Bubble gut – VAT, SAT, both - or something else

[mcs]

Somehow I've developed a distended abdomen/hard belly and umbilical hernia (inverted navel) similar to the attached photo. I cannot tell if it's visceral adipose tissue (VAT) or subcutaneous abdominal adipose tissue (SAT) - perhaps both. I cannot see my abs even when I flex so there's SAT. It's not just on the lower part of abdomen but on the upper as well. I don't take any AAS or GH. Not on T but need to address that since my levels are in the tank. The subcutaneous fat is there but I can only pinch an inch when I tighten my abs. It's the musculature underneath that has shaped into a bubble and is hard. At the end of a day of eating/drinking fluids, it gets pretty noticeable, like blowing up a balloon with the navel sticking out. By morning, it somewhat dissipates.

Abdominal ultrasound did not reveal any VAT (at least not reported) nor any abnormalities. The hepatic hemangioma in the report is benign.

Colonoscopy revealed a grade 3 hiatal hernia of which I am asymptomatic.

Diet is clean, approx 2000kcals/day 35-40% protein, 15-20% carbs, 40-50% fats

I've been this weight before and did not have this bubble gut or inverted navel. Losing weight doesn't seem to shrink the bubble.

What the hell is this and what can I do?

 

[Vince]

Somehow I've developed a distended abdomen/hard belly and umbilical hernia (inverted navel) similar to the attached photo. I cannot tell if it's visceral adipose tissue (VAT) or subcutaneous abdominal adipose tissue (SAT) - perhaps both. I cannot see my abs even when I flex so there's SAT. It's not just on the lower part of abdomen but on the upper as well. I don't take any AAS or GH. Not on T but need to address that since my levels are in the tank. The subcutaneous fat is there but I can only pinch an inch when I tighten my abs. It's the musculature underneath that has shaped into a bubble and is hard. At the end of a day of eating/drinking fluids, it gets pretty noticeable, like blowing up a balloon with the navel sticking out. By morning, it somewhat dissipates.

Abdominal ultrasound did not reveal any VAT (at least not reported) nor any abnormalities. The hepatic hemangioma in the report is benign.

Colonoscopy revealed a grade 3 hiatal hernia of which I am asymptomatic.

Diet is clean, approx 2000kcals/day 35-40% protein, 15-20% carbs, 40-50% fats

I've been this weight before and did not have this bubble gut or inverted navel. Losing weight doesn't seem to shrink the bubble.

What the hell is this and what can I do?

Visceral Fat: What It is & How to Get Rid of It

Visceral fat is a type of belly fat that lies deep within your abdominal walls and surrounds your organs. You can get rid of it with a healthy diet and exercise.

my.clevelandclinic.org

 

[BigTex]

Somehow I've developed a distended abdomen/hard belly and umbilical hernia (inverted navel) similar to the attached photo. I cannot tell if it's visceral adipose tissue (VAT) or subcutaneous abdominal adipose tissue (SAT) - perhaps both. I cannot see my abs even when I flex so there's SAT. It's not just on the lower part of abdomen but on the upper as well. I don't take any AAS or GH. Not on T but need to address that since my levels are in the tank. The subcutaneous fat is there but I can only pinch an inch when I tighten my abs. It's the musculature underneath that has shaped into a bubble and is hard. At the end of a day of eating/drinking fluids, it gets pretty noticeable, like blowing up a balloon with the navel sticking out. By morning, it somewhat dissipates.

Abdominal ultrasound did not reveal any VAT (at least not reported) nor any abnormalities. The hepatic hemangioma in the report is benign.

Colonoscopy revealed a grade 3 hiatal hernia of which I am asymptomatic.

Diet is clean, approx 2000kcals/day 35-40% protein, 15-20% carbs, 40-50% fats

I've been this weight before and did not have this bubble gut or inverted navel. Losing weight doesn't seem to shrink the bubble.

What the hell is this and what can I do?

From what I can see from the picture, this is most likely Diastasis Recti. This frequently happens in postpartum women but also can happen in men, typically men who lift heavy. It is caused by weakness and separation of the muscles in the mid-abdomen. I have seen it very common in bodybuilders and powerlifters who do heavy squats. Most learn to protect the spine when squatting you have to create intrabdominal pressure causing a natural belt protecting the spine. When using the belt we are taught to press the abdomen against the belt when squatting. Over time, this can cause a stretching of the linea alba (center of the abs) as see in the the picture below.

