In general, bodybuilders and male athletes have an understanding of the relationship between testosterone and building muscle— “more is better.” However, this mantra of masculinity is very misleading. Testosterone production is a well-regulated process in healthy, adult men. However, as people age, or are exposed to a varietyof chemical, physical or metabolic trauma, testosterone production falls. “Normal” testosterone levels support a healthy mental state and metabolism. It also allows the body to respond to stressors that are consistent with genetic expectations based upon the life experiences of our distant ancestors and more recent generations. Even modern soldiers cannot perform at an intense level under stress for weeks without suffering marked loss of lean mass and strength, as well as negative effects on their natural hormone balance.1 However, there have been dramatic changes in the last few generations that should make a prudent man take pause and consider testosterone from a clearer perspective.
If you define a man by how much testosterone he produces naturally, today’s males are less manly than preceding generations.2,3 Though the factors involved are legion— a biblical reference meaning more than can be named— it is clear that the environment and lifestyle of today has resulted in more men below or hovering near the “normal” range’s lower limit. This is associated with, and likely promotes, a variety of metabolic conditions related to poor health and early mortality.4,5 Testosterone replacement therapy (TRT) is now begrudgingly accepted as a legitimate treatment, though it is not without risk in older men or those predisposed to clotting.6,7 Beginning treatment in the elderly is a more complex issue, and will not be addressed.
THE BIRTH OF DRUG-ENHANCED BODYBUILDING
During the 1940s through the 1960s, a variety of testosterone derivatives (anabolic-androgenic steroids or AAS) were developed by major pharmaceutical companies; physically active men noted beneficial effects on strength, vigor and muscularity. This was the “birth” of the culture of drug-enhanced bodybuilding. From this point onward, a new condition emerged that has received very little scientific attention— a state of prolonged elevated (supraphysiologic) androgen exposure in adult men, caused by AAS misuse, that significantly exceeds the upper limit of natural testosterone production. Lacking even a clinical term, it could be called generically “hyperandrogenemia.” The closest clinical entityis “testotoxicosis,” which occurs in children and adolescents, and has not been reported in adult men. The “best” information offered by the variety of well-funded agencies are posters of nude male images with Day-Glo organs containing a variety of labeled “side effects.” Some of these “side effects” are physiologic responses expected with the use of testosterone or AAS; have been disputed or proven to be incorrect; relate to adolescents or females; many are transient; or can be avoided by abstaining from C-17 alpha-akylated oral AAS. Certain serious side effects are missing.
For the purposes of this discussion, only testosterone esters will be considered, used by adult males. Obviously, a variety of injectable, oral, implanted and topical AAS exist and are used by bodybuilders, athletes and non-sportsmen; usually in combination (aka stacking). However, altering the testosterone molecule results in altered effects in the body, increasing the difficulty to predict or assess risk.
Testosterone esters are the most commonly misused drug for enhancing muscle. Most users are not athletes or bodybuilders, but men seeking to improve their physical fitness, health and appearance.8 Aside from a minority of users willingly exposed to great risk to attain the sheer mass seen in today’s professionals, most are not willing to accept an early death or being disabled as a consequence of AAS abuse. Note, the term abuse is used to describe AAS use that causes harm; misuse describes use for personal goal seeking without significantly risking health or affecting social relationships. As the injectable forms of testosterone are controlled substances, all illicit users face legal risks, including felony conviction and incarceration.
‘TYPICAL’ AAS MISUSERS
Most studies report that the “typical” AAS misuser administers between 200-600 milligrams of testosterone equivalent per week. Clinical dosing varies from a rigidly conservative 75 milligrams per week to 200 milligrams per week of injectable testosterone enanthate or cypionate ester.9 Select populations may receive higher doses, such as those suffering from HIV-associated wasting. Other individuals may require a higher dose due to a rapid clearance of the ester outside the expected pharmacokinetic range. In other words, what may last seven days in most people may not last that long in those who have a higher rate of clearance. It has been reported that testosterone and nandrolone esters may upregulate one of the enzymes responsible for cleaving the ester from the steroid.10 While this makes the steroid available more quickly, it may also reduce the half-life.
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