Why can't we just give steroids to people with muscular dystrophy? | Hacker News Reader

Why can't we just give steroids to people with muscular dystrophy?

trevorklee.com

153 pointsklevertree121 comments

I don't really understand. Clearly the muscles work to some extent, so isn't making more a lot better than doing nothing?

> It’d be like if you had a construction project, and you found out that all of the wooden beams you were receiving from a supplier were rotten. Would you order more beams from that same supplier to fix the problem?

If my other option is shrugging and doing nothing and being sad as the house falls apart, then obviously yes I do. Quadruple up all the beams.

The beam analogy doesn't work because the rotted wood can provide some support. But the author states that the muscle just dies due a defect. So it's more akin to having tires that develop bubbles in the first 50 miles. Giving you more tires isn't going to help because that means you will spend more time changing them out over and over again.

The muscle fibers are likely to fail but they still have muscles.

In the case of DMD, it's a matter of when and which (typically heart), not if. The muscle fibers turn into fiberous tissues that aren't functional muscle. They fail.

Well "matter of when" would still suggest that more is better, within reasonable bounds.

But if they turn into tissue that gets in the way, that would be a big reason not to want more. Is that the main reason?

I don't think I understand it very well, but one reason focusing on the analogy doesn't help is that muscle has a lot higher ongoing maintenance cost than a beam.

I don’t think the author of the linked article understands either. Why is it obvious that myostatin inhibitors would ameliorate muscular dystrophy in mice but not humans? Nothing in this essay answers that question. Some people with certain types of muscular dystrophy spend years or even decades at near-normal muscle strength, so if you could return them to their previous muscle mass somehow, presumably it would do some good.

Sorry, didn't mean that it was obvious scientifically. I meant obvious in terms of pharmaceutical progress. They built a mouse model to mimic muscular dystrophy and cured the mouse model of muscular dystrophy, which is why they felt confident spending their millions on human muscular dystrophy. Unfortunately, it was not a good model, in the same way that most most mouse models are not good models.

> Why is it obvious that myostatin inhibitors would ameliorate muscular dystrophy in mice but not humans?

It's not obvious, that's why we have clinical trials.

What is obvious is that if your research process tests everything in mice first, and only tests in humans what already works in mice, you will find many treatments that work in mice but not humans. (Any treatment with the opposite character - works in humans but not mice - gets discarded by your process and never tested in humans...)

> Any treatment with the opposite character - works in humans but not mice - gets discarded by your process and never tested in humans

Which actually seems suboptimal in a case like this. We know the risks and side effects of steroids in the human body pretty well at this point, and they're not not too bad. If I had muscular dystrophy I'd probably be willing to give them a shot, even if they didn't work in mice.

Right. I completely agree that human clinical trials were required, but the essay claims that the results of the trial were “predictable” and “might seem pretty obvious.”

There’s a saying that it’s a great time to be a mouse with muscular dystrophy. It does seem like using mice as a model hasn’t worked very well, but I am not sure what the alternative might be (chimps?) or why researchers continue to use mice anyway. Edited to add: It would probably be emotionally/ethically more difficult to use chimps … they do some pretty awful things to the mice, making them run until they collapse repeatedly and then killing them at the end (for example).

In this analogy, I meant to indicate all the wooden beams were rotten to the core, in the same way that muscles die in Duchenne muscular dystrophy. Quadrupling up the beams just means that you've spent a lot more resources on something that's fundamentally unusable.

They said: work to some extent, so not fundamentally unusable.

To use your metaphor, quadrupling up all the rotten beams would only increase the burden of said beams without proportionally increasing their strength.

You're just making the house obese and the structure will collapse under its own weight because your building materials are trash.

Anabolic steroids have side-effects that increase with dosage, as they don't only affect muscle. Might for example fail the heart or the liver. It's not worth it, unless it's really effective (and its not in this case). I imagine even if it did work, doctors will prescribe only a small dosage and monitor closely the side effects.

A different question. As someone who had to recover from Achilles tear and had to rebuild an atrophied calf muscle.

Why don’t we just give anabolic steroids to people if their muscles atrophied after wearing a cast?

or hgh

Both are good. I think HGH is the more interesting compound for soft tissue injuries (ligaments and such). I do BJJ and I will for sure use both to recover any major injury I get after having researched it and seen how pro BJJ folks do it with really good results.

E: I should add both compounds can have severe side effects. Testosterone cycles can destroy your natural test production and HGH can have undesirable side effects. It makes things grow indiscriminately so you really have to do it with good medical advice. There are ways to prevent and manage the negative side effects.

Ya. And it's probably worth pointing out that in the context of a recovery (say after a cast) that taking steriods and/or HGH will still require physical rehab, with even more doctor supervision. While it would probably lower the median time to "full recovery", it would probably also have significantly worse worst case outcomes, and still require significant work from the patient.

