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Respiratory Management (Rehab Phase)

Anabolic Steroids

Anabolic steroids are derivatives of testosterone. Their exact physiologic effects on the respiratory system are unclear, but they have been studied as a possible treatment in chronic obstructive pulmonary disease, especially for their role in potentially increasing muscle mass. Anabolic steroids have potentially serious side effects, including effects on liver function, lipid profile and the reproductive system. The long-term safety of anabolic steroids such as oxandrolone in SCI has not been established.

Author Year; Country
Score
Research Design
Total Sample Size
Methods Outcome
Halstead et al. 2010; USA
Pre-post
N=10
Population: 10 males; tetraplegia; SCI injury C5-C8; 7 AIS A, 3 AIS B, age 32.5; DOI 8.8.
Treatment: Oxandrolone (20 mg/day orally in divided doses, 8 weeks).
Outcome Measures: FVC; FVE1, FEV1 / FVC, PEFR, maximum ventilator volume (MVV).
  1. Following treatment, there were non-significant increases in FVC by 3.3%, FEV1 by 3.1% and MVV by 9.3%; and a non-significant decrease in PEFR by 3.4%.
  2. Administration of oxandrolone over 8 weeks had no effect on pulmonary function.
Spungen et al. 1999; USA
Pre-Post
N=10
Population: 10 tetraplegia (C4-5), motor complete, all male, mean(SD) age: 41(9) yrs, 16(8) yrs post-injury.
Treatment: Administration of oxandrolone 20 mg/day for 1 month.
Outcome Measures: Weight gain, spirometry, MIP, MEP, resting self-rate of dyspnea (Borg scale), serum lipid profiles and liver function tests.
  1. On average, participants gained 1.4 (1.5) kg (2(2)%).
  2. A significant improvement was seen in combined measures of spirometry (9(2)%).
  3. A significant improvement was seen in MIP (10(7)%). The improvement was seen in MIP (10(7)%). The improvement in MEP was not significant (9(13)%).
  4. Borg scale decreased by an average of 37(28(%).

Discussion

There are two studies in the literature on the effects of anabolic steroids on pulmonary function in SCI. Spungen et al. (1999) treated 10 male subjects with motor complete C4-C5 tetraplegia with a one month course of oxandrolone, an oral anabolic steroid. Following oxandrolone, significant improvements were seen in weight gain, FVC, FEV1 and forced inspiratory vital capacity. There was a significant increase in MIP from baseline and a non-significant increase in maximal expiratory pressure (PE max). Subjects experienced a significant decrease in subjective dyspnea. There was no long-term follow-up of subjects to see if any of the improvements were permanent. Halstead et al. (2010) treated ten male subjects with motor complete tetraplegia with oxandrolone for 8 weeks and found non-significant improvements in lung function.

Conclusion

There is conflicting evidence (Spungen et al. 1999; Halstead et al. 2010) that the short-term use of oxandrolone improves pulmonary function in subjects with tetraplegia.

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