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A 12 INCH NEEDLE IN MY LIVERI was 20 years old and in for a routine check-up that included some labs. At this point in life, I lifted weights six times a week. I assumed everything would look flawless. I was wrong. I got a call back from the sports medicine GP saying I needed to come back in and discuss some elevated lab values.
The doctor was very concerned about why my liver values (AST and ALT) were elevated. He felt that there was a possibility for liver disease occurring, or worse. He decided an ultrasound was needed to get a better look at my liver. I got the ultrasound done and started to do some reading about the lab aberrations in my results. I found that there were possibilities my doctor overlooked, like hard weight training.

?The ultrasound came back normal. The doctor wanted to move on to a liver biopsy, but that was where I drew the line. I kinda disliked the idea of sticking a 12-inch needle into my liver. Turns out, the doc hadn't considered the effects of training on lab results.
Athletes Are DifferentIt's not that an athlete's body is functioning differently than his non-lifting brethren. It just comes down to the stress placed on the body when someone intensely exercises. Heavy exercise doesn't affect all of the labs, but it does change some key ones that might be run as general wellness checks.
Heavy training is a trauma and stress on the body. Resistance exercise tears muscle fibers, creating damage and releasing various enzymes into the body. Heavy running can create enough muscle damage that urine will even change color from hemolyzed red blood cells. Hydration levels can fluctuate considerably depending on the training environment. Diet is another area that can affect the blood levels of various enzymes and markers.

Lab BasicsLabs are typically ordered in groups called panels. A panel that analyzes electrolyte levels and kidney function is referred to as a "basic metabolic panel" or chem 7. A "complete blood count" or CBC delves into the body's circulating cells. Each panel measures various biomarkers that represent indicators of different organs or functions in the body.
Each lab value has a range of accepted standard values – the reference range. Any value that falls out of the reference range is considered abnormal. As you can imagine, a larger deviation from the reference range requires more attention. Think about labs as one piece to the puzzle. They don't tell the whole story; they just provide one chapter.


Common Abnormal Labs1. CREATINE KINASE (CK) LEVELSCK is found in the mitochondria and cytoplasm of skeletal muscle (predominantly), cardiac muscle, brain, and other visceral tissues. Its primary function is in the generation and facilitation of transportation of high-energy phosphates.
Skeletal muscle, myocardium, and neuronal tissue are the primary sources of CK-MM, CK-MB, and CK-BB, respectively. It catalyzes the reaction of forming high energy molecules of ATP from ADP. ATP is the source of energy for cells to carry out various reactions, and in skeletal muscle ATP is used for contraction of muscle fibers.
Increased CK is predominantly used to diagnose neuromuscular diseases and acute myocardial infarction. Neuromuscular disorders include myopathies, muscular dystrophy, drug-induced myopathies, neuroleptic malignant syndrome, and seizures. Since it's elevated in response to muscle breakdown, misdiagnosis can occur with intense exercise, trauma, severe shivering, and even EMG studies.
So, if your CK levels come back elevated there's a possibility it's from disease, but it might also be from muscle damage incurred during training. These elevations can last for up to 7 days after a bout of training. The more damage during exercise, the higher the levels will rise and the longer they can stay elevated.
2. BUN (BLOOD UREA NITROGEN)BUN is a measure of urea levels in the blood. Urea is made from ammonia which is toxic to the body at high levels. So, under normal PH levels, ammonia is converted to urea to be filtered through the kidneys and excreted. Ammonia is generated from the disposal of nitrogen.
One place that we find nitrogen is in amino acids – the building blocks of protein. As more protein is broken down, nitrogen and therefore ammonia is generated. This ammonia is converted into urea and excreted (the ammonia cycle).
A high-protein diet combined with hard training create protein turnover and urea production is increased, which is fine. But this turnover can cause BUN levels to be elevated, so your doc may think it means kidney dysfunction and dehydration. Make sure your healthcare providers know of the possible reasons for BUN elevation so they don't jump to conclusions.
3. ALANINE AMINOTRANSFERASE (ALT), ASPARTATE AMINOTRANSFERASE (AST)The liver has many roles in the body. For one, it plays a role in the conversion of amino acids. Two enzymes that are involved in the conversion of amino acids are ALT and AST. These enzymes are commonly used as a surrogate marker for damage to the liver.
ALT is found mostly in the liver so it's more specific to hepatocellular damage (liver damage). AST is found in the cytosol of many other cells like muscle, brain, lung and pancreas, which makes it less specific to the liver. AST and ALT have both been found to be elevated after acute bouts of training. One study found that levels can be elevated for up to 7 days after a bout of lifting in men not used to weight training.
The muscle damaged incurred during heavy endurance training or lifting releases the enzymes into the bloodstream which will then cause the blood tests to be elevated. High-protein diets have also been shown to increase the concentration of these enzymes. The rise doesn't occur from damage but because the body upregulates the production of these enzymes as you consume more protein.
You can see how combining hard training with a high-protein diet can cause elevations in AST and ALT. Now, of course, there can be a disease process occurring as well. So you shouldn't just write off elevations, especially in conjunction with other symptoms like abdominal pain, jaundice, change in stool color, and darkening of the urine. (Of note, alcohol and medications can also cause increases in liver values.)

Recap

• Heavy and hard training creates lab abnormalities that must be taken into account when discussing health.
  
• Muscle damage releases enzymes like CK, ALT and AST which can also be elevated in various disease processes.
  
• Have a discussion with your doctor about these factors to make sure he or she is aware that you train hard.
  

You just had some blood work done, and the friggin' doctor or his nurses are guarding the results as if they're state secrets. However, after much cajoling and explaining that you'd like to at least be an informed partner in your own goshdarn health care, they begrudgingly give you a copy of your lab tests.
Trouble is, as much as you've been posturing about how you've had more than a smattering of medical education, you still can't figure out what half the tests are for and whether or not those abnormal values are anything to worry about.
Well, in the following article, I'm going to go over each of the most common tests. I'll include why it's performed, what it tells you, and what the typical ranges are for normal humans. That way, you'll have something more to go on in assessing your health other than your family doctor saying, "Well, these few values are a little worrisome, but you'll probably be okay."

?One note, though, before I get started. The values I'll be listing are merely averages and the ranges may vary slightly from laboratory to laboratory. Also, if there's only one range given, it applies to both men and women.
Lipid Panel – Used to determine possible risk for coronary and vascular disease. In other words, heart disease.
HDL/LDL and Total Cholesterol
These lipoproteins should look rather familiar to most of you. HDL is simply the "good" lipoprotein that acts as a scavenger molecule and prevents a buildup of material. LDL is the "bad" lipoprotein which collects in arterial walls and causes blockage or a reduction in blood flow. The total cholesterol to HDL ratio is also important. I went in to detail about this particular subject – as well as how to improve your lipid profile – in my article " Bad Blood".
Nevertheless, a quick remonder: your HDL should be 35 or higher; LDL below 130; and total to HDL ratio should be below 3.5. Oh and don't forget VLDL (very low density lipoprotein) which can be extremely worrisome. You should have less than 30 mg/dl in order to not be considered at risk for heart disease.
On a side note, I'm sure some of you are wishing that you had abnormally low plasma cholesterol levels (as if it's something to brag about), but the fact is that having extremely low cholesterol levels is actually indicative of severe liver disease.
Triglycerides
Triglycerides are simply a form of fat that exists in the bloodstream. They're transported by two other culprits, VLDL and LDL. A high level of triglycerides is also a risk factor for heart disease as well. Triglycerides levels can be increased if food or alcohol is consumed 12 to 24 hours prior to the blood draw and this is the reason why you're asked to fast for 12-14 hours from food and abstain from alcohol for 24 hours. Here are the normal ranges for healthy humans.

Quote:16-19 yr. old male
40-163 mg/dl
Adult Male
40-160 mg/dl
16-19 yr. old female
40-128 mg/dl
Adult Female
35-135 mg/dl

Quote:Males and Females age 0-30
4.6-8.1 umol/L
Males age 30-59
6.3-11.2 umol/L
Females age 30-59
4.5-7.9 umol/L
>59 years of age
5.8-11.9 umol/L

Quote:4,500-11,000/mm3

Quote:2,500-8,000 cells per mm3

Quote:Adult Male
4,700,000-6,100,000 cells/uL
Adult Female
4,200,000-5,400,000 cells/uL

Quote:Males and females 6-18 years
10-15.5 g/dl
Adult Males
14-18 g/dl
Adult Females
12-16 g/dl

Quote:Male and Females age 6-18 years
32-44%
Adult Men
42-52%
Adult Women
37-47%

Quote:Adult Male
80-100 fL
Adult Female
79-98 fL
12-18 year olds
78-100 fL

Quote:12-18 year old
35-45 pg
Adult Male
26-34 pg
Adult Female
26-34 pg

Quote:12-18 year old
31-37 g/dl
Adult Male
31-37 g/dl
Adult Female
30-36 g/dl

Quote:Adult Male
11.7-14.2%
Adult Female
11.7-14.2%

Quote:Child
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L
Adult
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L

