14 ms·

Why can't we just give steroids to people with muscular dystrophy?

153 points by klevertree 5y ago

nikita 5y ago
A different question. As someone who had to recover from Achilles tear and had to rebuild an atrophied calf muscle. Why don’t we just give anabolic steroids to people if their muscles atrophied after wearing a cast?
- woleium 5y ago
  or hgh
  - bitexploder 5y ago
    Both are good. I think HGH is the more interesting compound for soft tissue injuries (ligaments and such). I do BJJ and I will for sure use both to recover any major injury I get after having researched it and seen how pro BJJ folks do it with really good results. E: I should add both compounds can have severe side effects. Testosterone cycles can destroy your natural test production and HGH can have undesirable side effects. It makes things grow indiscriminately so you really have to do it with good medical advice. There are ways to prevent and manage the negative side effects.
    - icegreentea2 5y ago
      Ya. And it's probably worth pointing out that in the context of a recovery (say after a cast) that taking steriods and/or HGH will still require physical rehab, with even more doctor supervision. While it would probably lower the median time to "full recovery", it would probably also have significantly worse worst case outcomes, and still require significant work from the patient. Edit: Oh and specifically for steroids - one of the things that -can- (dunno how frequent really) happen is that your muscle strength growth outgrows your connective tissue (such as your Achilles tendon) growth rate and you end up with more connective tissue damage. Maxing out your muscle growth rate might be the best strategy, especially when recovering from connective tissue damage.
      - bitexploder 5y ago
        Yeah, it is no panacea for sure. For me, I have been lifting for years, doing BJJ for years. Ran for almost two decades. I consider myself in pretty good shape for a random dude on the street. It all takes work. Especially with Rehab you really have to put in the rehab work to direct the healing and if you went with pharmaceuticals like we are discussing that becomes extra important. But I think at low, therapeutic dosage it is all really safe. On a 3 month cycle during injury recovery you are unlikely to grow muscle quickly enough to do any real damage either.
    - cgh 5y ago
      Look into BPC-157.
  - leroy_masochist 5y ago
    BPC and TB are highly synergistic with HGH, so it's not really an either/or. Sermorelin+ipamorelin at night (HGH secretogogues) make the BPC/TB more effective and have the added nice effect of driving some fat loss/workout recovery, and are not crazy expensive like HGH is.
- justinator 5y ago
  Because your muscles, even in an atrophied state, will build back faster than the Achilles tear can heal (close) to 100%. Steroids don't make connective tissue grow faster/better/stronger.
  - bobthepanda 5y ago
    not only that, but I remember reading while looking up stuff after an ACL tear that steroids would actually be counterproductive, in that the faster than expected growth of muscle would put more strain on the healing connective tissue and possibly cause reinjury.
- cgh 5y ago
  In men, there are complications with your body’s natural testosterone production. If you inject test (the most basic anabolic steroid) then in order to maintain a sort of homeostasis, your body will lower its natural test production. The same goes for any other anabolic steroid, as they are all test derivatives. As a result, when you end your cycle, your body needs to restart its natural test production. There can be a delay while this happens and it leads to unpleasant, though temporary, side effects, like weight gain and a loss of sexual appetite. This can be mitigated somewhat by taking estrogen regulators such as Clomid, which is a prescription drug for women. Anyway, the upshot of all this is injecting steroids in men is sort of complicated. For your rehab scenario, your doctor would have to monitor your test and estrogen levels as you end your cycle. For moderate cycles like with your calf rehab, the dangers are vastly overblown in the media, but the short-term side effects can be bothersome. Note that women don’t face these issues and indeed women can take convenient oral steroids like eg Winstrol without having to inject test to compensate for their natural production getting shut down, because they hardly have any natural production to begin with. Indeed, ethics aside, the arguments for women to do a very moderate cycle for your rehab scenario or just athletic performance are pretty strong.
  - gruez 5y ago
    >As a result, when you end your cycle, your body needs to restart its natural test production. There can be a delay while this happens and it leads to unpleasant, though temporary, side effects, like weight gain and a loss of sexual appetite. Why not just slowly taper it off?
    - wisty 5y ago
      Test is injected into muscles, usually once every 2-4 weeks. It can't be taken orally. This makes dosage control difficult. The long half-life also means that your body's control systems are slow to act (if they reacted quickly then you'd risk ending up with too much, and be unable to get rid of it).
      - ggreer 5y ago
        There are plenty of other anabolic steroids. Some are oral, and many have the same primary effect with fewer side effects. There's even a new class of drugs that can work for women.[1] 1. https://en.wikipedia.org/wiki/Selective_androgen_receptor_modulator https://en.wikipedia.org/wiki/Selective_androgen_receptor_mo...
- vimy 5y ago
  Or BPC 157.
  - dillondoyle 5y ago
    Has anyone here used it? Or TB-500? I have a tendon/pulley injury that doesn't seem to want to heal and I've been researching it. At least one relevant study. There is one Dr. in my area (a gyno of all things) that has a website promoting his practice using it. So has at least a sheen of professionalism. https://pubmed.ncbi.nlm.nih.gov/21030672/ https://pubmed.ncbi.nlm.nih.gov/21030672/
