There has been a growing medical interest in safe and effective anabolic steroid agents appropriate for use in patients with chronic wasting conditions and to combat the weakness associated with muscle loss consequent to natural aging.  Anabolic androgenic steroids (AAS) have a long term history of use in the treatment of these and a number of disorders.  The heralding of negative public opinion has stifled the medical community in studying this class of hormones which have proven invaluable over the past 35 years in improving the health and well-being of a vast patient base.

One anabolic steroid, oxandrolone, often publicly recognized by its Mexican registration name of Anavar ™, has emerged among the most frequently researched anabolic steroid.   Oxandrolone has been used extensively for clinical applications since 1964 to treat HIV muscle wasting, severe burn recovery, wasting consequent to major surgery or trauma, neuromuscular disorders, alcoholic hepatitis, and more recently osteoporosis and the pain associated therewith.

In America, the US-FDA has continually expanded the on-label approved purposes for oxandrolone as new applications for clinical use emerge.   The US-FDA has recently added catabolism of muscle mass and weight loss after trauma, major surgery, and infections to the list of approved on-label uses and well as in the combatting of malnutrition due to alcoholic cirrhosis,  Dchenne’s and Becher’s muscular dystrophy, and Turner’s Syndrome.    The US-FDA is among the most conservative FDA’s in the world with respect to safety profiles and the most conservative in the world with respect to anabolic steroid hormones and yet the US-FDA continues to approve new on-label uses for oxandrolone.  This is a significant symbolic step toward the global recognition of oxandrolone and its enormous and profound value to the medical community and patients.

Numerous US NIH and private studies have continued to reaffirm oxandrolone’s clinical efficacy and safety profile with respect to these and other conditions.  The evidence in favor of oxandrolone is strong and overwhelming, leading many countries to restrict or discontinue registrations for anabolics with poor safety profiles such as oxymetholone (aka “Anadrol”) and methandienone (aka “Dianabol”) and expand registrations and on-label indications for oxandrolone.  Oxymetholone and methandienone are well known for severe hepatotoxicity short term, hypertension, eccentric left ventricular hypertrophy,  emotional morbidity, rapid onset of hypogonadism by HPTA suppression, renal stress, severe insomnia, severe acne, and generally only suitable for short-term patient use.  A number of prominent athletes have presented with cardiomyopathy consequent to oxymetholone and methandienone use in prior years.

Oxymetholone and methandienone are extremely powerful anabolic agents but have questionable safety profiles to where clinical use is extremely limited.  Oxandrolone is a moderate strength anabolic agent with a more acceptable safety profile leading to its expanded use in clinical applications.

Oxandrolone improves body composition by increasing lean muscle mass while reducing body fat, improving muscular function and overall strength, and aiding in recovery from diseases associated with a catabolic state, particular those diseases associated with catabolism consequent to poor nutritional status.  The research available includes scores of double-blind peer-reviewed studies from respected institutions and researchers demonstrating the safety and efficacy of oxandrolone protocols for an ever growing number of clinical applications.

Oxandrolone’s evolution in clinical treatments appears to be expanding toward generalized use for improvement of healing and use in conditions where an increase in muscle mass is of positive value to the patient’s health including concomitant use with corticosteroids to offset muscle catabolism.  The safety profile continues to be well established.

The consideration of oxandrolone in the treatment of sarcopenia remains a subject of controversy.  The medical community has proven resistant to the acceptance of oxandrolone for pure age related conditions but rather accepting of oxandrolone in the treatment of specific conditions more frequently expressed in the geriatric population such as osteoporosis and the pain associated therewith.

Oxandrolone is a 17-alpha alkylated anabolic androgenic steroid.  Oxandrolone is dihydrotestosterone with a substitution and thusly already reduced from testosterone and will not be aromatized and produce estrogens.   17-alpha alkylated steroids such as stanozolol, methandienone, and oxymetholone are generally associated with hepatoxicity, inherently limiting their use in clinical applications, particularly in long-term applications.  Oxandrolone exhibits a remarkable resistance to metabolism in the liver while still yielding anabolic activity.  Serious hepatotoxic side effects such as jaundice and hepatitis are very rare, albeit with the rapid growth and popularity of clinical use the US-FDA has required a black box warning for oxandrolone and the risk of liver cysts.

Oxandrolone still exhibits the traditional side effects one can expect from anabolic steroids in general including transient elevations in AST and ALT and changes in cholesterol metabolism leading to downward shifts in serum HDL and elevation of serum LDLs.   As is the case with many classes of medication, the optimal risk to benefit ratios determine the medical acceptability.  Oxandrolone presents one of the best risk to benefit ratios among anabolic steroids and similar agents.   The side effect profiles are substantially diminished in magnitude and frequency versus other oral anabolic agents making oxandrolone the most acceptable oral anabolic steroid for clinical applications registered today.

