Nelson Vergel
Founder, ExcelMale.com
Recently presented at a Urology conference Nov 2018 in Miami.
Title: Nandrolone Decanoate Improves Joint Pain in Hypogonadal Men Within 8 Weeks: A Novel Prospective Pilot Study
Authors: Alexander J. Tatem, Jonathan A. Beilan, Jason R. Kovac, Jabez Gondokusumo, Nannan Thirumavalavan, Larry I. Lipshultz
Introduction and Objective
5-20% of adult men suffer from hypogonadism (HG). Comorbidities linked with HG, such as diabetes and obesity, are often associated with significant and debilitating joint pain (JP). Nandrolone decanoate (ND) is an FDA approved testosterone derivative for treatment of anemia and muscle-wasting syndrome that has anecdotally been linked to reduced JP. Here we quantify this effect prospectively in a novel pilot study.
Methods
Hypogonadal men taking injectable testosterone therapy (TTh) presenting to a single andrology clinic between July 2018 and October 2018 were evaluated for the presence of JP. Men who reported significant JP and denied prior ND usage were invited to take part in the study.
The Rheumatoid Arthritis Pain Scale (RAPS) is a validated questionnaire initially developed to assess/characterize pain levels in adults with rheumatoid arthritis. It contains 24 statements about JP that patients assign a value ranging from 0 (never) to 6 (always). Pain scores are totaled with higher scores representing worse pain and can then be divided into physiologic, affective, sensory-discriminative, and cognitive components.
Men were asked to complete the RAPS questionnaire prior to starting ND. Patient-specific characteristics were recorded, including pain location and pain medication use/dosages. Men subsequently started injectable ND at half the dosage of their current testosterone regimen with all other medications kept constant. After 8 weeks, they filled out the survey again.
Results
32 eligible patients completed the initial survey and 11 men (34.4%) responded to follow-up requests at the time of this review. Mean duration of therapy was 54 days. All patients reported marked improvements in JP with 4 (36.4%) reporting a decreased need for pain medication. Patients’ total pain scores decreased from an average of 61.7 to 34.5 (p=0.038). Significant improvements in each sub-category were noted (Table 1). No adverse events were reported.
Conclusions
ND is a promising new adjunctive therapy for hypogonadal men with JP. It reduced pain scores by an average of 44% and decreased pain medication requirements in 36.4% of patients. Reducing pain medication needs is paramount in today’s opioid crisis climate. Further studies are required to better characterize ND’s effects across a larger study population.
All About Nandrolone
Source of Funding: This work is supported in part by NIH grant K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program (NT is a K12 Scholar).
Listen to summary by clicking this image:
UPDATE:
Novel pilot study
Introduction
Nandrolone’s complex relationship with joint health extends beyond healing in the rotator cuff model. Interestingly, various members of online bodybuilding communities and discussion boards have frequently asserted that nandrolone alleviates joint pain (16). While there have been two double-blind, placebo-controlled trials showing that nandrolone alleviates bone pain in post-menopausal osteoporosis, studies specifically evaluating joint pain are quite limited (62,63). In 1987, Bird et al. conducted a controlled trial in postmenopausal women with rheumatoid arthritis in which the intervention arm received intramuscular ND 50 mg every 3 weeks for 2 years finding no significant difference in joint or bone pain compared with the control arm as assessed by visual analog scales (64). Despite the equivocal findings in rheumatoid arthritis, there are two trials that, while limited, do support a role for nandrolone in the alleviation of non-inflammatory arthralgia. Darracott et al. found that, compared to placebo, weekly intramuscular ND resulted in clinically improved symptoms and patellar bone density measurements after 6 weeks in patients with patellofemoral pain syndrome, a condition in which patients experience peripatellar pain at the patellofemoral joint (65,66). More recently, Hohmann et al. conducted a double-blind, placebo-controlled randomized trial of ND in 10 patients who underwent total knee arthroplasty and were followed for 1 year. They found a significant improvement in quadriceps strength throughout the post-operative period in addition to improved Knee Society Score (KSS) at 6 weeks, 6 months, and 12 months in the group receiving nandrolone (67). The KSS includes an assessment of knee pain in its composite score but, unfortunately, the authors did not report the pain subscore specifically (68). Therefore, while promising, it is unclear if this study provides any evidence about nandrolone’s prospective use for joint pain.