Many of our top IFBB Pro BB'ers have this issue. Ronnie Coleman had to work hard to control his abs. You can see in the picture below the stretching of the linea alba



Here is a view where he is relaxed

As you see, this guy is not fat, sub-1 of visceral yet he has a gut. Its not the GH or IGF-1. It is damage to the linea alba. You can look at ab shots of most competitive BB'ers and many of them have the separation in the center of the abs.

 

[mcs]

From what I can see from the picture, this is most likely Diastasis Recti. This frequently happens in postpartum women but also can happen in men, typically men who lift heavy. It is caused by weakness and separation of the muscles in the mid-abdomen. I have seen it very common in bodybuilders and powerlifters who do heavy squats. Most learn to protect the spine when squatting you have to create intrabdominal pressure causing a natural belt protecting the spine. When using the belt we are taught to press the abdomen against the belt when squatting. Over time, this can cause a stretching of the linea alba (center of the abs) as see in the the picture below.
View attachment 29390
Many of our top IFBB Pro BB'ers have this issue. Ronnie Coleman had to work hard to control his abs. You can see in the picture below the stretching of the linea alba



Here is a view where he is relaxed

View attachment 29391


As you see, this guy is not fat, sub-1 of visceral yet he has a gut. Its not the GH or IGF-1. It is damage to the linea alba. You can look at ab shots of most competitive BB'ers and many of them have the separation in the center of the abs.

So, if that's the case, I can't think of what caused it. What do I do to correct it? I don't squat these days, only work legs once a week and do leg press when I do. Where I was lifting heavy was doing standing BB curls.

I am attaching actual photos of myself. No amount of dieting or cardio seems to make much difference. I notice when I do crunches, I notice what looks like like a ridge, which runs down the middle of the belly area. I've had that for the last several years. I have no discomfort or pain.

 

[BigTex]

If this is the case, there are exercises you can do that may help. First you may want to check to see if you have it. To do this, lay on your back, knees up and lift your head up and hold it. Place your finger in the center of your abs and light press. One finger 1st, if you have more than one finger your have separation. Place two fingers, 3 fingers etc until you find our how many fingers separation there is. Then you can go above and below the umbilical and find out how long it is. small separations can be corrected with exercise but more than two fingers the internal organs can push through some and cause the abdomen to resemble a half football shape when you do a crunch. Severe cases like this will need surgery if you decide to correct it.

If you have this problem, avoid any exercises that will place direct pressure on your stomach, which can cause your midsection to bulge or worsen muscle separation. No sit-ups, crunches are any variations. These exercises may cause abdominal pain and potentially worsen your muscle separation.

Here is a good exercise:

Here are a few more you can do at home:

 

[mcs]

If this is the case, there are exercises you can do that may help. First you may want to check to see if you have it. To do this, lay on your back, knees up and lift your head up and hold it. Place your finger in the center of your abs and light press. One finger 1st, if you have more than one finger your have separation. Place two fingers, 3 fingers etc until you find our how many fingers separation there is. Then you can go above and below the umbilical and find out how long it is. small separations can be corrected with exercise but more than two fingers the internal organs can push through some and cause the abdomen to resemble a half football shape when you do a crunch. Severe cases like this will need surgery if you decide to correct it.

If you have this problem, avoid any exercises that will place direct pressure on your stomach, which can cause your midsection to bulge or worsen muscle separation. No sit-ups, crunches are any variations. These exercises may cause abdominal pain and potentially worsen your muscle separation.

Here is a good exercise:

Here are a few more you can do at home:

Big difference from the above photos: 20lbs lighter and did not have this issue. I am perplexed as to why this wasn't diagnosed from my ultrasound I linked above since ultrasounds are used to diagnose IRD. Maybe because they were focusing on the internal organs.

 

[BigTex]

From what I can see you have, it is very similar to a hernia.....where the lenia alba is stretched to the point the whole abdominal region has stretched and distended. I can also see in the above picture that you have a larger than 2 finger separation in the center of the upper abs. Maybe your primary care physican can determine if you have this.

