Written by Dr.George Touliatos, MD
28 January 2020









Dr. Testosterone
By George Touliatos, MD




Diuretics are a class of drugs increasing urine output by the kidney, thus prescribed against hypertension, left heart failure and pulmonary or systemic edema.

Furosemide is a powerful diuretic, available both in injectable and per os form.

Furosemide is of immediate action and flushes urine within 20 minutes.

It works at the loop of Henle of the kidney, inhibiting the sodium-potassium-chloride pump and leading to increased diuresis and natriuresis (increased sodium loss).


The drug also induces renal synthesis of prostaglandins, which contributes to its renal action.

Furosemide is capable of reducing all electrolytes and minerals, leading to hypokalemia, hyponatremia, hypocalcemia and hypomagnesemia, which is likely to cause cramps and metabolic alkalosis.

dr.love 565 2


On the contrary, spironolactone is a potassium-sparing diuretic.

It belongs to the aldosterone inhibitors, a class of diuretics that antagonize the actions of aldosterone at the distal segment of the distal tubule.

Aldosterone is a hormone that belongs to the mineralocorticoids and is secreted by the adrenal cortex.

It influences the reabsorption of sodium and excretion of potassium of the kidney, thus increasing water retention, blood pressure and blood volume.


Because potassium is the principal intracellular ion, its retention (by spirolactone’s action), will contribute to a better cellular volume, positively affecting the maintenance of the cellular size. Aldosterone plays an important role in the last week before a bodybuilding contest.

In order to inhibit aldosterone and eliminate water retention, we trick the body with an intentional increased intake of sodium chloride.


This apparently will suppress any sodium retention the following days.


Usually we quit from extra sodium intake, the very last day of glycogen depletion, just before the carb-loading phase.

Abuse of spironolactone might lead to life-threatening side effects, due to dramatic elevation of potassium (hyperkalemia) and metabolic acidosis.

Myocardium is quite sensitive to this metabolic imbalance and can easily undergo severe arrhythmias (ventricular tachycardia, fibrillation) or even cardiac arrest. ECG changes in a patient with hyperkalemia are an ominous portent of potentially fatal arrhythmias.


Given the fact that the adrenal cortex produces a fair amount of dehydroepiandrosterone (DHEA), it is understandable that abuse of spironolactone will lead to dose-dependent gynecomastia.

The anti-androgenic property of spironolactone (breast tenderness and enlargement) is even more apparent in women who lack the gonads (testicles), and the ovaries and adrenals substantially produce their testosterone.

Women use spironolactone in order to reduce the aesthetic androgenic side effects of androgenic-anabolic steroids (AAS), specifically hirsutism.


Spironolactone acts suspensively on the steroid hormone synthesis and leads to hypogonadism with decreased sperm count and motility.


Spironolactone is not of immediate action, and stable concentrations are achieved within almost three days of treatment initiation.




dr.love 665For better metabolism, the dosage should be split into a.m./p.m. timing.

The appropriate timing for spironolactone’s use would be the very first day of carb- depletion phase.


Potassium-rich foods (bananas or potatoes) are strictly prohibited.


Spironolactone should get gradually reduced in order to avoid any possible rebound effect.


The most efficient method in order to achieve the best results of diuretics should be the combination of potassium-sparing and non potassium-sparing diuretics, hence spironolactone and furosemide. However, dosages should be reduced to half.


Diuretics are extremely dangerous substances, responsible for hypovolemia and dehydration, spasms of striated muscles (cramps), hypotension (a drop of systemic blood pressure) and severe arrhythmias.

A notable example of the cardiovascular collapse caused by abuse of diuretics was the tragic death of ‘’the giant killer,’’ Arab bodybuilder Mohammed Benaziza (Momo) at the Dutch Grand Prix in 1993. Not only did he abuse spironolactone, but he also quit water intake and consumed clenbuterol in powder form, according to his close friend, Samir Bannout.


Diuretics are preferably used before night sleep, in order to avoid any possible fainting episode, due to hypotension.


Potatoes and bananas, rich in potassium, can help in case of hypokalemia.


Diuretics are useful in the days of carbohydrate overload to avoid the risk of possible water retention under the skin.


The morning of the contest, in case there is still water retention, the combination of a moderate dose of furosemide (10mg) along with spironolactone (12.5mg), is a safe way to eliminate extra water. Note that dehydrated muscles are not capable of proper contraction. In such cases, calcium tablets and liquid magnesium are good choices.

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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