Quote:55-70%

Quote:Basophils
0.5-1%
Eosinophils
1-4%

Quote:Lymphocytes
20-40%
Monocytes
2-8%

Quote:Adults
136-145 mEq/L

Quote:Adults
3.5-5 mEq/L

Quote:Adult
98-106 mEq/L

Quote:Adults
23-30 mEq/L

Quote:Adult Male
65-120 mg/dl
Adult Female
65-120 mg/dl

Quote:Adults
10-20 mg/dl

Quote:Adult Male
0.6-1.2 mg/dl
Adult Female
0.5-1.1 mg/dl

Quote:Adult
6-25

Quote:Adult
9-10.5 mg/dl

Quote:Adult
Total Protein: 6.4-8.3 g/dl
Albumin: 3.5-5 g/dl
Globulin: 2.3-3.4 g/dl

Quote:Adult
0.8-2.0

Quote:Total Bilirubin for Adult
0.3-1.0 mg/dl

Quote:16-21 years
30-200 U/L
Adult
30-120 U/L

Quote:Adult
0-35 U/L (Females may have slightly lower levels)

Quote:Adult
4-36 U/L

Quote:Male

Quote:Age 14
<1200 ng/dl
Age 15-16
100-1200 ng/dl
Age 17-18
300-1200 ng/dl
Age 19-40
300-950 ng/dl
Over 40
240-950 ng/dl

Female

Quote:Age 17-18
20-120 ng/dl
Over 18
20-80 ng/dl

Normal range, free Testosterone:

Quote:Male
50-210 pg/ml

Quote:Adult Male
1.24-7.8 IU/L
Adult Female
Follicular phase: 1.68-15 IU/L
Ovulatory phase: 21.9-56.6 IU/L
Luteal phase: 0.61-16.3 IU/L
Postmenopausal: 14.2-52.3 IU/L

Quote:Adult Male
10-50 pg/ml
Adult Female
Follicular phase: 20-350 pg/ml
Midcycle peak: 150-750 pg/ml
Luteal phase: 30-450 pg/ml
Postmenopausal: 20 pg/ml or less

Quote:16-20 years old
80-210 ng/dl
20-50 years
75-220 ng/dl or 1.2-3.4 nmol/L
Over 50
40-180 ng/dl or 0.6-2.8 nmol/L

Quote:Adult Male
4-12 ug/dl or 51-154 nmol/L
Adult Female
5-12 ug/dl or 64-154 nmol/L

Quote:0.8-2.8 ng/dl or 10-36 pmol/L

Quote:Adult
2-10 uU/ml or 2-10 mU/L

TESTOSTERONE REPLACEMENT: GET FIT FIRSTEditor's Note: Ali Gilbert, the "Queen of Men's Health," has an interesting perspective when it comes to testosterone replacement therapy (TRT). She advises her clients to get healthy FIRST, primarily by leaning up and improving cardiovascular fitness, before starting therapy.
That way, the T will work even better and have fewer possible side effects. What do you think? Check out her strategy below.

?
High Obesity, Low TestosteroneIf you were born in the 1980s, you remember a time when doing menial tasks warranted a greater physical demand than the present day. For example, changing the channel on the TV, rolling down a car window, and even stalking your current crush from the bushes. Today we can do all of that by just pressing a button.
We no longer have an inherent need to move as a society; we can literally sit on the couch and have everything delivered to us. This, of course, has contributed to our current obesity levels. But most importantly, it's one of the reasons men's testosterone levels have plummeted – about one percent a year since 1982, to be exact.
Obesity in this country has skyrocketed, and it isn't likely to decline anytime soon despite access to gyms, information, and technology that can help improve it. This, in turn, has men showing up with lower and lower testosterone levels due to an overwhelming amount of body fat.
More body fat means more of the most inflammatory tissue. This brings with it conversion to estrogen, which makes the brain think there's enough testosterone in the body if the natural conversion to estradiol is occurring.
Testosterone replacement therapy (TRT) can combat a lot of the health issues men experience. TRT can:

• Increase insulin sensitivity
  
• Reduce body fat levels
  
• Reduce fasting glucose levels
  
• Improve body composition
  
• Improve metabolic syndrome
  
• Help lower the risk of prostate cancer
  
• Provide neuroprotection and cardio protection, despite the fear-mongers saying the opposite
  

• Blood Pressure
  
• Resting Heart Rate
  
• HRV (Heart Rate Variability)
  
• Body Temperature
  
• Blood Glucose
  
• VO2
  

IS ALL HAIR LOSS THE SAME?No. In fact, there are numerous types of hair loss that can occur due to different things, such as autoimmune disorders or from using certain medications. But the most frequently occurring and frustrating is the type known as androgenetic alopecia.
Androgenetic alopecia simply means male pattern (or hereditary) hair loss. This doesn't mean that it occurs solely in men, however. Women get it, too. Regardless of who's suffering from this type of hair loss, it's important to understand the underlying causes so that it can be fought.

?
Causes of Hair LossThe most common causes include:
GENETICSAs much as 60% of men experience some degree of hair loss by age 60. The main culprit is the testosterone metabolite dihydrotestosterone (DHT). It latches onto follicle receptors, which causes them to shrink and become deprived of nutrients necessary for hair growth. DHT blockers are one popular category of hair loss treatments.
EXCESS ESTROGEN LEVELSThe relationship shared by testosterone, estrogen, and progesterone is complex, to say the least. It's even been hypothesized that estrogen is the "trigger" factor that may begin the hair loss cascade, as elevated levels result in increased DHT production in an effort to counteract estrogen. Progesterone, on the other hand, is suppressive of both estrogen and DHT, and is reduced under periods of high stress and from aging.
DRUGSSome medications may affect the normal growth phases of hair, or may exacerbate the effect that particular hormones have on hair follicles.
MEDICAL CONDITIONSThere are autoimmune disorders that cause antibodies to attack hair follicles, in addition to other conditions that indirectly affect healthy growth of hair.

Hair Loss PreventionThe good news is, even if you're already experiencing hair loss, or have a very strong predisposition to it, you can start using some of the currently available products and experience benefits.
MINOXIDILQuite likely the most popular hair loss treatment on the planet, it originally went by the name Rogaine. Today, there are numerous brands you can purchase over the counter, generic brands being considerably cheaper than big name brands.
Minoxidil was originally developed for use in hypertension, but was discovered to cause excessive hair growth (hypertrichosis). At the time, this excessive hair growth was merely regarded as a side effect, but it was quickly determined that the drug could be used to treat hair loss in susceptible persons.
Minoxidil's mechanism of action is due to its ability to increase blood flow to the hair follicles, which subsequently promotes delivery of nutrients and oxygen to the starved follicles. Minoxidil is currently one of only two FDA approved treatments for hair loss, and is available in various strength preparations, higher concentrations being superior.
KETOCONAZOLEKetoconazole was primarily used as an anti-fungal agent, at least until it was discovered to have anti-androgenic effects. In fact, it's this same effect that makes ketoconazole (Nizoral) exceptionally good, since it has the ability to treat hair loss of a fungal origin as well as androgenetic alopecia.
Ketoconazole was proven in studies to be able to suppress the effect of DHT in the scalp by binding to the androgen receptors found on the follicle and preventing DHT from interacting. It's important to note that Ketoconazole doesn't prevent DHT production, but rather prevents DHT from interacting with its receptor.
SPIRONOLACTONEThis is a diuretic agent used to help manage hypertension. It also seems to be another case of an accidental discovery. Spironolactone, when taken orally, was found to be another potent anti-androgen, binding with androgen receptors and blocking their effects. However, subsequent research found that it works equally well when applied topically to the scalp, but without the negative effects (sexual dysfunction, loss of motivation) that occur when taken orally.
FINASTERIDEFinasteride is an extremely popular medication used by thousands of men to treat symptoms of an enlarging prostate. However, it's also exceptionally good at treating symptoms of hair loss; so effective in fact that it's the only other FDA approved treatment for hair loss besides Minoxidil.
Frequently appearing as the brands Proscar or Propecia, finasteride is a 5-alpha reductase inhibitor, capable of preventing the conversion of testosterone to its metabolite DHT.
However, Finasteride is often not kind. It's notorious for its range of negative sexual side effects, including inability to maintain or achieve an erection, as well as causing libido and ejaculation issues. In the past, Finasteride was deemed ineffective when used topically, but a recent study determined that a topical form was effective if combined with Minoxidil for maintenance (after an initial two years of oral treatment).
Finasteride is currently being studied for causing a phenomenon known as "post finasteride syndrome" or PFS. PFS is attributed to changes in neuro-chemical levels following cessation of its use, resulting in suicidal idealation and depression, along with total loss of sexual function. It's likely that the results of the study, along with mounting pressure from consumers, could result in its withdrawal from the market completely.
PROGESTERONE CREAMSThough many men aren't aware of this hormone, much less its use in hair loss, it remains a potentially viable option. Considered a female hormone, progesterone is also produced in men but in smaller amounts.
It's a potent inhibitor of the 5-alpha reductase enzyme and can suppress excessive estrogen levels, thus preventing estrogen dominance. That means that topical application of a progesterone-based cream is likely to help treat hair loss, as well as excessive production of DHT.
Progesterone levels decline rapidly in men over 45, which would also help to explain the accelerated rate of hair loss that happens around this point, as well as with the appearance of many DHT related issues like enlarged prostate. (However, progesterone's estrogen-controlling effects may be more of an issue in preventing BPH than progesterone itself.)


