user be familiar with the
William Llewellyn's ANABOLICS, 10th ed.
dosage and actions of any specific insulin preparation
injecting a dose, as some find they tolerate slightly more
they intend to use so that peak-effect, total time of effect,
or less insulin than weight guidelines would dictate.
total dosage, and carbohydrate intake can be closely
Athletes using growth hormone in particular often have
monitored. Rapid-acting insulin preparations (Novolog,
slightly higher insulin requirements, as HGH therapy is
Humalog, and Humulin-R) are the most popular choices
shown to both lower secretion of, and induce cellular
for physique- or performance-enhancing purposes, and
resistance to, insulin.
the subject of the dosing information presented in this
One must also remember that it is very important to
book. It is also important to stress that before one
consume carbohydrates for several hours following
considers using insulin they should also become very
insulin use. One should generally follow the rule-of-thumb
familiar with using a glucometer. This is a medical device
of ingesting at least 10-15 grams of simple carbohydrates
that can give you a quick and accurate reading of your
per IU of insulin injected (with a minimum immediate
blood glucose level. This device can be indispensable in
intake of 100 grams regardless of dose).This is timed 10 to
helping one manage and optimize their
30 minutes after subcutaneous injection of Humulin-R, or
immediately after using Novolog or Humalog.The use of a
carbohydrate replacement drink is often used as a fastcarbohydrate source. Properly cautious insulin users will
Short acting forms of insulin (Novolog, Humalog,
always have a source for simple sugars on-hand in case an
Humulin-R) are designed for subcutaneous injection.
unexpected drop in glucose levels is noticed. Many
Following subcutaneous injection, the injection site
athletes will also take creatine monohydrate with their
should be left alone and not rubbed, to prevent the drug
carbohydrate drink, since the insulin may help force more
from releasing into circulation too quickly. It is also
creatine into the muscles. 30-60 minutes after injecting
advised to rotate subcutaneous injection sites regularly to
insulin, one should also eat a good meal and consume a
avoid the localized buildup of subcutaneous fat that may
protein shake. The carbohydrate drink and meal/protein
develop due to the lipogenic properties of this hormone
shake are absolutely necessary, as without them blood
(see Adverse Reactions: Lipodystrophy). The medical
sugar levels may drop dangerously low and the athlete
dosage will vary depending on the individual
may enter a state of hypoglycemia (see Adverse
requirements of the patient. Furthermore, changes in such
Reactions: Hypoglycemia). Carbohydrates and proteins are
things as diet, activity level, or work/sleep schedule may
continually provided in sufficient amounts to meet
the required insulin dose. Although not
glucose requirements throughout the entire window of
recommended medically, it is possible to administer some
insulin effect.
short-acting insulins via intramuscular injection. This,however, may create more variability (and potential risk)
with regard to drug dissipation and hypoglycemic effect.
and Biphasic Insulins):
Insulin dosages can vary slightly among athletes, and are
Intermediate-acting, long-acting, and biphasic insulins are
often dependent upon factors like body weight, insulin
designed for subcutaneous injection. Intramuscular
sensitivity, activity level, diet, and the use of other drugs.
injection will cause the drug to be released too rapidly,
Most users choose to administer insulin immediately after
potentially resulting in hypoglycemia.
a workout, which is the most opportunistic time of the day
subcutaneous injection, the injection site should be left
to use this drug. Among bodybuilders, dosages of regular
alone and not rubbed, to prevent the drug from releasing
insulin (Humulin-R) used are usually in the range of 1IU
into circulation too quickly. It is also advised to rotate
per 15-20 pounds of lean bodyweight; 10IU is perhaps the
subcutaneous injection sites regularly to avoid the
most common dosage. This amount may be adjusted
localized buildup of subcutaneous fat due to the
downward slightly for users of the more rapid-acting
lipogenic properties of this hormone (see Adverse
Humalog and Novolog preparations, which provide a
Reactions: Lipodystrophy). The medical dosage will vary
higher and faster peak effect. First-time cautious users
depending on the individual requirements of the patient.
usually ignore bodyweight guidelines, and instead start at
Furthermore, changes in such things as diet, activity level,
a low dosage with the intention of gradually working up
or work/sleep schedule may affect the required insulin
to a normal dosage. For example, on the first day of insulin
dose. Intermediate-acting, long-acting, and biphasic
therapy one may begin with a dose as low as 2 IU. Each
not widely used for physique- or
consecutive post-workout application this dosage might
performance-enhancing purposes due to their longer
be increased by 1IU, until the user determines a
acting nature, which makes them poorly suited for
comfortable range. Many feel this is safer and much more
concentrating the nutrient partitioning effect of insulin
tailored to the individual than simply calculating and
during the short post-workout enhanced-nutrient-uptake
William Llewellyn's ANABOLICS, 10th ed.
U-100 insulins may be dispensed from pharmacies in theUnited States without a prescription. This is so that aninsulin-dependent diabetic will have easy access to thislife-saving medication. Concentrated (U-500) insulin issold by prescription only. In most regions of the world,high medical use of the drug leads to easy access and lowprices on the black market.
Testosterone Enanthate
Enanthate generic from Paddock (U.S.)
Previous packaging for Paddock generic (U.S.)
Enanthate generic from Watson (U.S.)
10mL version from Watson (U.S.)
U.S. Delatestryl from Savient
Depo-Test 250 ampules and vial from Unigen (Thailand)
Cidoteston from CID (Egypt)
Counterfeit Egyptian Cidoteston
Older box from CID
Primoteston-Depot from CID/Schering Egypt (NLM)
Testoviron Depot from Lebanon
Winstrol tablets from Desma (Spain)
Winstrol Depot from Desma (Spain)
Counterfeit Desma box/ampules
Counterfeit on left
Zambon Winstrol tablets (Spain) NLM
Winstrol Depot from Zambon (Spain) NLM
Counterfeit Zambon vial
Genotropin (U.S.)
Older U.S. Serostim box
Old U.S. Saizen packaging
U.S. Protropin (somatrem)
Signature (U.S.) NLM
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Introduction to psychology Objectives: 1. To be able to understand the scientific nature of Psychology. 2. To enumerate the goals of Psychology. 3. To briefly trace the historical development of Psychology. 4. To describe the different schools of thought and contemporary approaches in 5. To be familiar with the different methods used by psychologists. 6. To identify different issues tackled by the different subfields of psychology.
USING ENZYMES TO CLEAN UP PESTICIDE RESIDUES Tara Sutherland and Robyn Russell from CSIRO Entomology in Canberra, Australia, and Michael Selleck ofOrica Australia Pty Ltd. describe exciting work being done on the use of enzymes to clean up pesticideresidues Current research focuses on several major insecticide classes Increasing pesticide use in recent years has led to public