 

[mcs]

From what I can see you have, it is very similar to a hernia.....where the lenia alba is stretched to the point the whole abdominal region has stretched and distended. I can also see in the above picture that you have a larger than 2 finger separation in the center of the upper abs. Maybe your primary care physican can determine if you have this.

So I tried the exercise and can only fit one finger. But there is a ridge/bulge when I do which is described here. So I still don't know for sure. Can the abdominal region still stretch and distend without separation? Will need to get to a doc that can properly diagnose it.

 

[BigTex]

I understand your concern. I have the same problem but mine is severe. If I do a sit up it looks like I have a football in the center of my abs. I never had this until the late 30's when my squats started getting very heavy. I have very little body fat but have bad abdominal distension. Of course insurance will not fix this because it is considered cosmetic. So I just live with it. After 27 year competing as a powerlifter, that is the least of my concerns. Let me know how this turns out,.

That ridge or bulge means the linea alba has become weak and thin and the internal organs are pushing upward when you put pressure on the abs.

 

[Nelson Vergel]

Tell your doctor to send an order for a one
Slice L4-L5 CT scan. You will have to pay cash since it’s not cover by insurance. Around 300 dollars.

 

[Nelson Vergel]

Steroid Belly: Anabolic Steroids Increase Visceral and Decrease Subcutaneous Fat in Bodybuilders

Reason for the steroid belly? Clin Endocrinol (Oxf). 2017 Sep;87(3):249-256. doi: 10.1111/cen.13372. Epub 2017 Jun 8. Insulin sensitivity in relation to fat distribution and plasma adipocytokines among abusers of anabolic androgenic steroids. Rasmussen JJ1,2, Schou M2,3, Selmer C1, Johansen...

www.excelmale.com

 

[BigTex]

Steroid Belly: Anabolic Steroids Increase Visceral and Decrease Subcutaneous Fat in Bodybuilders

Reason for the steroid belly? Clin Endocrinol (Oxf). 2017 Sep;87(3):249-256. doi: 10.1111/cen.13372. Epub 2017 Jun 8. Insulin sensitivity in relation to fat distribution and plasma adipocytokines among abusers of anabolic androgenic steroids. Rasmussen JJ1,2, Schou M2,3, Selmer C1, Johansen...

www.excelmale.com

I do have some concerns with this study, especially when they use the term "Abuse of anabolic androgenic steroids. What exactly is steroids abuse, and what exact steroids are being abused? When I see this term being use I suspect some bias. Could the term anabolic steroid user's shown less bias?

Then I see this:

Funding Information
AntiDoping Denmark (grant number: N/A), Research Foundation of Herlev Hospital (grant number: N/A), Danish Heart Foundation (grant number: 15-R99-A5797-22952), Faculty Scholarship from University of Copenhagen to JJR (grant number: N/A). The financial sources had no role in study design, conduction of study, statistical analyses, writing of manuscript or decision to publish final version of manuscript

Any way, I would certainly like to see more work done in this area as these findings are interesting.

Noticed also that in the Elbers etal (1997) study that the increase in visceral fat was most pronounced in those subjects who had gained weight. The changes in weight ranged from −10.0 to 9.6 kg after 1 yr and from −9.0 kg to 13.9 kg after 3 yr of treatment.

Were these gains from diet, or sedentary life styles or perhaps both. What is the leading cause of visceral fat? Poor diet and lack of exercise, which is especially a danger as you age because it increases your health risks

Jolanda M. H. Elbers, Henk Asscheman, Jacob C. Seidell, Jos A. J. Megens, Louis J. G. Gooren, Long-Term Testosterone Administration Increases Visceral Fat in Female to Male Transsexuals, The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 7, 1 July 1997, Pages 2044–2047, Long-Term Testosterone Administration Increases Visceral Fat in Female to Male Transsexuals1​

Effects of androgen therapy on adipose tissue and metabolism in older men - PubMed

