TEAM MD

Third of a three-part series
Muscular Development covers the bodybuilding industry better than anyone else on the planet, because we educate readers on how to build muscle, burn fat and enhance performance through all means possible. Chemical enhancement is no chump-change player in your bodybuilding goals. Every month, our team of doctors, researchers, industry experts and insiders gives readers the cold, hard truth— cutting-edge research and authoritative information about supplementation that’s scientifically sound— not broscience or schmoe science. Knowledge is power, and armed with the truth, our readers can decide how far they want to take their bodybuilding endeavors. In the final part of this three part series MD presents the facts 25-37 facts on chemical enhancement that every bodybuilder should know.

25. Testosterone Helps Treat Sports Injuries
Testosterone increases muscle protein synthesis and is an obvious treatment for promoting more rapid healing of some types of sports injuries. Unfortunately, testosterone’s use as a performance-enhancing drug has discouraged its legitimate use in the rehabilitation of athletic injuries. A review of literature by Korean scientists discussed the benefits of the drug for exercise rehabilitation. Testosterone, when used under medical direction, is effective and efficient for promoting recovery and rejuvenation from athletic injuries and overtraining. However, a political cloud of uncertainty covers the use of testosterone in sport, which will make it difficult for legitimate medical uses in athletes. (Journal Exercise Rehabilitation, 11: 2-4, 2015)
26. Testosterone Implants Offer Long-Term Treatment Option For Testosterone Therapy
In the 1966 science fiction film “Fantastic Voyage,” scientists shrunk to microscopic size traveled into the body to repair the damaged brain of an important person who was shot in the head. While we can’t travel around in the body in miniature spaceship-like vehicles, nanomedicine is a reality. Miniature systems can be implanted in the body to deliver drugs and monitor organ and cell function. Scientists led by Alessandro Grattoni, from the Department of Nanomedicine at Houston Methodist Research Institute, reported the development of a nano-testosterone delivery system that could maintain normal testosterone levels for six months in hypogonadal men. When approved and available, this system will provide a simple way to maintain biologically normal levels of the hormone. (Journal of Sexual Medicine, published online June 5, 2015)

27. Heart Attack and Stroke Risks Greater From Testosterone Injections Than from Patches and Gels
The safety and effectiveness of testosterone supplements has been controversial since their development in the 1930s. Several recent studies found an increased risk of heart attack and stroke in men receiving testosterone, but these studies have been severely criticized by most hormone specialists. Television ads warning of the dangers of “low T” has tripled the number of prescriptions written for testosterone in the last 10 years. Nearly four percent of United States men over 60 take testosterone in the form of injections, gels and patches. A study led by J. Bradley Layton from the University of North Carolina at Chapel Hill found that testosterone injections resulted in a greater incidence of heart attack, stroke, chest pains, hospitalization and death than patches and gels. (JAMA Internal Medicine, published online May 11, 2015)
28. Side Effects of Long-Acting Injectable Testosterone
Testosterone undecanoate (TU), marketed in the United States as Aveed and Nebido, is a long-acting drug that maintains hormone levels for 12 to 14 weeks. Administration involves injecting four milliliters of TU suspended in castor oil. The large volume of the injection can be extremely painful and can cause side effects— according to researchers from the University of Sydney in Australia. They reported on side effects from more than 3,000 injections given to nearly 350 patients over three-and-a-half years. Fifty-six of the injections resulted in an immediate cough and shortness of breath resulting from oil residue entering the lungs. One patient experienced a bruise, but only a few patients developed small increases in blood thickness (i.e., hematocrit). In general, long-acting testosterone is well tolerated. (European Journal Endocrinology, 172: 511-517, 2015)

29. Testosterone Has Benefits for Sports Rehabilitation
Testosterone has been controversial since its synthesis in 1934. Early medical applications used the drug to improve sexual performance in men and women and enhance muscle performance in soldiers during World War II. The use of testosterone and other anabolic steroids in sports has put blinders on the medical community for its legitimate use in the rehabilitation of athletic injuries. A review of literature by Korean scientists discussed the benefits of the drug for exercise rehabilitation. Testosterone, when used under medical direction, is effective and efficient for promoting recovery and rejuvenation from athletic injuries and overtraining. However, a political pall lies over the use of testosterone in sport, which will make it difficult for legitimate medical uses in athletes. (Journal Exercise Rehabilitation, 11: 2-4, 2015)

30. Testosterone Sales Level Off Because of Safety Concerns
The sale of testosterone to aging men is a multibillion-dollar business in the United States. A television ad campaign by AbbVie and Eli Lilly in 2013, costing more than $113 million, warned men of the dangers of “low T.” Prescriptions for testosterone jumped from 1.3 million in 2010 to 2.3 million in 2013.Two recent controversial studies showing that testosterone replacement therapy increased the risk of heart attack and stroke may limit the availability of supplemental testosterone. A committee from the U.S. Food and Drug Administration (FDA) advised that testosterone should only be prescribed to men with severe testosterone deficiency. AbbVie, the makers of AndroGel, reported a five percent decrease in sales in the first half of 2014. Clinical trials are underway to determine the benefits of testosterone to aging healthy men. (Bloomberg Business Week, November 6, 2014)
31. Testosterone Therapy Does Not Harm Cardiovascular Health
Supplementing testosterone improves health in men with low levels of the hormone— according to a review of literature by Abraham Morgentaler from Harvard University, and colleagues. The review included articles written since 1940. Researchers concluded that low testosterone was linked to premature death from all causes, and to cardiovascular disease. They found no evidence linking testosterone therapy to stroke. Low testosterone was linked to plaque thickness in the arteries supplying the brain. Testosterone therapy prevents obesity and reduces LDL cholesterol, which is associated with coronary artery disease, promotes blood sugar regulation, muscle mass and strength, and peak oxygen uptake in aging men. Testosterone therapy promotes health and quality of life in aging men. (Mayo Clinic Proceedings, 90:224-251, 2015)