Edit: Oh and specifically for steroids - one of the things that -can- (dunno how frequent really) happen is that your muscle strength growth outgrows your connective tissue (such as your Achilles tendon) growth rate and you end up with more connective tissue damage. Maxing out your muscle growth rate might be the best strategy, especially when recovering from connective tissue damage.

Yeah, it is no panacea for sure. For me, I have been lifting for years, doing BJJ for years. Ran for almost two decades. I consider myself in pretty good shape for a random dude on the street. It all takes work. Especially with Rehab you really have to put in the rehab work to direct the healing and if you went with pharmaceuticals like we are discussing that becomes extra important. But I think at low, therapeutic dosage it is all really safe. On a 3 month cycle during injury recovery you are unlikely to grow muscle quickly enough to do any real damage either.

Look into BPC-157.

BPC and TB are highly synergistic with HGH, so it's not really an either/or. Sermorelin+ipamorelin at night (HGH secretogogues) make the BPC/TB more effective and have the added nice effect of driving some fat loss/workout recovery, and are not crazy expensive like HGH is.

Because your muscles, even in an atrophied state, will build back faster than the Achilles tear can heal (close) to 100%. Steroids don't make connective tissue grow faster/better/stronger.

not only that, but I remember reading while looking up stuff after an ACL tear that steroids would actually be counterproductive, in that the faster than expected growth of muscle would put more strain on the healing connective tissue and possibly cause reinjury.

In men, there are complications with your body’s natural testosterone production. If you inject test (the most basic anabolic steroid) then in order to maintain a sort of homeostasis, your body will lower its natural test production. The same goes for any other anabolic steroid, as they are all test derivatives.

As a result, when you end your cycle, your body needs to restart its natural test production. There can be a delay while this happens and it leads to unpleasant, though temporary, side effects, like weight gain and a loss of sexual appetite. This can be mitigated somewhat by taking estrogen regulators such as Clomid, which is a prescription drug for women.

Anyway, the upshot of all this is injecting steroids in men is sort of complicated. For your rehab scenario, your doctor would have to monitor your test and estrogen levels as you end your cycle. For moderate cycles like with your calf rehab, the dangers are vastly overblown in the media, but the short-term side effects can be bothersome.

Note that women don’t face these issues and indeed women can take convenient oral steroids like eg Winstrol without having to inject test to compensate for their natural production getting shut down, because they hardly have any natural production to begin with. Indeed, ethics aside, the arguments for women to do a very moderate cycle for your rehab scenario or just athletic performance are pretty strong.

>As a result, when you end your cycle, your body needs to restart its natural test production. There can be a delay while this happens and it leads to unpleasant, though temporary, side effects, like weight gain and a loss of sexual appetite.

Why not just slowly taper it off?

Test is injected into muscles, usually once every 2-4 weeks. It can't be taken orally. This makes dosage control difficult. The long half-life also means that your body's control systems are slow to act (if they reacted quickly then you'd risk ending up with too much, and be unable to get rid of it).

There are plenty of other anabolic steroids. Some are oral, and many have the same primary effect with fewer side effects. There's even a new class of drugs that can work for women.[1]

1. https://en.wikipedia.org/wiki/Selective_androgen_receptor_mo...

more current test treatments are recommending much more frequent injections to more closely mimic the 'constant' production your body actually creates. Rather than injecting once a week, injecting multiple times a week eliminates a lot of the really highs and lows from injecting on schedules like you recommend.

The issue is compliance - nobody really wants to inject themselves every day or every other day.

I’m surprised that doctors are prescribing TRT, with testosterone enenthate, but then only having the patient inject once a week. That half-life is really sputtering out by the end of the week.

(Well, I know why—like you said, compliance. But c’mon, left cheek on Monday, right check on Thursday, easy enough.)

I think a lot of it has to do with Doctors relying on old knowledge and not investigating too closely.

IM injection is one of the best ways to get correct dosage control (apart from IV controlled delivery of course).

Also there are several steroids with different half-lives, so you can pick the best for your case.

It has been recently found that you can inject it subcutaneously using insulin needles, which makes taking it much easier. Works just as well as intramuscular.

Exogenous testosterone in any quantity will make the body stop producing natural test. If the goal is to have the body produce natural testosterone again tapering off will only delay and make it more difficult for that to happen.

What you’re saying is true for long term abuse of steroids, but a modest one month cycle of deca for recovery from surgery will not result in any of these side effects in the vast majority of cases. Sensible tapering would make them even less likely.

As others in this thread have pointed out it’s not necessarily a good approach for healing a tendon, and could be counterproductive.

