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Testosterone treatment of cardiovascular diseases
Arch. Gerontol. Geriatr., 10 (1990) 311-312
311
Elsevier AG-G 00330
Book Review
Testosterone Treatment of Cardiovascular Diseases J. Moller and H. Einfeldt Springer-Verlag, New York, 1984 ISBN: 0-387-13045-4, 84 pp. (Received 19 March 1990; accepted 21 March 1990)
This is a unique book, which - - as the title implies - - attempts to provide a scientific basis for the use of anabolic steroids to treat atherosclerosis. Although Dr. Einfeldt is listed as a co-author, this appears to be a courtesy, as she is credited only with a three-page historical review. The remainder of the text was written by Dr. Moller. The book is primarily a review of the literature concerning therapeutic uses of anabolic steroids in diabetes and cardiovascular disease. It includes many valuable citations and many anecdotal reports from the author's 25 + years of experience with this therapy. The author's theory of the pathogenesis of atherosclerosis is that with aging there is a shift from aerobic to anaerobic metabolism. This shift is accompanied by a change in the hexosamine to collagen ( H / C ) ratio in connective tissue. Moller thinks that the H / C ratio is so important that it should be used as a measure of biological age. The decreased H / C ratio indicates an increase in tissue fibrillar density, which interferes with the rate of metabolic processes and oxygenation necessary to maintain vital cellular energies and functions. This may cause the physiological changes that take place with age. Moller's theory, thus far, seems to parallel Bjorksten's cross-linking theory. Furthermore, he finds that the resultant oxygen deficiency causes decreased testosterone synthesis from cholesterol. This causes both the increased cholesterol and reduced testosterone levels that are frequently associated with aging and atherosclerosis. MoUer also correctly points out that urinary ketosteroids (KS) decrease significantly with age, while urinary hydroxycorticosteroids (OHCS) show a less dramatic decrease. This causes the O H C S / K S ratio to increase with age. This ratio is also increased in patients with severe atherosclerosis or those who have had a recent myocardial infarction. Abbo believes that the O H C S / K S ratio is the best indicator of the biological age of the adrenals. However, despite the apparent significance of this ratio and its relation to atherosclerosis, Dr. Moller fails to correlate these changes with his thesis, nor does he give us any indication whether or not anabolic steroids will effect adrenal function or this important ratio (although I have seen in other sources that 17-KS excretion does increase with anabolic steroids which lack an alkyl or halogen substituent). 0167-4943/90/$03.50 © 1990 ElsevierSciencePublishers B.V. (Biomedical Division)
312 Moller claims that the use of exogenous testosterone causes many clinical and pathological changes related to atherosclerosis to be restored to normal, including: (1) increased H / C ratio; (2) decreased cholesterol; (3) increased fibrinolysis; (4) decreased fibrinogen; (5) improved glucose tolerance; (6) decreased scar formation in myocardial infarction; (7) improved exercise tolerance; (8) decreased angina and claudication pains; and (9) normalized abnormal ECGs. The author presents a series of impressive before-and-after color photos of some of his patients with severe peripheral vascular disease-induced gangrene. Critics will be quick to note the lack of controlled trials to substantiate the use of testosterone. Although the author spends a great deal of time trying to justify this shortcoming, he fails to present a convincing argument. The book is also not particularly well organized. Bits and pieces of the author's pathogenetic theory of atherosclerosis are strewn throughout, requiring more than a little motivation by the reader to wade through the mass of data to put these sporadic pieces of the puzzle together. Part of the fault is that Erighsh is not the native language of the author and that the book was edited by someone who may not have had a medical background. The two-page index is woefully inadequate, especially considering the difficulty in following the book's organization. Most of these shortcomings are minimized, however, by the conciseness of the book which allows the reader to flip back and forth to find missing details. Finally, only the sketchiest details of the treatment protocols are presented. As well as I can determine, it usually consists of injecting 250 mg of testosterone enanthate intramuscularly three times per week for men, and 100 mg three times per week for women. This amounts to a whopping 750 mg of testosterone per week for men - - a dose that even many anabolic steroid-using bodybuilders would consider excessive. This dosage is continued until benefit is obtained and then gradually reduced, depending on the response. In my experience, such doses may cause gynecomastia, fluid retention and abnormal liver function tests in a significant percentage of patients. The author did not give any details of clinical parameters to follow to detect possible adverse side effects. In fact, the only side effect he mentioned was fluid retention, which he treated with a diuretic. Despite its shortcomings the book is worth reading. The author shows a great deal of insight into the complexities of endocrinology, cardiology, biochemistry and physiology. His synthesis of knowledge from these various specialties deserves careful consideration. The potential contribution of this form of therapy may be extremely significant. The treatment described is certainly worth trying, considering its low cost, great potential benefits and relative safety (when properly monitored). Ward Dean, M.D. The Center for Bio-Gerontology P.O. Box 7837 Thousand Oaks, CA 91359, U.S.A.