32. The Risks of Testosterone Therapy in Aging Men
The safety and effectiveness of testosterone supplements has been controversial since their development in the 1930s. Several recent studies found an increased risk of heart attack and stroke in men receiving testosterone, but these studies have been severely criticized by most hormone specialists. Television ads warning of the dangers of “low T” has tripled the number of prescriptions written for testosterone in the last 10 years. Nearly four percent of men in the United States over 60 take testosterone. German Rodriguez from the West Park Medical Group in New York City concluded that the two studies showing severe side effects left many unanswered questions about the safety of testosterone therapy, particularly in older men. Another study from the U.S. Department of Veterans Affairs found that death rates were lower in men receiving testosterone therapy. Rodriguez concluded that until more information is available, physicians could continue offering testosterone to aging men with low levels of the hormone. (Integrative Medicine, 17 (12): 133-136, 2014)

33. FDA Scrutinizes Testosterone Replacement Therapy
Two recent studies showing an increased risk of heart attack and stroke in men receiving testosterone supplements have initiated a full-blown investigation by a subcommittee of the U.S. Food and Drug Administration (FDA). There were nearly 2.3 million prescriptions for testosterone in 2013. More than half of these men were also taking cardiovascular medications to treat blood clotting, high blood pressure, high cholesterol and chest pain. The interaction of testosterone with these drugs is poorly understood. The committee suggested that the possibility of increased cardiovascular risk should be added to the drug's labeling. The committee suggested that further studies be conducted to assess the cardiovascular risk of testosterone supplementation in aging men. (Journal American Medical Association, published online December 11, 2014)
34. SARMs: Anabolic Drugs With Fewer Side Effects
The next generation of anabolic steroids will be selective androgen receptor modulators (SARMs) that target androgen receptors in specific tissues such as muscle or bone. SARMs are the holy grail of anabolic drugs because they build muscles without affecting other organs or tissues. These drugs will help promote bone and muscle growth, promote healing following traumatic injuries and invariably help athletes improve performance.
Current anabolic steroids (including testosterone) bind and activate androgen receptors throughout the body, and their effects are not specific to any tissue. While they turn on protein synthesis in muscle, they also bind to androgen receptors in the prostate, sex organs, heart, liver, skin and brain, which can cause unwanted effects in non-target tissues. General receptor binding causes side effects, such as acne, prostate enlargement, thickening of the blood and masculinization in women and children. SARMs target specific androgen sites in muscles and do not bind to receptors in other tissues, which minimizes side effects and improves the usefulness of the drugs. (Andrology, 1: 29-36, 2013)

35. Should Aging Men Take Testosterone Supplements?
Prescriptions for testosterone replacement have tripled since the year 2000. Nearly four percent of U.S. men over 60 years take testosterone. The safety and effectiveness of testosterone supplements have been controversial ever since the development of testosterone drugs in the 1930s. Several recent studies found an increased risk of heart attack in patients receiving testosterone, but these studies have been severely criticized by most hormone specialists. A column in the New England Journal of Medicine called Clinical Decisions presented the case of a 61-year-old overweight man with slightly elevated blood fats, blood pressure and PSA (predictor of prostate problems) and decreased sex drive. One physician recommended testosterone supplements to boost sex drive and muscle mass. Another physician recommended against supplements because of possible risks to the cardiovascular system and prostate. The benefits were not worth the risks. The risks and benefits of testosterone therapy will probably be controversial for another 50 years. (New England Journal of Medicine, 371: 2032-2034, 2014)

36. FDA Subcommittee Recommends Limiting Testosterone Prescriptions
Testosterone prescriptions increased from 1.3 million in 2010 to more than 2.5 million in 2014. Much of the increase was due to aggressive advertising to “combat low T.” A subcommittee of the U.S. Food and Drug Administration (FDA) from the Endocrine Society recommended that testosterone prescriptions be limited to men with low testosterone levels (hypogonadism). They also recommended large-scale studies to determine the effects of testosterone supplements on the long-term risks of cardiovascular and prostate disease. Most, but not all, studies show that testosterone supplements increase muscle mass and strength, improve sexual performance and enhance mood in aging men. Other studies found that supplements increase the risk of cardiovascular disease. (Endocrine News, October 2014)

37. Longtime Steroid Use Leads to Sustained Improvements in Muscle Mass and Strength
Athletes have used anabolic steroids since the 1950s. While the practice has been fairly widespread, particularly in recreationally active men, we have little information on the long-term effects of sustained steroid use. Swedish researchers from Umeå University found that men using steroids for five to 15 years showed improvements in muscle strength that were dose-dependent: men who took higher doses were stronger than aged-matched controls who didn't use steroids. Steroid users also showed greater increases in lean leg mass, muscle fiber size, muscle cell nuclear density and muscle capillary density. This study on humans agrees with animal studies showing that steroids lead to adaptations that provide long-term advantages in muscle physiology. (PlosOne, 9 (9): E105330, 2014)