Cardiovascular Health, Testosterone, and Oxandrolone: Leveraging the Myotrophic-Androgenic Ratio in Males with a Sarcopenic Obese Phenotype

Abstract

Anabolic-Androgenic Steroids (AAS) are a group of organic compounds that include testosterone, or related compounds that induce similar effects by serving as structural analogues. Because of their propensity to induce gene expression that promotes protein synthesis, increased lean body mass, and strength, they have found utility in medicine to aide patients with chronic wasting syndromes, deficiencies in growth stature, and trauma recovery (e.g., burns). Contemporary off-label use of these classes of agents are also being used in anti-aging capacities under clinical supervision, and those with cardiovascular deficits related to metabolic derangement. Nevertheless, as hormones, testosterone and its analogues have systemic effects and their glut can be deleterious to global organs, namely the heart. Chronic utilization of these agents can be seen in domains of competitive physical activities given their performance enhancing effects. Associated with this abuse in particular have been ubiquitous clinical accounts of Major Adverse Cardiovascular Events (MACE), chronic hypertension, dyslipidemia, and left ventricular remodeling given the pleiotropic effects of testosterone and its analogues. One agent in particular, oxandrolone, a synthetic AAS, has an interesting profile as it has a biological disposition to more anabolic and metabolic effects compared to other AAS, with less profuse androgenic properties. There has been evidence to show that even oxandrolone supplementation may show promise in improving peripheral homeostasis conducive to positive cardiovascular health, especially in obese patients with features of metabolic syndrome, a condition related to endocrinological dysfunction and aberrant adiposity. In this commentary we will review the effects of this AAS with a commentary on cardiovascular physiology constructed around translational biology and clinical data. Commentaries such as the latter are scant in the literature and offer perspectives crucial to understanding the intersections between habitus, physiologic status, and the heart. Overall, oxandrolone shows promise related to its pharmacology in patients with low muscle tone and significant adiposity, namely cardiometabolic profiles if administered with clinical prudence due to its novel structure, metabolism, and effects.