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SARMs also could be useful, but not merely confined to, the treatment of osteopaenia, osteoporosis and sarcopaenia in elderly men and postmenopausal women (assuming sufficient anabolic’androgenic dissociation can be achieved for the latter), glucocorticoid-induced osteoporis, HIV wasting, cancer cachexia and different types of muscular dystrophies. The clinical applications of anabolic steroids has been reviewed recently by Basaria et al. Historically, the usefulness of anabolic steroids in reversing the catabolic state of patients had not proved convincing and, by the end of the 1980s, many anabolic steroids had been withdrawn as licensed products and those remaining were limited for the purpose of hormone replacement therapy and the treatment of specific diseases (see next paragraph). A detailed analysis of the plethora of clinical reports, including uncontrolled trials and case studies, together with consideration of the risks versus benefits of various anabolic steroids for protein-building purposes is beyond this review. What is especially of note, however, is that lately the potential of anabolic steroids as therapeutic agents to increase weight, lean body mass and strength is being currently revisited. Anabolic steroids, such as testosterone esters, and the 17?-alkylated steroids oxymetholone and oxandrolone, may play a significant role in the treatment of cachexia associated with AIDS, severe burns and renal failure, where nutrition and standard care have been ineffective, as reviewed by Basaria et al. Further, nandrolone decanoate has been demonstrated to be effective in countering sarcopaenia in patients receiving dialysis (Johansen et al. In the older woman, oxandrolone administration stimulates muscle protein anabolism (Sheffield-Moore et al. Notwithstanding the above, a number of regulatory and conceptual issues are hindering progress in deciding which clinical conditions may benefit from intervention with anabolic steroids (Bhasin et al. For example, although, theoretically, an increase in lean body mass and weight in HIV-infected individuals suffering from weight loss should lead to improved physical functioning and quality of life, and ultimately to increased survival, this has not been demonstrated (Johns et al. Carefully designed randomized trials may eventually give the definitive answers as to the clinical usefulness of therapy with anabolic steroids, and whether xenobiotic anabolic steroids offer any advantage over supraphysiological doses of testosterone to men. In designing trials involving women, to help reduce unwanted androgenic effects, the administration of a xenobiotic steroid with a favourable myotrophic’androgenic index should be considered. In the interim, at the very least it seems sensible to consider hormone replacement therapy to men in a catabolic state where there is a significant decrease in circulating testosterone associated with the chronic disease, for example, those with severe burn injuries or HIV-associated wasting. For hormone replacement therapy, testosterone preparations are used in male hypogonadism and male hormonal contraception (where progestogens are administered to inhibit gonadotropin secretion). Mesterolone is also available for the treatment of male hypogonadism but it is seldom used, if at all. Oxymetholone and stanozolol, which induce the production of a C-1 esterase inhibitor, were used in the prevention and control of attacks of hereditary angio-oedema (except in pregnant women and prepubertal patients due to the risk of virilization) but the latter steroid has been recently withdrawn in the United Kingdom. Anabolic steroids also stimulate erythrocyte synthesis, which can be useful in the treatment of hypoplastic anaemias but their use in wealthy countries is likely to be limited with the relative recent availability of recombinant human erythropoietin and its analogues. In postmenopausal women, the treatment of osteoporosis with anabolic steroids, such as nandrolone decanoate, is not advocated given the success of oestrogen replacement and, more recently, with the introduction of the biphosphonates. Anabolic steroids as performance enhancers in sport. The action of anabolic steroid in increasing skeletal muscle mass and strength in women is not questioned.
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