We investigated the effects of oxandrolone on regional fat compartments and markers of metabolism. Thirty-two 60- to 87-yr-old men (body mass index, 28.1 +/- 3.4 kg/m(2)) were randomized to oxandrolone (20 mg/d; n = 20) or matching placebo (n = 12) treatment for 12 wk. Oxandrolone reduced total...

pubmed.ncbi.nlm.nih.gov

Got to be specific when we talk about anabolic steroids, case in point:

By magnetic resonance imaging, visceral adipose tissue decreased (-20.9 +/- 12 cm(2); P < 0.001), abdominal sc adipose tissue (SAT) declined (-10.7 +/- 12.1 cm(2); P = 0.043), the ratio VAT/SAT declined from 0.57 +/- 0.23 to 0.49 +/- 0.19 (P = 0.002), and proximal and distal thigh SC fat declined [-8.3 +/- 6.7 cm(2) (P < 0.001) and -2.2 +/- 3.0 kg (P = 0.004), respectively]. Changes in proximal and distal thigh SC fat with oxandrolone were different than with placebo (P = 0.018 and P = 0.059). A marker of insulin sensitivity (quantitative insulin sensitivity check index) improved with oxandrolone by 0.0041 +/- 0.0071 (P = 0.018) at study wk 12. Changes in total fat, abdominal SAT, and proximal extremity SC fat were correlated with changes in fasting insulin from baseline to study wk 12 (r >or= 0.45; P < 0.05). Losses of total fat and SAT were greater in men with baseline testosterone of 10.4 nmol/liter or less (<or= 300 ng/dl) than in those with higher levels [-2.5 +/- 1.1 vs. -1.5 +/- 0.8 kg (P = 0.036) and -24.1 +/- 14.3 vs. -2.9 +/- 21.3 cm(2) (P = 0.03), respectively]. Twelve weeks after discontinuing oxandrolone, 83% of the reductions in total, trunk, and extremity fat by dual energy x-ray absorptiometry scanning were sustained (P < 0.02). Androgen therapy, therefore, produced significant and durable reductions in regional abdominal and peripheral adipose tissue that were associated with improvements in estimates of insulin sensitivity.

Might be we need to also look into aromatization of anabolic steroids. The more the ability to aromatize the greater the impact of estrogen on the estrogen receptors. One unique trait about oxandrolone as well as several other more anabolic steroids is that it doesn’t aromatize into estrogen or directly affect estrogen receptors.

Suspecting that some anabolic steroids might cause visceral fat one may need to add exercise to fight this. One thing for sure, pros do that most recreational lifers don't do much of is added cardio, particularly HIIT:

Conclusions: HIIT was well accepted by overweight adults, and opting for HIIT as an alternative to standard exercise recommendations led to no difference in health outcomes after 12 months. Although regular participation in unsupervised HIIT declined rapidly, those apparently adherent to regular HIIT demonstrated beneficial weight loss and visceral fat reduction.

High-Intensity Interval Training in the Real World: Outcomes from a 12-Month Intervention in Overweight Adults - PubMed

Australian New Zealand Clinical Trials Registry (ACTRN12615000010594), retrospectively registered.

pubmed.ncbi.nlm.nih.gov

OK, weight training is basically HIIT. Brief periods of high intensity followed by periods of rest, so does it help burn visceral fat?

Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE randomized trial - PubMed

Increased intensity in high volume training is efficient in improving visceral fat loss and carotid-intima-media-thickness, and is realistic in community dwelling, moderately obese individuals. High-intensity-resistance training induced a faster visceral fat loss, and thus the potential of...

pubmed.ncbi.nlm.nih.gov

Conclusion: Increased intensity in high volume training is efficient in improving visceral fat loss and carotid-intima-media-thickness, and is realistic in community dwelling, moderately obese individuals. High-intensity-resistance training induced a faster visceral fat loss, and thus the potential of resistance training should not be undervalued. All of these Cooper Clinic guys must be choking on this one. Aerobic training is not so effective because of the word "intensity."

