Medical examination “before” and “after” the cycle – Part I

Doping may be dangerous for health and life. Using pharmacological supplements may permanently change the functioning of endocrine system, especially among young people (under 21 years old). After all, according to research, the range of 30 – 60% of young people working out at the gym decides to use metandienone or other derivatives of testosterone. The problem is not larger or smaller use of doping, but lack of knowledge of devastation an “innocent pill” or “a few injections” may cause.

If you are less than 21, using doping is extremely dangerous for you. In general, people at this age aren't experienced properly in training – in order to use “help” right. The cost of doping is nothing compared to the money you have to spend on food and supplements – and sometimes to eliminate side effects (e.g. unblocking HPTA, regeneration of kidneys and liver). Many people who used doping more than moderately paid the highest price of their lives for that. People who overuse alcohol and/or drugs die really fast, just like the legendary Zyzz.

If you think that you are safe because you only use supplements – I have some bad news: the addition of forbidden substances has been proven to appear in diet supplements. In the research from the years 2001/2002 out of 634 products from 13 countries – 15% included illegal hormonal additives (mainly prohormones). The addition of traditional steroids, such as: metandienone, winstrol, boldenone, methyltestosterone or oxandrolone, is also proven [7].

The disturbance of HDL/LDL proportion = cardiovascular complications

It was stated that trace amount of winstrol influences drastically the level of HDL cholesterol. Supplying 6 mg of stanazolol a day for 6 weeks caused decrease of HDL by 33%, and HDL2 by 71%! As a comparison, testosterone (long esters) in the dose of 200 mg a week reduced the level of HDL by 9% (and it refers only to one fraction, HDL3). But that's not all. The level of LDL (bad cholesterol) increased by 29% due to winstrol and it decreased by 16% among competitors who got only testosterone enanthate [9]. That's even more shocking when you find out that some competitors use 50-100 mg of winstrol a day, and not 42 mg a week, like in the experiment! And it's very common that winstrol is used as one of few (dozens) of products.

Additionally, scientists connect hiperlipaemia with kidney diseases. In the next research it was stated that for a professional bodybuilder taking 371 mg of steroids a week, the level of HDL cholesterol fell after a year from 1.59 to 0.44 mmol/l, and HDL2 from 0.42 to 0.01 mmol.l. The contestant took steroids without any break, except for a 4-week period of discontinuation in the middle of the year [6]. Such low doses may be surprising (as for nowadays), but this research was done in 1985 when only such amount of steroids was used. During that year the bodybuilder gained 7 kg of lean mass (muscles). In another study it was stated that even small dose (200 mg per week) of testosterone enanthate lowered the level of the “good cholesterol” (High Density Lipoprotein – HDL – C) among 14 weightlifters by 16% and HDL2-C by 23%. The level of HDL-C decreased by 13%. Using the aromatase inhibitor (which blocks converting testosterone to estrogens) – only made the situation worse [8].

Conclusions and necessary medical examinations:

  • before and after the cycle do the full analysis of lipids (HDL, LDL, total chlesterol, triglycerides – TGL),

  • make sure that the level of LDL is lower than 100 mg/dL,

  • HDL should be over 35 mg/dL,

  • TGL should range between 60-160 mg/dL,

  • total cholesterol should be less than 200 mg/dL,

  • it's worth considering resigning from very harmfl for the HDL/LDL proportion steroids, such as winstrol, oxymetholone (anapolon), masteron (drostanolone propionate),

  • avoid saturated animal fats, fast food, fat cheese (quark and hard), mascarpone, limit the amount of lard, butter, etc.

  • balance the amount of omega 3 and omega 6 fats,

  • do regular aerobic or (if you can) interval activity,

  • in one of the studies, 4 weeks of supplying oral prohormone (3b-hydroxy-5a-androst-1-en-17-one) were enough to lower the level of HDL (the good one) by 38.7± 4.0%, and the bad one (LDL) rise by 32.8± 15.05% [15].

Changes in the heart

Many scientists speculate over the influence of large (doping) doses of steroids on heart. The hypertrophy of the left ventricle is very common among people who train – on average, it is larger by 45% among sports people comparing to inactive adults (Maron, 1986). Among strength competitors, the tendency of thickening walls of the left ventricle is noticeable. Can AAS intensify similar changes? The results of studies are not homogeneous (e.g. Pearson 1986, Urhausen 1989, Thompson 1992).