311
Elsevier AG-G 00330
Book Review
Testosterone Treatment of Cardiovascular Diseases J. Moller and H. Einfeldt Springer-Verlag, New York, 1984 ISBN: 0-387-13045-4, 84 pp. (Received 19 March 1990; accepted 21 March 1990)
This is a unique book, which - - as the title implies - - attempts to provide a scientific basis for the use of anabolic steroids to treat atherosclerosis. Although Dr. Einfeldt is listed as a co-author, this appears to be a courtesy, as she is credited only with a three-page historical review. The remainder of the text was written by Dr. Moller. The book is primarily a review of the literature concerning therapeutic uses of anabolic steroids in diabetes and cardiovascular disease. It includes many valuable citations and many anecdotal reports from the author's 25 + years of experience with this therapy. The author's theory of the pathogenesis of atherosclerosis is that with aging there is a shift from aerobic to anaerobic metabolism. This shift is accompanied by a change in the hexosamine to collagen ( H / C ) ratio in connective tissue. Moller thinks that the H / C ratio is so important that it should be used as a measure of biological age. The decreased H / C ratio indicates an increase in tissue fibrillar density, which interferes with the rate of metabolic processes and oxygenation necessary to maintain vital cellular energies and functions. This may cause the physiological changes that take place with age. Moller's theory, thus far, seems to parallel Bjorksten's cross-linking theory. Furthermore, he finds that the resultant oxygen deficiency causes decreased testosterone synthesis from cholesterol. This causes both the increased cholesterol and reduced testosterone levels that are frequently associated with aging and atherosclerosis. MoUer also correctly points out that urinary ketosteroids (KS) decrease significantly with age, while urinary hydroxycorticosteroids (OHCS) show a less dramatic decrease. This causes the O H C S / K S ratio to increase with age. This ratio is also increased in patients with severe atherosclerosis or those who have had a recent myocardial infarction. Abbo believes that the O H C S / K S ratio is the best indicator of the biological age of the adrenals. However, despite the apparent significance of this ratio and its relation to atherosclerosis, Dr. Moller fails to correlate these changes with his thesis, nor does he give us any indication whether or not anabolic steroids will effect adrenal function or this important ratio (although I have seen in other sources that 17-KS excretion does increase with anabolic steroids which lack an alkyl or halogen substituent). 0167-4943/90/$03.50 © 1990 ElsevierSciencePublishers B.V. (Biomedical Division)
312 Moller claims that the use of exogenous testosterone causes many clinical and pathological changes related to atherosclerosis to be restored to normal, including: (1) increased H / C ratio; (2) decreased cholesterol; (3) increased fibrinolysis; (4) decreased fibrinogen; (5) improved glucose tolerance; (6) decreased scar formation in myocardial infarction; (7) improved exercise tolerance; (8) decreased angina and claudication pains; and (9) normalized abnormal ECGs. The author presents a series of impressive before-and-after color photos of some of his patients with severe peripheral vascular disease-induced gangrene. Critics will be quick to note the lack of controlled trials to substantiate the use of testosterone. Although the author spends a great deal of time trying to justify this shortcoming, he fails to present a convincing argument. The book is also not particularly well organized. Bits and pieces of the author's pathogenetic theory of atherosclerosis are strewn throughout, requiring more than a little motivation by the reader to wade through the mass of data to put these sporadic pieces of the puzzle together. Part of the fault is that Erighsh is not the native language of the author and that the book was edited by someone who may not have had a medical background. The two-page index is woefully inadequate, especially considering the difficulty in following the book's organization. Most of these shortcomings are minimized, however, by the conciseness of the book which allows the reader to flip back and forth to find missing details. Finally, only the sketchiest details of the treatment protocols are presented. As well as I can determine, it usually consists of injecting 250 mg of testosterone enanthate intramuscularly three times per week for men, and 100 mg three times per week for women. This amounts to a whopping 750 mg of testosterone per week for men - - a dose that even many anabolic steroid-using bodybuilders would consider excessive. This dosage is continued until benefit is obtained and then gradually reduced, depending on the response. In my experience, such doses may cause gynecomastia, fluid retention and abnormal liver function tests in a significant percentage of patients. The author did not give any details of clinical parameters to follow to detect possible adverse side effects. In fact, the only side effect he mentioned was fluid retention, which he treated with a diuretic. Despite its shortcomings the book is worth reading. The author shows a great deal of insight into the complexities of endocrinology, cardiology, biochemistry and physiology. His synthesis of knowledge from these various specialties deserves careful consideration. The potential contribution of this form of therapy may be extremely significant. The treatment described is certainly worth trying, considering its low cost, great potential benefits and relative safety (when properly monitored). Ward Dean, M.D. The Center for Bio-Gerontology P.O. Box 7837 Thousand Oaks, CA 91359, U.S.A.