July 14, 2025 • 19 mins
This review podcast episode examines the efficacy and safety of oxandrolone, an anabolic androgenic steroid (AAS), in treating various wasting and catabolic disorders. It explores the drug's pharmacokinetic and pharmacodynamic properties, noting its unique resistance to liver metabolism compared to other oral AASs. The text details oxandrolone's clinical benefits in conditions like severe burns, HIV/AIDS-related wasting, and neuromuscular disorders, highlighting improvements in body composition and muscle function. Furthermore, the article addresses the potential for adverse effects, particularly concerning hepatic issues and cholesterol changes, while also discussing the drug's potential utility in treating age-related sarcopenia. Ultimately, it concludes by advocating for more extensive, long-term research to optimize its therapeutic application.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Okay, what if we told you there's a type of, well,
(00:02):
scaroid that's been safely and effectively used in medicine
for over 30 years.
Yeah, not for doping or anything like that.
Exactly, but to help patients recover from severe burns,
fight muscle wasting in conditions like HIV,
and even improve liver function
in alcoholic hepatitis.
It kind of challenges the common perception, doesn't it?
(00:23):
The compound we're diving into today
is an anabolic androgenic steroid,
or a deus called oxandralone.
Right, and while that word steroid
often brings up negative images,
our deep dive today is gonna unpack its,
well, frankly surprising and very well documented
medical uses.
So our mission today is basically to give you a shortcut
to being truly well-informed on this really fascinating
(00:46):
compound.
We're digging into a comprehensive medical review from 2004.
A pretty detailed look at its effectiveness, its safety.
Yeah, especially in treating wasting
in these catabolic disorders.
We'll get into the science,
understand its unique properties,
look at the proven clinical benefits,
and importantly assess its safety.
Okay, let's get into it.
To really grasp what makes oxandralone stand out,
(01:08):
we probably need a quick foundation
on anabolic androgenic steroids,
estuulus in general.
Good idea.
So at their core, these are basically derivatives
or modifications of testosterone,
the main male sex hormone, a powerful steroid itself.
Right, and they have this kind of dual nature, don't they?
They're the anabolic effects and the androgenic effects.
(01:29):
Exactly, anabolic is the building up part,
think protein synthesis,
holding onto nitrogen, growing skeletal muscle,
tissue construction, no sense.
That's the desirable part, medically speaking.
Usually, yes.
Then you have the androgenic effects.
These are linked to male characteristics,
primary and secondary sexual traits.
And in women, these can show up as side effects
(01:51):
people definitely don't want,
like male pattern hair loss, deeper voice, facial hair.
Precisely.
And historically, separating those two effects,
getting the muscle building without the masculinization,
that's been the big challenge.
So how do they actually work at a molecular level?
Well, mostly they work by binding
to something called the androgen receptor, the AR.
It's a protein in our cells.
(02:13):
Like a docking station.
Kind of, yeah.
Once the AAS molecule binds to the AR,
this whole complex moves into the cell's nucleus.
Okay.
And there, it binds to DNA
and basically tells the cell machinery,
hey, make more protein.
These new proteins then do the work
the hormone is signaling for.
So the AR is like a specific lock
and the AAS are the keys.
(02:35):
That's a great analogy.
The issue is this lock is in muscle tissue,
which is good, but it's also in reproductive tissues
and others, which leads to those androgenic side effects.
It's hard to make a key that only fits the muscle lock.
Makes sense.
But that's not the whole story.
They also work indirectly.
For instance, they can interfere
with the glucocorticoid receptor.
Those are stress hormones like cortisol, right?
(02:57):
They break down tissue.
Exactly.
So by antagonizing that receptor,
AAS help inhibit protein breakdown or catabolism.
We see this with testosterone reducing muscle breakdown
in severe burn patients, for example.
Okay.
So they build muscle and prevent its breakdown.
Right.
Plus they can boost the liver's production of IGF-1,
insulin-like growth factor one.
(03:19):
Another muscle builder.
Yep.
And some evidence suggests that they might suppress myostatin,
which is a protein that naturally limits muscle growth.
So they take the breaks off too.
Wow.
Okay.
So multiple pathways leading to more muscle mass.
Understanding these mechanisms helps you see
why they're so potent, but also why you get
this package deal of effects, both good
and sometimes not so good.
(03:40):
Right.
It sets the stage for why finding something different.
Something like a Xandralone was so important.
We've got this picture of a crest powerful builders,
but often carrying that androgenic baggage.
The dream was always a key just for the muscle lock.
How did a Xandralone, made back in 1962, manage this?
Well, its chemical structure is really quite different.
It is a C-17 alpha-alkylated AIS,
(04:03):
which is common for oral steroids that modification
helps it survive the liver first pass.
Okay.
But how it's structured beyond that is unique.
It has an oxygen atom swapped in
where others have a methylene group at the two position
and it's missing something called a 4-ene function
in its eye ring.