Alternative TherapiesThe above options may not suit the needs of everyone. As such, consider these alternative options:
GROWTH HORMONE & IGF-1Growth hormone (GH) is an important anti-aging hormone, but levels start to rapidly decrease after the age of 30. Decrease in natural production of this hormone leads to accelerated breakdown of connective tissue (hair, skin, and nails) as well as other types of cells. Declines will also accelerate aging.
Decreased levels of GH also cause hair to grow much slower, gray faster, and in general be in poorer health. Lower levels of IGF-1, the principal hormone that mediates the effects of GH, also accompany lower levels of GH in the scalp. However, by promoting natural synthesis of growth hormone and IGF-1 levels in the scalp, hair loss may be prevented or partially reversed.
This may explain why some people experience transient hair loss when transitioning to a low carb diet. As the body becomes accustomed to a fat-based metabolism, IGF-1 levels drop, thus presumably accelerating hair loss.
PHYTOESTROGENSPhytoestrogens are the estrogen-like compounds derived from plants that may have similar effects to estrogen when consumed. In general, consuming too many highly estrogenic phytoestrogens (such as soy) is bad. They'll throw your optimal testosterone-to-estrogen ratio out of whack.
However, a small amount of phytoestrogens might be extremely helpful, especially since they help to reduce the amount of DHT active in the scalp. Many phytoestrogens aren't strongly estrogenic and bind to your estrogen receptors without causing estrogenic effects. Given that fact, it may be best to consume your phytoestrogens from proven sources, such as pomegranates or resveratrol.
SOY ISOFLAVONES AND CAPSAICINThough soy itself is a phytoestrogen and not desirable for regular consumption, the use of its supplemental isoflavone component in combination with capsaicin (cayenne pepper extract) has been shown to boost dermal levels of IGF-1. Diminished levels of IGF-1 has shown strong association with hair loss.
RU-58841While not approved for use in humans, an underground topical anti-androgen known as RU-58841 has been found to be extremely potent in preventing DHT from interacting with receptors found in the scalp.
The only human study was conducted in 2002, but it appears that it was abruptly ended, so no conclusions were drawn. It's also important to note that RU-58841 was renamed PSK 3841 somewhere along the lines of rights transfers, so it's not uncommon to see it going by that name, too.
Regardless, keep in mind that it's unapproved, illegal for use, and expensive to acquire. Still, there are many guys who order it online regardless and have been using it with good results. However, it's impossible to know the long-term effects or whether you're actually getting what you ordered. I can't encourage the use of it, but you're free to make an educated decision.
AZELAIC ACIDAzelaic acid is a topical preparation that's purported to have anti-inflammatory, 5-alpha reductase blocking activity, as well as being an anti-microbial agent. It appears to be primarily effective in treating another form of alopecia named alopecia areata (an autoimmune skin disease), but it also shows promise in treating androgenetic alopecia when combined with a stronger 5-alpha reductase inhibitor.
L-CARNITINEL-carnitine has been shown to promote hair growth, at least in vitro. This is attributed to numerous mechanisms, one of the more crucial being its ability to improve the functional ability in follicle mitochondria, which may have been shrunken from DHT suppression. At a minimum, a carnitine supplement could be used as an adjunct to stronger therapies.

RecommendationsIf you're genetically susceptible to hair loss, there's no easy 1-2 punch in preventing it. However, it's quite possible to reverse or maintain your current levels of hair by employing a "cocktail" of ingredients. Many popular shampoos and other topical products contain many of the following ingredients. As a good rule, though, be sure to use a few of them.

• Minoxidil: This product should be a staple in your hair growth arsenal. It won't block any hormones, but it should help promote healthier blood flow and stimulate growth.
  
• A Topical DHT Blocker: You can use either a topical ketoconazole or spironolactone product. Both work on the scalp via similar mechanisms. However, if your hair loss is due to bacteria or a fungus, ketoconazole may be the better option.
  
• Progesterone Cream: Progesterone creams are optional, but are much more important in older men (40+) with diminishing progesterone levels.
  
• Soy Isoflavones and Capsaicin: These two compounds increase levels of IGF-1 in the scalp.
  
• Phytoestrogens: Don't go overboard on these, but rather opt for healthier choices such as those found in pomegranates or even the natural anti-oxidant resveratrol.
  

IT'S ALL YOUR FAULTRealize that whatever went well and whatever went badly were both your fault. You are extremely blessed to have the choices you do and the physical and mental capacity to even compete in something like a Strongman competition. Do you have any idea of how many people would kill to have the opportunities and gifts we take for granted each and every day?
Having a bad yoke time makes for a rough afternoon. Not being able to walk to the bathroom under your own power is infinitely worse. Get some perspective. There are no victims at a Strongman competition... and very few real victims in life.

?Whether the promoter changed one of the events at the last minute or it was raining during your press medley, your performance is STILL your performance. If you blame others for your lack of preparation and poor showing, you won't make it far in this sport, or even in life for that matter.
DO THIS INSTEADIf you compete, never leave your fate in the hands of the judges. In regular life, never leave your fate in the hands of other people.
If your timekeeper was slow with the stopwatch for your farmer's walk event, switch the blame from the judge to yourself. Rather than berating the timekeeper for his lack of attention, look at what you could have done better. If you had moved the implements faster, then fractions of a second wouldn't be the thing that separates you from the rest of the pack.
Could you have asked the judge prior to your run for clarification on exactly what he was looking for before he stops the clock? If you would have told him a specific time you were trying to beat before you performed your run, do you think he would've been more in tuned to focusing in on what was about to take place? Everyone (judges included) likes to see people push themselves to new levels.
Now which guy is going to get more positive focus and attention? The guy who's polite and has voiced that he's trying to beat his PR, or the guy who yells at others and talks about them behind their backs?
The second you switch the blame to yourself and take ownership of your performance, the sooner you'll find ways to improve the next time. Whether you compete well or you drop the ball, the fault should always fall on your shoulders. Accept that and you'll get better... in competition and in life.

Check out this letter:
Dear Cy,
I've never done steroids before, but I'm thinking of giving them a go. I'll probably be using orals since they're safer, plus I'm not exactly ready to wrap tubing around my arm and start poking around for a vein! Anyway, I was wondering how many pills I should take. Thanks!