    - leksak 5y ago
      Climber? I've had three pulley injuries and returned to sport. What, specifically, have you been doing to rehab it?
      - dillondoyle 5y ago
        yup!! hang boarding, micro needling, some finger/arm exercises from PT. i climbed seriously as a kid until like 22 ish. then didn't for 7 ish years. it's now close to 2 years back (sep 24). I think that's the main issue, my skill/strength is higher than my fingers. Though I'm still decently strong just have pain/days I can't do much and fingers are weak compared to what I used to have. what about you? I've been thinking of seeing if this local Dr. has any ideas, it sounds like you have to get the peptides injected near the injury which freaks me out. Don't mess with my fingers!
        slowmotiony 5y ago
        I did it and it worked wonders for my shoulder injury. Not giving you medical advice, but it's easy and not expensive so I would go for it if i were you. And subcutaneous injections are so easy you dont even feel them, I pin daily every morning with my coffee and it takes me 20 seconds using a super-slim insulin needle.
        harimau777 5y ago
- matheusmoreira 5y ago
  Anabolic steroids must be administered very carefully because they are part of a neuroendocrine feedback system. https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93gonadal_axis https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary... The hypothalamus releases GnRH which tells the hypophysis to stimulate the testicles. The hypophysis releases LH which tells the testicles to release testosterone. If there's too much testosterone, the GnRH release of the hypothalamus is inhibited. If there's too little, it is stimulated. Through this mechanism, testosterone levels are regulated. Introducing exogenous testosterone can seriously screw with this system. The extra testosterone causes negative feedback on GnRH and LH, decreasing or stopping natural testosterone production: hypogonadism. Physical therapy does not have these risks and is effective at recovering functionality. Perhaps a specialist would use anabolic steroids in case physical therapy alone isn't enough.
- skylanh 5y ago
  There are a number of responses that don't make me comfortable. The clearest reasoning for why anabolic or androgenic steroids' are NOT given in the context for recovery strength or function in a professional medical setting are that: - it has unintended consequences that can be severe - it has unintended consequences that can be long-lasting - the expected consequences of use are more harmful than the regular recovery - and that these can be quite harmful, enough that the use of AAS isn't necessary. and finally the primary goal post surgical: > One of the most important considerations in selecting operative versus nonoperative treatment is the risk of rerupture. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031433/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031433/ Quite a few responses are getting into details of AAS use that isn't quite correct based on my understandings.
- uCantCauseUCant 5y ago
  Because steroids attack the bone? And suppress the imune system and everything is connected with everything..
- deleted 5y ago
  [deleted]
- Taylor_OD 5y ago
  We could. And it would be about as safe as much medicine that we use today. But like many drugs that could be useful... steroids === bad.
bluedino 5y ago
Weren't some SARMs trialed on cancer patients that were having muscle wasting?
- fortran77 5y ago
  I know they were used on people with AIDS.
  - perardi 5y ago
    As was Anavar, an anabolic-androgenic steroid. https://pubmed.ncbi.nlm.nih.gov/8970686/ https://pubmed.ncbi.nlm.nih.gov/8970686/ It was fairly commonly used in the Bad Old Days of HIV/AIDS, before there was anything resembling a real treatment. Got a lot of people out of bed.
    - henryaj 5y ago
      I have a female friend with pretty bad muscle wasting from a long-term leg injury – have wondered idly if something like Anavar (or a SARM) would be a good option for her to help rebuild muscle to kick-start her recovery. Doubt anyone would prescribe it though.
Fezzik 5y ago
Interesting close-to-the-end note related to much of the medical research (on mice) that gets posted to HN: “The end result, in retrospect, was predictable: they successfully cured muscular dystrophy in mice, but not in humans.”
- gzer0 5y ago
  A cure for muscular dystrophy for humans already exists. Only problem is, it costs a whopping $2 million USD. [1] https://www.reuters.com/article/us-novartis-genetherapy/novartis-2-million-gene-therapy-for-rare-disorder-is-worlds-most-expensive-drug-idUSKCN1SU1ZP https://www.reuters.com/article/us-novartis-genetherapy/nova... [2] https://www.npr.org/sections/health-shots/2019/05/24/725404168/at-2-125-million-new-gene-therapy-is-the-most-expensive-drug-ever https://www.npr.org/sections/health-shots/2019/05/24/7254041...
  - klevertree 5y ago
    That's not muscular dystrophy. That's a motor neuron disease.
Dylan16807 5y ago
I don't really understand. Clearly the muscles work to some extent, so isn't making more a lot better than doing nothing? > It’d be like if you had a construction project, and you found out that all of the wooden beams you were receiving from a supplier were rotten. Would you order more beams from that same supplier to fix the problem? If my other option is shrugging and doing nothing and being sad as the house falls apart, then obviously yes I do. Quadruple up all the beams.
- x86_64Ubuntu 5y ago
  The beam analogy doesn't work because the rotted wood can provide some support. But the author states that the muscle just dies due a defect. So it's more akin to having tires that develop bubbles in the first 50 miles. Giving you more tires isn't going to help because that means you will spend more time changing them out over and over again.
  - Dylan16807 5y ago
    The muscle fibers are likely to fail but they still have muscles.
    - fullburley 5y ago
