The efficacy of these substances for this purpose is unsubstantiated, however. Full Text of Background. The men in the exercise groups performed standardized weight-lifting exercises three times weekly. Before and after the treatment period, fat-free mass was determined by underwater weighing, muscle size was measured by magnetic resonance imaging, and the strength of the arms and legs was assessed by bench-press and squatting exercises, respectively.
Full Text of Methods. Neither mood nor behavior was altered in any group. Full Text of Results. Supraphysiologic doses of testosterone, especially when combined with strength training, increase fat-free mass and muscle size and strength in normal men. Full Text of Discussion.
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We sought to determine whether supraphysiologic doses of testosterone, administered alone or in conjunction with a standardized program of strength-training exercise, increase fat-free mass and muscle size and strength in normal men.
To overcome the pitfalls of previous studies, the intake of energy and protein and the exercise stimulus were standardized. Because some previous studies had demonstrated significant increases in muscle strength and hypertrophy in experienced athletes but not in sedentary subjects, we studied men who had weight-lifting experience.
This study was approved by the institutional review boards of the Harbor—UCLA Research and Education Institute and the Charles R. Drew University of Medicine and Science. All the study subjects gave informed written consent.
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They were recruited through advertisements in local newspapers and community colleges.
Men who had ever taken anabolic agents or recreational drugs or had had a psychiatric or behavioral disorder were excluded from the study. During the four-week control period, the men were asked not to lift any weights or engage in strenuous aerobic exercise.
Compliance with the diet was verified every four weeks by three-day records of food consumption. The dietary intake was adjusted every two weeks on the basis of changes in body weight. This dose is six times higher than the dose usually given as replacement therapy in men with hypogonadism and is therefore supraphysiologic. All the men trained at equivalent intensities in relation to their strength scores before the training. The number of sets was also increased from four to five, but the number of repetitions per set remained constant.
The men were advised not to undertake any resistance exercise or moderate-to-heavy endurance exercise in addition to the prescribed regimen. Sexual function and semen characteristics were not assessed. Muscle size was measured by MRI of the arms and legs at the humeral or femoral mid-diaphyseal level, the junction of the upper third and middle third of the bone, and the junction of the middle third and lower third.
The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men — NEJM
The cross-sectional areas of the arms and legs, the subcutaneous tissue, the muscle compartment, and the quadriceps and triceps muscles were computed, and the areas at the three levels were averaged.
Fat-free mass was estimated on the basis of measurements of body density obtained by underwater weighing. During weighing, the men were asked to exhale to the residual volume, as measured by helium dilution.
The effort-dependent performance of muscle was assessed on the basis of the maximal weight lifted for one repetition during the bench-press and squatting exercises.
For each man a live-in partner, spouse, or parent answered the same questions about the man’s mood and behavior. The Shapiro and Wilk test was used to test whether the outcome variables had a normal distribution. These values were averaged among the subjects in each group to obtain the group means. Analysis of variance was used to determine whether there were base-line differences among the four groups. Two-tailed, paired t-tests were used to test for changes in each outcome variable in each group.
This test adjusts for multiple comparisons, but it does not yield exact P values for pairwise comparisons between groups. Acne developed in three men receiving testosterone and one receiving placebo, and two men receiving testosterone reported breast tenderness, but no other side effects were noted. There was no change in the serum concentration of prostate-specific antigen in any group. The base-line serum concentrations of total and free testosterone in the four groups were similar.
The base-line serum concentrations of luteinizing hormone, follicle-stimulating hormone, and sex hormone—binding globulin were similar in the four groups, and the concentrations decreased significantly in the two testosterone groups. The P values shown are for the comparison between the change indicated and a change of zero.
The percentage of body fat did not change significantly in any group data not shown. No differences were found between the exercise groups and the no-exercise groups or between the placebo groups and the testosterone groups in any of the five subcategories of anger assessed by the Multidimensional Anger Inventory. No significant changes in mood or behavior were reported by the men on the Mood Inventory or by their live-in partners, spouses, or parents on the Observer Mood Inventory.
Our results show that supraphysiologic doses of testosterone, especially when combined with strength training, increase fat-free mass, muscle size, and strength in normal men when potentially confounding variables, such as nutritional intake and exercise stimulus, are standardized.
