Oxandrolone (Anavar) : The Most Studied Oral Anabolic Agent in Wasting and Catabolic Conditions

Oxandrolone is a man-made anabolic androgenic agent that has been studied by doctors for more than 30 years, mostly because it might help treat catabolic disorders and chronic wasting conditions like alcoholic hepatitis, severe burn injuries, trauma, neuromuscular disorders, and wasting caused by HIV/AIDS. This review aims to provide a comprehensive insight into the clinical utility, structural and functional characteristics, and risk-benefit considerations of oxandrolone based on a range of studies and clinical trials.

Clinical Evidence of Efficacy: Numerous research investigations have substantiated the effectiveness of oxandrolone in promoting weight gain and maintaining body mass in individuals afflicted with wasting disease and other conditions. The findings from these studies reveal a marked improvement in counteracting involuntary weight loss, a condition with potentially fatal consequences, thereby enhancing the quality of life for patients. These studies indicate a significant improvement in reversing unintentional weight loss that can lead to death and improve the quality of life for patients with minimal adverse effects, challenging the initial concerns leading to the withdrawal.

1. Overview and Clinical Efficacy:

Oxandrolone exhibits both anabolic and androgenic activity due to its derivative nature from the parent hormone testosterone. As an orally administered C17α-alkylated agent, oxandrolone is designed to resist liver metabolism and has a distinct chemical structure that confers high anabolic activity with relatively fewer androgenic effects.

Clinically, oxandrolone has shown significant efficacy in improving body composition, strength, functional capacity, and overall recovery from acute catabolic injuries. Notably, it is the only anabolic agent that the US FDA has approved for preventing weight loss due to severe trauma, extensive surgery, chronic infections, and particular muscular dystrophies. The compound is generally well-tolerated. The most reported side effects are short-lived and reversible changes in liver enzyme levels and lipid profiles. These are not the severe liver damage that is common with other oral agents. It is important to note that oxandrolone is not administered as a prolonged treatment; rather, physicians prescribe it for a finite duration until the desired weight gain and therapeutic benefits are achieved.

2. Specific Clinical Applications:

a. Catabolic Disorders: Oxandrolone has been beneficial for patients with various catabolic illnesses, including alcoholic liver disease and severe burn injuries. Studies report significant improvements in body composition, decreased catabolism, increased muscle protein synthesis, and enhanced recovery rates, contributing to better survival outcomes compared to controls. The treatment appears to have minimal toxicity, mainly causing transient mild elevations of liver enzymes.

b. HIV/AIDS-Associated Wasting: Several studies focusing on HIV/AIDS-associated wasting have observed positive outcomes with oxandrolone treatment. Improvements were noted in body composition, muscle function, and nutritional status, with some studies suggesting even better results when oxandrolone was combined with resistance training. These outcomes highlight the potential of oxandrolone in managing chronic wasting conditions prevalent in HIV/AIDS patients.

3. Patient Demographics

Oxandrolone has been widely studied for its clinical use in various catabolic conditions across different demographic groups. The following reviews the clinical applications of oxandrolone in children, women, and men, focusing on its efficacy, safety, and therapeutic outcomes in treating catabolic conditions.

Oxandrolone in Children

In children suffering from catabolic states, such as severe burns or growth retardation, oxandrolone has shown promising results. Studies indicate that oxandrolone, combined with structured exercise or other therapies, improves physical function, safety, and recovery in pediatric patients with severe burns and other catabolic conditions (Wischmeyer et al., 2020). It has also been proven beneficial in enhancing height, bone mineral content, and muscle strength in children suffering from severe burns up to 5 years post-burn (Porro et al., 2012). Moreover, in cases of uncomplicated growth retardation, oxandrolone significantly accelerates height age more than skeletal maturation (Limbeck et al., 1971).

Oxandrolone in Women

In women with catabolic conditions, oxandrolone has been used to preserve lean mass. It has been specifically effective in conditions such as Turner syndrome, where a low dose of 0.03 mg/kg per day increases adult height gain with minimal side effects (Freriks et al., 2012). Additionally, the drug has been indicated for use in severe thermal injury to improve wound healing and restore lean body mass (Miller et al., 2009). However, it is important to note that while its benefits include enhancing body composition, its use must be monitored for potential side effects.

