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

Review Article

Austin J Pharmacol Ther. 2021; 9(3).1139.

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

Nashawi M¹*, Ahmed MS¹, Ahmad M², Issa O² and Abualfoul M³

¹Department of Medicine-Cardiology, University of Texas Health Science Center San Antonio, Terxas

²Department of Biology, The University of Texas at Arlington, Texas

³Department of Internal Medicine, Methodist Dallas Medical Center, Texas

*Corresponding author: Mouhamed Nashawi, Department of Medicine-Cardiology, University of Texas Health Science Center San Antonio, Division of Medicine-Cardiology, MC 7872 UT Health San Antonio 7703 Floyd Curl Dr., San Antonio, 78229-3900, Texas

Received: May 12, 2021; Accepted: June 04, 2021; Published: June 11, 2021


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.

Keywords: Oxandrolone; Cardiovascular; Heart; Testosterone; Estrogen; Aromatization


Testosterone is a steroid derivative from cholesterol that serves multiple biological functions such as the induction of protein synthesis in myocytes, the mitigation of protein loss, promotion of bone density, and the development of secondary sexual characteristics in pubertal stages [1,2]. Part of the testosterone metabolism pathway includes conversion to its more potent counterpart Dihydrotesterone (DHT), by the enzyme 5a-reductase distributed throughout the body. As a non-polar compound, testosterone and DHT have the ability to cross the cellular membrane and binds to their intracellular receptor, the Androgen Receptor (AR) in the cytoplasm. Subsequent translocation to the nuclear membrane of affected cells sees these compounds primarily serve as transcription factors that bind to DNA promotor sequences, thus regulating gene expression to exert their pleiotropic effects (Figure 1). Research has also shown that testosterone and DHT binding to cellular AR can exert effects without direct genomic interaction through the regulation of cytoplasmic cell-signaling cascades and ion-flux, resulting in phosphorylation and activation of molecular constituents that ultimately yield a cellular effect congruent with the effects of testosterone, DHT, and related analogues of AAS [3-5].