Turek On Men's Health » anabolic steroids

The Testosterone Tipping Point

Paul Turek, MD — Mon, 06 Feb 2012 16:00:49 +0000

Sex and muscles are different when it comes to testosterone levels

Your car is not running well. It just doesn’t have the pick up it used to have. It’s low on gas so you fill it up, but it runs the same. OK, so it’s not the gas…it must be something else, so you begin looking for other causes. Yes, I’m an “old car guy,” but there is a point here.

Testosterone as Gasoline

Think of testosterone in your body as gasoline in your car. You need it to run and to run well. But a half tank of gas is just as good as a full tank, and topping off the gas tank is not going to help the car run any better. In other words, if you have enough gas—it’s not the problem.

When it comes to building muscle, it is clear that more testosterone is better. The higher the testosterone, the greater the anabolic effect. Weight lifters have known this for years. However, recent studies have shown that when it comes to sexual function, including erections and sex drive, the body may respond differently. More like a car does to gas: at some point adding more doesn’t help it run any better.

The Testosterone Plateau

There is a lot of scientific support for this idea. The most recent is from a European study of 2838 middle age and elderly men (yes, that’s ages 40-79) published last week. It examined the relationship between sexual function and male hormone levels in men who weren’t necessarily seeking care, typically referred to as a “community population.” Here are examples of the many prying questions that these men were asked:

How often do you think about sex?
How often do you attempt to have intercourse?
How frequently do you awake with a full erection?
Are you worried about your level of sexual desire?
Are you worried about your ability to have an erection?
How often do you perform self-stimulation?

What the study found was kind of expected: that testosterone levels correlated with overall sexual functioning in men. But the study also observed that there was a “plateau” effect of testosterone on sexual function. And this plateau occurred at 231 ng/mL (“normal” is 300-800ng/mL). In other words, sexual function worsened when testosterone levels fell below this point, but did not improve when levels increased above it. So, at least in these men, adding more gas to the tank would not necessarily help the car run better.

Notably, in six other clinical studies that have also examined this issue, a similar observation of plateauing testosterone levels was found. Not proof positive, but certainly suggestive of a true biological relationship.

Sexual Function is Not Muscle

So how does this percolate down into clinical practice? Well, I see men every day who have low energy and sex drive and poor erections and who feel “much older” than they feel they should for their age. Accompanying them is a lab report showing that their testosterone level is “low.” Maybe it’s 250 ng/mL, maybe 300 ng/mL. Although I believe that sexual function does not respond to testosterone like muscle does, I also understand that not all men are created equal, unlike assembly-line-built cars. In most cases, I respond “it’s not at all clear where your particular testosterone tipping point is, so lets get you above what you are now and see how you do.”

As with vintage cars, you really have to tinker with men to get them running right. And, it’s important to look beyond the gas issue to solve the problem of the poorly running machine. It’s our duty as good doctors not to just “top off the tank” and needlessly commit men to a life of testosterone replacement.

Your Hair or Your Hormones

Paul Turek, MD — Mon, 30 Jan 2012 16:00:25 +0000

Be nice to have Superman's hair…but at what price? (Courtesy; MovieBlog.com)

It’s the perfect drug for 40 million men in America who are going bald. Take it once a day to keep the hair on your head and shrink the prostate, which also commonly bothers men as they age. It’s a pill that has been used by at least 2 million reproductive age men over the last decade. But is it too good to be true?

The Best Hair Pill Yet

This magic pill is finasteride (trade names; Propecia, Proscar, Avodart). It represents a class of drug called the 5-alpha reductase inhibitors. These pills act as enzyme blockers: they prevent the male hormone testosterone from converting to its metabolite dihydrotestosterone (DHT). Although testosterone is responsible for a lot of our “male” features, DHT is more potent than testosterone for scalp hair and our internal reproductive organs (prostate, seminal vesicle). These drugs work by lowering DHT production and protect the gloriously youthful hair on our heads and the enviable ability to write your name in the snow while urinating.

