Methandienone is often referred to as a "classic" drug whose side effects have long been known and supposedly controlled. In fact, its risk profile is one of the broadest among anabolic steroids because it combines the effects of the androgenic, estrogenic, and 17α-alkylated nature of the molecule. The editors systematized the known risks by organ systems and by the time of their appearance.
Where does the broad risk profile come from
Side effects of methandienone can be divided into three groups according to their origin. The first is androgenic effects common to all anabolic steroids: inhibition of the hormonal axis, changes in lipids, effects on the myocardium, skin and psyche. The second is estrogenic effects associated with the formation of stable estrogen 17α-methylestradiol. The third is the consequences of 17α-alkylation, primarily for the liver.
The Endocrine Society Scientific Opinion on the Implications of Performance-Enhancing Drugs (Pope et al., 2014) emphasizes that most data on adverse effects are derived from observational studies and clinical cases. There are few randomized studies of supraphysiological doses for ethical reasons, so the real frequency of individual complications is unknown.
Another factor is the combination of drugs. Methandienone is rarely used in isolation, so it is difficult to separate its contribution from the effects of other androgens, alcohol, dietary supplements, or stimulants in an individual. However, it is known that the risks depend largely on the dose and duration.
Finally, some of the effects appear quickly and are reversible, while some develop covertly and become apparent years later. It is the distant consequences that are most often underestimated.
Liver and metabolism
Hepatic risks—the "calling card" of 17α-alkylated steroids. According to LiverTox, asymptomatic elevated liver enzymes are most common. Clinically significant lesions are less common but more serious: cholestatic hepatitis with pronounced jaundice, which may persist for weeks after withdrawal.
With long-term use, peliosis of the liver, adenomas and, rarely, hepatocellular carcinoma have been described. Peliosis and adenomas may not manifest themselves for years, and the first symptom is bleeding. A review by Solimini et al (2017) emphasizes the role of dose, duration and combination with other hepatotoxic agents.
A pitfall of interpretation should be kept in mind: AST and ALT may be elevated due to muscle damage in people who train intensively. Therefore, the evaluation of the liver condition requires a comprehensive approach of the doctor, including HGT, bilirubin, creatine kinase and, if necessary, ultrasound examination.
Regarding metabolism, anabolic steroids can affect insulin sensitivity and lipid profile. Methandienone, like other oral 17α-alkylated androgens, particularly strongly lowers HDL, the protective fraction of cholesterol. Changes in lipids are one of the links connecting hepatic and cardiovascular risks.
Heart, vessels and blood
Cardiovascular effects of anabolic steroids are systematized in a scientific statement from the American Heart Association (Baggish et al., 2017). Among them are a decrease in HDL and an increase in LDL, increased blood pressure, hypertrophy of the left ventricle with reduced function, accelerated development of coronary atherosclerosis and rhythm disturbances.
For metandienone with its pronounced retention of sodium and liquid, the increase in pressure is particularly characteristic. Estrogenic metabolite and androgenic action enhance sodium reabsorption in the kidneys, and the volume of circulating fluid increases.
Anabolic steroids stimulate erythropoiesis, which can lead to an increase in hematocrit and blood viscosity. Combined with high blood pressure and unfavorable lipids, this creates conditions for thrombotic complications. Cases of heart attacks and strokes in young people who used anabolic steroids have been described.
We write more about lipids, pressure and hematocrit in a separate article. Here it is important to emphasize: these changes are mostly asymptomatic, and a person may not suspect them for years without examination.
| System | Possible consequences | Turnover |
|---|---|---|
| Liver | Increased enzymes, cholestasis, peliosis, adenomas | Enzymes and cholestasis are usually reversible; tumors - no |
| Heart and vessels | Hypertension, ↓HDL, myocardial hypertrophy, atherosclerosis | Lipids and pressure are partially reversible; structural changes - not always |
| Blood | Erythrocytosis | Usually reversible |
| Endocrine | LH/FSH suppression, testicular atrophy, infertility | Mostly reversible, but long-term hypogonadism is possible |
| Mammary glands | Gynecomastia | Formed glandular tissue often requires surgery |
| Skin and hair | Acne, baldness | Partially reversible |
| Psyche | Irritability, aggression, depression after withdrawal, addiction | Various |
Hormones, fertility and gynecomastia
Methandienone, like any androgen in pharmacological doses, suppresses the secretion of gonadotropins. As a result, own testosterone decreases, the testicles decrease, and spermatogenesis is disturbed up to azoospermia. Rahnema et al (2014) describe this condition as anabolic steroid-induced hypogonadism, which is one of the most common reasons former users refer to andrologists.
After withdrawal of the drug, the own hormonal axis needs time to recover. During this period, symptoms of androgen deficiency are possible: decreased libido, erectile dysfunction, fatigue, depressed mood. Some people have hypogonadism for a long time.
Gynecomastia is one of the most characteristic complications of methandienone due to its stable estrogenic metabolite. In the early stage, it is manifested by sensitivity and tightness under the nipple. If the process continues, the glandular tissue becomes fibrotic and no longer disappears on its own; in such cases, surgical treatment is often required.
Any drugs to correct estrogenic effects or restore the axis are prescription and have their own risks. The editors do not provide schemes for their use: this is a matter of diagnosis and treatment that belongs to the competence of an endocrinologist or andrologist.
- Pain or tightness in the nipple area.
- Decreased testicles, decreased libido, problems with erection.
- Difficulty with conception.
- Symptoms of depression after withdrawal of the drug.
Skin, psyche, women and adolescents
Androgenic stimulation of the sebaceous glands leads to acne, sometimes severe forms on the back and chest. Androgenic baldness accelerates in genetically predisposed men. Although methandienone is weakly subject to 5α-reduction, these effects are still observed, particularly through an overall increase in androgen load.
Psychiatric effects include irritability, aggression, mood swings, sleep disturbances, and post-withdrawal depression. Pope et al. (2014) also draw attention to the development of dependence on anabolic steroids in some users, which is manifested by continued use despite harmful consequences.
For women, the main risk is virilization: coarsening of the voice, growth of facial hair, enlargement of the clitoris, irregular cycle. Archival data from the GDR program analyzed by Franke and Berendonk (1997) document similar irreversible effects in female athletes treated with oral anabolic steroids.
In adolescents, anabolic steroids, including aromatized ones, can cause premature closure of bone growth zones, limiting final growth. In addition, the adolescent's hormonal system is still forming, and interference with it is particularly unpredictable.
Editorial conclusion
The side effect profile of methandienone combines three components: androgenic, estrogenic, and hepatotoxic. Therefore, the risks affect almost all body systems — from the liver and heart to the psyche and fertility.
The most dangerous consequences — changes in lipids, pressure, and myocardium, as well as tumors and peliosis of the liver — often develop asymptomatically and are detected late.
Some of the effects, including gynecomastia with fibrosis and virilization in women, may be irreversible. The editors advise people who already have signs of side effects to consult a doctor and tell them frankly about the drugs used - this is important for a correct diagnosis.
We recommend that you also read our articles on the effects of methandienone on the cardiovascular system, its passage through the liver, and a general overview of this drug.
References
- Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341â375.
- Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017;135(21):1991â2002.
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Androgenic Steroids. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases.
- Solimini R, Rotolo MC, Mastrobattista L, et al. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmacol Sci. 2017;21(1 Suppl):7â16.
- Rahnema CD, Lipshultz LI, Crosnoe LE, et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101(5):1271â1279.
- Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem. 1997;43(7):1262â1279.
- Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. 2008;154(3):502â521.
