Anabolic Steroid Cycles

An Experts Guide to Optimum Use

Testosterone: Sprint or Marathon?

Ancient cultures spread learning through spoken lore, as much of the population could
not read. Given the literacy trends of the last decade or two, this educational style may
return. A collection of such tales has iconic status, known as Aesop's Fables. [Aesop
was a slave who lived in Greek society approximately 600 B.C.] One of his most well
known is the race between the tortoise and the hare. After ridiculing the ponderous
tortoise and challenging him to a race, the hare (a rabbit for those not familiar with the
term) sprinted ahead but stopped for a rest. When he realized he had goofed off too
long, he ran as fast as he could, only to see the tortoise crossing the line before him.
The moral of the story is slow and steady wins the race.
Consider for a moment the typical use pattern of testosterone (and other anabolic-
androgenic steroids, or AAS)— it is hare-like. Bodybuilders have been programmed by
gym lore to follow eight- to 12-week high-dosed AAS cycles to maximize muscle and
strength gains. While it is unquestionable that most men do achieve considerable
growth and strength enhancement during AAS cycles, it is also very common for these
gains to be temporary, with long-term mass and strength retention that is much less
than the peak experienced during the cycle. Further, in the rush to acquire maximal
growth during a cycle, injuries are common and dosages are pushed into a range
wherein adverse side effects occur. Some of these side effects can be mitigated with
the use of adjunct drugs (e.g., aromatase inhibitors), but many could be avoided if lower
doses were used. Also, these types of cycles can wreak havoc on the mental state and
mood of the user/abuser. Lastly, it is nearly certain that such cycles will result in the
suppression of natural testosterone (and sperm) production of variable duration. Some
men recover from AAS cycles quickly, especially if they tapered correctly; others may
suffer from months of depressed mood, loss of strength, sexual problems, etc. In rare
cases, this can become permanent or require specialized medical treatment.
Rumors of bodybuilders who are “always on” have circulated since the 1980s, if not
earlier. However, the practice is now spoken of more commonly. “On” does not mean
these bodybuilders are on nonstop cycles, rather that they are “bridging” between
cycles with replacement dosing of testosterone to avoid the setbacks that occur during
the post-cycle recovery. Given the dosing and duration of the cycles used by some, it is
possible that post-cycle recovery could take many months. Instead, they “bridge” for a
month or two at most between supraphysiologic mass-gaining or competition cycles. It
would be interesting to compare the rate of professional bodybuilders fathering children
during their competitive years now versus 20 or 30 years ago. The increased
prevalence of human chorionic gonadotropin (hCG) use during cycles to maintain
testicular size and Leydig cell function offers little in maintaining fertility as the Sertoli
cells, which are involved in sperm production, are stimulated by a different hormone
(FSH); hCG mimics the Leydig cell-associated pituitary hormone, luteinizing hormone
(LH).
Safer Testosterone Cycles
Fertility aside, one needs to look at the pattern of testosterone use with a more critical
eye. Is it possible that the common cycles are less effective than alternate patterns? Is it
possible that a long duration of testosterone exposure is necessary to obtain the
maximum benefits? If this were the case, and it does appear to be so, then perhaps
those abusing AAS could be convinced to accept relatively safer and more responsible
cycles. Of course, there can never be an absolute guarantee of 100 percent safe drug
use of any sort. Exogenous testosterone or AAS use of any concentration holds the
potential to render a man infertile or affect mood. This discussion does not condone
illicit AAS use or offer medical advice.
It is an indication of how retarded, meaning delayed, the state of clinical research
relating to testosterone is when one considers that pharmaceutical companies and
physicians do not have a firm grasp of the proper dosing or treatment course. So, it is
with great interest that the review of Farid Saad and colleagues titled, “Onset of effects
of treatment and time span until maximum effects are achieved,” published in
the European Journal of Endocrinology was received.1 It is underappreciated how many
systems in the body depend upon a healthy testosterone status, much like insulin or
cortisol. Too little testosterone and many tissues in the body do not function well; too
much and different effects emerge that are equally unhealthy. In the established manner
of erring on the side of caution, clinical medicine tends not to treat testosterone
deficiency unless it has reached a concentration low enough to allow for the health of an
individual to be threatened. Sadly, physicians are advised not to screen men for
testosterone deficiency unless symptoms are present that are considered relevant by
the established professional societies.2Unfortunately, they focus on the sexual effects of
testosterone and generally dismiss other systemic effects. The muscle-building effect of
testosterone is considered to be non-therapeutic and representative of abuse unless
treating a wasting condition.3
To fully benefit from the application of therapeutic testosterone replacement, one needs
to encourage the patient to allow several months to years for the body to accommodate
to the revised hormonal balance. Unfortunately, the primary signals monitored by the
physician and patient are erectile function and libido. Again, problems in these areas
may emerge while the testosterone concentration is still “normal.” Or the problems may
not emerge until testosterone concentrations are pathologically low, and respond rapidly
to a minor increase— at times subphysiologic. Failing to appreciate the need for a
longer duration of treatment, and more aggressive dosing, to meet the needs of other
organs and tissue is a failure of current male hormone replacement therapy. It has been
speculated that there are two separate dose-response curves— one at low
concentrations, the other at higher concentrations; this would support considering
elevating testosterone to high-normal concentrations rather than a minimal threshold.
Let's look at the findings of Dr. Saad and colleagues.

