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C-reactive Protein and Anabolic Steroids

Large doses of most anabolic steroids, particularly oral versions, tip the balance toward CVD risk.

As I said in my recent IRON MAN survey of cardiovascular blood tests, a previously obscure test for a protein called C-reactive protein has emerged as the leading predictor of future serious cardiovascular problems. CRP is a general indicator of inflammation in the body, and cardiovascular disease is now considered an inflammatory condition. Higher levels of CRP point to a five-to-seven-times-greater chance of dying of CVD.

Because CRP is inflammation-related, its levels have to be measured by blood test and compared to tests for total cholesterol, HDL, LDL and so on. Recently, CRP was also found to be an index of colon cancer; people with elevated CRP have a 2.5-times-greater chance of developing it. We know about the relationship between anabolic steroids and CVD. Large doses of most anabolic steroids, particularly oral versions, tip the balance toward CVD risk. Steroid users always show a dramatic decrease in high-density lipoprotein, the protective form of cholesterol. Steroids may increase thrombosis, or blood clotting, within arteries, which can precipitate a heart attack or possibly a stroke. Other studies show that steroids, through retention of sodium, can increase blood pressure.

In the latest study pointing an accusatory finger at anabolic steroids, British researchers compared the levels of CRP in 10 bodybuilders using steroids; 10 clean or self-professed natural, or drug-free, bodybuilders; and 10 sedentary male controls.1

The steroid group showed testosterone levels twice as high as the natural group, along with far lower levels of sex-hormone-binding globulin, a protein that binds with testosterone in the blood. The measurements indirectly confirmed steroid use, and those in the steroid group showed CRP levels nearly twice as high as both the naturals and the untrained control subjects. Measurements of troponin T, a protein found in cardiac muscle and released during heart damage, was the same in all groups.

The lack of difference in troponin T in all the groups shows that the elevated CRP in the steroid-using bodybuilders must come from somewhere besides the heart itself. I suspect that it emanates from their livers. Oral steroids in the doses athletes use nearly always lead to liver inflammation. Since any type of inflammation can lead to elevated CRP, I'd say the liver is the source.

There are other things to consider about this finding as well. The level of CRP in the bodybuilders was 1.2, considerably less than the level indicating serious risk of CVD. On the other hand, aerobic exercise is an effective way of reducing elevated CRP, and the study didn't disclose the steroid subjects' exercise activity.

The study can be viewed as a red flag but not a further indictment of anabolic steroids as a cause of CVD. That's particularly important when you consider that the steroid group showed the same levels of troponin T as the natural and nontraining groups, indicating no apparent heart damage.

Steroids and Drug Delivery

A primary medical use of testosterone preparations is to treat clinical hypogonadism, or low testosterone levels, in men. Testosterone-replacement therapy arouses considerable controversy in medical circles. Some scientists worry about the effect of increasing low T levels in older men because it may speed the development of prostate cancer or cause other problems, such as high blood pressure and sleep apnea.

The problems are more likely to happen with forms of testosterone that cause an initial spike in blood testosterone levels, which occurs with most injectable or oral versions of testosterone. Testosterone therapy doesn't produce the levels of the hormone athletes want but rather normal ranges.

The search for other vehicles for testosterone-replacement therapy led to topical creams and patches. Most of the patches contain about 1 percent testosterone, enough to produce not the anabolic effects athletes want but stable and reliable normal ranges.

Brand-name testosterone patches include Androderm and Androgel. Formerly, users had to shave off the hair on the scrotum and directly apply the patch to that area only. The improved versions can be applied anywhere on the body, such as the arms, abdomen, back or legs.

Studies of the newest testosterone patch, Androgel, show that it delivers an effective testosterone dose of 2.5 milligrams that equals a regular five-milligram dose of testosterone. Levels of testosterone rise within 30 minutes and remain elevated for 24 hours. While the dose sounds paltry, it's equal to the amount secreted naturally by most normal older men'and it has an 87 percent success rate in alleviating testosterone deficiency. One question about these dermal, or topical, delivery forms of testosterone is whether they can be transferred to another person.

A new study from Brazil looked at athletes who were using an old anabolic steroid called clostebol, sometimes in the form of a German drug with the trade name Megagrisevit-Mono.2 The drug has low androgenic activity, making it attractive to female athletes, and it can't be converted into estrogen and cause such side effects as water retention and gynecomastia in men. There's also less chance of other common steroid side effects, such as acne and male-pattern baldness. ALL Unfortunately, clostebol is also a weak anabolic, so it's rarely used alone but instead is stacked with other anabolic steroids. In Brazil clostebol is used in topical form, especially to treat gynecological problems in women. An example of one such preparation is Trofodermin by Searle, containing 200 milligrams of clostebol acetate and 200 milligrams of neomycin sulfate, an antibiotic. It's sold as a vaginal insert to treat various types of infections.

A couple of male athletes have tested positive for clostebol, which is banned for athletic use, and they claimed they got the drug from having sex with women. To test that assertion, Brazilian scientists had men have sex with women who used the vaginal insert drug (anything for science, I guess), while another group of men applied 200 milligrams of clostebol directly to their penises. Both groups participated in 20 minutes of activity. I'll leave to your imagination how the men who didn't have activity partners spent their 20 minutes.