Conclusions and necessary medical examinations:

  • control blood pressure on the regular basis, especially if you use e.g. beta2-andrenergic agonists (ephedrine, clenbuterol, salbutamol) or products influencing thermogenesis in other way, e.g. by blocking capturing noradrenaline – sibutramine, together with AAS,

  • before starting physical activity, do medical tests, the best would be at the sports doctor and cardiologist,

  • it's recommended to do: auscultation, static ECG and effort ECG (e.g. on the ergometer),

  • additionally, echocardiography (2D + Doppler) can reveal many changes – it is directed according to the request from ECG and auscultation,

  • you should rethink resigning from substances influencing worse work of heart, increased blood pressure, e.g. “fat burners” (e.g. large doses of caffeine, ephedrine and its derivatives), energy drinks, before-training boosters, such as JACK3D (until recently based on DMAA).

Blood pressure, kidneys damage

Kidneys regulate the long-term blood pressure by regulating the level of sodium in the body. During filtration and glomerular filtration, kidneys have large tolerance of differences in blood pressure ranging from 90 to 190 mm Hg [4]. Majority of doping substances acting like hormones, when used in large doses, can significantly increase blood pressure (especially systolic one) – e.g. all kinds of trenbolone and oxymetholone (anapolon) are famous for such activity. In research, moderate amount of testosterone undecanoate (1000 mg every 6 weeks, later the same dose every 12 weeks) among obese men at the age of about 58 with metabolic syndrome caused decrease of systolic blood pressure by 23 ± 10 mm Hg, and diastolic blood pressure by 16 ± 8 mm during 5 years of treatment! Additionally, the waistline circumference got smaller by 10 cm (in the control group it increased by 3 cm). Within the testosterone group the loss of weight was also observed by -15 ± 2.8 kg (all data concern the 60. month of treatment). [12]

But that's not all – due to the influence of DHT (dihydrotestosterone), which is much stronger testosterone derivative, on prostate – it's possible that hypertrophy of this gland may appear. And it's another risk factor for kidney diseases [5]. Some scientists speculate about the possibility of occurrence of kidney stones among people with high level of testosterone [10].

Some products have direct impact on kidney damage, e.g. the reason of chronic tubulo-interstitial nephritis is using slimming supplements with Chinese herbs containing aristolochic acid (the nephrotoxic alcaloid) [2]. It's very common among young people, who desperately want to lose body fat, to buy such products.

“A patient at the age of 17, with BMI 32.2, lost 20 kg during 4 months by using, among other specifics, products containing Chinese herbs. In short period of time, the patient's body developed high blood pressure, features of kidney failure up to the development of end-stage renal failure. On the basis of kidney biopsy, the image of end-stage kindey with intensified chronic and irreversible changes within glomeruli, as well as in intestitium were proven” [3].

“Chang et.al gathered in their study 20 cases of nephropatia among the citizens of Taiwan caused by Chinese herbs. All of the patients had proteinuria up to 2.8 g/day, appropriate urine sediment. 15 people had glucosuria and 7 had high blood pressure. The period of time of using products suspected of neurotoxicality was different – from 4 to 24 months. All the patients required kidney replacement therapy shortly after applying to the doctor's” [3].

Conclusions and necessary medical examinations:

  • do the basic urine test- you can get the refferal from your family doctor (you should gather the analytical unit from the so-called central stream, bring to the laboratory up to an hour after urinating),

  • pay attention to: blood, creatinine (kidney function), erythrocytes (e.g. urinary tract ailments, cirrhosis), leukocytes (e.g. the parameter may point at the infection of urinary tract, interstitial nephritis), proteins in urine, bilirubin, urobilinogen (it may illustrate cirrhosis or blocking the drainage of the bile from the liver) – if necessary, consult an urologist/nephrologist,

  • you should check blood pressure regularly (few different measures),

  • check GFR (glomerular filtration rate) if necessary,

  • if you have problems with urinating, do the prostate tests,

  • do not use any suspicious products, e.g. Chinese herbs, they can be toxic for the kidneys and lead to kidney failure, especially if you also use other medicines (e.g. steroids, diuretics),

  • consider resigning from potentially harmful for kidneys products of trenbolon kind,

  • do not use any products famous for their strong influence on blood pressure, e.g. metandienone (dianabol), oxymetholone, sustanon (omnadren) or trenbolone (larger dose = larger health problems),

  • in one of the studies, 4 weeks of supplying oral prohormone (3b-hydroxy-5a-androst-1-en-17-one) were enough to damage kidneys (GFR fell by 18.0 ± 3.3%!, creatinine increased by 19.6 ± 4.3%) [15].

Prostate gland

Testosterone (e.g. propionate, sustanon, enanthate, cypionate) is still the basis of majority of doping cycles for amateurs. Unfortunately, as a result of action of 5-alpha reductase, there is conversion of testosterone into DHT. It would be all fine, if not for the influence of dihydrotestosterone on acne, alopecia and prostate (slight hypertrophy). Attention: these changes strongly depend on individual conditioning – genetics, length of cycle, products used and doses. In literature some cases of using e.g. testosterone undecanoate by men in middle age gor 5 years (1000 mg every 6/12 weeks) or supplying 600 mg of “long” testosterone to young men for 5 months – without any side effects, are known [12, 13].

