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Anabolic steroids: Not just for bodybuilders anymore

Wound healing correlates with body mass

By Liza G. Ovington, PhD, CWS
President
Ovington & Associates
Fort Lauderdale, FL

Adequate nutrition is essential for optimal wound healing. The creation of new tissue is an anabolic process requiring sufficient calories, especially protein and nutrients. Nutrition’s importance to wound healing is highlighted by the fact that it is one of the parameters of the Braden Scale for risk assessment. Also, the Agency for Health Care Policy and Research guidelines for pressure ulcer treatment include recommendations related to nutritional assessment and augmentation.

In addition to impairing healing, inadequate nutritional intake has been shown to correlate with risk for and development of pressure ulcers. Even in a nutritionally competent subject, the presence of an open wound greatly increases metabolic demand.

20% loss of lean body mass directly impairs healing

Apart from underlying chronic conditions such as pressure or inadequate blood flow, malnutrition is perhaps the most common systemic cause of non-healing wounds. If a nutritional deficiency or the persistence of an open wound leads to a significant loss of lean body mass (muscle), the negative implications for health and healing increase. Involuntary loss of lean body mass is associated with a number of acute and chronic disease processes including AIDS, burns, renal failure, sepsis, cancer, COPD, and GI disorders as well as major surgery. It has been shown that a decrease in lean body mass of 10% leads to impaired immune function, which could increase the risk of infection. Lean body mass losses of 15% are associated with increased rates of pneumonia; losses of 20% impair the healing process directly.1

Several studies are investigating the use of anabolic steroid supplementation to indirectly improve wound healing. Conventional wisdom dictates that steroids impair wound healing; actually, however, it depends on which steroid you are talking about. Steroids are a large class of chemical compounds that share a common basic chemical structure or shape. In general, they are fat-soluble chemicals that can be made naturally by the body as well as by chemists in a laboratory.

Some steroids are catabolic, meaning that they promote destructive metabolism or the breakdown of molecules. Other steroids are anabolic, meaning that they promote constructive metabolism or the buildup of molecules.

Wound healing requires inflammation

The most widely used steroids in medicine are the corticosteroids (made in the adrenal cortex) such as cortisone and its derivatives. They are often used to treat inflammatory conditions such as allergic skin reactions and rheumatic diseases. It is precisely their anti-inflammatory effect that is associated with observed impairment of healing.

Inflammation is necessary to initiate the wound-healing process. If the inflammatory phase of healing is suppressed, subsequent effects such as impaired capillary budding, decreased fibroblast proliferation, collagen synthesis, and delayed epithelialization have been observed. These effects are essentially catabolic: Tissue synthesis is being impaired or delayed. In fact, some clinicians recommend the use of corticosteroids when they want to retard the growth of granulation tissue.

Anabolic steroids are another matter. These steroids promote tissue growth and are often used (and abused) by athletes who wish to increase their muscle mass and strength. A common side effect of oral anabolic steroids is liver toxicity.

One particular anabolic steroid, oxandrolone, has been shown to promote restoration of lean body mass when used adjunctively with appropriate nutritional supplementation. Oxandrolone is a synthetic analog of the anabolic steroid testosterone. It has minimal or no liver toxicity and can be taken orally. Oxandrolone currently is the only anabolic steroid approved by the FDA for the treatment of chronic weight loss.

The medical use of anabolic steroids in treating wasting diseases such as AIDS is gaining favor.2 It has been shown in animal models that anabolic steroids can even counteract the catabolic effects of corticosteroids on wound healing.3

Major burns (30% to 50% of body surface) are often associated with severe catabolism and significant loss of lean body mass. Losses of up to one pound per day have been described. Oxandrolone has proven effective in increasing the rate of restoration of weight gain post-burn injury.

One prospective study of oxandrolone examined its effects in major burn patients.1 Patients in the study were randomized to one of two groups:

• high-protein, high-calorie diet plus a protein supplement (2g/kg/day protein);

• high-protein, high-calorie diet plus protein supplement (MET-Rx) plus 10mg oxandrolone b.i.d.

Steroid patients gained more weight

Patients were followed at a rehab hospital. Their weight, muscle strength, and endurance were measured twice a week. After three weeks of treatment, it was found that the patients who received oxandrolone experienced weight gain double that of the control patients.

When the oxandrolone results were compared to retrospective data for standard nutritional management of burn patients with a high-protein, high-calorie diet plus a protein hydrolysate supplement (1.3 to 1.5 g/kg/day protein), the increase in weight gain with the anabolic steroid was fourfold.

A recent clinical study of oxandrolone in patients with pressure ulcers suggests that restoring lean body mass has a beneficial effect on wound closure.4 Eight patients with large non-healing wounds (averaging 12 months in duration) and significant involuntary weight loss (9% to 20% of normal body weight) were enrolled in the study. Their wounds remained nonhealing despite good local wound care.

Patients entered an initial four-week period where their nutrition was optimized (without oxandrolone). Optimal nutrition consisted of a diet containing 30% more calories than the RDA, protein content greater than 1.3g/kg/day, and a daily multivitamin plus 500 mg vitamin C. Patients subsequently entered the oxandrolone phase of the study if their wounds did not demonstrate significant healing (more than 15% reduction in wound volume) and if they did not experience weight gain of greater than one pound per week.

All eight patients entered the active oxandrolone treatment phase, receiving 10mg oxandrolone two times daily. In the first four weeks of oxandrolone treatment, the average weight gain per patient was more than three pounds per week. In the following eight weeks, the average weight gain per patient was 2.8 pounds per week. All patients reached their normal weight between 10 and 12 weeks of treatment.

Also, after 12 weeks of treatment with oxandrolone, five of the eight patients’ pressure ulcers had healed completely and the remaining three ulcers decreased in volume by 75%.

Study results revealed that neither good local care nor optimal nutrition effected a positive result in healing until lean body mass was restored. The correlation coefficient between weight gain and healing rate was 0.67, with the greatest increases in healing observed after at least 50% of the "lost" weight was regained. Only one patient was female, but she did not experience any androgenic effects from the 20mg daily dose of oxandrolone.

The study suggests that this particular anabolic steroid may constitute another tool to use in managing chronic nonhealing wounds.

[Editor’s note: Oxandrolone is manufactured by Iselin, NJ-based BioTechnology General Corp. under the trade name Oxandrin. Telephone: (800) 741-2698. Olsten Health Services is administering the Oxandrin Information Network to provide Oxandrin to patients with medical needs while minimizing the potential for abuse. Call (800) 741-2698 for 24-hour information.]

References

1. Demling R, DeSanti L. Oxandrolone, an anabolic steroid, significantly increases the rate of weight gain in the recovery phase after major burns. J Trauma 1997; 43:47-5.

2. Berger JR, Pall L, Simpson D, et al. Oxandrolone in AIDS wasting/myopathy. J Neurovirol 1996; 2:32.

3. Kim CS, Buchmiller TL, Fonakalsrud EW, Phillips JD. The effect of anabolic steroids on ameliorating the adverse effects of chronic corticosteroids on intestinal anastamotic healing in rabbits. Surg Gynecol Obstet 1993; 176:73-79.

4. Demling R, DeSanti L. Closure of the nonhealing wound corresponds with correction of weight loss using the anabolic agent oxandrolone. Ostomy Wound Management 1998; 44:58-68.