Back in the day when designer “pro-steroids” (basically tweaked pro-hormones that metabolized into anabolic steroids in the body) were widely and legally available from supplement manufacturers, I had a bone graft surgery scheduled and wrote to the chemist who had developed one of the better products to get advice on a cycle for my recovery. This is anecdotal of course, but my surgeon told me that when she was fixing up the bone she realized it was in worse shape than the MRI had indicated and she puts the odds of success at 50/50. She was amazed at the speed and completeness of my recovery. I still have Frankenstein scars where the stitches were because my skin had “healed so quickly” that the stitches were difficult to remove and left gnarly holes.

I like to think that the supplement tipped the odds in my favour. Despite the well-established benefits of anabolic steroids on bone healing, the stigma around them means they are almost never prescribed even in bad cases. YMMV, but other than a few friends commenting that I a bit of an asshole while on the cycle (which could have just been the misery of post-surgery), I suffered no ill after-effects and actually put on a few pounds of lean mass despite being largely convalescent.

Not all steroids will immediately shut down your HPTA like test would. There are drugs like Oxandrolone (Anavar) which will not have this side effect assuming a low dose and relatively short term of use - it was originally prescribed for burn victims but nowadays you can get it prescribed in regular clinics for heavy injuries too.

Oxandrolone is amazing. It's such a same there's a stigma around these substances because this particular one could improve so many lives.

Am I missing something? Is there a stigma around using prescription drugs? I mean, sure there is a stigma for bodybuilding - but this drug is used for a variety of medical things. In other words, it is already used to improve lives.

And it seems there is good reason to have it be a prescription: Some of the side effects aren't wonderful and it would seem reasonable to at least get regular blood tests if you are taking it. It is just benefits sometimes outweigh the risks.

There's a stigma against prescribing anabolic steroids, sort of like how there's a stigma against prescribing opioids. They are prescribed, but doctors are wary that patients might just want the gear and aren't suffering enough to warrant it.

A stigma in recreational sports too.

See it come across as "I got 2nd place in a men's triathlon. I found out the winner is on TRT, which is not allowed. How do I get them DQed so that I can rightly claim my medal?"

Which to me makes sense, but age groupers don't get any blood testing done, so it's a bit of a he-said she-said thing.

Or BPC 157.

Has anyone here used it? Or TB-500?

I have a tendon/pulley injury that doesn't seem to want to heal and I've been researching it. At least one relevant study.

There is one Dr. in my area (a gyno of all things) that has a website promoting his practice using it. So has at least a sheen of professionalism.

https://pubmed.ncbi.nlm.nih.gov/21030672/

Climber? I've had three pulley injuries and returned to sport. What, specifically, have you been doing to rehab it?

yup!! hang boarding, micro needling, some finger/arm exercises from PT.

i climbed seriously as a kid until like 22 ish. then didn't for 7 ish years. it's now close to 2 years back (sep 24). I think that's the main issue, my skill/strength is higher than my fingers. Though I'm still decently strong just have pain/days I can't do much and fingers are weak compared to what I used to have.

what about you?

I've been thinking of seeing if this local Dr. has any ideas, it sounds like you have to get the peptides injected near the injury which freaks me out. Don't mess with my fingers!

I did it and it worked wonders for my shoulder injury. Not giving you medical advice, but it's easy and not expensive so I would go for it if i were you.

And subcutaneous injections are so easy you dont even feel them, I pin daily every morning with my coffee and it takes me 20 seconds using a super-slim insulin needle.

A little off topic, but what is your goal with the micro needling? I thought that was a purely cosmetic procedure for things like acne scars, but now I'm wondering if I missed something.

It might not be the correct term, but my PT uses tiny needles and places them into my arm tendons (higher up). And then turns on electricity between the needles.

I know a lot of serious athletes swear by it and I definitely feel the effects.

It's hard to describe the sensation it doesn't hurt too much (though tapping into tight areas does hurt a bit). You can feel the change in how the tendon/whatever passes current when connected.

Like at first when really tight the finger doesn't really twitch but after a bit when it releases it goes wild.

Afterwards I'm weak for the afternoon and then feel looser after. I might equate it to an intenseness massage or Myofascial release treatment but highly specific for my inside the arm tendons.

I recommend it, but I would think only with an actual Doctorate PT.

i am not a climber but I had a pulley injury that didn't really go away until I got cortisone to kill the inflammation it was causing. But repeated cortisone shots is supposed to be bad for connective tissue.

That's what my actual Dr hand surgeon said. I'm getting an MRI in a few weeks, very very unlikely i have a full tear but I want to see if we can find something 'medium serious' that explains why I can't improve much with a year of PT.

well i can tell you mine healed after cortisone and I managed to not need surgery. But no matter how much PT/exercise/stretching I did up until the cortisone, nothing helped.