And these drugs work well. More effective than topical or “rub in” medications, finasteride is great for what’s called “male pattern” hair loss which is due to a receding hairline or balding on the top of the head. In essence, it slows the growth phase of hair in these areas. However, it doesn’t treat hair loss on the sides or temple area.

Finasteride, Sex and Male Fertility

Although it may keep you looking like Clark Kent, many male infertility specialists, including myself, have concerns about finasteride. First, there is a 10% chance of sexual side effects that include erectile and ejaculatory dysfunction and lowering of sex drive. These issues can be subtle while on the pill but become very obvious when men stop it; many of my patients have noted a sexual “curtain being lifted” or “coming alive” after discontinuing the pill.

Second, there is an even more profound concern about finasteride among specialists: male infertility. Before it received FDA approval, the drug trials showed that it lowered ejaculate volume but did not change sperm count or motility on semen analysis testing (actual human fertility studies are not routinely required by the FDA). Now that it has been on the market for 10 years, though, impressive declines in semen quality have been observed and published with finasteride by many of us. This effect is not subtle either, as patients with complete sterility (azoospermia) have had recovery of their sperm counts after stopping finasteride!

There are several clues that this effect on fertility was possible. The rabbit studies done for FDA approval of the drug actually showed this effect. At 3 months, there was no effect on rabbit fertility. But, when followed longer, rabbits showed significant decreases in natural fertility. In addition, while I was writing a recent reproductive physiology chapter for Campbell-Walsh Urology, our leading urology textbook, I researched at what levels the 5-alpha reductase enzyme is found in the human testis and epididymis. Lo and behold, there are gobs of this enzyme in these important organs for sperm production and maturation, implying that the blocking agent finasteride would have an effect. So now what do we do?

At this point, controlled clinical trials are needed to prove this effect on fertility. For the time being, current thinking is that finasteride may not dramatically change sperm production in healthy men, but can impair semen quality in infertile men. Typically, the effects of medications on male infertility are reversible. So, to be proactive men should consider stopping the pill at least 6 months prior to trying to conceive. And, have confidence that she loves you just as much for other reasons. As Telly Savalas once said: “We’re all born bald, baby!”

Ways to Naturally Boost Testosterone

Paul Turek, MD — Tue, 11 Oct 2011 15:00:28 +0000

Sunset or sunrise? You choose.

Honestly, it seems like testosterone is to blame for everything these days. The epidemic of low testosterone has been linked to economic recession, wars, bank failures and even global warming. Ok, so maybe I am exaggerating, but many men feel (or are told) that their testosterone levels are the root cause of much of the way they feel. Leaving aside causality and association, what can you do about it?

Testosterone and You

I am the first one to say that testosterone is important for a healthy, long life. Clearly, men with low levels, termed hypogonadism, do not live as long as men with normal testosterone levels. I understand too, what testosterone isn’t and can’t do.

So, I am entirely empathetic to patients who ask: “Doc, what can I do to naturally increase my testosterone levels?” Forget about expensive gels, creams, injections, pellets or patches of testosterone that have side effects. They want to know what they can do, on their own, to improve their testosterone balance. As a big fan of self-empowerment, I dedicate this post to these men.

Lifestyle Changes to Improve Testosterone Balance

Lose weight. Fat converts testosterone to female hormones called estrogens. Less fat means less circulating female hormone levels.
Exercise. Although it is true that while you exercise, testosterone levels may be lower, exercise stimulates muscle recovery and growth through increased testosterone at rest.
Don’t overtrain. Rest between exercise sessions allows testosterone to work its magic.
Get good sleep. Poor sleep habits stress the body as a whole and stress reduces testosterone levels. Perpetual jet lag is no place to be.
Eat smart and cut the alcohol. Eat healthy meals regularly; skipping is not allowed. Also cut down on alcohol as it tends to impair testosterone production and increase conversion to estrogens.