It sounds technical,
you're saying these small structural changes are key.
Absolutely key.
(04:24):
They fundamentally change how the molecule behaves in the body,
especially regarding metabolism and side effects.
Okay, so structure is unique.
What about pharmacokinetics?
How does the body handle it once you take it?
It gets absorbed pretty well orally.
You see peak levels in the blood after about an hour.
And how long does it stick around?
The elimination half-life is around nine hours,
(04:45):
so it has a decent duration of action.
It's also highly protein-bound, about 95%.
Got it.
Absorbed well lasts a while.
But what of metabolism you mentioned structure affects that?
And this is the big deal with oxandralone,
unlike many other oral ACEs that get heavily processed
or metabolized by the liver.
Which can cause liver strain, right?
Exactly.
Oxandralone is remarkably resistant
(05:07):
to that liver biotransformation,
that unique structure we talked about.
It inhibits the typical metabolic pathways.
So the liver doesn't break it down as much.
Much less.
In fact, about 28% of it is excreted unchanged in the urine.
That resistance is huge for its safety profile,
especially liver safety.
Wow.
Okay.
That's a major difference.
(05:28):
So structure leads to less liver breakdown.
What about what it does in the body?
The pharmacodynamics.
This is where it shines.
It has strong anabolic activity, muscle building,
but relatively weak endogenic effects.
Ah, so it managed to separate those effects better.
Significantly better.
Its anabolic to endogenic ratio is often cited as around 10.1,
(05:49):
which is much higher than testosterone or methylat testosterone.
In humans, its anabolic punch is about 6.3 times that of methyl testosterone.
And toxicity.
Animal studies show very low toxicity.
So for you listening, the takeaway here is this unique structure
isn't just a chemical novelty.
It leads to less liver metabolism and a much better ratio of muscle building
(06:10):
effects versus masculinizing effects.
It really is a different kind of oral steroid,
and that's critical when we get to the safety discussion.
Okay, so we've established its structurally unique handle differently by the body
and has this favorable anabolic endogenic ratio.
What does that translate to in the real world?
What are the proven clinical uses?
Well, the USFTA has actually approved it for some pretty specific things,
(06:32):
restoring weight loss after major trauma, surgery, or chronic infections.
Serious situations where people lose a lot of body mass.
Exactly.
Also for male nutrition related to alkylmolyxerosis and even certain types of muscular dystrophy,
like douchens or beckers.
So these aren't trivial conditions.
Not at all.
And the review of studies shows strong evidence for its effectiveness across the board.
(06:55):
You consistently see improvements in body composition, more lean mass,
less fat plus better muscle strength, better function, faster recovery from injury,
and improved nutritional status in most well-designed trials.
It's good specific.
Burns, for example.
That's a state of extreme catabolism, right?
Muscle just melts away.
Terribly so.
And oxandrelone has shown remarkable results there.
(07:17):
One study found it enhanced muscle protein synthesis by over 100% compared to controls.
Doubled it.
Wow.
It also significantly cuts down weight loss, nitrogen loss,
which is a marker of protein breakdown, and can speed up healing.
Think 30% faster healing of skin graft donor sites in one study.
That means shorter hospital stays too.
Absolutely.
One trial reported hospital stays reduced by about 35%.
(07:41):
Fewer complications, potentially better survival rates too.
That's incredibly impactful for those patients.
What about other acute situations like general trauma?
Similar benefits like improved pre-albeam in levels, which indicate nutritional status.
Though interestingly, a couple of studies did note slightly longer hospital or ICU stays,
maybe increased rates of pneumonia or sepsis compared to controls in trauma patients.
(08:04):
Mm-hmm.
OK.
So maybe not universally positive in every single acute scenario, but clearly powerful effects.
It highlights the need to look at specific patient groups.
Now, shift to chronic catabolic conditions.
Yes.
Like alcoholic hepatitis.
Where the liver is damaged, and patients often suffer malnutrition and muscle wasting.
Right.
Studies showed oxandrelone led to improvements in body composition,
(08:27):
liver function markers, and even survival rates.
One study found a 17% higher survival at six months,
and a 20% reduction in the severity of liver injury markers.
That's significant.
What about something like COPD?
Chronic lung disease often comes with muscle loss too.
Yes, it does.
There aren't as many big controlled trials here,
but the uncontrolled studies suggest similar benefits.
(08:49):
Better body weight, more body cell mass, improved functional status.
Promising, but needs more research.
OK.
And then there's HIV or AIDS-associated wasting.
That was a huge problem, especially earlier in the epidemic.
A devastating problem.
And multiple studies show oxandrelone produces positive results here,
improving body composition, muscle function, nutritional status.
(09:10):
Does combining it with anything else help?
Like exercise.
Great question.
Yes.
