This Testolent packaging was recently mailed to me from a reader in the Eastern European country of Slovenia. As the name alludes to, this is an injectable testosterone preparation. Each one-milliliter ampule contains 100 milligrams of steroid, and is packaged to include three doses in each box. It does not contain one of the standard three esters however (enanthate, propionate or cypionate). Testolent instead uses the unique phenylpropionate ester, which is the same used to make the fast-acting nandrolone in Durabolin. Although testosterone phenylpropionate has long been used as a component of Sustanon and some other sustained-release testosterone products, this preparation marks its first and only appearance as a stand-alone injectable to the best of my knowledge. The effect of this steroid is of course not very unique, and simply provides a delayed release of testosterone from the site of injection that’s close, but slightly slower, than that of propionate. This compound is certainly not worth going out of your way to look for; however it should be more than acceptable if found on the black market for a competitive price. Since it’s such an oddity, counterfeits are also not expected to be an issue. Pictured here is Ttokkyo’s new Stanol 50 product. This is an unusual step for Ttokkyo, as it contains half the dosage of the company’s older stanozolol product (50mg/ml as compared to the earlier Stanol V at 100mg/ml). The trend in Mexico these days seems to be toward higher-dosed and larger volume products than ever before, so one at first glance might wonder why Ttokkyo ever bothered to release this. The answer is found in the way the product is manufactured. This new injectable contains micronized stanozolol, which means the particle size is considerably smaller than normal stanozolol powder. The concentration is also more reasonable, allowing the drug to be injected with a much finer needle than the old 100mg/ml injectable, which to the chagrin of many anxious customers often jammed in needles smaller than 21 or 22 gauge. I have not heard feedback on the exact fineness of the new product, but am hoping Ttokkyo has refined it enough to compete with Stanazolic 50, an injectable stanozolol from Australia ground finely enough to pass easily through a 27-29 gauge insulin needle.
Anabolic Research Update
Non-surgical Treatment of Gynecomastia
By William Llewellyn I thought a good way to open my article on non-surgical treatments for gyno would be by referencing a letter printed in the New England Journal of Medicine in 1984.[1] It was published with the title “Tamoxifen for Gynecomasta Induced by Anabolic Steroids?” and relates an interaction between two doctors and a young anabolic steroid-using patient. The man, age 20, visited the doctor because he had developed gynecomastia from a two-month cycle of testosterone and nandrolone (200mg combined weekly). He’d gone for the purpose of getting the anti-estrogenic medication tamoxifen (Nolvadex®) specifically, which was recommended to him by a friend who had been using it to prevent the same side effect. The doctors, of course, refused to prescribe the drug. The closing of the letter explains the result of the visit very clearly. “Needless to say, we declined and gave him a stern lecture on the hazards of using such agents. One of us, a bodybuilder with muscles twice the size of the patient’s, demonstrated to him what could be done without these agents. Although we have made no follow-up observations, we are hopeful that we may have dissuaded him from this insane course.” We cannot really fault the two doctors for refusing the young patient, though. This is far from an approved use for tamoxifen in the U.S., and physicians are rightly not going to give bodybuilders such agents until their use is fully understood and approved. But, we are left wondering if perhaps the doctors didn’t even know if there were any effective drug treatments for an existing condition of gynecomstia. This raises a very commonly asked and important question. Putting the legal and ethical issues in prescribing such agents aside, could tamoxifen or other drugs be used to treat (not prevent) a standing case of gynecomastia? Reviewing the data on several logical courses of therapy to answer this does indeed suggest that there are some effective options that could be tried before patients are simply sent off to the surgeon. NolvadexIn the same year our two U.S. doctors mocked and refused to treat our young steroid user, investigators in Germany were busy undertaking a study that looked at the same drug this man visited the doctor to request.[2] They wanted to know the exact same thing as our young steroid user; namely, if tamoxifen could be used effectively to treat gynecomastia. In this investigation, 16 male patients with this condition were treated with tamoxifen for a period of two to four months. The daily dosage for all subjects was 20 milligrams, which was sufficient to partially or fully regress gynecomastia in an extremely remarkable 14 of the 16 patients. Of the 12 patients with gynecomastia characterized as painful, 10 became completely pain free. No notable incidences of side effects were reported during therapy, and for those patients successfully treated, gynecomastia did not return when the drug was discontinued. The success rate in this study was close to 90 percent and statistically impossible to ignore. Without question, this study supports the validity of our young man’s request. Had he left with tamoxifen, his condition may possibly have been improved or alleviated. Clomid
Clomid is an anti-estrogen very similar in structure and action to Nolvadex. It’s usually thought of as a weaker anti-estrogen than Nolvadex, but is still commonly used by bodybuilders for the same purposes, including prevention of gyno. Often, if Nolvadex is unavailable, Clomid will be purchased instead as a ready and acceptable substitute. The next obvious question, of course, is if that’s the case, can Clomid be effective for treating gyno as well? Although technically the answer is yes, we find that the positive results of studies with Clomid seemed to pale against the high success rate of Nolvadex in the previous investigation.