Dietary Supplements That Improve Testosterone Balance

Get zinc. Zinc is a co-factor for testoterone production. Oysters, peanuts, chicken, lamb and (how timely) pumpkin seeds are excellent source.
Get vitamin B. This vitamin is also a co-factor for making testosterone. Bananas, avocados, watermelon, eggs and raspberries are excellent sources.
Control cholesterol. Eat plenty of monounsaturated fats, as found in fish, yogurt, almonds, and olive oil.
Eat garlic. Some evidence suggests that allicin within garlic can help improve testosterone balance. Watch your breath, though.
Herbal remedies: Tongkat ali, Catuaba bark-Muira pauma, Mucuna pruriens, Tribulus, Yohimbine and Ginseng. You know my opinion on these so take at your own risk.

Medical Treatments that Improve Testosterone Balance

If all else fails, see a specialist, as there are excellent prescription medications that can boost your body’s testosterone production, which is not the same as testosterone replacement. Clomiphene citrate, tamoxifen and human chorionic gonadotropin (hCG) are not anabolic steroids, but nor are they FDA approved in the U.S. for this purpose. But they are drugs that either convince the brain to send more gas (luteinizing hormone, LH) to the testicles to make more of your own testosterone, or directly provide the LH to stimulate testicles to make it. Unlike anabolic steroids, they encourage bioidentical (read: “your own”) testosterone production and do not impair fertility or shrink testicles.

You should try to optimize testosterone balance naturally, as these behaviors are generally healthy and good for a long and happy life.

What Testosterone Isn’t

Paul Turek, MD — Mon, 12 Sep 2011 15:00:17 +0000

Testosterone: a molecule for life

I see a lot of patients who think that their testosterone levels should be higher for various reasons. I would like to set the record straight.

Even I have been heard to say that it is the “elixir of a man’s life.” Indeed, testosterone is one seriously important molecule throughout men’s lives. In the womb, it determines anatomic maleness. And during puberty, when another splash of testosterone hits boys and sticks for good, I don’t have to tell you what it does: feeds the growth spurt, cracks the voice, encourages hair growth, acne, stronger muscles and is the ultimate governor of teenage thought and action.

Testosterone in Adults

Testosterone in men is essential for health and well-being. First isolated in 1935, it is an anabolic hormone in that it generally induces growth. And it does this all over the body. In the brain, it influences sex drive, assertiveness, mood, energy and some aspects of thinking and verbal memory. In the heart, it helps dilate the arteries, which is good. Testosterone increases muscle strength and maintains normal bone density. It also reduces belly fat. In the kidney, it stimulates a hormone called erythropoietin that keeps blood counts normal. It also strengthens the immune system and helps blood to clot. In the male sexual organs, normal testosterone levels are important for erections and sperm production. So, it’s about as close to an “elixir” as any single circulating molecule in our bodies.

A List of What Testosterone Isn’t

Testosterone is not as vital to us as oxygen. For the record, here is what testosterone isn’t or doesn’t do:

It is not a common reason for erectile dysfunction (<6% of cases).
It is not a common cause for low sex drive.
It will not help you get more dates or make you a sex machine.
It will not magically make you a muscle man.
It will not magically cause weight loss or reduce fat. This requires a diet and exercise program.
It will not help you live forever; it falls with age.
It does not cause prostate cancer or liver cancer.
It is not higher during periods of stress; in fact, stress lowers testosterone levels.
It is generally lower in athletes than non-athletes.
It does not by itself cause baldness. Baldness is mainly genetic.
It does not get lower the more you masturbate.
It will not make you taller or your hands bigger as an adult.
More testosterone will not solve all of your problems.

What’s absolutely key to testosterone management is that there are symptoms present in association with low levels. In such cases, the benefits of treatment are clear. Think of testosterone as oil in your car: it helps everything work better, but when a problem occurs, it is usually something else that has gone wrong.

Timing (And Position) Are Everything

Paul Turek, MD — Mon, 18 Jul 2011 15:00:39 +0000

Does timing and position matter for sex like it does for surfing?

Missionary? Doggie? Cowgirl? Kneeling Lotus? Quarter moon? Full moon? No moon? Is there really a best lovemaking time or position to have a girl or boy?