Combining oxandrelone with progressive resistance training
showed significantly better results than either alone.
Synergistic effect.
Seems like it.
Greater gains in body weight like 2.5 kilos more in one study.
Better nitrogen retention, more lean body mass,
even better bone mineral content, less fat mass,
(09:32):
and boosted muscle strength and function.
So exercise plus oxandrelone is a powerful combo for rebuilding.
Definitely.
But even on its own, say 15 milligrams a day,
over several months, it showed continued weight gain,
improved appetite, and better physical activity levels.
What about neuromuscular disorders?
You mentioned muscular dystrophy earlier.
Right.
In Duchenne's muscular dystrophy, studies reported benefits like
(09:55):
increased body weight about 1.6 kilogram,
a bit more height gain, and improved muscle strength scores.
And spinal cord injury.
That often leads to pressure sores and respiratory issues.
Here, the results were quite striking in some cases.
One study found complete healing of previously non-healing
pressure ulcers in nearly 90% of patients treated with oxandrelone.
(10:17):
90%.
That's incredible for something notoriously hard to heal.
It really is.
And improvements in respiratory function too,
like a 9% increase in combined lung function measures.
This is a broad range of applications.
Any other sort of miscellaneous uses noted?
A few interesting ones.
In obese men, it was shown to decrease visceral fat,
the dangerous fat around the organs,
by about 35 square centimeters, while increasing thigh muscle area.
(10:42):
So shifting body composition favorably even in obesity.
Seems so.
It also showed benefits in lowering triglycerides and cholesterol
in certain specific types of hyperlipropartinemia.
And in a rare condition called hereditary angiodema,
it helped control the disease and reduced the frequency
and severity of swelling attacks.
Wow.
So these examples really drive home the point.
(11:03):
It's not just theoretical.
Exandrelone has demonstrated tangible benefits
across a wide spectrum of difficult conditions,
where muscle loss, wasting, or poor healing are major problems.
Absolutely.
It highlights its direct clinical utility
in helping patients facing serious debilitating health challenges.
Okay, now for the crucial part.
Uh.
Safety.
Because whenever you say steroid alarms tend to go off,
(11:25):
especially regarding side effects,
we know other A is particularly the oral C-17 alpha-alkylated ones,
have a bad reputation for liver toxicity,
cardiovascular issues.
Right.
Things like cholostatic jaundice,
where bioflow stops piliosis hepatitis,
which is blood-filled cis and the liver,
hyperplasia, adenomas,
even liver cancer have been associated with other A's,
often at high doses used for long periods, like over a year.
(11:48):
So how does oxandrelone stack up against that grim picture?
You mentioned its unique metabolism earlier.
And that is the key distinction here.
That resistance to liver metabolism,
conferred by its unique structure, really sets it apart.
So did the review find those severe liver problems with oxandrelone?
Generally no.
The review specifically notes that oxandrelone did not exhibit
(12:09):
the more serious adverse hepatic effects
attributed to other C-17 alpha-alkylated A's in the studies they looked at.
No specific cases of jaundice,
piliosis, hepatitis, or liver tumors
were singularly blamed on oxandrelone itself.
That's huge.
So what did they see regarding the liver?
The most common things were transient,
meaning temporary and asymptomatic,
(12:30):
meaning the patient didn't feel anything elevation,
elevations in liver enzymes, transaminases,
AST, ALT levels.
Exactly.
And also reductions in HDL cholesterol, the good cholesterol.
Importantly, these changes usually went back to normal
after stopping the drug.
How often did those enzyme elevations
cause someone to stop treatment?
Very rarely.
Out of 43 studies reviewed,
(12:51):
only three reported needing to stop oxandrelone
because of elevated transaminases, just three.
That's remarkably low.
It is, and there's an important nuance here too.
Elevated transaminases don't always mean liver damage.
Oh, what else can cause it?
Intense resistance exercise can cause muscle damage,
which also releases these enzymes into the bloodstream.
(13:13):
So it's possible that some reports of liver toxicity with other
agrass, especially when used alongside heavy training,
might be partly due to muscle breakdown,
not just direct liver harm.
Interesting point.
Needs careful interpretation.
Okay, so liver safety looks comparatively much better.
What about other side effects, the androgenic ones?
You mentioned the good ratio, but did they still occur?
(13:34):
They did occur, but seemingly quite infrequently,
considering women were included in 30 of the 43 studies.
Okay, so plenty of female participants.
Right.
And across about 1,000 patients in 27 studies
that reported on this, androgenic effects,
things like facial hair, acne, voice deepening,
increased libido, were noted in only 14 patients total.
14 out of 1,000.
(13:55):
That seems incredibly low for an AAS.
It really does attest to that favorable ratio.
Now it wasn't zero.
Two female patients did stop treatment
because of these virulizing effects.
But overall, the incidence appears remarkably low
based on this review.
What about cholesterol changes?