Depo Test 250, Unigen Life Sciences Ltd.’s registered Testosterone Enanthate injectable (250mg/mL) uses an ethyl oleate base thin enough to draw well through a 30 gauge needle.   This makes Depo Test 250 useful for administration of SQ injection based testosterone replacement therapy.

Subcutaneous injection based testosterone replacement therapy is not a new idea and has had its public proponents for over the years.  The risk of infection and abscess is lower with SQ vs. IM as-is patient compliance.   The greater comfort and compliance of SQ injections will favor therapies involving multiple intra-week injections to provide more balanced testosterone serum levels and reduced aromatization to estrogen.

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Oxandrolone is known by a number of recognized brand names Anavar ™ , Lonavar ™ , Oxandrin ™, Protivar ™, Provitar ™, Oxavar ™, Vasorome ™, and others.  Oxandrolone has been shown to have great efficacy in the treatment of osteoporosis.   Oxandrolone has an interesting history among anabolic steroids, at one point being orphaned by its U.S. manufacturer in 1989 only to find an orphan drug patent issued to another manufacturer in 1995, permitting U.S. oxandrolone patients to be victimized by expensive prices all over again.

Oxandrolone is useful in helping to increase body weight after extensive surgery or long term hospitalization.  Oxandrolone is particularly useful in helping to fight muscle loss common in trauma and chronic infection patients during long-term recoveries.  For patients receiving corticosteroids such as cortisol, hydrocortisone, methylprednisolone, and dexamethasone, significant muscle loss is common.   Oxandrolone is useful to counter muscle losses consequent to corticosteroid therapies and in reducing bone pain associated with osteoporosis.   Oxandrolone can be used to treat alcohol liver damage, extend the life span of patients with HIV wasting disease, help anemic patients, combat geriatric weight loss, and in very low doses can be used to treat Turner’s Syndrome in pediatric patients.   The medical applications of oxandrolone are quite broad and the future will no doubt find scores of on-label usages as research interests in anabolic steroids continue to grow.

One mainstream application of oxandrolone is in the treatment of osteoporosis.  In osteoporosis, the density of bone minerals reduces and the microstructure of bones and proteins about the bone are altered in a manner which increases the risks of bone fracture.  Osteoporosis is thus a bone disease, generally defined as 2.5 sigma (standard deviations) below the bone mineral density for the normal range (20-year old females in study).  Subject to this standard, DEXA scanners have emerged as an inexpensive manner of measuring bone density.

It is well established that men suffering from long-term hypogonadism (low testosterone) generally exhibit signs of osteoporosis.   Similarly, women who take Aromatase Inhibitors such as anastrozole (aka Arimozole ™ aka Arimidex ™) and letrozole (aka Femara ™) generally as part of a cancer treatment, often develop osteoporosis and are often treated with SERM’s such as tamoxifen ( aka Tamoxidex ™ aka Nolvadex ™ ) and raloxifene later to treat the osteoporosis.    Many women also begin estrogen replacement therapy in part to treat their osteoporosis.  In a far more limited scope, bodybuilders who utilize aromatase inhibitors and titrate their estrogens too low long-term often present with osteoporosis later.   There is a definitive connection between osteoporosis, estrogen, and testosterone.  Osteoporosis is useful not only in limiting the effects of osteoporosis but also in reducing the bone pain associated with osteoporosis.

Oxandrolone dosages associated most medical indications outside of a research environment is limited to a maximum of 20mg per day generally in 2.5mg – 10mg doses 2 to 4 times per day.   At these lower dosages, there is a reduced risk of liver enzymes elevating to the extent that continued oxandrolone therapy is contraindicated.   Lower dosage treatments are associated with a lesser extent of side effects, making long term oxandrolone therapy more reasonable for the patients.

Oxandrolone should be used under medical supervision only, particularly in the instance of long term therapy.   Practitioners should monitor serum hemoglobin and hematocrit, liver enzymes, and lipids.  Oxandrolone and most anabolic steroids change the patient’s lipid profile increasing LDLs and reducing HDL’s.  These changes are reversible upon discontinuation of oxandrolone treatment.   Oxandrolone patients on hypoglycemic agents, diabetics, and those on anticoagulants, particularly warfarin, must be monitored with increased care.  Oxandrolone is known to alter several clotting factors (common with oral 17-alpha steroids) and PT, PTT, and INR should be expected to change during therapy particularly when oxandrolone is first started or stopped.  Female oxandrolone patients must always be screened for signs of virilization: voice changes, new hair growth, menstrual changes, etc.   Special care must also be given to oxandrolone patients with compromised adrenal function as androgen therapies can increase the risk of adrenal fatigue.  Male oxandrolone patients should be monitored for signs of HPTA suppression and total and bioavailable testosterone monitored for long term therapies.  In patients with edema, administration of oxandrolone concomitant with adrenal corticosteroids or ACTH may result in increased edema.