History of Designing Sex for a Boy or Girl

Methods for determining baby gender are ancient, even prehistoric, and range from astrological, to dietary to positional. One of the earliest references to this concept is the Chinese Birth Gender Chart, said to have been discovered in a tomb near Beijing for where it lay for 700 years. It supposedly now resides in the Institute of Science in Beijing. It claims to predict the sex of the child from the month of conception and the age of the mother.

It has also been said the many myths about sex position and timing determining baby gender resulted from the mad rush of lovemaking that followed the end of the World Wars and the return home of soldiers. I’m sure this influx of war torn yet triumphant, and testosterone laden yet depraved men gave new meaning to the term “Honey, I’m home!” for many mid-century modern couples.

The Lovemaking Myths

Here are the most common myths regarding sexual position and timing to help get that boy or girl. Sorry, no pictures. I hear these from patients all the time, as they look at me bright eyed, with heads nodding, searching for my blessing.

Eat meat and salty food to get a boy.
Splurge on desserts to get a girl.
Both partners eat lots of fish and vegetables for a girl.
Make love standing or doggy style and during a quarter moon or at night for a son.
Use the missionary or cowgirl position and during a full moon for a daughter.
The Shettle method suggests having sex as close to ovulation as possible, for a boy, as boy sperm are less robust than girl sperm. Do the opposite for a girl.
If the male partner climaxes first, then a boy will be conceived. The opposite is suggested for a girl.

The Lovemaking Truths

Sorry to be the bearer of bad news. Despite all that you may have heard, there is no real data supporting the idea of a “best” position or time for sex to conceive a boy or girl. In fact, a prospective study of couples starting to conceive was actually published in 1995 in the New England Journal of Medicine that reported no relationship between the timing of intercourse and baby gender. Ah, but they did not study lovemaking position, thus keeping that myth and folklore alive! Come to think of it, that would be an interesting study to do, and one that I imagine would have no trouble enrolling subjects…

Are Sperm Counts Falling?

Paul Turek, MD — Sun, 27 Feb 2011 07:09:58 +0000

They asked me again. It never seems to end. CBS News interviewed me this week and wondered whether men’s sperm counts were falling over the last half century. Honestly, I am not convinced that there is an issue here.

Using statistics to strengthen data: the bar bell effect.

The Issue of Falling Sperm Counts

In the mid 1990s, a paper was published that suggested that the average sperm counts of healthy men had fallen over the past 50 years. This started the whole debate on this issue. The paper reviewed the findings from various studies done from 1938-1991 and found a decrease in sperm counts over time. Importantly, the data from the early part of this period was primarily from New York, while the later data was from Europe, with a large portion from Third World countries. They concluded that sperm counts had fallen over the past 50 years around the world. This paper, combined with the fact that the World Health Organization has lowered what is considered to be a “low” sperm count from 60 million sperm/mL to 15 million sperm/mL over the last two decades, has generated significant worldwide concern.

My Take on the Falling Sperm Count Issue

Knowing science the way I do, there may be some statistical “sleight of hand” going on here. Here’s why:

Sperm count data was “clustered” geographically in the paper which influences things. For example, if the New York data are excluded, there is no decline in sperm counts over a half century.
Semen analysis methodology has changed over time and could have influenced the findings.
The statistical methods used to analyze the “bar bell data” (two lumps of findings at either end with nothing in between) are too simplistic for the problem.
There are regional, continental and seasonal differences in sperm counts around the world. To the delight of New Yorkers, a subsequent study showed that their sperm counts are about 50% higher than those of men in Los Angeles. This really started the battle of the biggest Kahunas in the US.

Technically, then, the scientific argument that sperm counts are falling can be poked at and prodded to the point of becoming simply interesting cocktail conversation. Still, in the back of my mind, it occurs to me that just because it is not proven to be true doesn’t mean that it is not true.

So What’s A Guy to Do?