?Tom
I know, I know, you probably have the urge to reach through your computer, drag Tom out on his undereducated butt, and beat some sense into him. Yep, me too. Tom obviously doesn't know enough about steroids to even be thinking about starting a cycle. He doesn't realize that steroids are designed for intramuscular use (not intravenous use), he thinks orals are safer, and based on his question, I don't think he even knows that there are different kinds of 'roids! The sad part is that there are actually a few steroid newbies out there who know less than Tom about what they're about to put into their bodies.
Well, with all of those "dummies" books that have surfaced lately, we've decided to create our own version dealing with steroids, just for guys like Tom and all those who are thinking of making the big leap into the world of anabolics. Heck, if I'm lucky, maybe this'll become as popular as Windows for Dummies or Nude Golf for Dummies. In short, this article should serve as a quick reference guide for all the steroid newbies out there.
Oh, and please don't take offense at the word "dummy," as it's not meant to insult your intelligence in any way. It's just a way of "funnin" with those guys who are steroid virgins as well as providing some rudiments of steroids and their usage. Just think of this as a "Gear 101" survey class and get ready to take some notes. Here we go!
STEROIDS: WHAT THE HECK ARE THEY ANYWAY?Anabolic steroids are synthetic analogs or derivatives of Testosterone and nor-testosterone. In the 1930s, scientists found that these anabolic steroids could increase the growth of muscle in lab animals. The compounds were then used to treat debilitating diseases in humans.
In the 1950s, a doctor, John Ziegler had dispensed an oral anabolic steroid by the name of Dianabol. Soon after, athletes began to use this steroid in order to increase muscle mass and strength. Soon, more and more analogs and derivatives were being made available to athletes.
While all steroids have the same four ring carbon structure, simple chemical alterations produced different effects in terms of anabolic/androgenic activity. Anabolic activity refers to the steroid's ability to facilitate skeletal muscle growth, while androgenic activity refers to how potent the drug is at inducing the development of male sexual characteristics (facial hair, deep voice, the ability to channel surf and watch six TV programs at once, etc.)
HOW THEY DO DAT?Now, even though all of the exact mechanisms through which anabolic steroids exert their effects haven't been discovered, they all increase muscle mass to some degree. One way steroids are believed to work is by binding to the androgen receptor (AR). Once the steroid has bound to the AR, it begins to activate protein synthesis. This protein synthesis allows for an increase in muscle tissue over a rather short period of time. T-mag contributor Bill Roberts has classified steroids such as these as "Class I."
The other side of the coin would be steroids that bind to the AR slightly, or not at all. I think most of these steroids exert their effects by inhibiting the effects that glucocorticoids have upon muscle tissue. In other words, they prevent glucocorticoids from increasing glutamine synthetase and causing muscle tissue breakdown. This would be an anti-catabolic activity. This inhibition of glucocorticoids¹ effects may explain why most anabolic steroids work fairly well in the treatment of osteoperosis, since glucocorticoids can have influence or cause osteoperosis. This also backs up my belief, that on a mg per mg basis, Class II steroids will increase muscle tissue to a greater degree than Class I steroids.
While there still isn't a clear cut explanation of how anabolic steroids exert their effects, these two mechanisms help to explain most steroid actions. Bill Roberts refers to these steroids that don't exert their effects via the AR as "Class II." Also, keep in mind that some steroids work via the AR as well as through non-AR mechanisms. It should also be noted that anabolic steroids increase the retention of nitrogen, potassium, sodium, phosphorous, and chloride.
STEROID FLAVORS: THE DIFFERENCES BETWEEN VARIOUS 'ROIDSBelow I've compiled a list of some anabolic steroids, including their relative potency and some other info. Sometimes, the names of steroids can be confusing to a newbie. This is because you have the chemical name, the various brand names, and the slang or street names for each product.
For example, methandrostenolone is known to most people as Dianabol, but you probably hear it referred to as D-bol. Of course, you'll likely be using the veterinary version called Reforvit-B, whose street name is Reffie or Reffie-B. Got all that? Don't worry, the more you read the more you get used to all the terminology. To help you out, I've listed the chemical name as well as a few of the trade names for each 'roid.
FLUOXYMESTERONE (HALOTESTIN, STENOX)This is a 17-alpha alkylated steroid. In other words, it's been altered in order to withstand the liver's "first pass" metabolism to a better degree, i.e., the liver doesn't inactivate the stuff before it can exert its effects. Without this alkylation, you'd need much higher concentrations to get results, as is the case with any 17-AA. Anyhow, this steroid appears to have a lower affinity for the AR, but can agonize the receptor at higher dosages.
As far as "real world" effects, fluoxymesterone has a reputation for increasing strength to a large degree. However, gains in muscle mass on this steroid aren't very great. In clinical settings, dosages range from 2.5 mg to 40 mg a day in divided dosages. However, bodybuilders have been known to use from 30 to 80 mg per day. It has a half-life of approximately 9.2 to 10 hours. (I'll talk about why knowing about half-lives is important later.) Oh yeah, and it doesn't aromatize. This means it's not likely to convert to estrogen, the female hormone. In the real world, that means the risk getting gyno (bitch tits, i.e. breast tissue growth in males) is small to nonexistent.
METHANDROSTENOLONE (DIANABOL, REFORVIT, ANABOL)This 17-AA steroid was the first to be introduced to athletes in the 50s. Bodybuilders caught on soon after, no doubt. It's aromatizable, and therefore can increase estrogen levels. Since it doesn't bind very well to the AR, it's thought that it works by antagonizing the effects of catabolic glucocorticoids.
D-bol has a great reputation for increasing both size and strength to a pretty good degree. While the half life isn't readily available in the literature, it can be assumed through deductive reasoning that it's around four to seven hours. Bodybuilders typically use around 25 to 100 mg per day depending on whether it's used alone or in conjunction with another steroid (a practice called stacking).
STANOZOLOL (WINSTROL)This steroid is also17-AA. It can't aromatize and doesn't bind very well to the AR. Consequently, it's likely to exert its anabolic effects in a similar fashion to that of methandrostenolone. In other words, it affects glucocorticoids in a beneficial manner.
Another benefit may be its ability to antagonize or block progesterone from binding to receptors. Progesterone is one of the reasons why certain anabolics cause water retention.
Stanozolol has a great reputation for increases in strength as well as moderate increases in muscle mass. Actually, these "moderate" gains are rather impressive, considering that this drug doesn't cause much water retention. In clinical settings, typical dosages are between 2 to 6 mg daily. In order to see desired effects, bodybuilders typically consume between 25 to 100 mg daily. While I can't locate any literature on its half-life, based on its molecular composition it would seem to have a slightly longer half-life than most of the other orals. I'd say it's likely to be in the range of 7 to15 hours.
OXANDROLONE (SOLD AS OXANDROLONE POWDER OR OXANDROLONA)This is yet another 17-AA. It won't aromatize but appears as though it will bind to the AR as long as the dosages are high enough. It has a reputation for increasing strength gains, as well as having a "hardening" effect. This is supported somewhat, as oxandrolone was shown to reduce subcutaneous fat to a greater degree than Testosterone. Whether this is an inherent property of all 17-AA steroids or an effect that's unique to oxandrolone, I'm not sure.
Oxandrolone, along with most of the other synthetic steroids, are thought to be equally (if not more) anabolic than Testosterone on a milligram per milligram basis, while minimizing androgenic side effects. Oxandrolone was shown to have approximately six times the anabolic effect of methyltestosterone in human subjects, following oral doses. Oxandrolone may also increase the number of skeletal muscle androgen receptors.
In clinical settings, dosages have ranged from 1.25 to 80 mg per day. Bodybuilders may take anywhere from 25 to 160 mg per day. The half-life is approximately nine hours.
METHENOLONE ACETATE AND ENANTHATE (PRIMOBOLAN)This steroid doesn't aromatize and can either be ingested via the acetate version or injected via the enanthate. This steroid does bind rather well to the AR and is known for its mild gains in muscle mass. Still, considering that it'll cause next to zero water retention, these gains are rather good. (Note that some bodybuilders think certain steroids work better based solely on the weight they gain. In actuality, they could be just retaining a lot of water along with the muscle gains. These are the same guys who think they "lose" a lot of muscle after their cycle is completed, when they actually just lost much of the water they'd been holding.)
Clinical dosages that are commonly seen with methenolone range from 10 to 20 mg daily, sometimes a little higher for the oral version. For the enanthate version, dosages are usually 100 mg every two to four weeks. Bodybuilders typically use 400 to 1000 mg a week. The half-life appears to be very similar to Deca, perhaps slightly shorter. So with this in mind, I'd say the half-life would be around five to seven days.
OXYMETHOLONE (ANADROL)This 17-AA steroid can't aromatize, but has been known to have progestenic properties and thus, can cause water retention. It has a great reputation for increasing muscle mass and strength to a large degree. It's also thought to have a very high anabolic/androgenic ratio.
The typical dosage in clinical settings is one to five milligrams per kilogram of bodyweight per day. So, a 150 pound person would consume anywhere from 68 to 341 mg per day. However, the higher dosages aren't employed that often. Bodybuilders typically consume around 50 to 150 mg per day. While I can't find info on the half-life in the formal literature, it would seem it's similar to that of stanozolol. Obviously, this isn't a hard fact, but the half-life should be right in the neighborhood of 7 to15 hours. Only God and Bill Roberts know for sure.
TESTOSTERONE ENANTHATE, CYPIONATE, PROPIONATE, SUSPENSION (COMMONLY CALLED "T")This steroid can aromatize and binds well to the AR. It's well known for its ability to produce great gains in muscle size and strength, provided that the dosages are high enough. It does cause quite a bit of water retention and has quite a few side effects when compared to the other anabolics.
Clinical dosages vary, but cypionate and enanthate are both injected every two to three weeks at dosages of around 200 to 300 mg. Propionate and suspension aren't preferred as they don't provide that long of a sustained release. Bodybuilders typically use around 500 to 1,000 mg per week. The cypionate ester has a half-life of around eight days. Enanthate is just slightly shorter and propionate is quite a bit shorter. By the way, Testosterone in a suspension has a half-life of only 10 to 100 minutes.
NANDROLONE DECANOATE AND LAURATE (USUALLY REFERRED TO AS DECA)This steroid binds very well to the AR and doesn't aromatize. It can produce moderate gains in muscle mass with little water retention. However, it, like oxymetholone, can be progestenic leading to water retention when higher dosages are used.
In clinical settings, dosages are around 50 to 100 mg every three to four weeks. Bodybuilders use around 300 to 800 mg per week. The decanoate ester has a half-life of six to eight days and the laurate ester commonly seen in veterinary products has a slightly longer half-life.
HOW DO I GET THESE HERE STEER-OIDS ANYWAY?Easy! Just call 1-555-I WANNA TO BE HYOOGE and tell Gunter what you want! Tell him Cy sent ya! Okay, you knew I couldn't give you a real source, right? Still, it doesn't take much searching to find some gear. Searching on the Web is one way, or you can do it the old fashioned and usually more expensive way and look for one of the local dealers. I mean don't go up to the largest guy in the gym and say in a loud voice, "Hey man, do you have any of that Reforvit stuff?" Just ask around in a discrete manner. Someone always knows a certain "guy." For a more in depth look, check out Chris Shugart's article called Getting the Gear.
HOW TO CONSTRUCT A CYCLE: THE CLIFF NOTES VERSIONThe dosages should be determined after evaluating two things: one, what results you'd like to see and two, which drugs you're stacking. There are other factors to consider, but for the sake of simplicity we'll stick with these two for now.
Regardless of what type of results you're looking for, it would be wise to stack two drugs that work through different mechanisms in order to get a synergistic effect. For instance, you'd get better results by stacking nandrolone with stanozolol as opposed to nandrolone and oxandrolone. This is because nandrolone and oxandrolone both bind to the AR. I've given you a few examples of stacks below. I'll give a quick review afterward.