Within a few months of cortisone it felt great and didn't have mobility issues (I had scar tissue buildup that was cuasing trigger finger too) and now a year and a bit later its 100% functional with no pain and full mobility/range.

worth a try.

I have tried both, for a nagging rugby-induced shoulder injury.

Nothing. Nada. No perceptible difference. I am…passingly acquainted…with injectable performance-enhancing drugs, and TB-500 and BPC-157 just did nothing for me.

Nor did they for a good friend. Now, that is a tiny sample size, and largely meaningless. (Did our supplier actually manage to get ahold of or synthesize a complex long-chain peptide? Shrug!) But there’s my 2 cents.

Yes the supply is my #1 concern / question. It doesn't seem like there is any downside risk so long as it's really the actual not contaminated peptides.

I wonder if either of these would work for a nagging tennis elbow? I'm 50 and I've tried pin-firing and it doesn't seem to have cleared it up.

BPC/TB worked great on my BJJ-induced golfer's elbow. I'd recommend giving it a shot!

I used both BPC-157 and TB-500 for a grade 4 SLAP tear. There are different surgeries used for SLAP tears, and I could not find a surgeon that would do the surgery I wanted (in the UK). I can't remember the exact details, but one is more risky and has a higher chance of returning to pre-surgery performance (normally athletes would take this option). The other is less risky but screws up your performance (general population usually get this option). I could only get surgeons to agree to the latter in the UK.

Anyway, I went and injected both the peptides for 15 weeks, and after over a year of having a completely messed up shoulder, it fixed it well enough that I can surf.

I was going to transfer to a US office to get the surgery done, but covid fucked up my transfer. I'll probably never compete in a powerlifting event again, but I can surf and that's good enough for me.

I injected 0.25mg of BPC-157 twice a day(near the shoulder) and 3mg of TB-500 every 3.5 days (into belly).

Disclaimer: not a doctor, just my experience. I bought them off random websites which in hindsight was insane. I was depressed and desperate. If you can get it from a real doctor/clinic, it would obviously be much better.

I also have a SLAP tear and would love to use BPC or something else to fix it, as I'm not going to have surgery. However, injecting a grey market research chemical I bought off the Internet into my body is just way, way outside my risk tolerance. I could I guess imagine imbibing a pill or powder..... direct injection when you don't really know what it is, it's not from a regulated supplier- just seems nuts to me, no offense

Haha, no offence taken. I 100% agree with you.

I too have used BPC/TB for fixing nagging injuries and it works great.

One thing to note -- you don't need to inject BPC at the site of the injury. Subcutaneous anywhere on the body works just as well. Your body will direct the peptides to the fibroblast (healing) areas where it is needed.

What caused the SLAP tear?

Fell pretty hard while snowboarding.

i'm happy for you! yes serious athletes have different goals there are for sure athlete specific surgeons in the US. Check out the Steadman Clinic if you haven't already.

Not sure if sourcing is illegal on HN. If you have any suggestions I can't tell what is legitimate online or not. or if this is not good I have an email in my profile if you are willing to share

I used it once after I injured my shoulder doing straddle planches. I'm not sure exactly what was injured but it basically cured my shoulder overnight.

Anabolic steroids must be administered very carefully because they are part of a neuroendocrine feedback system.

https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary...

The hypothalamus releases GnRH which tells the hypophysis to stimulate the testicles. The hypophysis releases LH which tells the testicles to release testosterone.

If there's too much testosterone, the GnRH release of the hypothalamus is inhibited. If there's too little, it is stimulated. Through this mechanism, testosterone levels are regulated.

Introducing exogenous testosterone can seriously screw with this system. The extra testosterone causes negative feedback on GnRH and LH, decreasing or stopping natural testosterone production: hypogonadism.

Physical therapy does not have these risks and is effective at recovering functionality. Perhaps a specialist would use anabolic steroids in case physical therapy alone isn't enough.

There are a number of responses that don't make me comfortable.

The clearest reasoning for why anabolic or androgenic steroids' are NOT given in the context for recovery strength or function in a professional medical setting are that:

- it has unintended consequences that can be severe

- it has unintended consequences that can be long-lasting

- the expected consequences of use are more harmful than the regular recovery

- and that these can be quite harmful, enough that the use of AAS isn't necessary.

and finally the primary goal post surgical:

> One of the most important considerations in selecting operative versus nonoperative treatment is the risk of rerupture. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031433/

Quite a few responses are getting into details of AAS use that isn't quite correct based on my understandings.

We could. And it would be about as safe as much medicine that we use today. But like many drugs that could be useful... steroids === bad.