In this recent interview, I did cite my concern that the lifestyles of many men expose them to all sorts of sperm damaging activities such as hot tubs and baths, laptops on laps, recreational drugs, various hair-preserving medications and unrelieved stress. And I mentioned for the umpteenth time that men should treat their bodies like temples, and take all things in moderation if they want to conceive. Finally, bringing in one of my favorite analogies, I emphasized that sperm production loves to run hard like an engine, but it can also be detuned by poor lifestyle choices. I also stated something during the interview that didn’t make the cut on CBS television this time (but did in the past): that maybe women are simply more fertile than they were 50 years ago and that men are fully the men that their grandfathers were.

The Age of Aquarius

Paul Turek, MD — Sun, 19 Sep 2010 02:11:58 +0000

Is this the dawning of the Age of Aquarius?

It really seems like the moon is in seventh house, and that Jupiter is aligned with Mars. Why? Because our government gets it and want to know how it can help.

Last week, I spoke at a stakeholder meeting about men’s reproductive health, held at the Centers for Disease Control (CDC) in Atlanta. You may have heard of the CDC, begun in 1946, as the American government’s disease surveillance unit. Answering to the executive branch of the government and not to Congress, the CDC has a storied history over the past 60 years, being integral to the worldwide eradication of smallpox and to the control of measles and rubella and more recently, HIV. And who can forget the role that the CDC played in identifying the cause of Legionnaires disease, toxic shock syndrome and SARS? Well now they are interested in men’s reproductive health. You gotta believe.

What’s wrong with men’s reproductive health care in the U.S.? Well, in a sense, it doesn’t exist. Most men who are infertile do not get the care that they should; most male sexual health issues are verboten topics for public discourse; and men’s roles in family life and contraceptive planning are paltry at best.

It warms my heart to know that among all the government branches that could have taken men’s reproductive health seriously, the CDC has picked up the ball. After all, they are interested in assessing populations at-risk and controlling epidemics. And that is exactly the kind of thinking that will improve men’s reproductive health in the U.S., a condition that could certainly be termed an epidemic. A couple of years ago, I wrote an NIH grant (that was funded no less!) to help train male reproductive specialists at UCSF that began with the following sentence: “Men’s reproductive health is a large and underserved area of medicine in the U.S.” Amen.

This first-of-its-kind meeting was brimming with excitement. Attended by non-profits, academics, urologist thought leaders and numerous federal agencies, it was clear that the time had come to rethink the way we take care of young men. The definition of men’s reproductive health that guided the discussion was “the ability to have a responsible, satisfying and safe sex life and the capability to reproduce and the freedom to decide if, when and how often to do so.” In this context, awareness, public health, barriers to care, messaging, resources, engagement, and communication were terms addressed as if this topic were a true, national epidemic. In the words of Wallace Stevens: “Thought is an infection. In the case of certain thoughts, it becomes an epidemic.” For the good of a large chunk of our population, let’s hope that this issue goes viral.

The Man in the Mirror

Paul Turek, MD — Sun, 05 Sep 2010 04:50:57 +0000

For best fertility: look in the mirror

What is the most commonly asked question in my male fertility practice:

“What can I do to improve my sperm count?”

My answer:

“Treat your body like a temple; all things in moderation.”

I’m sure that this is a disappointing answer for many men, but it’s true. There are no tricks here. Here’s why: Unlike food or water, which we need to live from day to day and without which something will break down in our lives, sperm production is different.

The sperm making process, termed spermatogenesis, wants to run hard and fast—and all the time. The body is happiest making 1200 sperm/second in the normal healthy male. It would rather make sperm than not, given the chance. It is similar to the heart that wants to beat or to a self-winding watch.

So all one can really do is to try not to poison the sperm making process by unhealthy living. Fevers, illness, tobacco, hot tubs, obesity and poor eating habits are all examples of toxins or exposures that “sicken” the body and slow down sperm production. Stay healthy and sperm numbers should be just fine, thank you. A good reproductive body is a good healthy body.