When reviewing thyroid functions of patients on oxandrolone and most oral anabolic steroid therapies, practitioners are encouraged to order Free-T3 and Free-T4 panels to measure the unbound serum levels as thyroxine-binding globulin levels are generally suppressed in oxandrolone patients leading to decreased bound-T4 in serum and increased uptake of T3 and T4.  The Free T3 and Free T4 panels will not be changed.   Diagnostic procedures involved radioisotopes of iodine may exhibit deviations consequent to the decreased uptake in oxandrolone patients.

Oxandrolone patients should show greater vigilance in seeking medical attention for abdominal pain, dark colored urine, light colored stools, and yellowing of the eyes as these may be early signs of liver problems.  Some rare but serious side effects include allergic reactions (difficulty breathing, swelling lips, hives), edema of the arms or legs, persistent erections, and breast tenderness or enlargement (male).  Lesser side effects include insomnia, acne, headaches, and libido changes.

Oxandrolone contraindications include carcinoma of the prostate or male or female breast, whether suspected or known, hypercalcemia, nephrosis, or patients who are pregnant or may become pregnant because of masculinization risks to the fetus.  Animal studies have demonstrated embryotoxicity and fetotoxicity associated with oxandrolone.  Potential oxandrolone patients should discuss any prior heart or blood vessel disease, heart attacks, prostate issues, testosterone treatments, high cholesterol, clotting problems, diabetes, use of blood thinners, and prior or current kidney and liver problems with their physician.

Compared to other oral anabolics, oxandrolone is extremely well tolerated and side effects are substantially diminished.  Oxandrolone is among the safest of anabolic steroids when used under medical supervision.  The risks associated with oxymetholone (Anadrol), methandienone (Dianabol), and other common oral steroids are substantially greater accounting for their ever reducing use in medical applications and isolation almost exclusively to bodybuilding.   Oxymetholone was once used heavily in the treatment of HIV wasting diseases and anemia, however the substantial hepatoxicity and side effect profiled was seen to outweigh its value and many former oxymetholone patients have moved to oxandrolone therapies under supervision.

Oxandrolone and Nandrolone Decanoate remain the two most promising mainstream anabolics for use in a broad array of medical uses.

Oxandrolone is an anabolic steroid often associated with its Mexican registration name of Anavar ™ which has been highly successful in generating the growth of lean muscle in patients.  Oxandrolone has been studied across diverse patient populations with quantified success in the generation of lean muscle mass.  Oxandrolone has proven particularly effective in HIV wasting disease populations and with patients at risk for significant muscle loss consequent to corticosteroid therapy and/or patients undergoing long term recovery from trauma or chronic infection.

Oxandrolone is known by a number of recognized brand names Anavar ™ , Lonavar ™ , Oxandrin ™, Protivar ™, Provitar ™, Oxavar ™, Vasorome ™, and others.  Oxandrolone has been shown to have great efficacy in the treatment of osteoporosis.   Oxandrolone has an interesting history among anabolic steroids, at one point being orphaned by its U.S. manufacturer in 1989 only to find an orphan drug patent issued to another manufacturer in 1995, permitting U.S. oxandrolone patients to be victimized by expensive prices all over again.

Oxandrolone is useful in helping to increase body weight after extensive surgery or long term hospitalization.  Oxandrolone is particularly useful in helping to fight muscle loss common in trauma and chronic infection patients during long-term recoveries.  For patients receiving corticosteroids such as cortisol, hydrocortisone, methylprednisolone, and dexamethasone, significant muscle loss is common.   Oxandrolone is useful to counter muscle losses consequent to corticosteroid therapies and in reducing bone pain associated with osteoporosis.   Oxandrolone can be used to treat alcohol liver damage, extend the life span of patients with HIV wasting disease, help anemic patients, combat geriatric weight loss, and in very low doses can be used to treat Turner’s Syndrome in pediatric patients.   The medical applications of oxandrolone are quite broad and the future will no doubt find scores of on-label usages as research interests in anabolic steroids continue to grow.

One mainstream application of oxandrolone is in the treatment of osteoporosis.  In osteoporosis, the density of bone minerals reduces and the microstructure of bones and proteins about the bone are altered in a manner which increases the risks of bone fracture.  Osteoporosis is thus a bone disease, generally defined as 2.5 sigma (standard deviations) below the bone mineral density for the normal range (20-year old females in study).  Subject to this standard, DEXA scanners have emerged as an inexpensive manner of measuring bone density.