Oxandrolone in Men

Oxandrolone has a long-standing history of clinical use in men with catabolic conditions, including burn injuries, HIV-related muscle wasting, and other wasting conditions (Orr & Fiatarone Singh, 2012). Its anabolic effects have been demonstrated in enhancing protein synthesis and body weight in HIV-infected men with weight loss (Grunfeld et al., 2006). Furthermore, oxandrolone has been shown to improve wound healing and reduce hospital stays in burn patients (Ring et al., 2019).

4. Reevaluation of Safety Profile: New long-term studies and reviews by international regulatory bodies suggest that the side effects that were once linked to oxandrolone are much less common or severe when the drug is used under close medical supervision and at therapeutic doses. We contend that the initial safety concerns are based on outdated or misinterpreted data and do not reflect the drug's current safety profile when used appropriately.


Citations:

1. Clinical Efficacy of Oxandrolone:
   1. The anabolic androgenic steroid oxandrolone in the treatment of wasting and catabolic disorders: review of efficacy and safety
   2. The Anabolic Androgenic Steroid Oxandrolone in the Treatment of Wasting
   3. Approved Pharmacologic Interventions for Wasting: An Overview
   4. Neuroregenerative Effect of Oxandrolone: A Case Report
   5. Oxandrolone - ResearchGate
   6. Oxandrolone Improves Height Velocity and BMI in Patients with Cystic Fibrosis
2. Specific Clinical Applications of Oxandrolone:

• In Children:
  1. Five-Year Outcomes after Oxandrolone Administration in Severely Burned Children
  2. Effects of long-term oxandrolone administration in severely burned children
  3. Oxandrolone Therapy in Growth Retardation of Children
  4. Evaluation of the Effects of Oxandrolone on Malnourished HIV-Positive Pediatric Patients
  5. Safety and Efficacy of Oxandrolone in Growth Hormone-Treated Girls with Turner Syndrome: Evidence from Recent Studies and Recommendations for Use
  6. A randomized efficacy and safety trial of oxandrolone in the treatment of Duchenne dystrophy
  7. The Long-Term Effect of Oxandrolone on Hepatic Acute Phase Proteins in Severely Burned Children
• In Women:
  1. Oxandrolone for growth hormone-treated girls aged up to 18 years with Turner syndrome
  2. Oxandrolone for Management of Hypercatabolism in Severe Burns
  3. Oxandrolone Augmentation of Resistance Training in Older Women: A Randomized Trial
• In Men:
  1. Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study

1. Reevaluation of the Safety Profile:
   1. The efficacy and safety of oxandrolone treatment for patients with severe burns
   2. A Reappraisal of Oxandrolone in Burn Management
   3. Oxandrolone in the Treatment of Burn Injuries: A Systematic Review
   4. Effects Of Oxandrolone On Lean Body Mass (Lbm) In Severe Burn Patients
   5. Long-Term Administration of Oxandrolone Improves Lung Function in Pediatric Burn Patients

 

Role of oxandrolone, TRT, exercise and nutrition to promote recovery in ICU survivors

Purpose of review ICU survivors frequently suffers significant, prolonged physical disability. ‘ICU Survivorship’, or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest...

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Oxandrolone in Burn Management

A Reappraisal of Oxandrolone in Burn Management (2022) Jonathan Kopel, Ph.D., Grant Sorensen, MD, and John Griswold, MD Abstract Objective: Burn injuries remain among the most severe traumatic injuries globally. With the discovery of cortisol, the use of steroids has become an essential...

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Oxandrolone (Anavar) Medical Uses- Presentation Attached

Here is a presentation for download only for registered members:

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Incidence of hepatic dysfunction is equivalent in burn patients receiving oxandrolone and controls - PubMed

Oxandrolone has been shown to improve lean muscle mass in patients with burns. Hepatic dysfunction is a known side effect of treatment with oxandrolone. The purpose of this study was to examine the incidence of hepatic dysfunction in our series of burn patients receiving oxandrolone. Fourteen...

pubmed.ncbi.nlm.nih.gov

 

Wasting syndrome: oral oxandrolone re-released in U.S - PubMed

Wasting syndrome: oral oxandrolone re-released in U.S

pubmed.ncbi.nlm.nih.gov

FDA Removed Oxandrin (oxandrolone) tablets from the list of drug products published in the Orange Book

Pathetic! Could not upload the PDF due to ongoing server error issues! Available in the link posted below. https://www.alston.com/en/insights/publications/2023/09/health-care-week-in-review-september-15-2023 On September 12, 2023, FDA issued a notice entitled, Determination That Oxandrin...