Of course there are reasons to have low or no sperm counts that do not involve impaired sperm production, including vasectomy and lifelong or acquired blockages, but these are unusual. In addition, with infertility due to genetic causes, low sperm counts are likely the consequence of being handed fewer than normal numbers of testis stem cells, the cells that produce sperm. But even in cases of genetic infertility, the stem cells that are present are working their hardest to make as many sperm as possible. It just may not be enough sperm to get out of the testicle and into the ejaculate.

And yes, we have good ways of improving the sperm numbers in men with low sperm counts, but with these treatments we generally will not improve sperm counts to numbers that exceed those that the man would naturally have if he were healthy.

So, lifestyle and daily habits matter greatly for sperm production and fertility. I know it’s trite, but Michael Jackson was right: start with the man in the mirror.

A Sword with Two Edges

Paul Turek, MD — Sun, 22 Aug 2010 15:50:40 +0000

Testosterone: About as complicated as it gets.

You may know what testosterone can do for your strength, but did you also know that it is a contraceptive? That’s right, taking any synthetic testosterone will reliably make you infertile.

I’ve discussed the reason for this in other posts, but I’ll explain it again. Essentially, the brain drives the testicle to make sperm and testosterone with two hormones, FSH and LH. Think of the testicle as an engine that won’t run without the “gas” provided by these hormones. How much is gas delivered depends on how much testosterone is sensed by the brain. If enough is testosterone is present, the signal to make more decreased. So, with anabolic steroids, the brain figures that there is plenty of testosterone around (it doesn’t ask from whence it came) and it reduces the “gas” (LH and FSH) to the testicle. Thus, natural testosterone levels fall along with sperm production.

Recently, it became clear to me that milder, over the counter supplements such as DHEA or androstenedione can also have this effect. These are not the same as testosterone but are the building blocks for testosterone production. Importantly, they are available as over the counter supplements that do not require a doctor’s prescription to take.

Last week, I saw a patient who wanted a vasectomy reversal to have more children. He wrote down that he was taking creatine and other protein supplements, but when pushed further, he admitted to using DHEA. Worried about his sperm production, I checked LH and FSH levels and they were extremely low. No gas to the testis. No sperm being made. Based on this, I told him that his sperm count will be low or zero after a vasectomy reversal. Since then, he stopped the supplements and will wait several months before having the surgery. Luckily, in many cases, the effects of synthetic testosterone supplements are reversible when they are discontinued.

But, there are also ways to increase testosterone levels and maintain fertility. This is an important part of my practice as I treat young men with low testosterone who may want kids later on. It involves using pills or injections that stimulate “natural” or bioidentical testosterone production from the testicle. One way is to give the LH hormone (hCG) to stimulate the testicle to make testosterone. Given by a small needle injection several times weekly, it does the trick. Another method is to give pills called clomiphene citrate or tamoxifen that stimulate natural LH and FSH production. Since these medications are not approved by the FDA for men in the US, it is important to discuss benefits and side effects thoroughly before using them.

Is normal testosterone important for your health? Absolutely. But, like a sword, it is a hormone with two sharp edges. And such instruments should be wielded with skill and balance.

Testosterone, Steak and Eggs

Paul Turek, MD — Mon, 15 Jun 2009 21:39:19 +0000

One strong arm does not a man make…

Testosterone is one misunderstood molecule. It has such great influence over the human body that it has gained a reputation, a mystique. Society associates testosterone with Arnold Schwarzenegger (circa 1980s), with strength, virility, aggression, violence, square jaws and six-pack abs. We also tend to blame it for certain male tendencies and traits in our society, as well as certain medical disorders, although there is little scientific basis for this reasoning.

Testosterone is the major sex steroid hormone in men, and its effects are wide-ranging and powerful. It will make a boy into a man, for one thing. It sparks the development of facial and pubic hair, Adam’s apples, deeper voices, bigger muscles, broader chests. In the adult male, testosterone is necessary for sexual desire, erection maintenance, and sperm production. It also affects other body functions not directly related to sex–important ones–such as maintaining a normal blood count, bone strength, muscle mass and mood.

