The Novel Use of SARMS & Nandrolone with Testosterone Therapy in Men’s’ Health

Updated: Jan 24

Keywords: Deca, Nandrolone, Anavar, Oxandrolone, SARMS, Anabolic Steroids , Testosterone Cypionate, Anabolic Hormone, Androgenic Hormone. Nandrolone Decanoate, Deca-Durabolin, Nandrolone and ED, Nandrolone and Hair Loss, Androgenic Alopecia, Gynecomastia, Bodybuilding, Gym Athelete, Men's Health


Testosterone is both an androgenic and anabolic steroid hormone. The androgenic effects of testosterone are associated with masculinization, such as deeper voice, facial hair, development of acne, and hair loss. We observe the androgenic effects of testosterone during puberty as boys mature into men. The androgenic effects of Testosterone are commonly not desired by men. The anabolic effect of testosterone is associated with skeletal muscle growth, weight loss, improved memory, cognitions, performance, stamina, increased utilization of protein. As testosterone replacement is becoming more prevalent in society so has the science behind the development of testosterone derivatives that lessen the androgenic effects of testosterone and enhance the anabolic affects. Selective Androgenic Receptor Modulators (SARMs) are an evolving class of anabolic hormones that have unique properties similar to testosterone without the androgenic effects and have role in men’s health.


What does SARM stand for?


Selective Androgen Receptor Modulator


What are SARMS?


A SARM is molecule that binds to an androgenic receptor and exerts a powerful effect on a target tissue such as skeletal muscle. A SARM can be taken orally or by intramuscular (IM) injection. SARMS are a modification of testosterone and have a greater anabolic effect on target tissue than androgenic affect. Anabolic effects are growth, preservation of lean muscle mass, nitrogen retention and weight loss among others. Androgenic effects are prostate growth, acne development and deepening of the voice among others. SARMS were developed in the 1940’s to promote the beneficial and wanted affects most men desire from taking testosterone and reduce unwanted androgenic adverse effects. This makes SARMS a unique and attractive therapeutic agent for the treatment of several clinical and medical conditions.


As men age, lean muscle growth is lost resulting in muscle wasting, power and strength loss. Sarcopenia is the age-related loss of muscle mass and strength that can lead to disability and increased morbidity. This loss of muscle mass and strength reduces the body’s ability to prevent falls and reduces mobility, therefore the aging man becomes more fragile. SARMS are an anabolic medication used to combat aging muscle loss and fragility, aimed at promoting improved physical function and strength. While testosterone can be used to combat the signs of aging and improve lean muscle growth, supra-physiological doses can have unwanted side effects such as erythrocytosis and prostate growth leading to lower urinary tract symptoms. SARMS can achieve significant anabolic effects on muscle growth and muscle preservation at a much lower dose than testosterone and without the unwanted side effects.

To learn more about testosterone and erythrocytosis click here

To learn more about testosterone and lean muscle growth click here


What is the difference between steroidal and non steroidal SARMS?


Steroidal SARMS have the same chemical base structure, that of the testosterone steroid. All steroidal SARMS have the same testosterone base structure but the addition or subtraction of molecules to testosterone confers unique and therapeutic advantages.


For instance, the addition of a 17-alpha alkyl group prevents the breakdown of testosterone and provides the steroid to be taken orally. However, this form of testosterone is not utilized given its effect on the liver (hepatoxicity). A new oral testosterone medication named JatenzoTM was recently approved by the FDA with minimal to no liver toxicity. Jatenzo™️ is not a SARM but a testosterone prodrug. It is comprised of a testosterone molecule with an attached long chain fatty acid. The testosterone molecule does not exert an effect until the body breaks the faty acid chain (i.e. prodrug). The long chain fatty acid allows Jatenzo™️ to be absorbed through the lymphatic intestinal pathway and confers protection from the liver.


Non steroidal SARMS are currently in development, are not structurally comprised of the same structural base as testosterone and have may have different tissue specificity compared to steroidal SARMS. Much of the research of Non steroidal SARMS are not published and direct comparison to Steroid SARMS is unknown.


What is Nandrolone Decanoate?


Nandrolone Decanoate (often known as DECA, Deca-Durabolin, and 19-nortestosterone) is a steroidal SARM. It has the same chemical base structure as testosterone except for removal of the 19-methyl group. This small modification provides Nandrolone an increase in anabolic activity. When Nandrolone is broken down by 5 Alpha-Reductase it forms a less potent androgen compared to DHT (Dihydrotestosterone), called Dihydronandrolone. Dihydronandrolone is less aromatized into estrogen. Estrogen levels therefore do not rise as much with Nandrolone use compared to testosterone. As mentioned, Nandrolone does not get reduced into DHT which has potent effects on prostate growth and lower urinary tract symptoms. These factors make Nandrolone significantly different than testosterone and with higher androgenic potential.