 

[Guided_by_Voices]

A few ideas...1) Your report that this dissipates somewhat overnight suggests a possible digestive issue as well. You might want to investigate digestive enzymes and doing a multi-day fast. The fast would obviously not be a permanent fix but if that resolved the problem temporarily it would be a major clue that the issue is digestive. 2) I have heard numerous reports of people who went on a carnivore diet and had this issue resolve, which again is an easy low-risk thing to try and would again point toward digestion. 3) You maybe dealing with something like SIBO or some other related micro-biome/intestinal issue. 4) I have noticed that I have the least bloating and am at my abdominal leanest when I microdose metformin so that is another thing to try and it is reported to improve the gut-bacteria composition by raising akkermansia. For me microdosing is 250mg no more than once per day and only before a high-carb meal which I only do a couple of times per week, if at all. 5) I have heard of infections such as fungal infections causing something similar so that another thing to check. 6) If you have not had your insulin checked that is another thing to try. I have heard a theory that insulin resistance causes the involuntary layer of muscle that holds the organs in place to be unable to intake insulin and therefore become weaker which allows the organs to extend out, however that seem unlikely to resolve at night so I would not make that the highest priority. It also explains a lot (but not all) of the bodybuilder gut problems since both high-dose GH and injecting insulin would both promote insulin resistance. 7) And finally, speaking of HIIT, I have recently gotten more disciplined about focusing on sled pushing, and I would say it is one of the best overall exercises you can do, takes very little time, and will give you a serious HIIT workout, so I would try that no matter what, at least once you get your hormones sorted out.

 

[BigTex]

Here is another study I found I wanted to add to this discussion


Shalender Bhasin, Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression, Clinical Infectious Diseases, Volume 37, Issue Supplement_2, September 2003, Pages S142–S149, Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression

Testosterone administration to middle-aged men is associated with decreased visceral fat and glucose concentrations and increased insulin sensitivity. Testosterone infusion increases coronary blood flow. Similarly, testosterone replacement retards atherogenesis in experimental models of atherosclerosis.​

Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression

Plus this earlier study:

Atam B. Singh, Stanley Hsia, Petar Alaupovic, Indrani Sinha-Hikim, Linda Woodhouse, Thomas A. Buchanan, Ruoquing Shen, Rachelle Bross, Nancy Berman, Shalender Bhasin, The Effects of Varying Doses of T on Insulin Sensitivity, Plasma Lipids, Apolipoproteins, and C-Reactive Protein in Healthy Young Men, The Journal of Clinical Endocrinology & Metabolism, Volume 87, Issue 1, 1 January 2002, Pages 136–143, Effects of Varying Doses of T on Insulin Sensitivity, Plasma Lipids, Apolipoproteins, and C-Reactive Protein in Healthy Young Men

To determine the effects of different doses of T, 61 eugonadal men, 18–35 yr of age, were randomly assigned to 1 of 5 groups to receive monthly injections of long-acting GnRH agonist to suppress endogenous T secretion and weekly injections of 25, 50, 125, 300, or 600 mg T enanthate for 20 wk. Dietary energy and protein intakes were standardized.​

​

Over a wide range of doses, including those associated with significant gains in fat-free mass and muscle size, T had no adverse effect on insulin sensitivity, plasma lipids, apolipoproteins, or C-reactive protein. Only the highest dose of T (600 mg/wk) was associated with a reduction in plasma high density lipoprotein cholesterol and apolipoprotein A-I.​

Effects of Varying Doses of T on Insulin Sensitivity, Plasma Lipids, Apolipoproteins, and C-Reactive Protein in Healthy Young Men

Insulin

The effects of T administration on glucose metabolism and insulin sensitivity remain poorly understood. Total T levels are inversely related to insulin concentrations in several cross-sectional studies (39, 42–45). Fasting insulin levels are higher and T and SHBG values are lower in men with type 2 diabetes mellitus (39). Haffner et al. ( 39) reported that lower T levels were correlated with a higher waist/hip ratio and lower nonoxidative, whole body glucose disposal in men. Administration of exogenous androgens has been reported to induce glucose intolerance and hyperinsulinemia in some studies (20–22), but other studies found no significant changes in glucose tolerance or insulin concentrations with administration of T or 19-nor-T to men even at pharmacological doses (46). A marked lowering of T levels in the male rat by surgical castration as well as the administration of supraphysiological doses of T induces insulin resistance (20). This suggests that the relationship between T levels and insulin sensitivity might be curvilinear. Our study failed to find any significant changes in SI, SG, and AIRG in any treatment group over a wide range of serum T concentrations. Our data differ from those of Marin (17–19, 47), who reported improvements in insulin sensitivity, blood glucose, and blood pressure after T supplementation in middle-aged men who had visceral obesity and low T levels. In contrast to the studies by Marin et al. (17–19, 47), the subjects in our study were younger and had significantly lower fat mass. Marin et al. used euglycemic-hyperinsulinemic clamp, whereas we used frequently sampled iv glucose tolerance test to assess insulin sensitivity; we do not know whether the differences in methodology could have contributed to the observed differences in outcomes. We cannot exclude the possibility that in middle-aged men with midsegment obesity, T might decrease whole body and intraabdominal fat and thereby improve insulin sensitivity.​