• Stack 1: Nandrolone, 450 mg per week along with 50 mg per day of stanozolol
  
• Stack 2: Nandrolone, 450 mg per week along with 50 mg per day of methandrostenolone
  
• Stack 3: Oxandrolone, 40 mg per day along with 50 mg per day of stanozolol
  
• Stack 4: Testosterone enanthate, 500 mg per week along with 50 mg stanozolol or methandrostenolone per day
  
• Stack 5: Testosterone or nandrolone, 500 mg per week with 50 mg oxymetholone per day
  
• Stack 6: Methenolone, 600 mg per week with 50 mg per day stanozolol
  

ANABOLIC STEROIDS: A STORY THAT NEEDS TO BE TOLDSeveral things made me quit using anabolic steroids, the last of which was precipitated by four guys breaking into my house and putting a gun to my head and my dog's head, but I'll get to that later.
I knew at least ten people who died young due to bodybuilding pharmaceutical use and abuse. I knew countless others whose lives were ruined. Many more had heart attacks and mild strokes. They were lucky to survive, and yet they continued to roll the dice.
 
?I also know women in the hardcore competition world for whom PEDs served as a gateway to other dangerous recreational drugs. Some were using cocaine or methamphetamine to get ripped for the stage. It's one of the best-kept secrets of female bodybuilding. It would make me cringe to watch these same people go on social media and glorify the competitive experience while implying how healthy it was.
But I also know about the risks from personal experience. This is a story I've told very few people. Until now.
I'm Done With the Lunatic FringeIt began for me at a guest posing appearance at a bodybuilding pro show. The competitors talked about nothing but their drug use. One of them was limping. I looked at his legs and saw gross-looking welts. He said he'd been doing site injections into his vastus lateralis, hoping to bring out his thigh sweep.
That was just one of the stupid, disgusting things I saw that night that made me realize how dark bodybuilding had become.
I decided then and there that I was done with the hardcore world. I was supposed to go out and set up a booth just before intermission and sign photos, but I just gathered my things and walked out the back door.
I never wanted to be part of that world again. I still trained and coached competitors, and I would for the next several years, but I was done with the lunatic fringe. The lifestyle I cut my professional teeth on and was so devoted to and passionate about seemed to have disappeared.
But even though I was done with hardcore bodybuilding, hardcore bodybuilding wasn't done with me. I continued to use anabolic steroids and related drugs.

A Gun to the HeadAt the same time, I was training at a well-equipped hardcore gym. I liked the training atmosphere there a lot – old school clangin' n' bangin'. There were a couple of hardcore guys that often spotted me on heavy lifts, like when I needed to hoist 160-pound dumbbells to my chest for incline presses.
A few of them were in the same close-knit group, and they were always friendly to me. The rumor was that they were either affiliated or actual members of a biker gang, but that didn't matter to me; I've always responded to people the way they responded to me.
One day, two of these guys asked me about one-on-one coaching, but they didn't want me to do their assessment at the gym. Instead, they asked if they could come by my house to sign up and that maybe a couple of their friends were interested in signing up as well.
I agreed to see them and we set up a time for them to come by my place so I could do their physique assessments and get them started. When they came to my door, there were four of them. At first, I thought to myself, "Great, four new clients at once. That's a lot of money."
I walked them down to my office, and that's when one of them stuck a gun to my head. Even more frightening, one of them grabbed my dog Hooch and stuck a gun to his head as well. They were there because they thought I'd have a large stash of steroids they could parlay into a big score.
And the truth is, I did have some anabolics at my home, but not nearly on the scale they were hoping for. They took practically everything I had – cash and anything else that was valuable – and they were gone.

A Swollen, Bloated, Medical MessAfter this home invasion, I had a nasty physiological adrenal/stress response. My fingers and toes swelled up and hurt. Almost immediately, I developed what's known as "moon face." I looked like someone whose face was stung by a bee and had an allergic reaction. My stomach got hugely bloated too. I had been ripped, but my body turned into a gross, edematous mess in a few hours.
I went to the doctor right away. He prescribed some diuretics and a sedative, and he expedited some blood tests. I got the call later that day to come into the office because he wanted to go over my blood tests with me. That's never a good sign.
I'll never forget what he said: "Let me put it this way. I have a patient in his 60s who's had four serious heart attacks already, and his blood panel looks better than yours." That statement served as a gut punch. I felt disgusted that I'd treated my body this way while convincing myself I was part of a "fitness" industry.
I'd actually convinced myself I was healthy. I also felt disgusted that I'd been close to a group of people I'd invited into my home and who'd then put a gun to my head.
That did it. I was done. Done with all of it.
No tapering off, no rationalizing, or any of the mental gymnastics I'd used to justify my steroid use. I just stopped cold turkey the second I left the doctor's office.

The AftermathWithin 8 weeks off steroids, my blood panels returned to normal and healthy ranges again. At the 12-week follow-up, my blood panel was even better. When the doc looked at the results from my 20-week follow-up, he exclaimed, "I wouldn't have believed this if I hadn't seen it myself! Your blood looks like a healthy person in their 20s!"
As you'd expect, the heavy muscle weight came off slowly but surely. Regardless, my knowledge of the game of physique transformation allowed me to keep looking like a guy who walks his talk.
Below is a photo of me from the hardcore days:
And here's me on the beach in Dubai at age 55. Still the same physique structure overall, but obviously smaller.
I haven't weighed myself in years because, frankly, I don't believe in it, but I suspect I've dropped about 40-50 pounds. I went from 4X or 5X shirts to about a 2X and sometimes even an XL. I do mostly whole-body workouts now, and that works great for me.
I also transitioned to one-on-one coaching for a completely different demographic: regular, normal people who still seek realistic physique transformations. I've also become a best-selling author on Amazon and have created numerous online courses for physique transformation and weight loss.
Training bodybuilding and figure competitors to champion status and looking the "hardcore" part myself is well behind me, and I have no regrets and certainly no second thoughts about ever using PEDs again.
I'll likely always live the bodybuilding lifestyle, just without the pharmaceuticals. Still, I worry that people, too many people, won't get my message.

The Skeptics are Either Dead or DyingWhen I let it be known that I was forgoing the juice and letting go of that phase of my life, a few people were quite outspoken about it. Two former clients of mine were saying things like, "Yeah, right, once he starts shrinking, Abel will be right back on the sauce. He won't be able to handle getting small!"
The only reason I mention these two former clients is because both of them ended up dying in their 40s. One dropped dead on the gym floor, leaving behind a wife and three young daughters. The other was Greg Kovacs, who no one in the inner circle of bodybuilding expected would live a long life anyway.
In fact, I'd stopped training Greg Kovacs and dropped him as a client because of his insane, uncontrollable drug abuse. Mentioning these two guys is important because it points out that they were projecting onto me their fears of "getting small."
I only wish they were still around to face those fears, but if you knew them, you knew that wasn't ever going to happen. Similarly, I received an email from a former client who used to compete. He wanted to know how I was able to go natural after being "a jacked-up beast who could have competed in the Olympia."
He wanted to know how hard it was for me "to get small" again. He wanted to know if it played head games with me. He too was projecting his insecurities. But here's the crazy part – he'd just had his second heart attack.
He's barely 50 years old. He'd been advised to get off his steroid stacks if he wanted to avoid another cardiac episode, but he also wanted me to tell him there was some way to keep using steroids while magically improving his health.
He'd already gotten his answer – get off the steroids. He just didn't want to accept it.

Physique Competition and Health are Contradictory TermsWhen people come to me and ask me about the risks of steroid use, I know about them first hand, second hand, third hand, whatever. And the longer you stay on, the bigger the risk. And, of course, the higher the doses you use, the higher the risk – just like any drug, let alone a stack of drugs.
Imagine if you took a whole bottle of extra-strength Tylenol to ward off aches and pains and headaches, and you did it every single day. Could you rationalize this strategy? Sadly, this is what a lot of steroid users do.
The mental gymnastics these long-term steroid-using guys do when they experience health issues is beyond my comprehension. They'll bend and twist and stretch facts and figures to any length just to be able to say things like, "Yeah, I had a cardiac issue, but the research says it wasn't the steroids. It couldn't be!"
It's gotten to the point that, to me, using physique competition and health in the same sentence – or worse, using physique competition and "fitness" in the same sentence – is a contradiction in terms.
Worse yet, this industry's members are complicit in pretending there are no major consequences at all to dumping massive physiological doses of drugs into their bodies. It's not rational. In fact, it's downright creepy.
As usual, some of you will get it, some of you will not.

THE TRUTH HURTS (THEN HELPS)Every year political correctness gets worse. We can't say anything that might hurt someone's feelings, even if it's true. And don't even think about doing anything that might make someone feel like they may be different. (Newsflash: We're all different.)
Because of political correctness, objective truths are prohibited even if speaking them could help people get better. Health practitioners can't tell patients that being obese can reduce their lifespan and raise their chances of developing Type 2 diabetes, cardiovascular problems, and even depression.
 Telling people these things, even though it's based on sound science, is not acceptable anymore because it makes them feel bad.
But you know what? Maybe they should feel bad.
Feeling bad isn't always a bad thing. It's the best driving force behind change. If you tell me that I'm at risk of dying young, I'd feel bad too. And that'd be a necessary step towards better health.