      In the case of DMD, it's a matter of when and which (typically heart), not if. The muscle fibers turn into fiberous tissues that aren't functional muscle. They fail.
      - Dylan16807 5y ago
        Well "matter of when" would still suggest that more is better, within reasonable bounds. But if they turn into tissue that gets in the way, that would be a big reason not to want more. Is that the main reason?
- maxerickson 5y ago
  I don't think I understand it very well, but one reason focusing on the analogy doesn't help is that muscle has a lot higher ongoing maintenance cost than a beam.
symlinkk 5y ago
Why are steroids even a controlled drug? If a man wants to use them and knows the risks he should be able to. Same with any drug I guess.
- uptown 5y ago
  We’ll, for one it’d ruin sports. If it’s legal and up to the athlete to decide — then in order to remain competitive all athletes would need to take steroids. You’d basically be telling athletes that they’d need to subject their bodies to the side effects of steroids if they wanted to remain competitive in their sport. That seems like an unfair obligation to place on athletes.
  - IThoughtYouGNU 5y ago
    So, you mean like all pro sports already right now?
  - moron4hire 5y ago
    These athletes play in leagues that make their own rules and have their own governing bodies. What does the civil government have to do with that?
    - flemhans 5y ago
      And why should the whole world depend on some people who want to play games with each other?
    - uptown 5y ago
      You do realize there's literally sports at all ages, right? High school, elementary school?
      - moron4hire 5y ago
        Maybe we should ban sports, then. I don't know anyone who doesn't play sports who abuses steroids. Sounds like sports is a gateway drug. OMG! WOULD SOMEONE! PLEASE! ANYONE! THINK OF THE CHILDREN!>?!?!
gzer0 5y ago
A cure for muscular dystrophy for humans already exists. Only problem is, it costs a whopping $2 million USD. [1] https://www.reuters.com/article/us-novartis-genetherapy/novartis-2-million-gene-therapy-for-rare-disorder-is-worlds-most-expensive-drug-idUSKCN1SU1ZP https://www.reuters.com/article/us-novartis-genetherapy/nova... [2] https://www.npr.org/sections/health-shots/2019/05/24/725404168/at-2-125-million-new-gene-therapy-is-the-most-expensive-drug-ever https://www.npr.org/sections/health-shots/2019/05/24/7254041...
- Dylan16807 5y ago
  Also you can only use it on babies. But as pointed out elsewhere, wrong disease. As for that drug, I doubt the price would need to be that high if people were ordering a thousand doses a year, but I'm no expert.
- fullburley 5y ago
  That's for one type of muscular dystrophy, SMA, there are many other types without great treatment options. Lifelong exon skipping treatments recently approved for subsets of DMD are >1M USD per year, and result in dystrophin expression at only a few percent of "normal" (see data from trials of casimersin).
- staticautomatic 5y ago
  Muscular Dystrophy isn’t a single disease— it’s an umbrella term for a whole class of neurodegenerative diseases with different etiologies. We need to be clear on which one we’re talking about when we talk about cures.
  - ben_bai 5y ago
    The industry is going the route of gene therapy. > SAREPTA THERAPEUTICS ANNOUNCES GENE THERAPY PROGRAM FOR LGMD2A/R1 Today https://investorrelations.sarepta.com/news-releases/news-release-details/sarepta-therapeutics-executes-licensing-agreement-gene-therapy https://investorrelations.sarepta.com/news-releases/news-rel...
- gpt5 5y ago
kahon65 5y ago
This article says weightlifting can add skeletal muscle cells to make it hypertrophied. Wrong. Hypertrophy occurs by making existing muscle cells bigger. No skeletal muscle cells creation can exist, except in very few precise contexts. Also, studies show that weightlifting actually fight or even prevent sarcopenia. Same for steroids. (sarcopenia = muscular distrophy) Obviously the author just doesn't like sports........
hellothere1337 5y ago
Well if you're speaking from an incentive point of view. The incentive of society is to keep men as docile as possible. Testosterone is not the best hormone to achieve this effect. On the other hand estrogen is quite freely given if you want to go the other way. Giving testosterone to people dying from dystrophy would open the discussion of steroids and it would counter the narrative that steroids are the worst drugs in existence, designed to kill you the moment you take a miligram.
ethn 5y ago
On the other hand an MPC inhibitor like RCGD423 should reactivate the muscle stem cells [1]. For a similar reason an oral TZD (which are selective MPCi) should also help. [1] https://hscnews.usc.edu/small-molecule-could-make-a-big-difference-for-arthritis-patients https://hscnews.usc.edu/small-molecule-could-make-a-big-diff...
yawaworht1978 5y ago
One problem is, it would have to be permanent, once the steroids are stopped, the extra muscle will mostly fade away and the natural testosterone production will be inhibited, this is the worst effect, the people end up with a lower testosterone production than before. But it's true, so long enough calories are given, they would gain some muscle, even without training at all. An alternative might be hgh , but that comes with other issues. Last but not least, all steroids are not equal, they're all testosterone derivates, the tablets are very toxic to the liver, and some derivates come with some more side effects than plain testosterone. Science tried to develop a mild steroid with great anabolic effects , but all of them are not powerful without adequate androgenic properties. The androgenic properties is what makes a steroid strong and....causes most side effects and hormonal imbalances post going off. To this day, testosterone seems to be the choice of medicine and by no means it's a weak drug, it simply upsets the body bit less as it's the same thing that the body produces. There might be more points on why not give it to these patients, but that's the steroid side of things.
qwerty456127 5y ago