You mentioned lower HDL.
Yes, that was the main effect.
(14:16):
HDL cholesterol often dropped significantly,
sometimes 36, 47% below baseline levels.
That's quite a drop.
HDL is protective, right?
Generally considered protective, yes.
Some studies also saw increases in total cholesterol,
or LDL, the bad cholesterol.
The big question mark is the long term
cardiovascular impact of these changes.
(14:37):
Why is it a question mark?
Because most of these studies were relatively short term.
We don't have long term data from these specific clinical trials
to know the real world consequences years down the line.
Fair enough.
Any other side effects pop up?
Psychological.
There were some reports, 13 patients in total
across the studies experiencing transient psychological effects.
Things like mood swings, agitation, irritability, anxiety.
(14:59):
Okay, relatively small numbers again.
Yes.
And edema, or swelling, was reported in some elderly patients,
especially those who already had conditions like heart failure or COPD,
which can predispose them to fluid retention anyway.
Makes sense.
And the big one people worry about with male hormones, prostate cancer.
It's a general concern for all ass because they are related to testosterone.
(15:23):
However, in the studies reviewed covering oxandralone,
no cases of prostate cancer were reported.
But again, long term follow up is needed.
Absolutely.
As with any hormonal therapy, long term monitoring is crucial.
So the picture that emerges is, yes, there are potential side effects,
like the HDL changes in the low risk of anergenic or psychological effects.
But compared to other oral ass, especially regarding the liver,
(15:46):
oxandralone seems to have a markedly better safety profile in these clinical settings.
Exactly.
It underscores that you can't paint all steroids with the same brush.
Oxandralone stands out, making it a valuable, albeit carefully considered,
tool in specific medical situations where the benefits clearly outweigh these manageable risks.
Okay, so we understand its past and present uses and its relative safety.
(16:09):
Let's look ahead.
What about future potential?
A huge issue with aging is sarcopenia.
Right. That involuntary loss of muscle mass and function as we get older.
It's a massive problem, leads to weakness, falls, disability, loss of independence,
higher mortality, a growing concern globally with aging populations.
(16:30):
And is oxandralone being considered for this?
It hasn't been specifically studied in large trials for sarcopenia yet,
but it's considered a really attractive candidate.
Why?
What makes it a good fit?
Because it's known effects directly counteract many of the problems seen in sarcopenia.
We know oxandralone can decrease visceral fat,
increase muscle protein synthesis,
improve appetite and protein intake,
(16:52):
enhance nitrogen retention,
boost muscle function and activity levels.
Basically, all the things you'd want to do to fight age-related muscle loss.
Precisely.
Plus, it could potentially help substitute for the natural decline in androgen and estrogen levels
that happens with age, which also contributes to muscle loss.
So it seems like a logical fit.
What needs to happen to explore this further?
(17:13):
We definitely need more research.
Specifically, long-term studies think over a year focused on older adults
to really assess the efficacy and safety in that population for sarcopenia.
Doseage might need tweaking for older adults too.
Good point.
Better dose titration to find the sweet spot,
maximum benefit, minimum side effects,
(17:34):
maybe exploring intermittent therapy like cycles instead of continuous use.
What about combining it with other things like exercise or nutrition,
which are also key for sarcopenia?
Absolutely critical.
Studies combining oxandralone with progressive resistance training
or targeted nutritional support in older adults would be very valuable.
And what about women?
Sarcopenia affects older women significantly.
(17:56):
A crucial area for research.
Because testosterone has stronger androgenic effects,
its use in women is limited.
Oxandralone, with its better ratio,
might be a much more viable option for elderly women
who make up a large portion of those suffering from sarcopenia.
We need studies specifically in this group.
So this understanding opens up possibilities for tackling a major public health issue
(18:17):
associated with aging.
Imagine if a well understood compound, like oxandralone,
could safely help millions maintain muscle mass and function longer.
It's a really tantalizing prospect for improving quality of life in later years.
A lot of potential there.
Okay, so let's wrap this up.
We've taken a pretty deep dive into oxandralone today.
We've gone past the usual steroid stereotypes to see its unique chemical structure.
(18:41):
How that structure leads to resistance to liver breakdown.
It's wide range of powerful clinical uses,
from helping burn victims heal to fighting HIV wasting.
And importantly, it's comparatively favorable safety profile,
especially concerning the liver when used appropriately in medicine.
I think the main takeaway for you listening is that oxandralone really isn't just
another steroid.
(19:03):
It's proven itself as a medically valuable anabolic agent.
It has unique profile, and it's been providing real benefits in these tough wasting conditions
for decades now.
Decades of clinical use supporting that.
So here's a final thought to leave you with.
We've seen clear evidence for oxandralone's effectiveness,
and its relatively good safety record,
especially when you weigh it against the burden of conditions like
(19:25):
severe wasting or potentially sarcopenia.
