Q & A: Steroid Prescription for Extreme Slimness
with Michael Mooney (January 21, 1999)

Q. I am wondering if extreme "slimness" warrants steroids. I'm 6'1 and weigh a measly 117 pounds at 32 years old. Is this unhealthy? I know it is unhealthy mentally because I have very low self-esteem and everyone still pokes fun at me.

A. It isn't necessarily truly unhealthy physically, but I believe that self-esteem and the mental health that's related to it are just as important.

There is a rather safe, mild oral anabolic steroid called Oxandrin that has been prescribed for many years to male and female children with stunted growth and more recently to HIV patients with weight loss. The FDA-approved indication for Oxandrin includes the words "to promote weight gain ... in some patients who without definite pathophysiologic reasons fail to gain weight or maintain normal weight," so it would be legal for a doctor to prescribe it for you.

Tablets are sized at 2.5 mg and the dose that males typically use is 5 mg four times per day (20 mg), but we have seen doctors prescribe up to 12.5 mg four times per day (50 mg) for men with severe weight problems, in HIV, for instance. Although the Physician's Desk Reference (PDR) states that the 20 mg per day is a high dose, for many men 20 mg only has a small effect. The PDR also says that a 2 to 4 week period of time is usually adequate, but it is unlikely that anyone will gain more than a few pounds in a four week span. Usually when Oxandrin is prescribed medically in HIV the steroid cycle is 12 weeks long, and then the person takes a break afterwards for about 16 weeks. If more weight gain is desired, another 12 week steroid cycle may be instituted after the break, and this might repeat again, etc.

Safety
Oxandrin is considered to be relatively free from liver toxicity, but the truth is all oral anabolic steroids that are 17-alpha alkylated (17-AA) do have some potential for liver toxicity, especially with higher doses, so your doctor should monitor liver function tests. Oral 17-AA steroids also can affect blood cholesterol in ways that may increase the risk of cardiovascular disease. Specifically, they raise LDL cholesterol, and lower HDL cholesterol. To reduce this risk somewhat, we suggest that people who use oral steroids consider taking 400 to 800 IU of Vitamin E and 1000 to 2000 mg of Vitamin C with every meal, as taking these vitamins reduces the potential for cholesterol to oxidize. The oxidation of cholesterol promotes atherosclerosis (plaque formation in the arteries).

We suggest that people who use oral 17-AA steroids also take any of several dietary supplements that help protect the liver. One of the best of these supplements is the herb called silymarin (milk thistle) as a standardized extract. Standardized silymarin should be purchased from a health food store to get the best quality, and good brands include Enzymatic Therapy, and Jarrow.

Protecting the Liver
Here are the other supplements that can help to protect the liver when taking oral anabolic steroids (or any liver-toxic drugs):

See also Steroids and the Liver.

Weight-Lifting

To optimize the anabolic effect of steroids it is important to lift heavy weights for about an hour 3 to 4 times per week and eat a high protein diet.

Good luck.

Disclaimer: This article is provided for educational purposes only, and is in no way a substitute for the advice of a qualified medical doctor or a recommendation to do other than your doctor determines is best for you. You should present this information to your doctor for their analysis because appropriate medical therapy and the use of pharmaceutical compounds like anabolic steroids should be tailored by a knowledgeable doctor for the individual as no two individuals are alike. I do not recommend self-medicating with any pharmaceutical drug as you should consult with a qualified medical doctor who can determine your individual situation. If you use the information I present without the approval of your doctor, you do so strictly at your own risk and no responsibility is implied or intended on my part.