ORAL ANABOLIC-STEROID TREATMENT, BUT NOT PARENTERAL ANDROGEN TREATMENT, DECREASES ABDOMINAL FAT IN OBESE, OLDER MEN

OBJECTIVE: To compare the effects of testosterone enanthate (TE), anab olic steroid (AS) or placebo (PL) on regional fat distribution and hea lth risk factors in obese middle-aged men undergoing weight loss by di etary means. DESIGN: Randomized, double-blind, placebo-controlled clin ical trial, carried out for 9 months with primary assessments at 3 mon th intervals. Due to adverse blood lipid changes, the AS group was swi tched from oral oxandrolone (AS(OX)) to parenteral nandrolone decanoat e (AS(ND)) after the 3 month assessment point. SUBJECTS: Thirty health y, obese men, aged 40-60 years, with serum testosterone M levels in th e low-normal range (2-5 ng/mL). MAIN OUTCOME MEASURES: Abdominal fat d istribution and thigh muscle volume by CT scan, body composition by du al energy X-ray absorptiometry (DEXA), insulin sensitivity by the Mini mal Model method, blood lipids, blood chemistry, blood pressure, thyro id hormones and urological parameters. RESULTS: After 3 months, there was a significantly greater decrease in subcutaneous (SQ) abdominal fa t in the AS(OX) group compared to the TE and PL groups although body w eight changes did not differ by treatment group. There was also a tend ency for the AS(OX) group to exhibit greater losses in visceral fat, a nd the absolute level of visceral fat in this group was significantly lower at 3 months than in the TE and PL groups. There were significant main effects of treatment at 3 months on serum T and free T (increase d in the TE group and decreased in the AS(OX) group) and on thyroid ho rmone parameters (T-4 and T-3 resin uptake significantly decreased in the AS(OX) group compared with the other two groups). There was a sign ificant decrease in HDL-C, and increase in LDL-C in the AS(OX) group, which led to their being switched to the parenteral nandrolone decanoa te (AS(ND)) after 3 months. AS(ND) had opposite effects on visceral fa t from AS(OX), producing a significant increase from 3 to 9 months whi le continuing to decrease SQ abdominal fat. AS(ND) treatment also decr eased thigh muscle area, while AS(OX) treatment increased thigh muscle . AS(ND) reversed the effects of AS(OX) on lipoproteins and thyroid ho rmones. The previously reported effect of T to decrease visceral fat w as not observed, in fact, visceral fat in the TE group increased sligh tly from 3 to 9 months, although SQ fat continued to decrease. Neither TE nor AS treatment resulted in any change in urologic parameters. CO NCLUSIONS: Oral oxandrolone decreased SQ abdominal fat more than TE or weight loss alone and also tended to produce favorable changes in vis ceral fat. TE and AS(ND) injections given every 2 weeks had similar ef fects to weight loss alone on regional body fat. Most of the beneficia l effects observed on metabolic and cardiovascular risk factors were d ue to weight loss per se. These results suggest that SQ and visceral a bdominal fat can be independently modulated by androgens and that at l east some anabolic steroids are capable of influencing abdominal fat.