It makes you wonder.
What else is out there?
Exactly.
What other existing compounds might we be under appreciating or under researching for new uses?
Could a deeper dive into the nuanced pharmacology of known drugs,
like we've done today with oxandralone,
help us reshape how we tackle some of these widespread health challenges in the future?
(19:48):
It's a compelling question about finding new potential in what we might already have.
Food for thought.
Okay, what if we told you there's a type of, well,
(00:02):
scaroid that's been safely and effectively used in medicine
for over 30 years.
Yeah, not for doping or anything like that.
Exactly, but to help patients recover from severe burns,
fight muscle wasting in conditions like HIV,
and even improve liver function
in alcoholic hepatitis.
It kind of challenges the common perception, doesn't it?
(00:23):
The compound we're diving into today
is an anabolic androgenic steroid,
or a deus called oxandralone.
Right, and while that word steroid
often brings up negative images,
our deep dive today is gonna unpack its,
well, frankly surprising and very well documented
medical uses.
So our mission today is basically to give you a shortcut
to being truly well-informed on this really fascinating
(00:46):
compound.
We're digging into a comprehensive medical review from 2004.
A pretty detailed look at its effectiveness, its safety.
Yeah, especially in treating wasting
in these catabolic disorders.
We'll get into the science,
understand its unique properties,
look at the proven clinical benefits,
and importantly assess its safety.
Okay, let's get into it.
To really grasp what makes oxandralone stand out,
(01:08):
we probably need a quick foundation
on anabolic androgenic steroids,
estuulus in general.
Good idea.
So at their core, these are basically derivatives
or modifications of testosterone,
the main male sex hormone, a powerful steroid itself.
Right, and they have this kind of dual nature, don't they?
They're the anabolic effects and the androgenic effects.
(01:29):
Exactly, anabolic is the building up part,
think protein synthesis,
holding onto nitrogen, growing skeletal muscle,
tissue construction, no sense.
That's the desirable part, medically speaking.
Usually, yes.
Then you have the androgenic effects.
These are linked to male characteristics,
primary and secondary sexual traits.
And in women, these can show up as side effects
(01:51):
people definitely don't want,
like male pattern hair loss, deeper voice, facial hair.
Precisely.
And historically, separating those two effects,
getting the muscle building without the masculinization,
that's been the big challenge.
So how do they actually work at a molecular level?
Well, mostly they work by binding
to something called the androgen receptor, the AR.
It's a protein in our cells.
(02:13):
Like a docking station.
Kind of, yeah.
Once the AAS molecule binds to the AR,
this whole complex moves into the cell's nucleus.
Okay.
And there, it binds to DNA
and basically tells the cell machinery,
hey, make more protein.
These new proteins then do the work
the hormone is signaling for.
So the AR is like a specific lock
and the AAS are the keys.
(02:35):
That's a great analogy.
The issue is this lock is in muscle tissue,
which is good, but it's also in reproductive tissues
and others, which leads to those androgenic side effects.
It's hard to make a key that only fits the muscle lock.
Makes sense.
But that's not the whole story.
They also work indirectly.
For instance, they can interfere
with the glucocorticoid receptor.
Those are stress hormones like cortisol, right?
(02:57):
They break down tissue.
Exactly.
So by antagonizing that receptor,
AAS help inhibit protein breakdown or catabolism.
We see this with testosterone reducing muscle breakdown
in severe burn patients, for example.
Okay.
So they build muscle and prevent its breakdown.
Right.
Plus they can boost the liver's production of IGF-1,
insulin-like growth factor one.
(03:19):
Another muscle builder.
Yep.
And some evidence suggests that they might suppress myostatin,
which is a protein that naturally limits muscle growth.
So they take the breaks off too.
Wow.
Okay.
So multiple pathways leading to more muscle mass.
Understanding these mechanisms helps you see
why they're so potent, but also why you get
this package deal of effects, both good
and sometimes not so good.
(03:40):
Right.
It sets the stage for why finding something different.
Something like a Xandralone was so important.
We've got this picture of a crest powerful builders,
but often carrying that androgenic baggage.
The dream was always a key just for the muscle lock.
How did a Xandralone, made back in 1962, manage this?
Well, its chemical structure is really quite different.
It is a C-17 alpha-alkylated AIS,
(04:03):
which is common for oral steroids that modification
helps it survive the liver first pass.
Okay.
But how it's structured beyond that is unique.
It has an oxygen atom swapped in
where others have a methylene group at the two position
and it's missing something called a 4-ene function
in its eye ring.
It sounds technical,
you're saying these small structural changes are key.
Absolutely key.
(04:24):
They fundamentally change how the molecule behaves in the body,
especially regarding metabolism and side effects.
Okay, so structure is unique.
What about pharmacokinetics?
How does the body handle it once you take it?
It gets absorbed pretty well orally.