You Can't "Catch" ObesityAnother side effect of extreme political correctness is that we can't say that people are obese simply because they ate too much food. No, we need to tell them it's not their fault, that obesity is not a self-imposed condition that occurred because of the choices they made every day for years, but rather, an illness.
Let me be blunt: Obesity has more in common with being addicted to cigarettes than it does with the common cold. You "catch" or develop an illness mostly due to factors beyond your control.
You gain a severe weight surplus as a result of the decisions you make: food choices, food quantities, and physical activity. Kinda like how you decide to put that cigarette in your mouth.
As far as social norms go, there's a huge difference between our treatment of obesity and smoking though. Since obesity affects the way you look, it's considered discriminatory or hateful to point out the problems associated with it.
You can point out the problems with smoking all day long and nobody will bat an eye. But talk about obesity out loud and you'll instantly be labeled a bigot.
But obesity is associated with a higher mortality rate. That's factual. You can find dozens of studies establishing a very strong connection between obesity and cardiovascular diseases and diabetes as well as shorter lifespan. Cancer, too.
Pointing that out is not hate. Hate would be hiding it from you so that you don't do anything about it.

Overweight? It's Your FaultTo solve a weight problem, the first thing to do is take personal responsibility for getting to that point. Except for some rare exceptions, people are overweight simply because they ate more than they needed for a prolonged period of time.
This has been demonstrated scientifically. For example, Duvigneaud et al. concluded that "the main cause of obesity is the chronic overconsumption of energy compared to energy expenditure (1)."
We can look at both history and modern medicine to understand this better. During World War II, out of the millions of prisoners in the concentration camps, none were overweight. In fact, all of them were rail thin. Out of those millions, many likely had the genetic factors that could increase their risk of obesity, yet all were skinny.
Of course, that's an extreme example, but it illustrates that having a very low caloric intake and a high level of physical activity will lead to drastic weight loss in everybody. It's just a matter of finding the level of both that'll be sufficient to lead to the fat loss.
Another example is the significant weight loss in patients who undergo bariatric surgery. The main reason for the initial weight loss is the fact that you simply cannot eat a lot of food. Overeating will lead to throwing up in most cases. It also dramatically decreases hunger. Both of these things lead to a reduction in caloric intake.
Those who undergo bariatric surgery will regain the weight if they revert back to their old eating habits (over time you can tolerate more and more food even with the surgery) and start to increase portions or eat more calorie-dense foods.
Despite likely having worse hormonal conditions for becoming obese, a huge majority of people who get the surgery still lose fat, illustrating that consuming too much food is the main cause of fat accumulation.
There's good news though. If your decisions are the main reason for gaining fat, your decisions can also be the solution.


Overfed, Under-Full, and Inaccurate ReportingYou've probably heard something like this before: "But I don't really eat more than other people."
There are overweight people who swear that they don't eat a lot. I've worked with hundreds of them. And every one has said that they eat "normally" or that they don't eat more than their leaner friends and family members.
Are they lying? Not necessarily. They may be eating a normal VOLUME of food while unknowingly consuming a greater amount of calories.
The idea of eating a "normal" amount – or eating a little, a lot, more, or less – is just too vague. These terms aren't adequate when it comes to quantifying nutritional intake.
Why? Because having a low-calorie stew might make you feel like you've eaten a whole lot, while having a stack of high-calorie cookies might make you feel as though you've eaten very little.
Food can be deceiving when you're measuring it by your perceived intake, especially when that intake is mostly made up of food that doesn't contain a whole lot of volume or nutrition.
If your appetite remains high – even after eating a large amount of calories (but low volume meal) – then you might think you've eaten very little. But if your appetite is blunted after eating a highly-satiating meal (with much fewer calories) then you might think you've eaten a lot.
So it's no wonder a lot of people report that they don't eat more than others. They may be using the way they FEEL as a barometer for how much they've eaten.
But then there's the problem of underreporting. And it's been studied... a lot.
Research shows that overweight individuals underreport caloric intake more than leaner ones. Participants were asked to fill out a nutritional journal to study this. And the more overweight the participants were, the lower the reported caloric intake was compared to reality (2).
When compared to normal-weight individuals, and those suffering from anorexia, overweight individuals underreport food intake. In a study, normal-weight individuals reported food intake correctly (slight over-reporting). And as you might guess, people suffering from anorexia over-reported food intake (ate less than they reported) even more. Obese individuals underreported food intake by 16 percent (3).
Why does this happen? Researchers from another study may have the answer. They found that obese individuals underreport because they don't evaluate portion size correctly or don't report snacks (4).
A classic study looked at obese people who couldn't lose weight despite being on a "1200 calorie per day diet" and exercising regularly. Turns out their metabolic rate was normal for their height and weight, but they were underreporting their food intake by a whopping 47 percent. They also overestimated their activity level by 51 percent (5). They literally ate twice as much as they reported and exercised half as much.
So, it seems as though we've been asking the wrong questions. The question ISN'T are people fat because they overeat? Because the answer (for the vast majority) is a resounding yes.
A better question is, why? What is it that causes obese people to perceive their food intake differently? Is it because they've never accurately weighed, measured, and tracked what they've consumed? Or is it because what they're choosing to eat never really satisfies?
The answer is likely a combination of both.

Overeating Is Not (Necessarily) BingingPeople conflate overeating with binging. While binging is an extreme form of overeating, it's not the only way to overeat, nor is it the most prevalent way to overeat.
Overeating simply means taking in more than your body needs to maintain your current body composition. If you maintain your body fat level at 2,500 calories per day, then eating 3,000 calories per day is overeating. Unless your activity level rises to match it, that consumption can lead to fat gain... even though it may be very gradual and hardly noticeable.
Now let's say that you dispersed those calories fairly evenly over the course of the day. You eat four meals (three main meals plus a snack). That's only a surplus of 125 to 187 calories per meal. That might not seem like much – especially if the food is low volume and has a low nutrient density.
Obese individuals aren't lying about their food intake. Sometimes they just don't realize the true quantity of what they're eating and the difference in calories between different types of foods... even healthy ones.

Calories That Count, But Don't Get CountedMany years ago, I was training a boxer who needed to lose weight. After being on a diet for four weeks his weight hadn't moved. I couldn't understand why because the guy was very disciplined. One day we went to lunch together and he drank two large glasses of orange juice. I asked him if he drank a lot of juice. He replied, "Four to five glasses per day."
Of course, juice wasn't in his diet plan. And those four to five glasses added around 800-900 calories to his daily total! No wonder he wasn't losing weight.
People who can't seem to lose weight are often unaware that their habitual consumption of certain things comes with a caloric impact. This is really what differentiates a "healthy" diet from a diet that allows you to lose fat. Nutritious foods are often not measured out in appropriate serving sizes, or even counted as part of the day's total caloric intake.
Anyone can fall into this trap by forgetting the caloric "cost" of healthy-ish things they've been eating for years.
Here are some of the biggest culprits: Oils that you can add to salads and cooked meals, handfuls of nuts, fatty cuts of meat, oversized portions of cheese, dates, honey and other high-calorie ingredients that can be added to recipes.
Even if you're not splurging, you could very well be overeating. And if you consume even a small surplus every day for years, it will eventually accumulate into a significant amount of fat.

Are Hormones to Blame?Hormones are often blamed for fat gain and the inability to lose fat. They do play a role, but they're often not independent of overeating. In short, a lot of the hormonal problems which make it harder to lose fat are caused by what made you fat in the first place: chronic overeating.
When we think of the hormones that impact our capacity to lose fat, we normally think of insulin, leptin, cortisol, and thyroid hormones. So let's look at each of those individually.

InsulinIt's probably the most maligned hormone in the human body. And if you ask a keto dieter about it, they'll tell you it's the "fat gain hormone."
But insulin actually doesn't make you fat. Yes, it's a "storage" hormone so it's easy to assume that more insulin equals more fat gain. But in reality, insulin can only lead to the storage of the energy that you consumed. You cannot store more calories than what you've eaten. So, it's still a matter of eating more than what your body needed.
When we talk about insulin and weight gain, we usually talk about insulin resistance being the problem. Insulin resistance means that your cells don't respond well to insulin and as a result you need to produce more of it to get the job done.
If you're insulin resistant and you eat a meal, you release more insulin than someone who's insulin sensitive (especially if the meal was higher in carbs). As a result, insulin stays elevated for longer.
Why is that relevant? Because when insulin is elevated above baseline, the body is less efficient at mobilizing stored energy. It can still do it, but to a lesser extent. This means that it's a bit harder to lose body fat.
Understand that insulin resistance doesn't lead to more energy storage. When you're insulin resistant you need more insulin to do the same job. The main difference is in the inhibition of fat mobilization because of the lengthened amount of time during which insulin is elevated.
While there are a lot of factors that can lead to insulin resistance, the two main ones are chronic insulin elevation and having the energy stores filled up. If you always produce a ton of insulin, your cells can become less sensitive to this hormone. You'll need more and more to get the job done.
What will lead to excessive insulin production? Eating too much, too often. And overeating foods that increase blood sugar levels.
The second factor is having the energy reserves (muscles, liver, fat cells) topped off. When you eat a meal, your blood glucose level and/or blood fatty acids levels will increase. The body releases insulin to clear the blood of these nutrients.
But if the energy stores are full, you can't send the nutrients anywhere. The body reacts by releasing even more insulin to try to force the body to store those nutrients. Eventually that can lead to the creation of the new fat cells.
What can cause these energy reserves to be full? How about eating too much?
So, overeating can easily lead to insulin resistance. That's why there's a higher occurrence of Type 2 diabetes among obese individuals (6) (7) (8).