Here is another relevant study on muscle mass and gynoid fat or fat around the hips, thighs and chest areas.

Cite

• Nordström, Anna; Högström, Gabriel; Eriksson, Anders; Bonnerud, Patrik; Tegner, Yelverton; Malm, Christer. Higher Muscle Mass but Lower Gynoid Fat Mass in Athletes Using Anabolic Androgenic Steroids. Journal of Strength and Conditioning Research 26(1) 246-250, January 2012. | DOI: 10.1519/JSC.0b013e318218daf0

​

Thus, long-term AAS use seems to alter body constitution, favoring higher muscle mass and reduced gynoid fat mass without affecting BMD (bone mass density).​

​

Intake pattern was examined through extensive interviews and questionnaires. Ten of the athletes had used various AAS substances such as testosterone (oral and injectable anabolic steroids [250–2,000 mg·wk−1]), dianabole (Methandrostenolone, oral anabolic steroid [50–350 mg·wk−1]), deca-durabolin (Nandrolone Decanoate, injectable anabolic steroid [200–7,000 mg·wk−1]), boldenone (Boldenone undecylenated, injectable anabolic steroid [500–1,000 mg·wk−1]), and anadrol (Oxymetholone, oral anabolic steroid [175 mg·wk−1]) and also substances such as insulin (injected [10–12 IU·d−1]), insulin-like growth factor-1 (injectable growth protein [50 mg·d−1]), GH (Growth Hormone, injected [4–6 IU·d−1; 6 d·wk−1]), Ephedrine (oral appetite suppressor [60 mg·d−1]) and HCG (human chorionic gonadotropin, injectable glycoprotein hormone [10,000 IU total]). The substances had been used in different combinations and doses for a period of 5–15 years; thus, the exact doses are not possible to determine.​

Again, I am not fond of the term "abuse" or "doping."

But this study concluded: Increased percent lean body mass and decreased adipose tissue appear to be a result of long-term AAS abuse.​

 

[mcs]

Tell your doctor to send an order for a one
Slice L4-L5 CT scan. You will have to pay cash since it’s not cover by insurance. Around 300 dollars.

I'm assuming to check for herniated discs, disc degeneration, etc.? I've had painful episodes of lumbar issues on either side for the last several years from unintentional hyper-extending of the back during heavy lifts.

 

[mcs]

A few ideas...1) Your report that this dissipates somewhat overnight suggests a possible digestive issue as well. You might want to investigate digestive enzymes and doing a multi-day fast. The fast would obviously not be a permanent fix but if that resolved the problem temporarily it would be a major clue that the issue is digestive. 2) I have heard numerous reports of people who went on a carnivore diet and had this issue resolve, which again is an easy low-risk thing to try and would again point toward digestion. 3) You maybe dealing with something like SIBO or some other related micro-biome/intestinal issue. 4) I have noticed that I have the least bloating and am at my abdominal leanest when I microdose metformin so that is another thing to try and it is reported to improve the gut-bacteria composition by raising akkermansia. For me microdosing is 250mg no more than once per day and only before a high-carb meal which I only do a couple of times per week, if at all. 5) I have heard of infections such as fungal infections causing something similar so that another thing to check. 6) If you have not had your insulin checked that is another thing to try. I have heard a theory that insulin resistance causes the involuntary layer of muscle that holds the organs in place to be unable to intake insulin and therefore become weaker which allows the organs to extend out, however that seem unlikely to resolve at night so I would not make that the highest priority. It also explains a lot (but not all) of the bodybuilder gut problems since both high-dose GH and injecting insulin would both promote insulin resistance. 7) And finally, speaking of HIIT, I have recently gotten more disciplined about focusing on sled pushing, and I would say it is one of the best overall exercises you can do, takes very little time, and will give you a serious HIIT workout, so I would try that no matter what, at least once you get your hormones sorted out.