Testosterone Deficiency a Complex Picture

There has been no concerted effort to delineate the timeline of testosterone's action,
forcing Saad’s group to combine numerous studies with a preference toward
randomized, double-blind, placebo-controlled trials. In addition to sexual function,
testosterone's effects on the following were reviewed: red blood cells, prostate,
cholesterol and triglycerides, insulin sensitivity, fat mass, lean mass, strength, bone
density, quality of life and mood. As the authors astutely noted, there is no specific
threshold for symptoms of testosterone deficiency; some symptoms show up before
others are affected. This is further compounded by the fact that many testosterone-
related symptoms are affected by other factors as well. One example— erections are
not solely dependent upon testosterone concentration, but also vascular function,
nerves, psychological state and social relationships. In fact, erectile function is not
affected by testosterone deficiency until it reaches a concentration of 8 nmol/L, (230
ng/dL).4 This is very low. In contrast, the libido is affected when testosterone drops
below 15 nmol/L (430 ng/dL). The anabolic effects of testosterone may not be realized
until the concentration reaches 700 ng/ml.3 These numbers can vary widely among
individuals, confusing matters even more so.
It is interesting that the use of “percentage rise” dosing is suggested in the review. 1,3 In
plain English, this is basing the target testosterone concentration on the concentration
at which the patient reports symptoms. If a person has low testosterone symptoms at a
level of 250, he may be dosed to reach a concentration of 350-400; another person with
symptoms at a level of 400 may need to be dosed to maintain a concentration of 600
before experiencing benefit. Age of onset may be an issue as well.
Looking in more detail into the findings of Saad et al., they note that certain variables
affect an individual's response to testosterone replacement— the pharmacodynamics of
the type of testosterone used and the pharmacogenomics of the patient. The first refers
to how quickly testosterone is released to the bloodstream, how high a peak
concentration is reached and how long an elevated concentration can be maintained.
The second relates to how the individual responds to testosterone based on his unique
DNA. This is critical for the physician to keep in mind, but for the reader it is beyond the
scope of the article.
It is easiest to summarize the time course of effects in a table, as presented herein.