LeptinIt's a hormone released by the adipocytes (fat cells). When it reaches the brain, it connects to leptin receptors and essentially tells the brain that we're well fed. Metabolism stays normal, your appetite is kept under control, etc.
If you go on a diet, the more you lose fat the less leptin the fat cells will release. It's a way to tell your brain that you aren't getting enough energy in, and you need to do something about it. If leptin is low enough for long enough, the body will increase hunger to force you to consume more nutrients.
The less leptin you produce, the hungrier you get. If it stays low for long enough, it can even contribute to a slowing of your metabolism.
The fuller the fat cells are, the more leptin you produce. In theory, obese individuals should produce tons of leptin, which should also kill their appetites and lead to a lightning-fast metabolism, right? But that's not exactly what happens.
In fact, obese people produce so much leptin that they desensitize their leptin receptors. Their brain stops responding to leptin. Even though they produce a lot of it the result is the same as if they weren't producing much. They get hungry, they eat to satisfy that hunger, and their metabolism doesn't become powerful enough to counteract it.
In this case, yeah, hormones make it harder to lose fat. But the leptin problem they have is in fact due to their weight gain.
They overproduced leptin because they ate too much for too long, causing their fat cells to be completely saturated. Then when their cells were saturated, they produced new fat cells, which meant even more leptin. Over time this led to the leptin resistance that now makes it harder to lose fat.
It's not genetic. It's because of years of bad eating habits.

Thyroid HormonesIt's easy to make a connection between low thyroid levels and obesity. After all, thyroid hormones (mostly T3) regulate the metabolic rate – a large part of your daily energy expenditure.
Thyroid hormones regulate basal metabolism, thermogenesis, and play an important role in lipid and glucose metabolism, food intake, and fat oxidation (9). The theory is that when you have hypothyroid your metabolism slows down, which means you burn less fat and store it more easily. This leads to weight gain.
It sounds simple and elegant, but it's not as simple as that.
For one thing, hypothyroidism by itself only leads to a small amount of weight gain. It certainly wouldn't explain carrying an extra 100 pounds of fat. Hypothyroidism is certainly a risk factor that increases the chances of becoming obese, but by itself it's not enough.
More importantly, in most cases, it's what you did to gain weight in the first place that caused hypothyroidism.
Recent research has demonstrated that the excess in leptin production in obese individuals is one of the main causes of hypothyroidism in those individuals (10). Another cause is the fat cells' release of inflammatory cytokines which decreases the uptake of iodine, leading to lower thyroid hormone production (thyroid hormones are made from iodine and tyrosine).
So, like leptin and insulin issues, the thyroid problems seen in obese individuals will, more often than not, be caused by what made them obese in the first place or the obesity itself.

CortisolThis idea that cortisol will make you fat was popularized by Charles Poliquin. In his system (Biosignature, then Metabolic Analytics), storing too much fat on your abdomen is a sign of high cortisol.
But cortisol is actually a fat-loss hormone. One of its main functions is the mobilization of stored energy (glucose, fatty acids, and amino acids). It's not a fat-gain hormone.
If cortisol becomes chronically elevated, it can make fat loss harder by decreasing the conversion of the T4 thyroid hormone into the T3 thyroid hormone, which can decrease metabolic rate. But it won't make you obese by reducing metabolic rate by around 5%.
As awful as it is to consider Nazi concentration camp victims, don't you think they had high cortisol levels?
You can't discount the impact of hormones on fat gain and the capacity to lose fat. However, in most obese individuals, these hormonal problems are caused either by chronic overeating or the obesity itself. This is good news. It means you can take responsibility and do something about it.

What Can You Do? Start Here.

1. Accept responsibility. You aren't obese because of some genetic defect, or because of society. If you have a surplus of body fat it's because you've been overeating. If you want to reverse the situation, you'll need to be ready to make changes.
   
2. Measure your food. I know it's annoying, but there's not a big visual difference between 900 and 500 calories. You could easily be overeating 800 (or more) calories per day simply because of oversized portions.
   
3. Slow down on high-fat sauces. At McDonald's, the salad provides more calories than a burger if you use their vinaigrette. You could easily add 400 calories to a meal only from oils or sauces alone. Look for lighter alternatives.
   
4. Don't drink calories. Juices and soft drinks are one of the main causes of over-ingesting calories, and they won't make you satiated.
   
5. Adjust food intake every two weeks if your weight doesn't go down as planned. Lower your caloric intake by a factor of one x body weight (in pounds) per day. For example, if you're 250 pounds, you'd decrease calories by 250 if you're not losing weight. This is also why it's important to record food intake. How can you lower your caloric intake by 250 if you have no idea how many calories you're eating? Don't eyeball it; eyeballing it is what got you there in the first place.
   
6. Go easy on calorie-dense foods. These are foods that provide a lot of calories for a small volume of food. Because of leptin issues, you'll have a bigger appetite and will require more food volume. If you go with foods that are really dense in calories, this can lead to overconsumption of energy. Nuts can be part of a healthy diet, but they provide a very large amount of calories for a small portion. Dried fruits are similar.
   
7. Measure and record your splurges too. Get mentally prepared to hate this task. The last thing anyone wants to do after splurging is recall what and how much they ate. But it'll make you conscious about the caloric impact of pigging out. Also, knowing you're going to have to record your intake will help you make better choices. You'll think twice about what and how much you choose to eat.
   
8. Don't offset six days of eating right by pigging out on the seventh. One binge can destroy your efforts for the week. If you consumed a 500-calorie deficit per day for six days, but ate a 4,000-calorie surplus on Sunday, you might actually gain weight over the week.
   
9. Move more in general. Overweight individuals tend to overestimate how much they move. Always be more active than you think you need to be. You can actually buy a pedometer and shoot for a total of 9,000-10,000 steps per day. While these devices are not 100 percent accurate, they'll help you estimate daily physical activity and will help you know if you're moving enough or not.
   
10. Get more protein. If you want to lose fat, drink a protein shake 10 minutes before your main meals. First, it's very difficult to get fat from protein. More importantly, it'll go a long way to decrease hunger and will help you consume less food at your meals. A thicker protein blend like Metabolic Drive® Protein is the best choice.
    
11. Don't eat while doing other things. Extra distractions can cause you to ignore satiety signals and overeat. More interestingly, by having two sources of stimulation, you'll get a greater pleasure response (dopamine release) in the brain, which won't just make you want to eat more in that moment, it'll make you want to continue the habit of eating while watching... or scrolling as the case may be.
    

Human chorionic gonadotropin (HCG) is an LH (luteninizing hormone) analog. That means it's biochemically similar enough to the LH hormone to interact with the same receptors, so it can be used to turn on the testicular machinery, sperm, and testosterone production.
HCG AND "SIZE" GAINSThere are stories about HCG increasing ejaculation volume (this is true), and increasing penis size. This is true too, but it may only be the case for those with hypogonadism or "micro-penis." The internet chat boards certainly aren't without their stories of slight enlargement with HCG in normal men. In the two studies I found on micro-penis, gains were three-fourths of an inch in length and girth.

?BOOSTED T WITH FEWER SIDE EFFECTS?HCG is a great option for medically boosting testosterone because, unlike testosterone injections, HCG may actually help the hypothalamus gonadal axis as opposed to suppressing it. It also seems to have less impact on estrogen, prostate mass, and cardiovascular parameters compared to the more traditional TRT (testosterone replacement therapy), while being equal or better than TRT in raising testosterone.
This assessment is evidence-based and taken from a well done study on men aged 45-53 with low T. The study compared HCG against transdermal testosterone and two different injectables.
Many doctors give HCG along with their testosterone therapies to keep the hypothalamus working and the testicles from shrinking. Why would the testicles shrink? Testosterone from an outside source turns off the hypothalamus' secretion of LH, and therefore the testicles stop producing sperm and testosterone. This is why ejaculate volume and testicles can shrink in men taking testosterone. This usually isn't a huge issue if the drug isn't abused, but HCG helps keep this from happening.
As an aside, steroids do not shrink the size of the glans penis (the shaft), just the testicles, and only if used in very high amounts for too long.
Using HCG alone is a reliable promoter of testosterone, and may be the safer, more natural option to start with in those with HPG issues. It may also be the best approach for those who've been on testosterone for a long period of time.
DOCTOR PRESCRIBED HCG THERAPIESBased on the studies, there are a few approaches here. If using TRT, then the approach recommended is 250IU of HCG taken as an intramuscular injection (IM) daily. If you're using HCG alone, according to the study above where it was directly compared to TRT, the dose is 2000IU per week.
Most doctors don't like giving such a high dose of HCG all at once for fear of excess estrogen production and desensitization of LH receptors. Although this study didn't show that, it may be a consideration.
Keeping a once daily dose to 500IU or less seems wise, which means you'd be injecting 500IU 1-4 times per week (500IU – 2000IU) for HCG monotherapy.