The combination of strength training and testosterone produced greater increases in muscle size and strength than were achieved with either intervention alone. The exercise was standardized in all the men, and therefore the effects of testosterone on muscle size and strength cannot be attributed to more intense training in the groups receiving the treatment. Careful selection of experienced weight lifters, the exclusion of competitive athletes, and close follow-up ensured a high degree of compliance with the regimens of exercise, treatment, and diet, which was verified by three-day food records data not shown and the values obtained for serum testosterone, luteinizing hormone, and follicle-stimulating hormone.
Except for one man who missed one injection, all the men received all their scheduled injections. It has been argued that studies in which large doses of androgens are used cannot be truly blinded because of the occurrence of acne or other side effects.
In this study, neither the investigators nor the personnel performing the measurements knew the study-group assignments. Thus, it cannot be stated with certainty that the men were completely unaware of the nature of their treatments. Undoubtedly, some athletes and bodybuilders take even higher doses than those we gave. We do not know whether still higher doses of testosterone or the simultaneous administration of several steroids would have more pronounced effects.
The absence of systemic toxicity during testosterone treatment was consistent with the results of studies of the contraceptive efficacy of that hormone. Although the men receiving testosterone did have increases in muscle size, some of the gains in strength may have resulted from the behavioral effects of testosterone. The dose dependency of the action of testosterone on fat-free mass and protein synthesis has not been well studied.
Others have suggested that there may be two dose—response curves: one in the hypogonadal range, with maximal responses corresponding to the serum testosterone concentrations at the lower end of the range in normal men, and the second in the supraphysiologic range, presumably representing a separate mechanism of action — that is, a pathway of independent androgen receptors. Our results, however, do not preclude the possibility that still higher doses of multiple steroids may provoke angry behavior in men with preexisting psychiatric or behavioral problems.
Our results in no way justify the use of anabolic—androgenic steroids in sports, because, with extended use, such drugs have potentially serious adverse effects on the cardiovascular system, prostate, lipid metabolism, and insulin sensitivity. Moreover, the use of any performance-enhancing agent in sports raises serious ethical issues. Our findings do, however, raise the possibility that the short-term administration of androgens may have beneficial effects in immobilized patients, during space travel, and in patients with cancer-related cachexia, disease caused by the human immunodeficiency virus, or other chronic wasting disorders.
We are indebted to Dr. Indrani Sinha-Hikim for the serum hormone assays, to Dr. Paul Fu for the plasma lipid measurements, to the staff of the General Clinical Research Center for conducting the studies, and to BioTechnology General Corporation, Iselin, New Jersey, for providing testosterone enanthate. From the Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles S. Address reprint requests to Dr.
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Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Background Athletes often take androgenic steroids in an attempt to increase their strength. Conclusions Supraphysiologic doses of testosterone, especially when combined with strength training, increase fat-free mass and muscle size and strength in normal men.
Methods Study Design This study was approved by the institutional review boards of the Harbor—UCLA Research and Education Institute and the Charles R. Assessment of Muscle Size Muscle size was measured by MRI of the arms and legs at the humeral or femoral mid-diaphyseal level, the junction of the upper third and middle third of the bone, and the junction of the middle third and lower third.
Analysis of Body Composition Fat-free mass was estimated on the basis of measurements of body density obtained by underwater weighing. Measures of Muscle Strength The effort-dependent performance of muscle was assessed on the basis of the maximal weight lifted for one repetition during the bench-press and squatting exercises. Statistical Analysis The Shapiro and Wilk test was used to test whether the outcome variables had a normal distribution.
Endocrine Responses The base-line serum concentrations of total and free testosterone in the four groups were similar. Mood and Behavior No differences were found between the exercise groups and the no-exercise groups or between the placebo groups and the testosterone groups in any of the five subcategories of anger assessed by the Multidimensional Anger Inventory. Discussion Our results show that supraphysiologic doses of testosterone, especially when combined with strength training, increase fat-free mass, muscle size, and strength in normal men when potentially confounding variables, such as nutritional intake and exercise stimulus, are standardized.
Source Information From the Department of Medicine, Charles R. Most Viewed Last Week. Denying Visas to Doctors in the United States.
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There are many causes of high testosterone in women, and the symptoms of high testosterone levels can be just as debilitating as low testosterone levels.