As evidenced above, there is very little concrete data referencing any effect nandrolone may have regarding the alleviation of joint pain. However, nandrolone does have well-documented advantageous effects on bone and muscle along with quality trials showing its benefit in osteoporotic bone pain and historical documentation of its efficacy for patellofemoral pain syndrome. Therefore, it is reasonable to postulate that the anecdotal evidence ascribing non-inflammatory joint pain relief to nandrolone may be accurate. Additionally, male hypogonadism is linked with comorbidities such as diabetes and obesity, which are often associated with significant and debilitating joint pain (69,70). In such patients, the addition of nandrolone to their testosterone replacement regimen would avoid the potential side effect of ED, as discussed earlier, resulting in a highly-tolerable option for pain management, if efficacious.
The objective of the pilot study
Due to the paucity of research surrounding nandrolone and objective measurement of non-inflammatory joint pain—we designed a novel prospective pilot study to evaluate, quantify, and characterize the effects of ND on joint pain in hypogonadal men.
Methods
Study participants
All adult men with the diagnosis of hypogonadism (confirmed by sequential morning serum testosterone value of less than 300 ng/dL) who were currently using injectable intramuscular TTh were screened for the presence of joint pain at a single high-volume andrology clinic in Houston, Texas from August 2018 to January 2019. Inclusion criteria were men, aged 21–70 years old, confirmed diagnosis of hypogonadism currently treated with injectable intramuscular TTh, and report of significant joint pain at the screening. Exclusion criteria included prior nandrolone usage, inability to give informed consent, inability to perform intramuscular self-injection, an earlier diagnosis of solid organ cancer, and significant cardiovascular disease. All participants gave informed consent before inclusion in the study. The proposed study was reviewed and approved by our institutional review board.
Intervention
Eligible participants initiated intramuscular ND dosed at one-half of their current testosterone cypionate regimen (e.g., a participant using 200 mg testosterone cypionate weekly would continue that dose in addition to beginning 100 mg ND weekly). All other medications, including testosterone dosage, were kept constant throughout the trial period. The dose of ND was also kept constant until all data was collected.
Source: Nandrolone decanoate relieves joint pain in hypogonadal men: a novel prospective pilot study and review of the literature - PMC
Title: Nandrolone Decanoate Improves Joint Pain in Hypogonadal Men Within 8 Weeks: A Novel Prospective Pilot Study
Authors: Alexander J. Tatem, Jonathan A. Beilan, Jason R. Kovac, Jabez Gondokusumo, Nannan Thirumavalavan, Larry I. Lipshultz
Introduction and Objective
5-20% of adult men suffer from hypogonadism (HG). Comorbidities linked with HG, such as diabetes and obesity, are often associated with significant and debilitating joint pain (JP). Nandrolone decanoate (ND) is an FDA approved testosterone derivative for treatment of anemia and muscle-wasting syndrome that has anecdotally been linked to reduced JP. Here we quantify this effect prospectively in a novel pilot study.
Methods
Hypogonadal men taking injectable testosterone therapy (TTh) presenting to a single andrology clinic between July 2018 and October 2018 were evaluated for the presence of JP. Men who reported significant JP and denied prior ND usage were invited to take part in the study.
The Rheumatoid Arthritis Pain Scale (RAPS) is a validated questionnaire initially developed to assess/characterize pain levels in adults with rheumatoid arthritis. It contains 24 statements about JP that patients assign a value ranging from 0 (never) to 6 (always). Pain scores are totaled with higher scores representing worse pain and can then be divided into physiologic, affective, sensory-discriminative, and cognitive components.
Men were asked to complete the RAPS questionnaire prior to starting ND. Patient-specific characteristics were recorded, including pain location and pain medication use/dosages. Men subsequently started injectable ND at half the dosage of their current testosterone regimen with all other medications kept constant. After 8 weeks, they filled out the survey again.
Results
32 eligible patients completed the initial survey and 11 men (34.4%) responded to follow-up requests at the time of this review. Mean duration of therapy was 54 days. All patients reported marked improvements in JP with 4 (36.4%) reporting a decreased need for pain medication. Patients’ total pain scores decreased from an average of 61.7 to 34.5 (p=0.038). Significant improvements in each sub-category were noted (Table 1). No adverse events were reported.