I go further and wonder why don't we do that (steroids, growth hormones, sarms, everything) in advance as people reach certain age (and their natural secretion of the hormones falls below certain level). I feel inspired by Dr. Life and feel like starting taking hormones (from the black market, European doctors will never prescribe this officially) as I reach 50-60.

AFAIK the growth hormone even rejuvenates the thymus, the immune system (and may prevent cancer this way, if not over-used) and is the only way to trigger regeneration of joints.

Take this with a major grain of salt. But I learned that giving growth hormones will make the body produce less of its own. So the risk, as I understand it, is that by giving these hormones in advance may stump what little the body will produce on its own and "will definitely doom" these people to a full lifetime of hormones from external sources.

This is why I'm only going to do this after the rate of their production actually falls significantly below the healthy adult level. When they are not produced anyway it seems nothing to loose.

I didn't know this is also the case with the growth hormone, however. I thought this only applies to testosterone, also tyroxine and some other hormones.

At that point you still have a natural production, it's just less than at your lifetime peak. You can still destabilize your hormone signaling further and get symptoms like hypogonadism and gynomastia-- to say there's nothing to lose isn't quite right.

> At that point you still have a natural production, it's just less than at your lifetime peak. You can still destabilize your hormone signaling further and get symptoms like hypogonadism and gynomastia-- to say there's nothing to lose isn't quite right.

Sure, there isn't "nothing to lose", but let's not kid ourselves- if you're past retirement age and in a position to essentially be on TRT for the rest of your life, hypogonadism isn't a big deal unless for some crazy reason TRT becomes unavailable. As for gynecomastia, it's very easily managed with an aromatase inhibitor like exemestane or anastrozole.

I'm not saying there aren't risks or possible side effects, but exogenous testosterone shouldn't be dismissed out of hand because of the FUD surrounding steroids. If you haven't seen the documentary "Bigger, Stronger, Faster", I highly recommend it.

Let's set aside the obvious, that it probably has a lot of downsides and doesn't work well (like shrinking testicles and heart problems from steroids).

Our society has a real discomfort with "improving" "healthy" people. We make a clear, but somewhat artificial distinction between healthy and diseased, and the diseased people can get recognition and treatment but the healthy ones cannot. That's why there is often a battle to have certain things recognized as a medical condition. For example if you have trouble focussing, you might be considered lazy, but if you get a ADHD diagnosis people will be more accomodating (and you can legally take amphetamins!).

I was never especially athletic. I would love to workout more, but find it really hard to make time for it between work and family. And found that many people in my social circle or at the gym don't encourage me but make me feel like I don't belong there. But if I had a "real" recognized medical condition that required physiotherapy, I would get time off work and would get the gym paid (in my country), and most important people would support me. But if you are "healthy enough" and just want to improve yourself, you are on your own.

I would love to have a world where everybody can strive to improve themselves - become more healthy, strong, beautiful, smart, and so on - and where you would get the resources and the support needed to do so.

I agree to you 1000% :-) and share your concern.

I have always had severe ADHD (never diagnosed officially, also this doesn't give you legal amphetamines or any other benefits outside the US, nor does it convince people - people mostly say "in the US they drug kids to treat a condition that doesn't even exist", even though the condition actually is recognized officially), low muscles, and no free time/willpower for working out regularly.

I am a BLTC proponent too. Nevertheless, I speculate the probable downside of "a world where everybody can strive to improve themselves" is competition going even higher. If taking all kinds of meds this way would become a norm everyone would probably have to just to keep up with the new baseline. This (together with many ability-augmenting meds having adverse effects) supposedly is the logic backing the war on doping in professional sports.

But I think there is no point in caring about anything (like adverse effects, society's judgement) other than boosting your life quality by all means physically (and chemically) possible when you are old. And it seems logical to me to start in advance because doing so will probably give more effect, giving chance to actually prevent the decline instead of just helping to cope with it.

An excellent goal! I too hope that it will be possible to experiment and improve the performance of a human with tested, verified substances, known concentrations of active agents in them by legal means.

As it stands now, in my country in EU, not only it's impossible to legally take amphetamines for ADHD (only Concerta is allowed for children), it's actually forbidden to diagnose it in adults. So here I am, sitting with my 8/9 DSM-5 symptoms in inattention and the only thing I can do about it is go find a meth dealer!

You probably don't need meth. I once tried meth out of panic when I had an overwhelming pile of work and really too little time to do it (I had to design and develop a comparably serious app from scratch alone in a week to production + do a lot of accounting-related paperwork). It helped great and I had no problem quitting (but it felt a way making me sure most of the people will so I strongly recommend to stay away from it). I tried amphetamine in about a month and it had almost no effect so I concluded the medicine I would have to be taking if legally could is Desoxyn.