Conclusions and necessary medical examinations:

  • check your PSA (prostate-specific antigen), the level of PSA>4 ng/ml should be alarming [11],

  • it's good to check prostate, especially if you feel any discomfort (refferal from a doctor, urologist), it's high time if you have e.g. difficulties during urinating,

  • simple urine test may be very useful (you cen get the refferal from your family doctor),

  • consider resigning from any products of fluoxymesterone (halotestin), trenbolone or oxymetholone (anapolon) kind,

  • against common belief, e.g. saw palmetto has no influence on PSA [16].

Liver

Liver damage is usually caused by products with 17-alpha group, such as:

  • fluoxymesterone (halotestin),

  • oxymetholone (anapolon),

  • metandienone (methandrostenolone, dianabol),

  • stanazolol (winstrol),

  • methyltestosterone.

Attention: it doesn't matter if e.g. metandienone or winstrol is in pills or in a form of injections! There is no passage through digestive tract, but the hepatotoxicity is still the same!

Conclusions and necessary medical examinations:

  • if you are using AAS, avoid alcohol and other medicines which could additionally stress liver,

  • check liver regularly – the pointers of GPT (glutamic pyruvic transferase) – normal: 5 – 45 U/L, GOT (glutamic oxoloacetic transaminase) – narmal: 8 – 46 U/L, bilirubin (total and direct); of lower significance are: GGTP, ALP, LDH, ChE [14],

  • do not use oral AAS longer than 4-6 weeks, as they are highly toxic for the liver (group 17-alpha), especially in large doses,

  • consider using AAS in injections with more gentle influence on liver,

  • “prohormones” of unknown productions are extremely toxic for the liver.

 

Medical examination “before” and “after” the cycle – Part II

Sources: Budowa układu moczowego http://nefrologia.mp.pl/choroby/chorobyudoroslych/show.html?id=57153 2. Śródmiąższowe zapalenie nerek prof. dr hab. Stanisław Czekalski, dr n. med. Robert Drabczyk http://nefrologia.mp.pl/choroby/chorobyudoroslych/show.html?id=51930 3. „Nefropatia ziół chińskich — opis przypadku” Konrad Walczak, Anna Krysicka, Dariusz Moczulski. Klinika Chorób Wewnętrznych i Nefrodiabetologii, Uniwersytet Medyczny w Łodzi, Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej 4. „Fizjologia człowieka” J. Górski, Wydawnictwo PZWL, wyd I. 5. Nadciśnienie tętnicze a nerki, Rocznik 1998 Gazety Lekarskiej Numer 1998-02 6. Int J Sports Med. 1985 Feb;6(1):24-9. “Physical health and fitness of an elite bodybuilder during 1 year of self-administration of testosterone and anabolic steroids: a case study”. http://www.ncbi.nlm.nih.gov/pubmed/3921472 7. J Mass Spectrom. 2008 Jul;43(7):892-902. doi: 10.1002/jms.1452. “Nutritional supplements cross-contaminated and faked with doping substances.” 8. Metabolism. 1993 Apr;42(4):446-50. “The effect of testosterone aromatization on high-density lipoprotein cholesterol level and postheparin lipolytic activity” http://www.ncbi.nlm.nih.gov/pubmed/8487666 9. JAMA. 1989 Feb 24;261(8):1165-8. Contrasting effects of testosterone and stanozolol on serum lipoprotein levels. http://www.ncbi.nlm.nih.gov/pubmed/2915439 10. PLoS One. 2014 Apr 2;9(4):e93790. doi: 10.1371/journal.pone.0093790. eCollection 2014. Androgens involvement in the pathogenesis of renal stones formation. 11. Praktyczne aspekty rozpoznawania i leczenia zespołu niedoboru testosteronu (TDS) u mężczyzn http://www.przeglad-urologiczny.pl/artykul.php?1620 12. “Effects of Five-Year Treatment with Testosterone Undecanoate on Metabolic and Hormonal Parameters in Ageing Men with Metabolic Syndrome” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945028/ 13. “Testosterone dose-response relationships in healthy young men” http://www.ncbi.nlm.nih.gov/pubmed/11701431 14. http://twojawatroba.pl/proby-watrobowe 15. „Prohormone supplement 3b-hydroxy-5a-androst-1-en-17-one enhances resistance training gains but impairs user health” 16. http://www.ncbi.nlm.nih.gov/pubmed/23253958 J Urol. 2013 Feb;189(2):486-92. doi: 10.1016/j.juro.2012.09.037. Epub 2012 Dec 14. The effect of increasing doses of saw palmetto fruit extract on serum prostate specific antigen: analysis of the CAMUS randomized trial.