It is well established that men suffering from long-term hypogonadism (low testosterone) generally exhibit signs of osteoporosis.   Similarly, women who take Aromatase Inhibitors such as anastrozole (aka Arimozole ™ aka Arimidex ™) and letrozole (aka Femara ™) generally as part of a cancer treatment, often develop osteoporosis and are often treated with SERM’s such as tamoxifen ( aka Tamoxidex ™ aka Nolvadex ™ ) and raloxifene later to treat the osteoporosis.    Many women also begin estrogen replacement therapy in part to treat their osteoporosis.  In a far more limited scope, bodybuilders who utilize aromatase inhibitors and titrate their estrogens too low long-term often present with osteoporosis later.   There is a definitive connection between osteoporosis, estrogen, and testosterone.  Osteoporosis is useful not only in limiting the effects of osteoporosis but also in reducing the bone pain associated with osteoporosis.

Oxandrolone dosages associated most medical indications outside of a research environment is limited to a maximum of 20mg per day generally in 2.5mg – 10mg doses 2 to 4 times per day.   At these lower dosages, there is a reduced risk of liver enzymes elevating to the extent that continued oxandrolone therapy is contraindicated.   Lower dosage treatments are associated with a lesser extent of side effects, making long term oxandrolone therapy more reasonable for the patients.

Oxandrolone should be used under medical supervision only, particularly in the instance of long term therapy.   Practitioners should monitor serum hemoglobin and hematocrit, liver enzymes, and lipids.  Oxandrolone and most anabolic steroids change the patient’s lipid profile increasing LDLs and reducing HDL’s.  These changes are reversible upon discontinuation of oxandrolone treatment.   Oxandrolone patients on hypoglycemic agents, diabetics, and those on anticoagulants, particularly warfarin, must be monitored with increased care.  Oxandrolone is known to alter several clotting factors (common with oral 17-alpha steroids) and PT, PTT, and INR should be expected to change during therapy particularly when oxandrolone is first started or stopped.  Female oxandrolone patients must always be screened for signs of virilization: voice changes, new hair growth, menstrual changes, etc.   Special care must also be given to oxandrolone patients with compromised adrenal function as androgen therapies can increase the risk of adrenal fatigue.  Male oxandrolone patients should be monitored for signs of HPTA suppression and total and bioavailable testosterone monitored for long term therapies.  In patients with edema, administration of oxandrolone concomitant with adrenal corticosteroids or ACTH may result in increased edema.

When reviewing thyroid functions of patients on oxandrolone and most oral anabolic steroid therapies, practitioners are encouraged to order Free-T3 and Free-T4 panels to measure the unbound serum levels as thyroxine-binding globulin levels are generally suppressed in oxandrolone patients leading to decreased bound-T4 in serum and increased uptake of T3 and T4.  The Free T3 and Free T4 panels will not be changed.   Diagnostic procedures involved radioisotopes of iodine may exhibit deviations consequent to the decreased uptake in oxandrolone patients.

Oxandrolone patients should show greater vigilance in seeking medical attention for abdominal pain, dark colored urine, light colored stools, and yellowing of the eyes as these may be early signs of liver problems.  Some rare but serious side effects include allergic reactions (difficulty breathing, swelling lips, hives), edema of the arms or legs, persistent erections, and breast tenderness or enlargement (male).  Lesser side effects include insomnia, acne, headaches, and libido changes.

Oxandrolone contraindications include carcinoma of the prostate or male or female breast, whether suspected or known, hypercalcemia, nephrosis, or patients who are pregnant or may become pregnant because of masculinization risks to the fetus.  Animal studies have demonstrated embryotoxicity and fetotoxicity associated with oxandrolone.  Potential oxandrolone patients should discuss any prior heart or blood vessel disease, heart attacks, prostate issues, testosterone treatments, high cholesterol, clotting problems, diabetes, use of blood thinners, and prior or current kidney and liver problems with their physician.

Compared to other oral anabolics, oxandrolone is extremely well tolerated and side effects are substantially diminished.  Oxandrolone is among the safest of anabolic steroids when used under medical supervision.  The risks associated with oxymetholone (Anadrol), methandienone (Dianabol), and other common oral steroids are substantially greater accounting for their ever reducing use in medical applications and isolation almost exclusively to bodybuilding.   Oxymetholone was once used heavily in the treatment of HIV wasting diseases and anemia, however the substantial hepatoxicity and side effect profiled was seen to outweigh its value and many former oxymetholone patients have moved to oxandrolone therapies under supervision.

Oxandrolone and Nandrolone remain the two most promising mainstream anabolics for use in a broad array of medical uses.