You see peak levels in the blood after about an hour.
And how long does it stick around?
The elimination half-life is around nine hours,
(04:45):
so it has a decent duration of action.
It's also highly protein-bound, about 95%.
Got it.
Absorbed well lasts a while.
But what of metabolism you mentioned structure affects that?
And this is the big deal with oxandralone,
unlike many other oral ACEs that get heavily processed
or metabolized by the liver.
Which can cause liver strain, right?
Exactly.
Oxandralone is remarkably resistant
(05:07):
to that liver biotransformation,
that unique structure we talked about.
It inhibits the typical metabolic pathways.
So the liver doesn't break it down as much.
Much less.
In fact, about 28% of it is excreted unchanged in the urine.
That resistance is huge for its safety profile,
especially liver safety.
Wow.
Okay.
That's a major difference.
(05:28):
So structure leads to less liver breakdown.
What about what it does in the body?
The pharmacodynamics.
This is where it shines.
It has strong anabolic activity, muscle building,
but relatively weak endogenic effects.
Ah, so it managed to separate those effects better.
Significantly better.
Its anabolic to endogenic ratio is often cited as around 10.1,
(05:49):
which is much higher than testosterone or methylat testosterone.
In humans, its anabolic punch is about 6.3 times that of methyl testosterone.
And toxicity.
Animal studies show very low toxicity.
So for you listening, the takeaway here is this unique structure
isn't just a chemical novelty.
It leads to less liver metabolism and a much better ratio of muscle building
(06:10):
effects versus masculinizing effects.
It really is a different kind of oral steroid,
and that's critical when we get to the safety discussion.
Okay, so we've established its structurally unique handle differently by the body
and has this favorable anabolic endogenic ratio.
What does that translate to in the real world?
What are the proven clinical uses?
Well, the USFTA has actually approved it for some pretty specific things,
(06:32):
restoring weight loss after major trauma, surgery, or chronic infections.
Serious situations where people lose a lot of body mass.
Exactly.
Also for male nutrition related to alkylmolyxerosis and even certain types of muscular dystrophy,
like douchens or beckers.
So these aren't trivial conditions.
Not at all.
And the review of studies shows strong evidence for its effectiveness across the board.
(06:55):
You consistently see improvements in body composition, more lean mass,
less fat plus better muscle strength, better function, faster recovery from injury,
and improved nutritional status in most well-designed trials.
It's good specific.
Burns, for example.
That's a state of extreme catabolism, right?
Muscle just melts away.
Terribly so.
And oxandrelone has shown remarkable results there.
(07:17):
One study found it enhanced muscle protein synthesis by over 100% compared to controls.
Doubled it.
Wow.
It also significantly cuts down weight loss, nitrogen loss,
which is a marker of protein breakdown, and can speed up healing.
Think 30% faster healing of skin graft donor sites in one study.
That means shorter hospital stays too.
Absolutely.
One trial reported hospital stays reduced by about 35%.
(07:41):
Fewer complications, potentially better survival rates too.
That's incredibly impactful for those patients.
What about other acute situations like general trauma?
Similar benefits like improved pre-albeam in levels, which indicate nutritional status.
Though interestingly, a couple of studies did note slightly longer hospital or ICU stays,
maybe increased rates of pneumonia or sepsis compared to controls in trauma patients.
(08:04):
Mm-hmm.
OK.
So maybe not universally positive in every single acute scenario, but clearly powerful effects.
It highlights the need to look at specific patient groups.
Now, shift to chronic catabolic conditions.
Yes.
Like alcoholic hepatitis.
Where the liver is damaged, and patients often suffer malnutrition and muscle wasting.
Right.
Studies showed oxandrelone led to improvements in body composition,
(08:27):
liver function markers, and even survival rates.
One study found a 17% higher survival at six months,
and a 20% reduction in the severity of liver injury markers.
That's significant.
What about something like COPD?
Chronic lung disease often comes with muscle loss too.
Yes, it does.
There aren't as many big controlled trials here,
but the uncontrolled studies suggest similar benefits.
(08:49):
Better body weight, more body cell mass, improved functional status.
Promising, but needs more research.
OK.
And then there's HIV or AIDS-associated wasting.
That was a huge problem, especially earlier in the epidemic.
A devastating problem.
And multiple studies show oxandrelone produces positive results here,
improving body composition, muscle function, nutritional status.
(09:10):
Does combining it with anything else help?
Like exercise.
Great question.
Yes.
Combining oxandrelone with progressive resistance training
showed significantly better results than either alone.
Synergistic effect.
Seems like it.
Greater gains in body weight like 2.5 kilos more in one study.
Better nitrogen retention, more lean body mass,
even better bone mineral content, less fat mass,
(09:32):
and boosted muscle strength and function.
So exercise plus oxandrelone is a powerful combo for rebuilding.
Definitely.