SEX AND ATHLETIC PERFORMANCEAncient Greeks and Romans believed that athletes should refrain from sex before competition – that they should keep their togas cinched and their knotted loincloths dry. Does that belief hold up to modern scrutiny, though?
Consider the case of Mike Tyson. It was recently disclosed that prior to a bout, the boxer would have sex so that he could vent, geyser like, some of his aggression. He supposedly did this so he wouldn't end up, as he once explained, driving his opponent's "nose-bone" into his brain, killing him.

?According to his former bodyguard, a seething Tyson would "bang the shit" out of women that had been procured and tucked away in bathrooms and changing rooms. After he'd had his sexual fill, Tyson would twist his head to snap the neck vertebrae back into a more harmonious state and say, "Okay, this guy is going to live tonight."
Tyson's approach, contrary as it seems, actually supports what many athletes, coaches, and trainers have believed since ancient Greece – that sex before competition (or even before training itself) is detrimental, that it robs an athlete of aggression, energy, and ultimately, success.
Only, unlike Tyson, most athletes want the aggression and energy that sex supposedly robs them of. Maybe Mickey, Rocky Balboa's trainer, captured the idea the best: "Women weaken legs."
But is it true? Clearly, the issue isn't settled. If you want a little bit of empirical evidence, the organizers of the 2016 Olympics in Rio de Janeiro allocated 450,000 condoms for the 10,000 or so athletes that participated. That breaks down to 350,000 male condoms, 100,000 female condoms, and 175 thousand packets of lube. Breaking it down further, it means roughly 42 condoms per athlete. That's a whole lot of presumed fornication.
Apparently, a lot of athletes didn't believe in the whole abstinence before competition thing, and, as proof of their disbelief, a whole lot of World Records were broken.
I'm skeptical of this empirical evidence, though. To be brutally honest, it's unlikely that so many of those athletes, men or women, could have been 42-condom bone-able. Are we supposed to believe Olympic ping pong players got laid that much?
No, it's more likely that a lot of athletes still believe in the abstinence-before-competition thing and most of the condoms, emblazoned with the Olympic logo, were probably grabbed as souvenirs and taken home to molder in wallets or to hand out as quirky gifts.
But never mind about Tyson, Rocky Balboa, and supposedly super-horny Olympians. What's science say about sexual activity before competition?
There Goes My Testosterone, Into a KleenexThe basis for most of the hesitation about having sex before competition or even heavy training is a fear that ejaculation "draws" testosterone away from the body. The research on whether sex raises or lowers testosterone levels is a little mixed, but the preponderance of evidence suggests that sex increases T levels. However, the amount we're talking about is so small and so transient that it wouldn't have any effects on performance.
The converse is true, too. Even if sex caused testosterone to drop, the amount is so small as to be insignificant. Testosterone isn't like the glowing potions seen in sci-fi movies where you drink it and suddenly get all muscley and bust out of your Hilfigers.
Nope, you could even shoot some directly into a vein before a competition or workout and it wouldn't much help you. It just doesn't work that way. The visible or noticeable effects of testosterone occur over time – days, weeks, or months, not minutes or hours.
But let's look at some of the studies anyhow. One study conducted on sedentary males in 1995 (Boone and Gilmore) found that sex didn't affect performance on cyclo-ergometry if it took place 10 hours before exercise. There was, however, a slight negative effect – in the form of a slightly elevated heart rate – if it took place less than two hours before exercise.
Another, conducted in 2000 (McGlone and Shrier), found that sexual activity conducted the night before testing didn't affect hand-grip strength, which, I guess, is reassuring to sexually active professional arm wrestlers and mountain climbers.
One study compared the effects of different sexual behaviors in baseball and soccer (Fisher, 1997). Soccer players, more than baseball players, practice abstinence before matches and the researchers theorized that this abstinence had some positive effects on their performance, like allowing them to fake injuries with much more gusto.
Likewise, a study involving amateur runners (Sztajel, 2000) seemed to indicate that pre-race sex had positive effects on performance.
Only one decent study involved women (Johnson, 1968). The participants were all former athletes (ages 24 to 49), and they were all tested twice, once the morning after sex and once six days after. Neither situation had any effect on strength, as measured by a dynamometer (a device that measures grip strength).
As far as post-sex testosterone levels, the results of studies are conflicting. Hengevoss, et al. (2015) found no changes in T levels after sex. But another study, this one involving four heterosexual couples, found that test levels increased on evenings when the couples had sex and decreased when they didn't.

So, What Do We Make of These Studies?If we based our conclusions on the studies, we might conclude that sex before competition doesn't really have much of an effect on strength or VO2 max.
However, we might also conclude that sex before competition seemed to help athletes who were involved in matches where endurance was a factor (running). Maybe it's like rowing. In that sport, a single piece of seaweed, stuck to your scull, can create just enough drag to affect the outcome of the race. Maybe testicles and prostates that are still carrying a full load of spunk create drag, too. Nah, I'm kidding. Probably.
Instead, the researchers assumed that perhaps the slight increase in post-sex testosterone might have helped the runners endure the rigors of a long race, but that seems unlikely as any rise in post-sex testosterone would be insignificant and transitory.
One thing that chafes my mental ball-sack, though, is that "sex" is rarely defined in any of these studies. As most any non-incel knows, there's routine husband and wife, "Honey, hurry up and finish please because I've got an early morning" sex, which burns up about three calories, and there's just-picked-up-a-Hooter's-waitress-sex that may or may not involve a bed and more likely involves lots of hoisting and carrying and Cirque du Soleil type moves in general.
The latter, it surely can be concluded, potentially elevates testosterone levels significantly more than the former. However, it's also more exhausting, which will likely affect sports performance.
It seems that the lack of this type of clarity in the definition of sex in these many studies is a confounding factor.
 
Another Forgotten Possible VariableNowhere in the studies did I see a consideration of the hormone oxytocin, commonly known as the "love" or "cuddle" hormone. Oxytocin is a hormone neurotransmitter that's thought to be a driving force behind attraction and caregiving. It's released in both men and women after sex. It makes them want to snuggle.
If research is to be believed, it's not something you want to have an abundance of during a boxing match, cage match, or football game. Too much and a defensive lineman, after taking down a quarterback, might feel an inclination to spoon him, which might result in a 15-yard penalty for personal encroachment.
Of course, new research indicates the oxytocin might act like the volume dial on an old radio, amplifying whatever activity someone is already experiencing, be it love-making or pounding the snot out of an opponent. Even if that's true, though, the rise in the hormone is too transitory to have much of an effect, unless of course sex took place immediately before competition, like between the National Anthem and the kick-off, face-off, jump ball, or opening bell.
But oxytocin introduces another possible variable – post-sex relaxation.

Beyond Ball-Sack Weight and HormonesPlenty of sports aren't about aggression, power, or drive. Many are finesse sports where calmness and steady nerves rule – things like sharpshooting, archery, or golf. Sex might serve these activities well. There are also instances when an athlete might want to quell aggression, as in exceptionally aggressive boxers who want to avoid killing someone, ala Mike Tyson.
Conversely, prolonged abstinence might fuel frustration and, ipso facto, aggression, which in many sports can lead to better results. This is half of the "inverted U" sports psychology hypothesis. Lack of sex equals better performance, while sexual fulfillment can reduce the desire for sports success. In primal terms, why work hard for the rewards of victory, i.e., nookie, if you've already had some nookie?

What About Weight Training?There's a faction of trainers and scientists that believe that weight training keeps testosterone levels steady and thus makes lifters immune to the alleged T-robbing effects of sex. Maybe, but a decent amount of research shows that weightlifting causes a decline in testosterone levels, sometimes for a couple of days, post-workout.
Of course, this might stem from the steroid receptors actually "sopping up" a lot of serum testosterone, thus making it look like the blood sample of a lifter is testosterone sparse.
Regardless, it seems that non-competitive lifters and strength athletes shouldn't pay much attention to the sex and performance issue, anyhow, unless they're preparing for an especially heavy lifting day or are hoping to break some personal records.
It may be different for strength athletes who compete, though. In their case, they're probably asking the same questions as any other competitive athlete: to screw or not to screw?

To Screw or Not to Screw?If we consider the research, what we know about hormones, what we know about the emotional consequences of sex and the inherent variables of individual sports, we can come up with the following generalizations about sex before competition or even a hard training session:

• If you're involved in a sport where calmness and a steady hand is paramount, sex in the hours before competition might give you an advantage.
  
• If you're involved in a sport where aggression and hatred of your opponent is the equivalent to a performance-enhancing drug, then abstinence might give you an advantage. (And by abstinence, I'm talking about days or weeks.)
  
• However, if you can't help yourself and the lure of the animal is just too strong, probably try to refrain from sex – at least Flying Wallenda sex – for at least 10 hours before competition.