A couple of years passed, my brain chemistry recovered from the damage (tolerance in particular) meth does and now a minuscule speck of black market amphetamine dissolved in the morning tea is enough for amazing, satisfying full-day productivity and happiness. And it is many orders of magnitude less harmful than meth is.

Don't take meth. Also don't take amphetamine if you can. An alternative I actually use when I really need productivity is simple nicotine in form of a vape - it's not nearly as good but also helps significantly (if you only use it a couple of months a year). But I still recommend everyone to avoid starting with nicotine either.

Just to clarify, I'm not going to look up drug dealers and risk a charge forbidding any future international travel, etc. Also, if I would, it wouldn't be in the 'get high' dosage -- 20 mg for amphetamines, 10 mg for meth, typical dosage in ADHD medication would be the ceiling. Basically, legalizing them would allow me actual therapeutic experimentation.

I used to smoke 10 years ago, so going back to nicotine in this case is a big nono. :)

Yes, I think all the substances should be legal for qualified medical use. Even the substances with serious adverse effects in cases in which they do more good than harm. But a patient should have a right to opt-out and ask for an alternative treatment when there actually is any harm probable to expect.

> forbidden to diagnose it in adults.

This is plain outrageous.

By the way, given the fact American science is universally recognized, I actually wonder why won't all the counties and the EU countries in particular just recognize everything FDA approves. It is scientifically, clinically and time-proven Adderall helps with ADHD and hardly does any harm. Yet they stubbornly refuse to legalize it.

> European doctors will never prescribe this officially

Google "hormone replacement therapy".

> European doctors will never prescribe this officially) as I reach 50-60.

In Austria you can get HGH from several normal doctors easily (even against "stress" or sleeplessness).

E.g. https://antiaging-wien.at/wachstumshormon-hgh/

Try to stay away from the black market...

> growth hormone even rejuvenates the thymus, the immune system (and may prevent cancer this way, if not over-used)

I believe it's generally thought that HGH will always speed up tumor growth, so you should not assume there are safe amounts to take. The safe way is to get regular screening.

Actually steroids are used to treat people with muscular dystrophy: https://en.wikipedia.org/wiki/Anabolic_steroid#Medical

But they have a lot of side effects: https://en.wikipedia.org/wiki/Anabolic_steroid#Adverse_effec...

Therefor scientists started to investigate different substances like https://en.wikipedia.org/wiki/Selective_androgen_receptor_mo...

But these might still have severe side effects (https://en.wikipedia.org/wiki/Ligandrol#Adverse_health_effec...)

Your wiki link doesn't say anything about muscular dystrophy. It mentions treatment of wasting syndrome (e.g. from HIV or cancer) but that's a metabolic issue rather than a muscle issue.

A quick googling reveals a 1965 paper that says anabolic steroids are ineffective, and some follow-up papers that talk about oxandrolone being modestly effective but mostly through glucocorticoid mechanisms (e.g. like Prednisone, not Testosterone)

Why are steroids even a controlled drug? If a man wants to use them and knows the risks he should be able to. Same with any drug I guess.

We’ll, for one it’d ruin sports. If it’s legal and up to the athlete to decide — then in order to remain competitive all athletes would need to take steroids. You’d basically be telling athletes that they’d need to subject their bodies to the side effects of steroids if they wanted to remain competitive in their sport. That seems like an unfair obligation to place on athletes.

These athletes play in leagues that make their own rules and have their own governing bodies. What does the civil government have to do with that?

And why should the whole world depend on some people who want to play games with each other?

You do realize there's literally sports at all ages, right? High school, elementary school?

Maybe we should ban sports, then. I don't know anyone who doesn't play sports who abuses steroids. Sounds like sports is a gateway drug.

OMG! WOULD SOMEONE! PLEASE! ANYONE! THINK OF THE CHILDREN!>?!?!

Given that pro football players basically have to subject themselves to brain damage I don't think steroids usage is too unfair of a burden.

It doesn't follow that because there is one unfair burden that one person in a broad class that any lesser burden must be tolerated by all members of the class.

> We’ll, for one it’d ruin sports.

Sports competitions are already rife with athletes on the juice. So it's not like officially authorizing the use of steroids and performance enhancing drugs in competitions would significantly change anything for the worst. One can practice a sport without choosing to enter a competition. The health benefits don't require a medal.

> You’d basically be telling athletes that they’d need to subject their bodies to the side effects of steroids if they wanted to remain competitive in their sport.

Adults are responsible for the consequences of their own decisions. No one is forcing athletes to partake in competitions. Being competitive for the Olympics already pretty much require one to begin intensive training in childhood, if not earlier.

It is very difficult for one to become a professional musician and make a comfortable living from playing music if one doesn't dedicate most of their waking hours to practice and graduate from Juilliard.

It is very difficult for one to become an investment banker if one doesn't come from a target school and has a perfect academic record.