But even on its own, say 15 milligrams a day,
over several months, it showed continued weight gain,
improved appetite, and better physical activity levels.
What about neuromuscular disorders?
You mentioned muscular dystrophy earlier.
Right.
In Duchenne's muscular dystrophy, studies reported benefits like
(09:55):
increased body weight about 1.6 kilogram,
a bit more height gain, and improved muscle strength scores.
And spinal cord injury.
That often leads to pressure sores and respiratory issues.
Here, the results were quite striking in some cases.
One study found complete healing of previously non-healing
pressure ulcers in nearly 90% of patients treated with oxandrelone.
(10:17):
90%.
That's incredible for something notoriously hard to heal.
It really is.
And improvements in respiratory function too,
like a 9% increase in combined lung function measures.
This is a broad range of applications.
Any other sort of miscellaneous uses noted?
A few interesting ones.
In obese men, it was shown to decrease visceral fat,
the dangerous fat around the organs,
by about 35 square centimeters, while increasing thigh muscle area.
(10:42):
So shifting body composition favorably even in obesity.
Seems so.
It also showed benefits in lowering triglycerides and cholesterol
in certain specific types of hyperlipropartinemia.
And in a rare condition called hereditary angiodema,
it helped control the disease and reduced the frequency
and severity of swelling attacks.
Wow.
So these examples really drive home the point.
(11:03):
It's not just theoretical.
Exandrelone has demonstrated tangible benefits
across a wide spectrum of difficult conditions,
where muscle loss, wasting, or poor healing are major problems.
Absolutely.
It highlights its direct clinical utility
in helping patients facing serious debilitating health challenges.
Okay, now for the crucial part.
Uh.
Safety.
Because whenever you say steroid alarms tend to go off,
(11:25):
especially regarding side effects,
we know other A is particularly the oral C-17 alpha-alkylated ones,
have a bad reputation for liver toxicity,
cardiovascular issues.
Right.
Things like cholostatic jaundice,
where bioflow stops piliosis hepatitis,
which is blood-filled cis and the liver,
hyperplasia, adenomas,
even liver cancer have been associated with other A's,
often at high doses used for long periods, like over a year.
(11:48):
So how does oxandrelone stack up against that grim picture?
You mentioned its unique metabolism earlier.
And that is the key distinction here.
That resistance to liver metabolism,
conferred by its unique structure, really sets it apart.
So did the review find those severe liver problems with oxandrelone?
Generally no.
The review specifically notes that oxandrelone did not exhibit
(12:09):
the more serious adverse hepatic effects
attributed to other C-17 alpha-alkylated A's in the studies they looked at.
No specific cases of jaundice,
piliosis, hepatitis, or liver tumors
were singularly blamed on oxandrelone itself.
That's huge.
So what did they see regarding the liver?
The most common things were transient,
meaning temporary and asymptomatic,
(12:30):
meaning the patient didn't feel anything elevation,
elevations in liver enzymes, transaminases,
AST, ALT levels.
Exactly.
And also reductions in HDL cholesterol, the good cholesterol.
Importantly, these changes usually went back to normal
after stopping the drug.
How often did those enzyme elevations
cause someone to stop treatment?
Very rarely.
Out of 43 studies reviewed,
(12:51):
only three reported needing to stop oxandrelone
because of elevated transaminases, just three.
That's remarkably low.
It is, and there's an important nuance here too.
Elevated transaminases don't always mean liver damage.
Oh, what else can cause it?
Intense resistance exercise can cause muscle damage,
which also releases these enzymes into the bloodstream.
(13:13):
So it's possible that some reports of liver toxicity with other
agrass, especially when used alongside heavy training,
might be partly due to muscle breakdown,
not just direct liver harm.
Interesting point.
Needs careful interpretation.
Okay, so liver safety looks comparatively much better.
What about other side effects, the androgenic ones?
You mentioned the good ratio, but did they still occur?
(13:34):
They did occur, but seemingly quite infrequently,
considering women were included in 30 of the 43 studies.
Okay, so plenty of female participants.
Right.
And across about 1,000 patients in 27 studies
that reported on this, androgenic effects,
things like facial hair, acne, voice deepening,
increased libido, were noted in only 14 patients total.
14 out of 1,000.
(13:55):
That seems incredibly low for an AAS.
It really does attest to that favorable ratio.
Now it wasn't zero.
Two female patients did stop treatment
because of these virulizing effects.
But overall, the incidence appears remarkably low
based on this review.
What about cholesterol changes?
You mentioned lower HDL.
Yes, that was the main effect.
(14:16):
HDL cholesterol often dropped significantly,
sometimes 36, 47% below baseline levels.
That's quite a drop.
HDL is protective, right?
Generally considered protective, yes.
Some studies also saw increases in total cholesterol,
or LDL, the bad cholesterol.
The big question mark is the long term
cardiovascular impact of these changes.
