The Effect of Oxandrolone on the Endocrinologic, Inflammatory, and Hypermetabolic Responses During the Acute Phase Postburn
A possible concern associated with oxandrolone administration is an increase in liver enzymes, a phenomenon that has been described also by other groups.22,50 During our study period, oxandrolone significantly increased serum AST and ALT, which occurred 2 to 3 weeks after oxandrolone treatment was started. Serum AST and ALT are normally considered markers for hepatic damage, and therefore, one may suggest that oxandrolone cause some degree of liver damage; however, we further showed that oxandrolone decreased hepatic acute phase protein concentration whereas it increased constitutive hepatic protein concentration. This indicates an improved hepatic homeostasis and protein production by the liver. This finding was also shown by Thomas and colleagues.51 We also showed that liver size and weight was not significantly different between controls and oxandrolone patients, which indicates that oxandrolone did not cause hepatomegaly. It furthermore appears that oxandrolone did not cause major hepatic damage. We measured serum IGF-I, IGFBP-3, and GH, all of which are mainly synthesized in the liver52 and found no significant difference between controls and oxandrolone-treated patients. These data indicate that liver function maintains intact with the use of oxandrolone, but we suggest that the elevation of liver enzymes should be monitored during the treatment period with oxandrolone.
The Anabolic Androgenic Steroid Oxandrolone in the Treatment of Wasting and Catabolic Disorders
Abstract
There has been increasing interest in the development of effective agents that can be safely used to promote anabolism in the clinical setting for patients with chronic wasting conditions as well as in the prevention and treatment of frailty associated with loss of muscle tissue in aging (sarcopenia).
One such agent is the anabolic androgenic steroid (AAS) oxandrolone, which has been used in such clinical situations as HIV-related muscle wasting, severe burn injury, trauma following major surgery, neuromuscular disorders and alcoholic hepatitis for over 30 years. In the US, oxandrolone is the only AAS that is US FDA-approved for restitution of weight loss after severe trauma, major surgery or infections, malnutrition due to alcoholic cirrhosis, and Duchenne’s or Becker’s muscular dystrophy.
Our review of the use of oxandrolone in the treatment of catabolic disorders, HIV and AIDS-related wasting, neuromuscular and other disorders provides strong evidence of its clinical efficacy. Improvements in body composition, muscle strength and function, status of underlying disease or recovery from acute catabolic injury and nutritional status are significant in the vast majority of well designed trials. However, oxandrolone has not yet been studied in sarcopenia.
Unlike other orally administered C17α-alkylated AASs, the novel chemical configuration of oxandrolone confers a resistance to liver metabolism as well as marked anabolic activity.In addition, oxandrolone appears not to exhibit the serious hepatotoxic effects (jaundice, cholestatic hepatitis, peliosis hepatis, hyperplasias and neoplasms) attributed to the C17α-alkylated AASs. Oxandrolone is reported to be generally well tolerated and the most commonly documented adverse effects are transient elevations in transaminase levels and reductions in high density lipoprotein cholesterol level.
However, optimal risk: benefit ratios for oxandrolone and other agents in its class will need to be refined before widespread clinical acceptance of AASs as a therapeutic option in sarcopenia and other chronic wasting conditions.
A possible concern associated with oxandrolone administration is an increase in liver enzymes, a phenomenon that has been described also by other groups.22,50 During our study period, oxandrolone significantly increased serum AST and ALT, which occurred 2 to 3 weeks after oxandrolone treatment was started. Serum AST and ALT are normally considered markers for hepatic damage, and therefore, one may suggest that oxandrolone cause some degree of liver damage; however, we further showed that oxandrolone decreased hepatic acute phase protein concentration whereas it increased constitutive hepatic protein concentration. This indicates an improved hepatic homeostasis and protein production by the liver. This finding was also shown by Thomas and colleagues.51 We also showed that liver size and weight was not significantly different between controls and oxandrolone patients, which indicates that oxandrolone did not cause hepatomegaly. It furthermore appears that oxandrolone did not cause major hepatic damage. We measured serum IGF-I, IGFBP-3, and GH, all of which are mainly synthesized in the liver52 and found no significant difference between controls and oxandrolone-treated patients. These data indicate that liver function maintains intact with the use of oxandrolone, but we suggest that the elevation of liver enzymes should be monitored during the treatment period with oxandrolone.
The Anabolic Androgenic Steroid Oxandrolone in the Treatment of Wasting and Catabolic Disorders
Abstract
There has been increasing interest in the development of effective agents that can be safely used to promote anabolism in the clinical setting for patients with chronic wasting conditions as well as in the prevention and treatment of frailty associated with loss of muscle tissue in aging (sarcopenia).
One such agent is the anabolic androgenic steroid (AAS) oxandrolone, which has been used in such clinical situations as HIV-related muscle wasting, severe burn injury, trauma following major surgery, neuromuscular disorders and alcoholic hepatitis for over 30 years. In the US, oxandrolone is the only AAS that is US FDA-approved for restitution of weight loss after severe trauma, major surgery or infections, malnutrition due to alcoholic cirrhosis, and Duchenne’s or Becker’s muscular dystrophy.
Our review of the use of oxandrolone in the treatment of catabolic disorders, HIV and AIDS-related wasting, neuromuscular and other disorders provides strong evidence of its clinical efficacy. Improvements in body composition, muscle strength and function, status of underlying disease or recovery from acute catabolic injury and nutritional status are significant in the vast majority of well designed trials. However, oxandrolone has not yet been studied in sarcopenia.
Unlike other orally administered C17α-alkylated AASs, the novel chemical configuration of oxandrolone confers a resistance to liver metabolism as well as marked anabolic activity.In addition, oxandrolone appears not to exhibit the serious hepatotoxic effects (jaundice, cholestatic hepatitis, peliosis hepatis, hyperplasias and neoplasms) attributed to the C17α-alkylated AASs. Oxandrolone is reported to be generally well tolerated and the most commonly documented adverse effects are transient elevations in transaminase levels and reductions in high density lipoprotein cholesterol level.
However, optimal risk: benefit ratios for oxandrolone and other agents in its class will need to be refined before widespread clinical acceptance of AASs as a therapeutic option in sarcopenia and other chronic wasting conditions.