Unless you are born rich, we all have to sacrifice something, be it time, passions, family, or money.

The entirety of civilization is built on the idea of telling adults what they are allowed to do instead of letting people choose because given all factors because disinterested parties can see that the net result of user freedom would be bad for all involved. I cannot imagine why THIS is the line to be drawn when they benefit to doing so would be so paltry and the cost so clear. Most athletes in most sports aren't using steroids. Post legalization they all would or would be beaten out by someone who is.

> So it's not like officially authorizing the use of steroids and performance enhancing drugs in competitions would significantly change anything for the worst.

Citation needed. Note not a citation that there are many abusers historically but that right now steroid users aren't the minority.

I heard an interesting ethical discussion about this; considering natural levels of testosterone vary considerably between humans, couldn't it be considered fairer to allow steroid use provided total levels are below a particular level? It's interesting considering that NSAIDs are used in pretty huge amounts to keep (for example) football players on the field despite injuries, so what you're talking about is already happening to a degree.

You could have the equality league where people's limbs are shaved down to the regulation length too, and they get dosed with just the right amount of alcohol and other things before the game to bring their reaction times and thinking skills down to the level playing field.

https://en.wikipedia.org/wiki/Harrison_Bergeron

"In the year 2081, the 211th, 212th, and 213th amendments to the Constitution dictate that all Americans are fully equal and not allowed to be smarter, better-looking, or more physically able than anyone else. The Handicapper General's agents enforce the equality laws, forcing citizens to wear "handicaps": masks for those who are too beautiful, loud radios that disrupt thoughts inside the ears of intelligent people, and heavy weights for the strong or athletic. "

In women, they tried to go opposite way and disallow natural production that is too high.

>considering natural levels of testosterone vary considerably between humans, couldn't it be considered fairer to allow steroid use provided total levels are below a particular level?

People have varying natural levels of testosterone. What might be low for some might be normal for others. Just making all the numbers match won't equalize the way everyone's unique bodies work

Every athlete subjects themselves to the side effects of training for their sport. Most careers end with lingering injuries that just would not have happened otherwise.

> We’ll, for one it’d ruin sports

Do you mean ruin professional sports? And for the professional sportspeople only? If so that doesn't seem on its own like a restriction that would need to apply society-wide.

Sports at all ages. High school. Elementary school. College.

Everyone is already using PEDs, sports can't possibly get more ruined

Here, I’ll play devil’s advocate, even though I may have dabbled in anabolics once or twice. (Kidding, DEA! Obviously! D.A.R.E. worked for me!)

The potential side effects are real. Very real. It requires a high degree of information literacy to do even a basic testosterone cycle, as you need to understand the injection frequency, how to control estrogen on cycle, and post-cycle therapy. It’s not like weed, were you can just go buy a vape cartridge. It’s a little complex, and liable to end up going poorly in the most interested market of young naïve men.

Now, that’s the best argument, though if you’re libertarian minded, it’s still a terrible argument.

Of course the real truth is…do you have money? Do you live in or near a large city? If you do, there are “male enhancement clinics” who are more than happy to provide you with testosterone and maybe more, and guide you through all the side effects and post-cycle therapy. It is trivially easy to get ahold of steroids, and it is not hard to find a doc who will look the other way.

Why do you need to wear a safety belt in a car? If a man doesn't want to use them and knows the risks he should be able to. Same with any belt I guess.

> Why do you need to wear a safety belt in a car?

Because a body moves and can come to harm and harm others when it does. How would taking a steroid or something of that ilk harm others?

A cure for muscular dystrophy for humans already exists. Only problem is, it costs a whopping $2 million USD.

[1] https://www.reuters.com/article/us-novartis-genetherapy/nova...

[2] https://www.npr.org/sections/health-shots/2019/05/24/7254041...

Also you can only use it on babies.

But as pointed out elsewhere, wrong disease.

As for that drug, I doubt the price would need to be that high if people were ordering a thousand doses a year, but I'm no expert.

That's for one type of muscular dystrophy, SMA, there are many other types without great treatment options. Lifelong exon skipping treatments recently approved for subsets of DMD are >1M USD per year, and result in dystrophin expression at only a few percent of "normal" (see data from trials of casimersin).

Muscular Dystrophy isn’t a single disease— it’s an umbrella term for a whole class of neurodegenerative diseases with different etiologies. We need to be clear on which one we’re talking about when we talk about cures.

The industry is going the route of gene therapy.

> SAREPTA THERAPEUTICS ANNOUNCES GENE THERAPY PROGRAM FOR LGMD2A/R1 Today

https://investorrelations.sarepta.com/news-releases/news-rel...

Interesting. Hopefully the insane price will actually do good by incentivizing more gene therapy innovation.