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Comparative Analysis of Anabolic and Androgenic Potency: Oxandrolone vs. Testosterone​

Oxandrolone and testosterone exhibit distinct pharmacological profiles due to structural differences that confer divergent anabolic-to-androgenic activity ratios (AAR). These differences underpin their clinical applications, safety considerations, and suitability for specific patient populations.

Structural Determinants of Activity​

Testosterone:​

• Baseline Hormone: Natural androgen with balanced anabolic:androgenic ratio (1:1)26.
• Metabolic Fate: Converted via 5α-reductase to dihydrotestosterone (DHT), amplifying androgenic effects in tissues like prostate and skin26.
• Aromatization: Converted to estradiol, contributing to estrogenic effects (e.g., gynecomastia)6.

Oxandrolone:​

• Synthetic Modifications:
  1. 2-Oxa Substitution: Oxygen atom at C2 resists 3α-hydroxysteroid dehydrogenase degradation, preserving anabolic activity36.
  2. 17α-Methylation: Enhances oral bioavailability but increases hepatotoxicity risk36.
  3. 5α-Reduction Resistance: Avoids conversion to DHT, minimizing androgenic effects26.
• Non-Aromatizable: Does not convert to estrogen, eliminating gynecomastia risk5.

Anabolic:Androgenic Ratio (AAR)​

Agent	Anabolic:Androgenic Ratio	Androgenic:Anabolic Ratio
Testosterone	1:1246	~1:126
Oxandrolone	10:1456	1:3–1:1323

Key Observations:

1. Anabolic Potency: Oxandrolone demonstrates 6-13× higher anabolic activity per unit androgenic effect compared to testosterone246.
2. Muscle Selectivity: In rodent assays, oxandrolone increases levator ani muscle mass (anabolic) by ~3× more than ventral prostate growth (androgenic)26.

Clinical Implications​

Therapeutic Efficacy:​

• Testosterone:
  • Balanced effects suitable for androgen replacement (e.g., hypogonadism)2.
  • Limited by androgenic side effects (acne, prostate growth) at higher doses6.
• Oxandrolone:
  • Burn Recovery: Increased lean body mass (LBM) by 3.0 kg vs. placebo in elderly men1.
  • HIV Wasting: Sustained fat reduction (-1.5 kg total fat) post-treatment1.
  • Women/Pediatrics: Preferred due to low virilization risk at ≤10 mg/day35.

Safety Profile:​

Parameter	Testosterone	Oxandrolone
Virilization Risk	High (dose-dependent)6	Low (≤10 mg/day)35
Estrogenic Effects	Moderate (via aromatization)	None35
Hepatotoxicity	Rare	Significant (17α-methyl)3
Lipid Impact	Reduces HDL by 10-20%6	Reduces HDL by 30-40%13

Mechanistic Differences​

1. Receptor Interaction:
   • Oxandrolone binds androgen receptor (AR) with 0.3% affinity of DHT but achieves potent anabolism via prolonged tissue retention6.
   • Testosterone's effects depend on local conversion to DHT (prostate) or estradiol (adipose)2.
2. Protein Synthesis:
   • Oxandrolone increases mixed muscle protein synthesis by 25-30% vs. 15-20% for testosterone16.
   • Nitrogen Retention: Oxandrolone improves balance by 0.8 g/day in catabolic states3.

Conclusion​

Oxandrolone's structural innovations decouple anabolic from androgenic effects, yielding a therapeutic index 10× higher than testosterone. While both agents activate the AR, oxandrolone's resistance to 5α-reductase and aromatase minimizes virilization and estrogenic effects, making it preferable for women and pediatric populations. However, its hepatotoxicity and dyslipidemic risks necessitate rigorous monitoring. Testosterone remains foundational for androgen replacement but requires careful dose titration to balance anabolic benefits with androgenic liabilities.