What is Nandrolone Decanoate Used for?


Nandrolone has been well studied and available for several decades. Its primary indication for your use is prevent muscle wasting and improve anemia in patients with sarcopenia, renal failure, chronic obstructive pulmonary disease (COPD) and HIV.


How is Nandrolone Decanoate delivered?


Nandrolone bares many similarities to testosterone. Nandrolone is given as an intramuscular injection. It has a plasma half-life of approximately 8 days. But unlike testosterone, Nandrolone binds and interacts with androgen steroid receptors with more affinity (stronger) enhancing anabolic and myotrophic (muscle) activity.


How does Nandrolone Decanoate different than Testosterone?


Nandrolone has a much higher attraction to the androgen receptor when compared to testosterone. Nandrolone also had a greater effect on building and stimulating larger muscle mass than testosterone.


Testosterone is broken down by 5 alpha- reductase into two components DHT and estradiol. DHT has unwanted side effects on the prostate (causing prostate growth) and hair follicle atrophy (androgenic alopecia / male pattern baldness). Nandrolone is also broken down by 5 alpha reductase, but into Dihydro-19-nortestosterone. This breakdown product has less activity and affinity for the prostate and hair follicle lending to less side effects, less androgenic alopecia, less urinary tract symptoms.


Nandrolone and Muscle Growth


Nandrolone is structurally similar to testosterone except for a simple removal of the 19-methyl group. This small structural change confers greater anabolic effects of the steroid hormone and less adverse unwanted androgenic effects. Testosterone has an anabolic to androgenic ratio of 1:1. This means it is able to build muscle and reduce waist circumference (anabolic effects) just as much as it stimulates prostate growth, hair loss and deepening of the voice (androgenic effects). Nandrolone, on the other hand, has an anabolic to androgenic ratio of 11:1. A significantly higher myotrophic/anabolic (muscle building) effect. The enhanced anabolic effect of Nandrolone minimizing the catabolic effect corticosteroids have during stress (stress hormones released during athletic activity). Second, Nandrolone enhances nitrogen retention and balance, improving protein utilization, reducing fatigue to enhance training abilities.

Because of this amazing muscle building property of the hormone its use has been primarily in patients with anorexia, COPD, cachexia, chronic renal failure, HIV, and AIDS wasting syndrome.


Nandrolone and Erectile Dysfunction (ED)


Nandrolone will cause erectile dysfunction. The hypothesis for this side effect is Nandrolone’s ability to reduce natural testosterone and DHT production. This suppression of endogenous testosterone production by the testicles may lend to ED.



In order to prevent ED with Nandrolone, concomitant use with testosterone will preserve erectile function. This addition of an in additional androgenic hormone in men who use nandrolone for alternative purposes is termed “stacking”. Stacking Nandrolone with Testosterone is a commonly used regimen for physique and bodybuilding athletes who use the medication alternatively and beyond it intended use.


Nandrolone Use Among Bodybuilding Athletes and Gym Athletes


According to studies, the prevalence of Nandrolone Decanoate usage among gym and bodybuilding athletes approaches 75%. The average duration of Nandrolone is approximately for 14 months with fluid retention, decreased testicular size and acne reported as the most common side effects.


According to a study conducted in the United Kingdom of 4 gyms and 100 male steroids users 33% of men were professional bodybuilders and 67% recreational gym athletes. All users cycle was guided by their own experience or anecdotal evidence. Other medications, not a steroid hormone, used by men include Clenbuterol, Ephedrine, and L-thyroxine to improve protein deposition in muscle, training stimulation/performance and reduce subcutaneous fat respectively. Diuretics were found to be commonly also utilized in steroid users to reduce the unwanted effect of water retention. Anti-estrogen agents such as Tamoxifen and Arimidex were also utilized with cycles of steroid users. Physical signs prevalent in up to 1/3 of users in the study included the triad of acne, gynecomastia, and striae.


Pan MM, Kovac JR. Beyond testosterone cypionate: evidence behind the use of nandrolone in male health and wellness. Transl Androl Urol 2016;5(2):213-219. doi: 10.21037/tau.2016.03.03


Evans, Nick. Gym and Tonic. Br Journal of Sports Medicine 1997;31:54-58

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