Thanks. SIBO has been a likely issue. Already on Metformin (as a geroprotective and prediabetes prevention) and have been taking betaine HCL and pancreatin for years. I have done extensice gut biome testing. I tend toward IR, hence the metformin and many other supplements + LC diet. Working on balancing the gut is a lifelong and never-ending pursuit!

 

[Fernando Almaguer]

Here is another study I found I wanted to add to this discussion


Shalender Bhasin, Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression, Clinical Infectious Diseases, Volume 37, Issue Supplement_2, September 2003, Pages S142–S149, Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression

Testosterone administration to middle-aged men is associated with decreased visceral fat and glucose concentrations and increased insulin sensitivity. Testosterone infusion increases coronary blood flow. Similarly, testosterone replacement retards atherogenesis in experimental models of atherosclerosis.​

Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression

Plus this earlier study:

Atam B. Singh, Stanley Hsia, Petar Alaupovic, Indrani Sinha-Hikim, Linda Woodhouse, Thomas A. Buchanan, Ruoquing Shen, Rachelle Bross, Nancy Berman, Shalender Bhasin, The Effects of Varying Doses of T on Insulin Sensitivity, Plasma Lipids, Apolipoproteins, and C-Reactive Protein in Healthy Young Men, The Journal of Clinical Endocrinology & Metabolism, Volume 87, Issue 1, 1 January 2002, Pages 136–143, Effects of Varying Doses of T on Insulin Sensitivity, Plasma Lipids, Apolipoproteins, and C-Reactive Protein in Healthy Young Men

To determine the effects of different doses of T, 61 eugonadal men, 18–35 yr of age, were randomly assigned to 1 of 5 groups to receive monthly injections of long-acting GnRH agonist to suppress endogenous T secretion and weekly injections of 25, 50, 125, 300, or 600 mg T enanthate for 20 wk. Dietary energy and protein intakes were standardized.​

​

Over a wide range of doses, including those associated with significant gains in fat-free mass and muscle size, T had no adverse effect on insulin sensitivity, plasma lipids, apolipoproteins, or C-reactive protein. Only the highest dose of T (600 mg/wk) was associated with a reduction in plasma high density lipoprotein cholesterol and apolipoprotein A-I.​

Effects of Varying Doses of T on Insulin Sensitivity, Plasma Lipids, Apolipoproteins, and C-Reactive Protein in Healthy Young Men

Insulin

The effects of T administration on glucose metabolism and insulin sensitivity remain poorly understood. Total T levels are inversely related to insulin concentrations in several cross-sectional studies (39, 42–45). Fasting insulin levels are higher and T and SHBG values are lower in men with type 2 diabetes mellitus (39). Haffner et al. ( 39) reported that lower T levels were correlated with a higher waist/hip ratio and lower nonoxidative, whole body glucose disposal in men. Administration of exogenous androgens has been reported to induce glucose intolerance and hyperinsulinemia in some studies (20–22), but other studies found no significant changes in glucose tolerance or insulin concentrations with administration of T or 19-nor-T to men even at pharmacological doses (46). A marked lowering of T levels in the male rat by surgical castration as well as the administration of supraphysiological doses of T induces insulin resistance (20). This suggests that the relationship between T levels and insulin sensitivity might be curvilinear. Our study failed to find any significant changes in SI, SG, and AIRG in any treatment group over a wide range of serum T concentrations. Our data differ from those of Marin (17–19, 47), who reported improvements in insulin sensitivity, blood glucose, and blood pressure after T supplementation in middle-aged men who had visceral obesity and low T levels. In contrast to the studies by Marin et al. (17–19, 47), the subjects in our study were younger and had significantly lower fat mass. Marin et al. used euglycemic-hyperinsulinemic clamp, whereas we used frequently sampled iv glucose tolerance test to assess insulin sensitivity; we do not know whether the differences in methodology could have contributed to the observed differences in outcomes. We cannot exclude the possibility that in middle-aged men with midsegment obesity, T might decrease whole body and intraabdominal fat and thereby improve insulin sensitivity.​

Here is another relevant study on muscle mass and gynoid fat or fat around the hips, thighs and chest areas.