I go further and wonder why don't we do that (steroids, growth hormones, sarms, everything) in advance as people reach certain age (and their natural secretion of the hormones falls below certain level). I feel inspired by Dr. Life and feel like starting taking hormones (from the black market, European doctors will never prescribe this officially) as I reach 50-60. AFAIK the growth hormone even rejuvenates the thymus, the immune system (and may prevent cancer this way, if not over-used) and is the only way to trigger regeneration of joints.
- Y-bar 5y ago
  Take this with a major grain of salt. But I learned that giving growth hormones will make the body produce less of its own. So the risk, as I understand it, is that by giving these hormones in advance may stump what little the body will produce on its own and "will definitely doom" these people to a full lifetime of hormones from external sources.
  - qwerty456127 5y ago
    This is why I'm only going to do this after the rate of their production actually falls significantly below the healthy adult level. When they are not produced anyway it seems nothing to loose. I didn't know this is also the case with the growth hormone, however. I thought this only applies to testosterone, also tyroxine and some other hormones.
    - southeastern 5y ago
      At that point you still have a natural production, it's just less than at your lifetime peak. You can still destabilize your hormone signaling further and get symptoms like hypogonadism and gynomastia-- to say there's nothing to lose isn't quite right.
      - bigwavedave 5y ago
        > At that point you still have a natural production, it's just less than at your lifetime peak. You can still destabilize your hormone signaling further and get symptoms like hypogonadism and gynomastia-- to say there's nothing to lose isn't quite right. Sure, there isn't "nothing to lose", but let's not kid ourselves- if you're past retirement age and in a position to essentially be on TRT for the rest of your life, hypogonadism isn't a big deal unless for some crazy reason TRT becomes unavailable. As for gynecomastia, it's very easily managed with an aromatase inhibitor like exemestane or anastrozole. I'm not saying there aren't risks or possible side effects, but exogenous testosterone shouldn't be dismissed out of hand because of the FUD surrounding steroids. If you haven't seen the documentary "Bigger, Stronger, Faster", I highly recommend it.
tailius 5y ago
I had low T and hypotrophy. You can't just give anabolic steroids or testosterone to men of fertile age because it causes testicular shrinkage, prolactin level rises (risks of breast development), and risks strokes and infarctions.
amai 5y ago
Actually steroids are used to treat people with muscular dystrophy: https://en.wikipedia.org/wiki/Anabolic_steroid#Medical https://en.wikipedia.org/wiki/Anabolic_steroid#Medical But they have a lot of side effects: https://en.wikipedia.org/wiki/Anabolic_steroid#Adverse_effects https://en.wikipedia.org/wiki/Anabolic_steroid#Adverse_effec... Therefor scientists started to investigate different substances like https://en.wikipedia.org/wiki/Selective_androgen_receptor_modulator https://en.wikipedia.org/wiki/Selective_androgen_receptor_mo... But these might still have severe side effects (https://en.wikipedia.org/wiki/Ligandrol#Adverse_health_effects https://en.wikipedia.org/wiki/Ligandrol#Adverse_health_effec...)
- sterlind 5y ago
  Your wiki link doesn't say anything about muscular dystrophy. It mentions treatment of wasting syndrome (e.g. from HIV or cancer) but that's a metabolic issue rather than a muscle issue. A quick googling reveals a 1965 paper that says anabolic steroids are ineffective, and some follow-up papers that talk about oxandrolone being modestly effective but mostly through glucocorticoid mechanisms (e.g. like Prednisone, not Testosterone)
Galactasm 5y ago
I read one of the linked articles in the article, the one that said men who take steroids and don’t exercise gain more muscle mass than men who don’t take steroids but do exercise. I should admit that I’m personally biased against the conclusion but I find the results interesting. I had a few nitpicks however: 1. I question how optimal the training stimulus was. They said it was controlled and they worked out 3 times a week and for the squat/bench press they started out at 4 sets of 6 reps varying between 70/80/90 % initial one rep max and then increased weights after 5 weeks and increased the number of sets to 5. I think it’s obvious that more exercise would result in more muscle mass gain up to a certain point and I think the amount of volume they’re doing is really suboptimal even for a more average weight lifter. I didn’t see them go into more detail about the workout routine which would’ve been nice. 2. With such a minimal routine, muscle mass gain is going to be limited to the areas that are being exercised. Taking steroids is going to increase all muscle mass throughout the body. The placebo + exercise group had a slightly higher increase in strength, very slight, but still higher than the steroid + no exercise group. If they wanted, a weight lifter could change the routine to maximize overall muscle mass gain. Presumably they weren’t really hitting some muscle groups (shoulders, hamstrings, calves, back, core). They weren’t doing deadlifts. So it makes sense that the steroid + no exercise group had higher muscle mass gain because they were experiencing a full body stimulus whereas the exercise + placebo were not (even if they were I question how optimal the routine was since as far as I could tell they didn’t release detailed workout routine). 3. This is even more nitpicky, but there is going to be a limited ceiling with no external stimulus (exercise). In the long run the steroid + no-ex group will plateau whereas the placebo + ex group will be able to increase muscle for much longer. So I guess I disagree with the conclusion “men who take steroids but don’t exercise gain more muscle mass than no steroids + exercise” despite the results supporting it.
deleted 5y ago
[deleted]