As expected, the men who directly applied the drug to their sex organs showed higher levels than the men whose contact with it occurred during sex; however, both groups had levels high enough to test positive for the drug, confirming that sexual delivery of the drug is indeed possible.

In a 1999 study a father who was a bodybuilder put a testosterone cream on his arms and back, then played with his two-year-old son. After several months the boy showed signs of virilization, including penile enlargement, acne and facial hair. After the father stopped exposing his son (unintentionally) to testosterone via the cream on his body, all signs of testosterone excess disappeared'except for the penile enlargement. In another study 11 out of 17 female partners of men using testosterone gel treatments had elevated testosterone levels. In one case, for reasons that remain obscure, the male partner directly applied the testosterone to his female partner. Four of the women showed hirsutism, or excess body and facial hair. The cause was traced to gel delivered during sex or the use of shared clothing (what is that all about?).

A study of testosterone topical gels showed that even after eight hours, 50 percent of the original dose remains on unwashed skin.3 The same study showed that a relatively high level of test can be transferred from one person's skin to another's. Since it takes 10 minutes for the skin to absorb the testosterone from a gel patch, if the skin is washed after that time, the chances of interpersonal testosterone transfer drops considerably without loss of the therapeutic value of the testosterone. The newer gel forms have the lowest level of possible T transference to another person.

Keeping Muscles Young, Notcherly

Most people get weaker with age. What happens in many cases is that the fast-twitch muscle fibers most amenable to muscular-size increases gradually convert into the smaller and weaker type 1, or slow-twitch, fibers. In other cases the muscle fibers disappear, a condition called sarcopenia. Scientists examining the molecular processes underlying muscle metabolic and repair reactions note that older muscles seem to lose their ability to repair themselves. Unless the repair can occur, the chances of adding muscle with advancing age are nil.

Exercise can diminish adverse age-related changes'the biological law of use it or lose it. When you continue to exercise, you maintain hormonal and other processes that protect muscle, including the secretion of the anabolic hormones testosterone and growth hormone. A product of growth hormone, insulinlike growth factor 1, is particularly vital to the muscle-repair process. You maintain it with consistent exercise.

The muscle-repair process that preserves the youthful characteristics of muscle tissue is a little complex but revolves around immature muscle cells called satellite cells. During muscle repair, satellite cells fuse with muscle tissue to regenerate muscle.

A study reported in the November 28, 2003, issue of Science offers hope to all of us with muscles that just don't respond the way they used to. It involved aged mice that couldn't activate myoblasts and repair muscle. It turns out that satellite cells are controlled by a cell-membrane protein called Notch and its ligand, Delta. The researchers used a drug to activate dormant Notch in the rodents, and the mice started regenerating muscle pretty much like their young counterparts. Regeneration and recovery apparently produced no ill effects. If the experts can figure out a way to use this therapy in humans, you can envision 80-year-olds with the same level of strength and recuperation as teenagers. Think of all the money you'd save on growth hormone. Book Review:
Building the Perfect Beast

Building the Perfect Beast is L. Rea's second volume in his concise exploration of chemical ergogenic aids. If his first book, Chemical Muscle Enhancement, is the introductory course, then Beast is the advanced guide to the world of anabolic enhancement through chemistry.

Beast features a fictional bodybuilder named Frank N. Steroid, who begins as a burned-out bodybuilder seeking to overcome his anabolic plateau. While Frank may be fictional, the methods described in the book that convert him from a mediocre competitor into a monstrous beast are anything but. If Rea's original book can be likened to playing with matches, the sequel must be compared to playing with chemical dynamite. As I noted in my review of CME, this type of information is only for the highly motivated, someone who wants to compete on even ground on the highly competitive playing field of professional bodybuilding. Or for someone who just wants to look like the beasts.

Here are some highlights from the book:

'Synergistic chaos training

'Various drug cycles with explanations

'Liver health

'The truth about oral steroids

'Anabolic and fat-burning phases

'How to retain lean mass following a drug cycle And much more. It's a feast for every beast.

The book provides concise drug programs to be used over the year. Some programs emphasize bodyfat loss, and others focus on increasing muscular bulk. The book, to put it simply, is a precise roadmap to producing a freakish physique typical of what roams the posing platforms of the world today. As they used to say on 'Saturday Night Live,' this book will pump you up. Those who buy it can access the beast online forum and have pertinent questions answered by Rea and others. To my knowledge, no other book offers such continuing education. For more information on Building the Perfect Beast, go to It's also available from Home Gym Warehouse, (800) 447-0008 or


1 Grace, F.M., et al. (2004). Raised concentrations of C-reactive protein in anabolic steroid-using bodybuilders. Br J Sports Med. 38:97-98.
2 Pereira, H., et al. (2004). Incidental clostebol contamination in athletes after sexual intercourse. Clin Chem. 50:456-57.
3 Rolf, C., et al. (2002). Interpersonal testosterone transfer after topical application of a newly developed testosterone gel preparation. Clin Endocrin. 56:637-41. IM

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