Citations:​

1. https://journals.physiology.org/doi/10.1152/japplphysiol.00808.2003
2. https://en.wikipedia.org/wiki/Anabolic_steroid
3. https://en.wikipedia.org/wiki/Oxandrolone
4. https://www.researchgate.net/figure/Anabolic-androgenic-ratio-of-anabolic-steroids_tbl3_7782038
5. https://www.regenxhealth.com/post/anavar-oxandrolone
6. https://www.endocrine.org/~/media/endosociety/files/ep/rphr/57/rphr_vol_57_ch_19_anabolic_steroids.pdf
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC1959346/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC9837614/
9. https://jamanetwork.com/journals/jama/fullarticle/189427
10. https://my.clevelandclinic.org/health/treatments/5521-anabolic-steroids
11. https://academic.oup.com/jcem/article/84/8/2705/2864236
12. https://www.polypharm.solutions/blog-details/1
13. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2005.04218.x
14. https://www.ncbi.nlm.nih.gov/books/NBK548931/
15. https://academic.oup.com/jcem/article/104/7/2490/5310131
16. https://www.nata.org/sites/default/files/position-statement-steroids.pdf

 

According to Perplexity, Oxandrolone significantly reduces Lp(a) which makes it one of the very few compounds to do this. It can reduce it by around 65%, which is more than twice what niacin or nandrolone will accomplish. It also seems to have a longer lasting impact after the drug is discontinued, however unlike the other two, Oxandrolone may increase LDL in some people.

 

Oxandrolone, a synthetic anabolic androgenic steroid (AAS), has been used clinically for over three decades to manage a wide range of catabolic and wasting conditions. In the United States, oxandrolone holds FDA approval for specific indications including the restitution of weight loss following severe trauma, major surgery, or chronic infections. It is also approved for addressing malnutrition resulting from alcoholic cirrhosis, as well as for the treatment of Duchenne’s and Becker’s muscular dystrophy¹.

According to Perplexity, Oxandrolone significantly reduces Lp(a) which makes it one of the very few compounds to do this. It can reduce it by around 65%, which is more than twice what niacin or nandrolone will accomplish. It also seems to have a longer lasting impact after the drug is discontinued, however unlike the other two, Oxandrolone may increase LDL in some people.

Beyond its FDA-approved uses, oxandrolone has demonstrated therapeutic efficacy in a variety of off-label and investigational contexts. In acute catabolic states, particularly among patients recovering from severe burn injuries, oxandrolone has been shown to reduce weight loss, enhance nitrogen retention, accelerate healing times, and shorten hospital stays¹. Similarly, in patients undergoing recovery from multiple trauma or major surgical interventions, the drug has been associated with improvements in protein synthesis, functional recovery, and nutritional markers¹.


In chronic catabolic disorders, oxandrolone has produced notable outcomes in conditions such as alcoholic hepatitis. Studies report improvements in liver function, body composition, and survival rates, particularly when combined with adequate caloric intake¹. Patients with chronic obstructive pulmonary disease (COPD) have also shown gains in lean body mass, physical performance, and appetite during oxandrolone therapy, although these findings are primarily drawn from uncontrolled studies¹. A single case report also suggests that oxandrolone may benefit patients with Crohn’s disease by improving overall body weight and composition¹.


One of the most extensively studied off-label applications for oxandrolone is in the management of HIV/AIDS-associated wasting. Across numerous clinical trials, oxandrolone has consistently demonstrated positive effects on lean body mass, nitrogen balance, physical strength, and quality of life. It has also improved appetite and activity levels in HIV-positive men. Several studies have explored its use in conjunction with progressive resistance training, showing additive benefits for body composition and muscle function¹.


In the domain of neuromuscular disorders, oxandrolone has proven beneficial for patients with Duchenne’s muscular dystrophy, inclusion body myositis, spinal cord injury, and amyotrophic lateral sclerosis (ALS). Clinical trials and case studies have documented improvements in body composition, muscle strength, respiratory function, wound healing, and overall functional status. Notably, in Duchenne’s muscular dystrophy, oxandrolone treatment has led to increases in height, weight, and muscle performance with minimal adverse effects¹.