153 points by klevertree 5y ago

A different question. As someone who had to recover from Achilles tear and had to rebuild an atrophied calf muscle. Why don’t we just give anabolic steroids to people if their muscles atrophied after wearing a cast?

woleium 5y ago
or hgh
- bitexploder 5y ago
  Both are good. I think HGH is the more interesting compound for soft tissue injuries (ligaments and such). I do BJJ and I will for sure use both to recover any major injury I get after having researched it and seen how pro BJJ folks do it with really good results. E: I should add both compounds can have severe side effects. Testosterone cycles can destroy your natural test production and HGH can have undesirable side effects. It makes things grow indiscriminately so you really have to do it with good medical advice. There are ways to prevent and manage the negative side effects.
  - icegreentea2 5y ago
    Ya. And it's probably worth pointing out that in the context of a recovery (say after a cast) that taking steriods and/or HGH will still require physical rehab, with even more doctor supervision. While it would probably lower the median time to "full recovery", it would probably also have significantly worse worst case outcomes, and still require significant work from the patient. Edit: Oh and specifically for steroids - one of the things that -can- (dunno how frequent really) happen is that your muscle strength growth outgrows your connective tissue (such as your Achilles tendon) growth rate and you end up with more connective tissue damage. Maxing out your muscle growth rate might be the best strategy, especially when recovering from connective tissue damage.
    - bitexploder 5y ago
      Yeah, it is no panacea for sure. For me, I have been lifting for years, doing BJJ for years. Ran for almost two decades. I consider myself in pretty good shape for a random dude on the street. It all takes work. Especially with Rehab you really have to put in the rehab work to direct the healing and if you went with pharmaceuticals like we are discussing that becomes extra important. But I think at low, therapeutic dosage it is all really safe. On a 3 month cycle during injury recovery you are unlikely to grow muscle quickly enough to do any real damage either.
  - cgh 5y ago
    Look into BPC-157.
- leroy_masochist 5y ago
  BPC and TB are highly synergistic with HGH, so it's not really an either/or. Sermorelin+ipamorelin at night (HGH secretogogues) make the BPC/TB more effective and have the added nice effect of driving some fat loss/workout recovery, and are not crazy expensive like HGH is.
justinator 5y ago
Because your muscles, even in an atrophied state, will build back faster than the Achilles tear can heal (close) to 100%. Steroids don't make connective tissue grow faster/better/stronger.
- bobthepanda 5y ago
  not only that, but I remember reading while looking up stuff after an ACL tear that steroids would actually be counterproductive, in that the faster than expected growth of muscle would put more strain on the healing connective tissue and possibly cause reinjury.
cgh 5y ago
In men, there are complications with your body’s natural testosterone production. If you inject test (the most basic anabolic steroid) then in order to maintain a sort of homeostasis, your body will lower its natural test production. The same goes for any other anabolic steroid, as they are all test derivatives. As a result, when you end your cycle, your body needs to restart its natural test production. There can be a delay while this happens and it leads to unpleasant, though temporary, side effects, like weight gain and a loss of sexual appetite. This can be mitigated somewhat by taking estrogen regulators such as Clomid, which is a prescription drug for women. Anyway, the upshot of all this is injecting steroids in men is sort of complicated. For your rehab scenario, your doctor would have to monitor your test and estrogen levels as you end your cycle. For moderate cycles like with your calf rehab, the dangers are vastly overblown in the media, but the short-term side effects can be bothersome. Note that women don’t face these issues and indeed women can take convenient oral steroids like eg Winstrol without having to inject test to compensate for their natural production getting shut down, because they hardly have any natural production to begin with. Indeed, ethics aside, the arguments for women to do a very moderate cycle for your rehab scenario or just athletic performance are pretty strong.
- gruez 5y ago
  >As a result, when you end your cycle, your body needs to restart its natural test production. There can be a delay while this happens and it leads to unpleasant, though temporary, side effects, like weight gain and a loss of sexual appetite. Why not just slowly taper it off?
  - wisty 5y ago
    Test is injected into muscles, usually once every 2-4 weeks. It can't be taken orally. This makes dosage control difficult. The long half-life also means that your body's control systems are slow to act (if they reacted quickly then you'd risk ending up with too much, and be unable to get rid of it).
    - ggreer 5y ago
      There are plenty of other anabolic steroids. Some are oral, and many have the same primary effect with fewer side effects. There's even a new class of drugs that can work for women.[1] 1. https://en.wikipedia.org/wiki/Selective_androgen_receptor_modulator https://en.wikipedia.org/wiki/Selective_androgen_receptor_mo...
vimy 5y ago
Or BPC 157.
- dillondoyle 5y ago
  Has anyone here used it? Or TB-500? I have a tendon/pulley injury that doesn't seem to want to heal and I've been researching it. At least one relevant study. There is one Dr. in my area (a gyno of all things) that has a website promoting his practice using it. So has at least a sheen of professionalism. https://pubmed.ncbi.nlm.nih.gov/21030672/ https://pubmed.ncbi.nlm.nih.gov/21030672/
  - leksak 5y ago
    Climber? I've had three pulley injuries and returned to sport. What, specifically, have you been doing to rehab it?
    - dillondoyle 5y ago
      yup!! hang boarding, micro needling, some finger/arm exercises from PT. i climbed seriously as a kid until like 22 ish. then didn't for 7 ish years. it's now close to 2 years back (sep 24). I think that's the main issue, my skill/strength is higher than my fingers. Though I'm still decently strong just have pain/days I can't do much and fingers are weak compared to what I used to have. what about you? I've been thinking of seeing if this local Dr. has any ideas, it sounds like you have to get the peptides injected near the injury which freaks me out. Don't mess with my fingers!
      - slowmotiony 5y ago
        I did it and it worked wonders for my shoulder injury. Not giving you medical advice, but it's easy and not expensive so I would go for it if i were you. And subcutaneous injections are so easy you dont even feel them, I pin daily every morning with my coffee and it takes me 20 seconds using a super-slim insulin needle.
      - harimau777 5y ago
matheusmoreira 5y ago
Anabolic steroids must be administered very carefully because they are part of a neuroendocrine feedback system. https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93gonadal_axis https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary... The hypothalamus releases GnRH which tells the hypophysis to stimulate the testicles. The hypophysis releases LH which tells the testicles to release testosterone. If there's too much testosterone, the GnRH release of the hypothalamus is inhibited. If there's too little, it is stimulated. Through this mechanism, testosterone levels are regulated. Introducing exogenous testosterone can seriously screw with this system. The extra testosterone causes negative feedback on GnRH and LH, decreasing or stopping natural testosterone production: hypogonadism. Physical therapy does not have these risks and is effective at recovering functionality. Perhaps a specialist would use anabolic steroids in case physical therapy alone isn't enough.
skylanh 5y ago
There are a number of responses that don't make me comfortable. The clearest reasoning for why anabolic or androgenic steroids' are NOT given in the context for recovery strength or function in a professional medical setting are that: - it has unintended consequences that can be severe - it has unintended consequences that can be long-lasting - the expected consequences of use are more harmful than the regular recovery - and that these can be quite harmful, enough that the use of AAS isn't necessary. and finally the primary goal post surgical: > One of the most important considerations in selecting operative versus nonoperative treatment is the risk of rerupture. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031433/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031433/ Quite a few responses are getting into details of AAS use that isn't quite correct based on my understandings.
uCantCauseUCant 5y ago
Because steroids attack the bone? And suppress the imune system and everything is connected with everything..
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Taylor_OD 5y ago
We could. And it would be about as safe as much medicine that we use today. But like many drugs that could be useful... steroids === bad.