(14:37):
Why is it a question mark?
Because most of these studies were relatively short term.
We don't have long term data from these specific clinical trials
to know the real world consequences years down the line.
Fair enough.
Any other side effects pop up?
Psychological.
There were some reports, 13 patients in total
across the studies experiencing transient psychological effects.
Things like mood swings, agitation, irritability, anxiety.
(14:59):
Okay, relatively small numbers again.
Yes.
And edema, or swelling, was reported in some elderly patients,
especially those who already had conditions like heart failure or COPD,
which can predispose them to fluid retention anyway.
Makes sense.
And the big one people worry about with male hormones, prostate cancer.
It's a general concern for all ass because they are related to testosterone.
(15:23):
However, in the studies reviewed covering oxandralone,
no cases of prostate cancer were reported.
But again, long term follow up is needed.
Absolutely.
As with any hormonal therapy, long term monitoring is crucial.
So the picture that emerges is, yes, there are potential side effects,
like the HDL changes in the low risk of anergenic or psychological effects.
But compared to other oral ass, especially regarding the liver,
(15:46):
oxandralone seems to have a markedly better safety profile in these clinical settings.
Exactly.
It underscores that you can't paint all steroids with the same brush.
Oxandralone stands out, making it a valuable, albeit carefully considered,
tool in specific medical situations where the benefits clearly outweigh these manageable risks.
Okay, so we understand its past and present uses and its relative safety.
(16:09):
Let's look ahead.
What about future potential?
A huge issue with aging is sarcopenia.
Right. That involuntary loss of muscle mass and function as we get older.
It's a massive problem, leads to weakness, falls, disability, loss of independence,
higher mortality, a growing concern globally with aging populations.
(16:30):
And is oxandralone being considered for this?
It hasn't been specifically studied in large trials for sarcopenia yet,
but it's considered a really attractive candidate.
Why?
What makes it a good fit?
Because it's known effects directly counteract many of the problems seen in sarcopenia.
We know oxandralone can decrease visceral fat,
increase muscle protein synthesis,
improve appetite and protein intake,
(16:52):
enhance nitrogen retention,
boost muscle function and activity levels.
Basically, all the things you'd want to do to fight age-related muscle loss.
Precisely.
Plus, it could potentially help substitute for the natural decline in androgen and estrogen levels
that happens with age, which also contributes to muscle loss.
So it seems like a logical fit.
What needs to happen to explore this further?
(17:13):
We definitely need more research.
Specifically, long-term studies think over a year focused on older adults
to really assess the efficacy and safety in that population for sarcopenia.
Doseage might need tweaking for older adults too.
Good point.
Better dose titration to find the sweet spot,
maximum benefit, minimum side effects,
(17:34):
maybe exploring intermittent therapy like cycles instead of continuous use.
What about combining it with other things like exercise or nutrition,
which are also key for sarcopenia?
Absolutely critical.
Studies combining oxandralone with progressive resistance training
or targeted nutritional support in older adults would be very valuable.
And what about women?
Sarcopenia affects older women significantly.
(17:56):
A crucial area for research.
Because testosterone has stronger androgenic effects,
its use in women is limited.
Oxandralone, with its better ratio,
might be a much more viable option for elderly women
who make up a large portion of those suffering from sarcopenia.
We need studies specifically in this group.
So this understanding opens up possibilities for tackling a major public health issue
(18:17):
associated with aging.
Imagine if a well understood compound, like oxandralone,
could safely help millions maintain muscle mass and function longer.
It's a really tantalizing prospect for improving quality of life in later years.
A lot of potential there.
Okay, so let's wrap this up.
We've taken a pretty deep dive into oxandralone today.
We've gone past the usual steroid stereotypes to see its unique chemical structure.
(18:41):
How that structure leads to resistance to liver breakdown.
It's wide range of powerful clinical uses,
from helping burn victims heal to fighting HIV wasting.
And importantly, it's comparatively favorable safety profile,
especially concerning the liver when used appropriately in medicine.
I think the main takeaway for you listening is that oxandralone really isn't just
another steroid.
(19:03):
It's proven itself as a medically valuable anabolic agent.
It has unique profile, and it's been providing real benefits in these tough wasting conditions
for decades now.
Decades of clinical use supporting that.
So here's a final thought to leave you with.
We've seen clear evidence for oxandralone's effectiveness,
and its relatively good safety record,
especially when you weigh it against the burden of conditions like
(19:25):
severe wasting or potentially sarcopenia.
It makes you wonder.
What else is out there?
Exactly.
What other existing compounds might we be under appreciating or under researching for new uses?
Could a deeper dive into the nuanced pharmacology of known drugs,
like we've done today with oxandralone,
help us reshape how we tackle some of these widespread health challenges in the future?
(19:48):
It's a compelling question about finding new potential in what we might already have.
Food for thought.
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