Written by Dr. George Touliatos, MD
10 December 2019




Dr. Testosterone
By George Touliatos, MD




It is quite common: the image of bodybuilding champions with a great protrusion of the abdomen. There are several mechanisms that cause this phenomenon:


1) It is known that HGH via somatomedin C (IGF-1) causes the hypertrophy/hyperplasia of the skeletal muscles, the body viscera and the soft tissues (lips, ears, tongue, gums).This actually takes place under higher doses of somatropin (>8IU/day).


The viscera (stomach, small and large intestine, kidney) has a large number of receptors of IGF-1, which will lead to them inflating.This effect is not immediate; it depends on the dose and time.Therefore, the abuse of rHGH for an extended period of time creates the extrusion of the abdomen due to organomegaly.This is, however, something that former chemist of BALCO and KetoSports, Patrick Arnold, disputes.He supports that after the closure of epiphyseal plates, hyperplastic phenomena do not occur, at least in skeletal-contractile-striated muscle tissue.

2) Accumulation of visceral/omental fat occurs between the organs of the abdomen and the omentum.The greater and lesser omentum are layers of peritoneum surrounding the viscera and their vessels and nerves.The omentum creates bends and sinuses between the abdominal organs (peritoneal cavity). The accumulation of fat happens mainly because of the lipogenesis (fat storage) induced by the use of insulin that is administrated synergistically with the HGH.Both act synergistically and they regulate glucose metabolism.

CD01918A-3E88-4280-8114-3134CEC156D6Since somatropin raises serum glucose (through gluconeogenesis in liver) and insulin lowers serum glucose (and activates glycogen synthase enzyme in liver), they apparently have opposite effects on the metabolism of carbohydrates.Therefore, HGH causes hyperglycemia and the release of hepatic glycogen in blood. On the other hand, insulin leads to hypoglycemia and enhances formation of liver and muscle glycogen.


Insulin resistance is the decrease in body’s ability to respond properly to the metabolism of insulin and glucose, leading to a floating glucose than can’t enter into cells.This will apparently stimulate pancreas for further insulin release as a response to high serum glucose.The result will be further hypoglycemia, hunger and fatigue, a classic symptom of obesity and insulin resistance.

As it is known, the chronic use of rHGH decreases insulin sensitivity, resulting in a growing need of insulin that eventually will exceed the body’s ability to properly regulate it.In that case, drugs reducing insulin resistance (e.g., metformin) are required. Berberine, chromium picolinate, alpha-lipoic acid and vanadyl sulphate are among the supplements that improve insulin sensitivity.


The extent to which the combination of HGH and insulin will lead to abdominal distension differs from person to person.Factors such as the type of diet, cardiovascular exercise, frequency of weightlifting, the type of insulin used and supplements can affect the sensitivity and therefore the likelihood of developing visceral fat. 

3) Insulin interferes with the electrolyte balance, increasing the retention of water and sodium, therefore leading to edema and swelling of tissues.This water retention occurs not only subcutaneously, but on the whole body as well, which is why many people hold water in the abdomen after the injection, especially with the regular use of insulin.

4) The consumption of large portions of food is another factor in stomach distention. Therefore, the larger amounts of food consumed, the more difficult the digestion is, resulting in the distention of the intestine. 

5) The chronic use of AAS in tablet form (17 alkylated) lowers and modifies the operation of the normal intestinal flora.This change disrupts the normal bowel function and causes constipation, overproduction of gas and distension of the intestine.The use of lactobacillus acidophilus probiotic bacteria as a supplement, or the consumption of kefir and organic yogurt, could be of great value. 

6) Digestive disorders such gluten sensitivityandlactose intolerance thatlead to the overproduction of gas in the intestine.

7) The excessive intake of red meat and the inadequate fiber intake burdens the colon, which inflames because of the toxins.In order to facilitate the digestion and assimilation of the gastrointestinal tract, it is necessary to consume vegetables and fruit that are rich in fiber every day, since that facilitates the intestinal peristalsis, and prevents constipation and bowel distension. 

8) The weakening of the transverse abdominal muscle plays also an essential role.The transverse abdominal muscle originates from the lumbar fascia, the last six sides, the iliac crest, the inguinal ligament and ends at a white line with its denervation.It is located beneath the medial oblique and rectus abdominis muscle.




The action of the transverse abdominis helps to control the body’s stability, the cornering and bending of the trunk, the support of the abdominal wall and the production of intra-abdominal pressure. The transverse abdominal muscle contracts before the other muscles of the body do, and creates the base of the body movement.Its contraction creates a rigid cylinder because of its location and its crown shape mobilizes the thoracolumbar fascia; thus creating the conditions for the increase of the intra-abdominal pressure.It basically acts like a belt around your midsection, holding the truck.


Relaxation of the transverse abdominis could be the result of the technique of many exercises with a large increase of intra-abdominal pressure (squats, deadlifts, leg press, lunges), leading to abdominal distension.

George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book Anabolics, 11th Edition (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/


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