Cite

• Nordström, Anna; Högström, Gabriel; Eriksson, Anders; Bonnerud, Patrik; Tegner, Yelverton; Malm, Christer. Higher Muscle Mass but Lower Gynoid Fat Mass in Athletes Using Anabolic Androgenic Steroids. Journal of Strength and Conditioning Research 26(1) 246-250, January 2012. | DOI: 10.1519/JSC.0b013e318218daf0

​

Thus, long-term AAS use seems to alter body constitution, favoring higher muscle mass and reduced gynoid fat mass without affecting BMD (bone mass density).​

​

Intake pattern was examined through extensive interviews and questionnaires. Ten of the athletes had used various AAS substances such as testosterone (oral and injectable anabolic steroids [250–2,000 mg·wk−1]), dianabole (Methandrostenolone, oral anabolic steroid [50–350 mg·wk−1]), deca-durabolin (Nandrolone Decanoate, injectable anabolic steroid [200–7,000 mg·wk−1]), boldenone (Boldenone undecylenated, injectable anabolic steroid [500–1,000 mg·wk−1]), and anadrol (Oxymetholone, oral anabolic steroid [175 mg·wk−1]) and also substances such as insulin (injected [10–12 IU·d−1]), insulin-like growth factor-1 (injectable growth protein [50 mg·d−1]), GH (Growth Hormone, injected [4–6 IU·d−1; 6 d·wk−1]), Ephedrine (oral appetite suppressor [60 mg·d−1]) and HCG (human chorionic gonadotropin, injectable glycoprotein hormone [10,000 IU total]). The substances had been used in different combinations and doses for a period of 5–15 years; thus, the exact doses are not possible to determine.​

Again, I am not fond of the term "abuse" or "doping."

But this study concluded: Increased percent lean body mass and decreased adipose tissue appear to be a result of long-term AAS abuse.​

@Nelson Vergel even though this conclusion here was made... there is some doubt as to whether or not aas are good for visceral fat, correct?

 

[BigTex]

Fernando, I think the reports saying AAS cause visceral fat and insulin resistance are dead wrong. There are quite a few studies that have shown this is not true as well. Plus, lots of TRT and BB'ers who have seen the opposite. No one really knows what exactly is causing the bubble gut, I know a lot of it is diastasi recti, some distension caused from eating 7500-10,00 calories per day, some feel hGH and the use of insulin could be the cause. No doubt heavy weight BB'ers are much larger and weight much more at contest that they did 40-50 years ago, they are also lifting much more weight that they use to in the past. You absolutely can't lift heave weight as a 300lb man had nave a 27" waste. You absolutely have to have a core that will support the spine and the weight. Will we ever find out what is causing this? I doubt it because it is not that important to science.

 

[BigTex]

Here is another study

Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Nonobese Aging Men

Abstract. Background: Trials of testosterone therapy in aging men have demonstrated increases in fat-free mass (FFM) and skeletal muscle and decreases in f

academic.oup.com

Conclusion: Testosterone therapy, relative to placebo, selectively lessened visceral fat accumulation without change in total body FM and increased total body FFM and total body and thigh skeletal muscle mass. Further studies are needed to determine the impact of these body compositional changes on markers of metabolic and cardiovascular risk.

 

[Fernando Almaguer]

Here is another study

Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Nonobese Aging Men

Abstract. Background: Trials of testosterone therapy in aging men have demonstrated increases in fat-free mass (FFM) and skeletal muscle and decreases in f

academic.oup.com

Conclusion: Testosterone therapy, relative to placebo, selectively lessened visceral fat accumulation without change in total body FM and increased total body FFM and total body and thigh skeletal muscle mass. Further studies are needed to determine the impact of these body compositional changes on markers of metabolic and cardiovascular risk.

well, that is the polar opposite conclusion!