Onset and Maximum Benefit of Testosterone*

Muscle Mass/Strength
Reduced Fat Mass
Increased Exercise Capacity
Bone Mineral Density
Decreased Total Cholesterol
Decreased LDL (bad) Cholesterol
Decreased Triglycerides
Increased HDL (good) Cholesterol
Reducing Elevated Fasting Glucose 1 week; 12 months
Reduced Insulin Resistance
Reduced Blood Pressure/Pulse
Arterial Dilation
Reduced Inflammation
Erectile Function
Quality of Life
Improved Mood
12-20 weeks; 6-12 months
12 weeks; 24 months
12 weeks; 12 months
6 months; 36+ months
4 weeks; 12 months
12 weeks; 24 months
4 weeks; 12 months
12 weeks; 24 months
1 week; 12 months
12 weeks; 12 months
12 weeks; 40 weeks
3 weeks; 24 months
2 weeks; 12 months
4 weeks; 24 months
3 weeks; 18-30 months
Red Blood Cells 3 months; 12 months
Prostate (PSA) 3 months; 6 months
*Replacement dosing in testosterone-deficient men.
What is clear from the pattern is that testosterone’s effects on mental functions and
mood, as well as vascular effects, are rapid. Increases in libido, quality of life,
depressive mood, cholesterol and triglycerides occur within three to four weeks, though
additional benefits can be gained for months before the maximum benefit is reached.
This suggests that the effects of testosterone in these areas are related to non-genomic
effects.5 This means that certain cell types are able to respond to testosterone
immediately, much like the heart begins racing as soon as the shock of adrenalin kicks
in. Most other effects related to testosterone take longer to be realized and the
maximum benefit may not be realized for months to years. This includes the anabolic
effects of testosterone on muscle and bone, increase strength and red blood cell mass,
as well as reduction in body fat (especially abdominal fat). Improvements in insulin
sensitivity are initially rapid, but continue over time as related changes improve (e.g.,
reduced liver fat, lower inflammation, increase in muscle mass). These slower changes
are dependent on testosterone activating beneficial genes and suppressing adverse
(harmful) genes that slowly change the functional status of the specific tissue types
involved (e.g., muscle, bone, fat).
For a man experiencing changes associated with declining testosterone, this is valuable
information as it provides guidance as to how long it may take to see improvements with
replacement therapy. An unintended benefit of this review may be in persuading men
who have chosen to misuse testosterone or AAS to build muscle or increase strength to
dose moderately, achieving equivalent or greater response over a longer period of time.
Before diving in, there are differences between the population of healthy young men
with normal testosterone and aging men with low testosterone. Healthy young men
might benefit slightly from a physiologic replacement dose of testosterone, but it would
be like selling snow to Eskimos. Appreciable changes, particularly in muscle mass and
strength, do require supraphysiologic dosing in young, healthy men. However, it does
not require the exaggerated doses commonly reported.

Taking Exercise Out of the Equation

An interesting series of studies was reported in the last decade from the UCLA-affiliated
Charles R. Drew University of Medicine and Science, headed by Shalender Bhasin,
M.D.6 It looked at the effect of various doses of testosterone enanthate for 20 weeks on
a variety of parameters, including muscle size and strength. Note, the young men in this
study (18-35 years old) all had normal testosterone at the start of the study. They were
instructed not to exercise other than light aerobic activity. Thus, the effect of
testosterone on muscle size and strength is solely based on the change in that
hormone, not heavier lifting. Obviously, combining the effect noted with the training
response to weightlifting would amplify the increases seen.
In this study, men receiving less than the replacement dose of testosterone (resulting in
lower blood testosterone concentration), maintained muscle size and strength. Those
receiving supraphysiologic testosterone (300 mg/week and 600 mg/week) experienced
significant increases in size and strength, in a dose-dependent manner. Though no
claims of safe use can be made, no significant adverse effects were noted, though HDL
(good) cholesterol did drop. The authors noted that the doses were chosen based upon
prior clinical studies, with 600 milligrams per week having been used safely previously.
It was noted that certain functions (e.g., libido, erections, prostate) were maintained
even at the lowest (below normal) testosterone dose, while muscle changes were only
seen at the higher doses.
In closing, the hormonal yo-yo of eight-week cycles may result in temporary changes in
size and strength, but requires aggressive dosing that is associated with many harmful
effects. It appears that appreciable gains are delivered using more moderate dosing that
has been safely administered for 20 weeks in small clinical studies, even in subjects
who do not exercise. Bodybuilding and gym AAS use has been dominated by the “more
is better” crowd needing immediate gratification. Safer and longer cycles, that are more
effective, less risky and offer persisting results, may be the more intelligent approach.
Again, this is not medical advice, nor does it condone illicit drug use. Instead, for those
making the choice to use AAS, this may provide for a more informed decision.