bluedino 5y ago

Weren't some SARMs trialed on cancer patients that were having muscle wasting?

fortran77 5y ago
I know they were used on people with AIDS.
- perardi 5y ago
  As was Anavar, an anabolic-androgenic steroid. https://pubmed.ncbi.nlm.nih.gov/8970686/ https://pubmed.ncbi.nlm.nih.gov/8970686/ It was fairly commonly used in the Bad Old Days of HIV/AIDS, before there was anything resembling a real treatment. Got a lot of people out of bed.
  - henryaj 5y ago
    I have a female friend with pretty bad muscle wasting from a long-term leg injury – have wondered idly if something like Anavar (or a SARM) would be a good option for her to help rebuild muscle to kick-start her recovery. Doubt anyone would prescribe it though.

Fezzik 5y ago

Interesting close-to-the-end note related to much of the medical research (on mice) that gets posted to HN: “The end result, in retrospect, was predictable: they successfully cured muscular dystrophy in mice, but not in humans.”

gzer0 5y ago
A cure for muscular dystrophy for humans already exists. Only problem is, it costs a whopping $2 million USD. [1] https://www.reuters.com/article/us-novartis-genetherapy/novartis-2-million-gene-therapy-for-rare-disorder-is-worlds-most-expensive-drug-idUSKCN1SU1ZP https://www.reuters.com/article/us-novartis-genetherapy/nova... [2] https://www.npr.org/sections/health-shots/2019/05/24/725404168/at-2-125-million-new-gene-therapy-is-the-most-expensive-drug-ever https://www.npr.org/sections/health-shots/2019/05/24/7254041...
- klevertree 5y ago
  That's not muscular dystrophy. That's a motor neuron disease.

Dylan16807 5y ago

I don't really understand. Clearly the muscles work to some extent, so isn't making more a lot better than doing nothing? > It’d be like if you had a construction project, and you found out that all of the wooden beams you were receiving from a supplier were rotten. Would you order more beams from that same supplier to fix the problem? If my other option is shrugging and doing nothing and being sad as the house falls apart, then obviously yes I do. Quadruple up all the beams.

x86_64Ubuntu 5y ago
The beam analogy doesn't work because the rotted wood can provide some support. But the author states that the muscle just dies due a defect. So it's more akin to having tires that develop bubbles in the first 50 miles. Giving you more tires isn't going to help because that means you will spend more time changing them out over and over again.
- Dylan16807 5y ago
  The muscle fibers are likely to fail but they still have muscles.
  - fullburley 5y ago
    In the case of DMD, it's a matter of when and which (typically heart), not if. The muscle fibers turn into fiberous tissues that aren't functional muscle. They fail.
    - Dylan16807 5y ago
      Well "matter of when" would still suggest that more is better, within reasonable bounds. But if they turn into tissue that gets in the way, that would be a big reason not to want more. Is that the main reason?
maxerickson 5y ago
I don't think I understand it very well, but one reason focusing on the analogy doesn't help is that muscle has a lot higher ongoing maintenance cost than a beam.