Interesting close-to-the-end note related to much of the medical research (on mice) that gets posted to HN: “The end result, in retrospect, was predictable: they successfully cured muscular dystrophy in mice, but not in humans.”

A cure for muscular dystrophy for humans already exists. Only problem is, it costs a whopping $2 million USD.

[1] https://www.reuters.com/article/us-novartis-genetherapy/nova...

[2] https://www.npr.org/sections/health-shots/2019/05/24/7254041...

That's not muscular dystrophy. That's a motor neuron disease.

One problem is, it would have to be permanent, once the steroids are stopped, the extra muscle will mostly fade away and the natural testosterone production will be inhibited, this is the worst effect, the people end up with a lower testosterone production than before. But it's true, so long enough calories are given, they would gain some muscle, even without training at all. An alternative might be hgh , but that comes with other issues. Last but not least, all steroids are not equal, they're all testosterone derivates, the tablets are very toxic to the liver, and some derivates come with some more side effects than plain testosterone. Science tried to develop a mild steroid with great anabolic effects , but all of them are not powerful without adequate androgenic properties. The androgenic properties is what makes a steroid strong and....causes most side effects and hormonal imbalances post going off. To this day, testosterone seems to be the choice of medicine and by no means it's a weak drug, it simply upsets the body bit less as it's the same thing that the body produces. There might be more points on why not give it to these patients, but that's the steroid side of things.

I read one of the linked articles in the article, the one that said men who take steroids and don’t exercise gain more muscle mass than men who don’t take steroids but do exercise. I should admit that I’m personally biased against the conclusion but I find the results interesting. I had a few nitpicks however:

1. I question how optimal the training stimulus was. They said it was controlled and they worked out 3 times a week and for the squat/bench press they started out at 4 sets of 6 reps varying between 70/80/90 % initial one rep max and then increased weights after 5 weeks and increased the number of sets to 5. I think it’s obvious that more exercise would result in more muscle mass gain up to a certain point and I think the amount of volume they’re doing is really suboptimal even for a more average weight lifter. I didn’t see them go into more detail about the workout routine which would’ve been nice.

2. With such a minimal routine, muscle mass gain is going to be limited to the areas that are being exercised. Taking steroids is going to increase all muscle mass throughout the body. The placebo + exercise group had a slightly higher increase in strength, very slight, but still higher than the steroid + no exercise group. If they wanted, a weight lifter could change the routine to maximize overall muscle mass gain. Presumably they weren’t really hitting some muscle groups (shoulders, hamstrings, calves, back, core). They weren’t doing deadlifts. So it makes sense that the steroid + no exercise group had higher muscle mass gain because they were experiencing a full body stimulus whereas the exercise + placebo were not (even if they were I question how optimal the routine was since as far as I could tell they didn’t release detailed workout routine).

3. This is even more nitpicky, but there is going to be a limited ceiling with no external stimulus (exercise). In the long run the steroid + no-ex group will plateau whereas the placebo + ex group will be able to increase muscle for much longer.

So I guess I disagree with the conclusion “men who take steroids but don’t exercise gain more muscle mass than no steroids + exercise” despite the results supporting it.

On the other hand an MPC inhibitor like RCGD423 should reactivate the muscle stem cells [1].

For a similar reason an oral TZD (which are selective MPCi) should also help.

[1] https://hscnews.usc.edu/small-molecule-could-make-a-big-diff...

Weren't some SARMs trialed on cancer patients that were having muscle wasting?

I know they were used on people with AIDS.

As was Anavar, an anabolic-androgenic steroid.

https://pubmed.ncbi.nlm.nih.gov/8970686/

It was fairly commonly used in the Bad Old Days of HIV/AIDS, before there was anything resembling a real treatment. Got a lot of people out of bed.

I have a female friend with pretty bad muscle wasting from a long-term leg injury – have wondered idly if something like Anavar (or a SARM) would be a good option for her to help rebuild muscle to kick-start her recovery. Doubt anyone would prescribe it though.

This article says weightlifting can add skeletal muscle cells to make it hypertrophied. Wrong. Hypertrophy occurs by making existing muscle cells bigger. No skeletal muscle cells creation can exist, except in very few precise contexts.

Also, studies show that weightlifting actually fight or even prevent sarcopenia. Same for steroids.

(sarcopenia = muscular distrophy)

Obviously the author just doesn't like sports........

Well if you're speaking from an incentive point of view. The incentive of society is to keep men as docile as possible. Testosterone is not the best hormone to achieve this effect. On the other hand estrogen is quite freely given if you want to go the other way. Giving testosterone to people dying from dystrophy would open the discussion of steroids and it would counter the narrative that steroids are the worst drugs in existence, designed to kill you the moment you take a miligram.

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