Although not yet studied specifically for the treatment of sarcopenia, the age-related loss of muscle mass and function, oxandrolone's pronounced anabolic properties and favorable safety profile suggest it may hold promise for future application in this setting. Researchers have identified its potential utility in preventing frailty and promoting muscle maintenance in older adults¹.


Oxandrolone has also been used in the treatment of Turner’s syndrome and constitutional delay of growth and puberty, although these conditions fall outside the scope of the reviewed literature. Nevertheless, the available evidence collectively supports oxandrolone's efficacy in improving clinical outcomes across a diverse array of muscle-wasting and catabolic disorders¹.

---

References​

1. Orr, R., & Fiatarone Singh, M. (2004). The anabolic androgenic steroid oxandrolone in the treatment of wasting and catabolic disorders: Review of efficacy and safety. Drugs, 64(7), 725–750. https://doi.org/10.2165/00003495-200464070-00003

According to Perplexity, Oxandrolone significantly reduces Lp(a) which makes it one of the very few compounds to do this. It can reduce it by around 65%, which is more than twice what niacin or nandrolone will accomplish. It also seems to have a longer lasting impact after the drug is discontinued, however unlike the other two, Oxandrolone may increase LDL in some people.

Can you please pull out the reference from Perplexity?

All I can find is the effect of injectable T on lp(a)

Injectable testosterone esters​

• Magnitude and consistency of change – Weekly intramuscular testosterone enanthate 200 mg given to healthy men for 12 weeks produced a 25–59 % fall in Lp(a) in every participant whose baseline level exceeded 25 nmol/L; men starting with low Lp(a) showed no change.¹PubMed
• Duration – Values returned to baseline a few weeks after injections stopped, indicating that suppression is reversible and exposure-dependent.¹PubMed
• Lipid profile context – Longer-term studies using the same dose for 12 months confirm a modest drop in HDL-C (≈ 0.16 mmol/L) with no adverse LDL-C rise, suggesting the overall lipid effect is neutral-to-favourable despite the HDL change.²PubMed
• Mechanism (proposed) – Hepatic androgen-receptor activation appears to down-regulate apo(a) gene transcription; aromatization to estradiol may amplify this, because estrogens also lower Lp(a).¹PubMed

 

Can you please pull out the reference from Perplexity?

Here is a link for Oxandrolone:



Research Trends.

Here is another for Oxandrolone however the cited text is behind a paywall that I don’t have access to but the cited text is:

y AG Olsson · 1974 · Cited by 33 — The Lp(a) lipoprotein was reduced 65 ± 23% by the steroid treatment (off treatment 5.5 ± 5.5, on treatment 1.4 ± 0.7 mg/dl; P < 0.02).

https://www.sciencedirect.com/science/article/abs/pii/0021915074900689



And here is one for Nandrolone that may have more drugs behind the paywall:

Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein (a) | British Journal of Sports Medicine





Here below is the quote from Google (Perplexity won’t let me copy) and google seems to have more references. There is apparently a large amount of variability between people, but since almost nothing else has this affect, it seems like it would be worth a try for those with an lp(a) issue. Google contradicts itself elsewhere and says there are no lp(a) lowering medications, but that’s one reason to be skeptical of AI generated summaries.

Google Summary:

Yes, research indicates that oxandrolone, an anabolic steroid, can reduce lipoprotein(a) [Lp(a)] levels.

Key points regarding oxandrolone and Lp(a):

Studies have shown Lp(a) reduction: Several studies have reported significant reductions in Lp(a) levels following oxandrolone administration.

Potential mechanism: While the exact mechanism by which oxandrolone lowers Lp(a) is not fully understood, it's suggested to be mediated by decreasing apolipoprotein(a) synthesis, a key component of the Lp(a) particle.

Clinical significance: Lp(a) is considered an independent risk factor for cardiovascular disease, so a reduction in its levels could potentially be beneficial for those at risk.

Context within overall lipid profile: It's important to note that oxandrolone, like other anabolic steroids, can have unfavorable effects on other aspects of the lipid profile, such as lowering HDL ("good") cholesterol and raising LDL ("bad") cholesterol, which increases the risk of cardiovascular disease.

In summary, oxandrolone may have a favorable effect on Lp(a) levels, but this needs to be considered within the broader context of its potential impact on the overall lipid profile and cardiovascular health.