This is apparent in a study published a year earlier in the American Journal of Diseases of Children, which looked at the effectiveness of Clomid for treating 12 boys with persistent adolescent gynecomastia.[3] Here, only five patients noticed significant reductions in breast tissue size, ranging from 20 to 36 percent. The remaining seven had reductions ranging from nothing to only 17 percent, and several went on to have reconstructive surgery to correct the problem. A quarter of the total group was seemingly totally unaffected by the drug. Although we could say the overall response rate was 75 percent, if taking into account even the slight reductions that were followed up by surgery, only one patient actually reported that he was satisfied with the results at the end of therapy. In this study, ultimately Clomid seemed to be a failure. Although other studies have been a little more favorable, with one showing a 44 percent patient satisfaction rate, and another some visible gynecomastia reduction in 64 percent of patients, Nolvadex still seems to be coming out the clear winner in terms of patient approval and overall effectiveness. Transdermal DHTThe same year the Clomid paper was published, another study was being conducted in France to look at the effects of transdermal dihydrotestosterone on gynecomastia.[4] The use of DHT seems quite sensible for this purpose given some thought, as it’s a non-aromatizable steroid capable of increasing androgenicity while simultaneously lowering estrogen levels (through negative feedback inhibition of testosterone release). Instead of blocking estrogens at their receptor like the previous two agents, DHT shifts that balance of androgens to estrogens such that conditions might begin to favor the regression of mammary tissues. In this study, 40 men with gynecomastia were treated with 250 milligrams daily of transdermal dihydrotestosterone, applied either directly to the nipples or the abdominals. Treatment lasted anywhere from 15 days to seven months. The results were quite positive, with 10 patients (25 percent) noting the full disappearance of gyno, 19 (47.5 percent) a partial regression of the condition, and 11 (27.5 percent) no change. A clear difference was noticed in blood hormone levels of unresponsive patients, who tended to receive much smaller increases of dihydrotestosterone and a less dramatic shift in the androgen to estrogen ratio than the responsive patients. This was attributed to individual differences in skin permeability and drug transport. Although the possibility of a local effect on mammary tissues could not be excluded, application on the abdominal skin produced a similar positive response to application directly on the gynecomastia, suggesting the drug works mostly via its systemic effect on hormone levels. Treatment Success The above details several studies in which cases of gynecomastia were effectively treated with prescription drugs. The success rate was not 100% in any of the studies, which likely has a lot to do with individual differences in the state of the condition. Gynecomastia that’s deemed severe is often characterized by fibrosis, or the development of partially fibrous (hard) tissue. When the condition has advanced to this stage, we expect it be much less responsive to drugs than a milder case. With noticeable fibrosis unfortunately, surgery is most often the only treatment option that will be visibly successful. On the other hand, the less serious cases of gynecomastia, characterized more by puffiness and soft tissue growth under the nipples than hard lumpy growth, are likely to be much more responsive to changes in the ratio of androgens to estrogens in the blood. The length the condition has been present is usually a factor in how developed and treatable it is, with a short standing case such as our 20-year-old steroid user probably among the easiest to treat. I’ll close without getting into the moral and ethical arguments concerning the treatment or refusal of patients such as the young man discussed above. Clearly, there are issues that could, and likely should, be addressed in regard to gaining FDA approval for the use of such drugs. The real focus was simply to look at some of the more promising treatment options that have been evaluated in a clinical setting. Certainly, the data presented suggests that drugs alone can be used effectively to treat gynecomastia in many instances. Hopefully, one day those suffering with this condition in the U.S., either from steroid abuse or other causes, can look forward to help at the doctor’s office and pharmacy first, and not immediately have to worry about going under the knife. References
[1] Tamoxifen for gynecomastia induced by anabolic steroids? F. Spavo, W. Ryan. NEJM 311 (13) 1984 p 861-2
[2] Testosertone and estradiol levels in male gynecomastia: clinical and hormonal finding in the treatment with tamoxifen. Eversmann, Moito and Werder. Dtsch. Med. Woschr 109 (1984) 1678-82
[3] Clomiphene in the Treatment of Adolescent Gynecomastia. Plourde, Kulin, Santer. Am. J. Dis Child 137 (1983) 1080-83
[4] Studies on the treatment of idiopathic gynaecomastia with percutaneous dihydrotestosterone. Kuhn, Roca et al. Clin Endocrinol 19 (1983) 513-20
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