symlinkk 5y ago

Why are steroids even a controlled drug? If a man wants to use them and knows the risks he should be able to. Same with any drug I guess.

uptown 5y ago
We’ll, for one it’d ruin sports. If it’s legal and up to the athlete to decide — then in order to remain competitive all athletes would need to take steroids. You’d basically be telling athletes that they’d need to subject their bodies to the side effects of steroids if they wanted to remain competitive in their sport. That seems like an unfair obligation to place on athletes.
- IThoughtYouGNU 5y ago
  So, you mean like all pro sports already right now?
- moron4hire 5y ago
  These athletes play in leagues that make their own rules and have their own governing bodies. What does the civil government have to do with that?
  - flemhans 5y ago
    And why should the whole world depend on some people who want to play games with each other?
  - uptown 5y ago
    You do realize there's literally sports at all ages, right? High school, elementary school?
    - moron4hire 5y ago
      Maybe we should ban sports, then. I don't know anyone who doesn't play sports who abuses steroids. Sounds like sports is a gateway drug. OMG! WOULD SOMEONE! PLEASE! ANYONE! THINK OF THE CHILDREN!>?!?!

gzer0 5y ago

A cure for muscular dystrophy for humans already exists. Only problem is, it costs a whopping $2 million USD. [1] https://www.reuters.com/article/us-novartis-genetherapy/novartis-2-million-gene-therapy-for-rare-disorder-is-worlds-most-expensive-drug-idUSKCN1SU1ZP https://www.reuters.com/article/us-novartis-genetherapy/nova... [2] https://www.npr.org/sections/health-shots/2019/05/24/725404168/at-2-125-million-new-gene-therapy-is-the-most-expensive-drug-ever https://www.npr.org/sections/health-shots/2019/05/24/7254041...

Dylan16807 5y ago
Also you can only use it on babies. But as pointed out elsewhere, wrong disease. As for that drug, I doubt the price would need to be that high if people were ordering a thousand doses a year, but I'm no expert.
fullburley 5y ago
That's for one type of muscular dystrophy, SMA, there are many other types without great treatment options. Lifelong exon skipping treatments recently approved for subsets of DMD are >1M USD per year, and result in dystrophin expression at only a few percent of "normal" (see data from trials of casimersin).
staticautomatic 5y ago
Muscular Dystrophy isn’t a single disease— it’s an umbrella term for a whole class of neurodegenerative diseases with different etiologies. We need to be clear on which one we’re talking about when we talk about cures.
- ben_bai 5y ago
  The industry is going the route of gene therapy. > SAREPTA THERAPEUTICS ANNOUNCES GENE THERAPY PROGRAM FOR LGMD2A/R1 Today https://investorrelations.sarepta.com/news-releases/news-release-details/sarepta-therapeutics-executes-licensing-agreement-gene-therapy https://investorrelations.sarepta.com/news-releases/news-rel...
gpt5 5y ago

kahon65 5y ago

This article says weightlifting can add skeletal muscle cells to make it hypertrophied. Wrong. Hypertrophy occurs by making existing muscle cells bigger. No skeletal muscle cells creation can exist, except in very few precise contexts. Also, studies show that weightlifting actually fight or even prevent sarcopenia. Same for steroids. (sarcopenia = muscular distrophy) Obviously the author just doesn't like sports........

hellothere1337 5y ago

Well if you're speaking from an incentive point of view. The incentive of society is to keep men as docile as possible. Testosterone is not the best hormone to achieve this effect. On the other hand estrogen is quite freely given if you want to go the other way. Giving testosterone to people dying from dystrophy would open the discussion of steroids and it would counter the narrative that steroids are the worst drugs in existence, designed to kill you the moment you take a miligram.

ethn 5y ago

On the other hand an MPC inhibitor like RCGD423 should reactivate the muscle stem cells [1]. For a similar reason an oral TZD (which are selective MPCi) should also help. [1] https://hscnews.usc.edu/small-molecule-could-make-a-big-difference-for-arthritis-patients https://hscnews.usc.edu/small-molecule-could-make-a-big-diff...

yawaworht1978 5y ago

One problem is, it would have to be permanent, once the steroids are stopped, the extra muscle will mostly fade away and the natural testosterone production will be inhibited, this is the worst effect, the people end up with a lower testosterone production than before. But it's true, so long enough calories are given, they would gain some muscle, even without training at all. An alternative might be hgh , but that comes with other issues. Last but not least, all steroids are not equal, they're all testosterone derivates, the tablets are very toxic to the liver, and some derivates come with some more side effects than plain testosterone. Science tried to develop a mild steroid with great anabolic effects , but all of them are not powerful without adequate androgenic properties. The androgenic properties is what makes a steroid strong and....causes most side effects and hormonal imbalances post going off. To this day, testosterone seems to be the choice of medicine and by no means it's a weak drug, it simply upsets the body bit less as it's the same thing that the body produces. There might be more points on why not give it to these patients, but that's the steroid side of things.

qwerty456127 5y ago

I go further and wonder why don't we do that (steroids, growth hormones, sarms, everything) in advance as people reach certain age (and their natural secretion of the hormones falls below certain level). I feel inspired by Dr. Life and feel like starting taking hormones (from the black market, European doctors will never prescribe this officially) as I reach 50-60. AFAIK the growth hormone even rejuvenates the thymus, the immune system (and may prevent cancer this way, if not over-used) and is the only way to trigger regeneration of joints.

