[Within these same pages (forum), I wrote of the use of AAS for obesity more than 10 years ago!]
Kovac JR, Scovell J, Kim ED, Lipshultz LI. A positive role for anabolic androgenic steroids: preventing metabolic syndrome and type 2 diabetes mellitus. Fertil Steril. http://www.fertstert.org/article/S0015-0282(14)00458-0/abstract
TO THE EDITOR: We recently discussed the diagnosis and treatment of anabolic steroid induced hypogonadism (1). A subsequent commentary (2) detailed the dilemma of treating patients after anabolic androgenic steroid (AAS) use. Pervasive throughout the medical literature is the paradigm that ‘‘illicit’’ AAS use is unsafe (2) and that it is used to satisfy body-dysmorphic disorder (3). But perhaps there is something constructive to be learned from men who have used AAS at a young age.
All types of T supplementation therapy (TST) are forms of AAS. It is the most effective treatment for hypogonadism using legally approved and pharmaceutical-grade AAS (usually T). The monitoring and management of known side effects (i.e., infertility, erythrocytosis [1]) in a physician-controlled environment has made TST more accepted. Given these changing views, perhaps other beliefs regarding AAS, and by definition TST, should be revisited.
Consider the following scenario: a young and obese, currently overtly ‘‘healthy,’’ but unusually fatigued man begins using AAS. In spite of the inherent risks, the young man changes his diet, exercises, loses fat, and gains muscle mass. We can then debate whether AAS has decreased the likelihood of more significant disease in this man as he ages. If a physician were to evaluate this young man, identify his hypogonadism and treat him with a T preparation (or derivative), he could gain the benefits of TST while identifying and treating side effects. In this context, it is tempting to speculate that the possible benefits of AAS/TST could potentially mitigate other, more serious health conditions such as obesity and metabolic syndrome (MetS), the precursor to type 2 diabetes mellitus.
This concept is particularly important given the staggering increase of MetS. Current estimates note the prevalence of MetS in adults to be 39%, with approximately 7% of the pediatric/adolescent population affected (4). These statistics are critical because MetS increases a patient's risk for developing type 2 diabetes mellitus fivefold and makes patients three times more likely to suffer a myocardial infarction or stroke—underscoring the true nature of this health crisis (4). The current cornerstones of MetS treatment are diet, exercise, and education. As such, an opportunity exists to enhance the current intervention strategies with adjunct alternatives to prevent MetS.
Treatment of MetS with TST has shown benefits with improvements in individual risk factors (i.e., abdominal obesity, body mass index [BMI], blood pressure, and cholesterol), as well as complete resolution of MetS in some individuals (4). Although TST is efficacious in both treating and reversing MetS, perhaps it is time to consider TST as a preemptive treatment strategy against MetS. Indeed, TST in combination with weight loss, exercise, and a change in lifestyle may be sufficient to ward off future negative health problems in adulthood.
A well-designed, prospective randomized control trial evaluating TST in young, obese men before the overt diagnosis of MetS/type 2 diabetes mellitus would be extremely valuable. A study like this could determine whether TST should be used as a preemptive medication in conjunction with dietary modification and exercise. It may even be that early TST could become a significant adjunct in preventing MetS/type 2 diabetes mellitus in the at-risk patient.
REFERENCES
1. Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroidinduced hypogonadism: diagnosis and treatment. Fertil Steril 2014;101: 1271–9.
2. Nangia AK. Anabolic steroid abuse: a paradox of manliness. Fertil Steril 2014; 101:1247.
3. Pope HG Jr, Gruber AJ, Choi P, Olivardia R, Phillips KA. Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. Psychosomatics 1997;38:548–57.
4. Kovac JR, Pastuszak AW, Lamb DJ, Lipshultz LI. Testosterone supplementation therapy in the treatment of metabolic syndrome. Postgrad Med. In press.