Testosterone might explain the perpetual sexual desire of a sixteen year-old whose previously unannointed body is now seeing it for the first time, but it does not explain away acts of violence. One popular belief is that excessive testosterone can make one uncontrollably aggressive. However, men actually tend to feel moodier and more anxious with lower testosterone levels, and there are reports that testosterone treatment can disperse these negative feelings. Also, studies show that there is a higher correlation between acts of violence and a past history of violence, than between violence and testosterone levels.

It is also untrue that high testosterone levels cause male pattern baldness and prostate cancer. Baldness is not a sign of virility, and is not associated with high testosterone levels. It is associated with genetics, specifically from the mother’s side of the family (male pattern, crown centered baldness) or the father’s side (overall baldness). Prostate cancer, meanwhile, appears to be associated with low levels of testosterone, and not high ones. So, basically, despite being the cause of hairiness, sweatiness, smelliness, and horniness, testosterone is very good for men.

Does it deserve the bad rap it gets? Taken appropriately, as replacement for naturally low levels, testosterone is not dangerous, nor is it illegal. If taken as a supplement, things are different. Anabolic steroids are synthetically produced variants of natural testosterone. Some common street or slang names for anabolic steroids include arnolds, gym candy, pumpers, roids, stackers, weight trainers, and juice. There are about 100 different types of anabolic steroids circulating nowadays and you will get over 1 million hits on Google by entering “buy steroids,” if you’re interested. When anabolics are taken as a supplement to boost normal testosterone levels, they can lead to some interesting side effects: shooting blanks instead of having a normal sperm count, getting tender breasts when you really don’t want them, and acne like when you were fourteen. Here’s where the bad rap enters the picture. And with steroid abuse, all bets are off regarding the healthy benefits that normal testosterone balance has on cholesterol balance, liver and heart health, blood pressure and mood. So be just like the power hitter Jim Thome, who said: “The strongest thing I put into my body is steak and eggs.”

Ramirez: A Lesson in Steroid Biology

Paul Turek, MD — Tue, 12 May 2009 14:57:52 +0000

Build muscles naturally, like Joe Wieder in the 1970′s.

When a record-breaking athlete gets caught for doping, it’s not news anymore. It shouldn’t be. People have been taking drugs to increase physical prowess since ancient times. We’ve recently seen it with Barry Bonds, Jason Giambi, and now LA Dodger’s star Manny Ramirez, whose urine tested positive for a medication on MLB’s banned substance list.

The MLB was questioning the discovery of synthetic testosterone in Ramirez’s lab tests. Ramirez had been planning on waving that suspicion away by saying he had been using DHEA, a supplement made in the adrenal gland that is weaker than testosterone and that is currently not banned. What sealed the deal was his positive test for hCG (human chorionic gonadotropin). It occurs naturally in a woman’s body when she’s pregnant, and is a drug that is only federally approved for use as a fertility medication. In women, it is used to induce ovulation, the release of an egg from the ovary. For boys, it is used to induce natural testosterone production in the testicles to help with puberty. For men, the only medical reason a man might use it is to boost testosterone levels for fertility purposes. It is not commonly given for erectile dysfunction, as Viagra, Cialis or Levitra are more effective treatments and are less painful to administer. hCG can only be given by injection, while both Cialis and Viagra come in handy dandy pills.

So why hCG? Well, testosterone supplements are taken by athletes because they are anabolic: they increase muscle mass and performance. However, steroids effectively shut down a man’s own testosterone production. Because the body is being supplied with a steroid that serves testosterone’s purpose, the testicles see no need to continue to produce their own testosterone and cease production. Fertility is wiped out too while men are taking anabolic steroids. Because of these effects, the testicles actually shrink. HCG is commonly used by steroid users when coming off of anabolic steroids, to normalize the hormone signaling and prevent testicle shrinkage. It stimulates the testicles to start testosterone production again, after being told to turn it off. This makes the system able to respond to the next cycle of anabolic steroids. And on and on it goes, the process of steroid stacking and cycling.

So, the fact that hCG was found in Ramirez’s blood suggests that he was doing other things with other supplements as well. Another star now fallen off the pedestal…

Men, Oysters and Sex