Y-bar 5y ago
Take this with a major grain of salt. But I learned that giving growth hormones will make the body produce less of its own. So the risk, as I understand it, is that by giving these hormones in advance may stump what little the body will produce on its own and "will definitely doom" these people to a full lifetime of hormones from external sources.
- qwerty456127 5y ago
  This is why I'm only going to do this after the rate of their production actually falls significantly below the healthy adult level. When they are not produced anyway it seems nothing to loose. I didn't know this is also the case with the growth hormone, however. I thought this only applies to testosterone, also tyroxine and some other hormones.
  - southeastern 5y ago
    At that point you still have a natural production, it's just less than at your lifetime peak. You can still destabilize your hormone signaling further and get symptoms like hypogonadism and gynomastia-- to say there's nothing to lose isn't quite right.
    - bigwavedave 5y ago
      > At that point you still have a natural production, it's just less than at your lifetime peak. You can still destabilize your hormone signaling further and get symptoms like hypogonadism and gynomastia-- to say there's nothing to lose isn't quite right. Sure, there isn't "nothing to lose", but let's not kid ourselves- if you're past retirement age and in a position to essentially be on TRT for the rest of your life, hypogonadism isn't a big deal unless for some crazy reason TRT becomes unavailable. As for gynecomastia, it's very easily managed with an aromatase inhibitor like exemestane or anastrozole. I'm not saying there aren't risks or possible side effects, but exogenous testosterone shouldn't be dismissed out of hand because of the FUD surrounding steroids. If you haven't seen the documentary "Bigger, Stronger, Faster", I highly recommend it.

tailius 5y ago

I had low T and hypotrophy. You can't just give anabolic steroids or testosterone to men of fertile age because it causes testicular shrinkage, prolactin level rises (risks of breast development), and risks strokes and infarctions.

amai 5y ago

Actually steroids are used to treat people with muscular dystrophy: https://en.wikipedia.org/wiki/Anabolic_steroid#Medical https://en.wikipedia.org/wiki/Anabolic_steroid#Medical But they have a lot of side effects: https://en.wikipedia.org/wiki/Anabolic_steroid#Adverse_effects https://en.wikipedia.org/wiki/Anabolic_steroid#Adverse_effec... Therefor scientists started to investigate different substances like https://en.wikipedia.org/wiki/Selective_androgen_receptor_modulator https://en.wikipedia.org/wiki/Selective_androgen_receptor_mo... But these might still have severe side effects (https://en.wikipedia.org/wiki/Ligandrol#Adverse_health_effects https://en.wikipedia.org/wiki/Ligandrol#Adverse_health_effec...)

sterlind 5y ago
Your wiki link doesn't say anything about muscular dystrophy. It mentions treatment of wasting syndrome (e.g. from HIV or cancer) but that's a metabolic issue rather than a muscle issue. A quick googling reveals a 1965 paper that says anabolic steroids are ineffective, and some follow-up papers that talk about oxandrolone being modestly effective but mostly through glucocorticoid mechanisms (e.g. like Prednisone, not Testosterone)

Galactasm 5y ago

I read one of the linked articles in the article, the one that said men who take steroids and don’t exercise gain more muscle mass than men who don’t take steroids but do exercise. I should admit that I’m personally biased against the conclusion but I find the results interesting. I had a few nitpicks however: 1. I question how optimal the training stimulus was. They said it was controlled and they worked out 3 times a week and for the squat/bench press they started out at 4 sets of 6 reps varying between 70/80/90 % initial one rep max and then increased weights after 5 weeks and increased the number of sets to 5. I think it’s obvious that more exercise would result in more muscle mass gain up to a certain point and I think the amount of volume they’re doing is really suboptimal even for a more average weight lifter. I didn’t see them go into more detail about the workout routine which would’ve been nice. 2. With such a minimal routine, muscle mass gain is going to be limited to the areas that are being exercised. Taking steroids is going to increase all muscle mass throughout the body. The placebo + exercise group had a slightly higher increase in strength, very slight, but still higher than the steroid + no exercise group. If they wanted, a weight lifter could change the routine to maximize overall muscle mass gain. Presumably they weren’t really hitting some muscle groups (shoulders, hamstrings, calves, back, core). They weren’t doing deadlifts. So it makes sense that the steroid + no exercise group had higher muscle mass gain because they were experiencing a full body stimulus whereas the exercise + placebo were not (even if they were I question how optimal the routine was since as far as I could tell they didn’t release detailed workout routine). 3. This is even more nitpicky, but there is going to be a limited ceiling with no external stimulus (exercise). In the long run the steroid + no-ex group will plateau whereas the placebo + ex group will be able to increase muscle for much longer. So I guess I disagree with the conclusion “men who take steroids but don’t exercise gain more muscle mass than no steroids + exercise” despite the results supporting it.

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