Conclusions
ND is a promising new adjunctive therapy for hypogonadal men with JP. It reduced pain scores by an average of 44% and decreased pain medication requirements in 36.4% of patients. Reducing pain medication needs is paramount in today’s opioid crisis climate. Further studies are required to better characterize ND’s effects across a larger study population.
All About Nandrolone
Source of Funding: This work is supported in part by NIH grant K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program (NT is a K12 Scholar).
Listen to summary by clicking this image:
UPDATE:
Novel pilot study
Introduction
Nandrolone’s complex relationship with joint health extends beyond healing in the rotator cuff model. Interestingly, various members of online bodybuilding communities and discussion boards have frequently asserted that nandrolone alleviates joint pain (16). While there have been two double-blind, placebo-controlled trials showing that nandrolone alleviates bone pain in post-menopausal osteoporosis, studies specifically evaluating joint pain are quite limited (62,63). In 1987, Bird et al. conducted a controlled trial in postmenopausal women with rheumatoid arthritis in which the intervention arm received intramuscular ND 50 mg every 3 weeks for 2 years finding no significant difference in joint or bone pain compared with the control arm as assessed by visual analog scales (64). Despite the equivocal findings in rheumatoid arthritis, there are two trials that, while limited, do support a role for nandrolone in the alleviation of non-inflammatory arthralgia. Darracott et al. found that, compared to placebo, weekly intramuscular ND resulted in clinically improved symptoms and patellar bone density measurements after 6 weeks in patients with patellofemoral pain syndrome, a condition in which patients experience peripatellar pain at the patellofemoral joint (65,66). More recently, Hohmann et al. conducted a double-blind, placebo-controlled randomized trial of ND in 10 patients who underwent total knee arthroplasty and were followed for 1 year. They found a significant improvement in quadriceps strength throughout the post-operative period in addition to improved Knee Society Score (KSS) at 6 weeks, 6 months, and 12 months in the group receiving nandrolone (67). The KSS includes an assessment of knee pain in its composite score but, unfortunately, the authors did not report the pain subscore specifically (68). Therefore, while promising, it is unclear if this study provides any evidence about nandrolone’s prospective use for joint pain.
As evidenced above, there is very little concrete data referencing any effect nandrolone may have regarding the alleviation of joint pain. However, nandrolone does have well-documented advantageous effects on bone and muscle along with quality trials showing its benefit in osteoporotic bone pain and historical documentation of its efficacy for patellofemoral pain syndrome. Therefore, it is reasonable to postulate that the anecdotal evidence ascribing non-inflammatory joint pain relief to nandrolone may be accurate. Additionally, male hypogonadism is linked with comorbidities such as diabetes and obesity, which are often associated with significant and debilitating joint pain (69,70). In such patients, the addition of nandrolone to their testosterone replacement regimen would avoid the potential side effect of ED, as discussed earlier, resulting in a highly-tolerable option for pain management, if efficacious.
The objective of the pilot study
Due to the paucity of research surrounding nandrolone and objective measurement of non-inflammatory joint pain—we designed a novel prospective pilot study to evaluate, quantify, and characterize the effects of ND on joint pain in hypogonadal men.
Methods
Study participants
All adult men with the diagnosis of hypogonadism (confirmed by sequential morning serum testosterone value of less than 300 ng/dL) who were currently using injectable intramuscular TTh were screened for the presence of joint pain at a single high-volume andrology clinic in Houston, Texas from August 2018 to January 2019. Inclusion criteria were men, aged 21–70 years old, confirmed diagnosis of hypogonadism currently treated with injectable intramuscular TTh, and report of significant joint pain at the screening. Exclusion criteria included prior nandrolone usage, inability to give informed consent, inability to perform intramuscular self-injection, an earlier diagnosis of solid organ cancer, and significant cardiovascular disease. All participants gave informed consent before inclusion in the study. The proposed study was reviewed and approved by our institutional review board.
Intervention
Eligible participants initiated intramuscular ND dosed at one-half of their current testosterone cypionate regimen (e.g., a participant using 200 mg testosterone cypionate weekly would continue that dose in addition to beginning 100 mg ND weekly). All other medications, including testosterone dosage, were kept constant throughout the trial period. The dose of ND was also kept constant until all data was collected.
Source: Nandrolone decanoate relieves joint pain in hypogonadal men: a novel prospective pilot study and review of the literature - PMC
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