Background:  Since the passage of The Dietary Supplement Health and Education Act in 1994, there has been a flood of new "dietary" supplements promoting anti-aging benefits such as the enhancement of growth hormone or testosterone levels. Androstenediol and androstenedione are such products. This study's purpose was to elucidate the physiological and hormonal effects of 200 mg/d of oral androstenediol and androstenedione supplementation in men aged 35 to 65 years while participating in a 12-week high-intensity resistance training program.

Methods:  Fifty men not consuming any androgenic-enhancing substances and with normal total testosterone levels, prostate-specific antigen, hemoglobin, and hematocrit, and with no sign of cardiovascular or metabolic diseases participated. Subjects were randomly assigned to a placebo, androstenediol (diol), or androstenedione (dione) group using a double-blind study design. Main outcomes included serum sex hormone profile, body composition assessment, muscular strength, and blood lipid profiles.


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Results:  During the 12 weeks of androstenedione or androstenediol use, a significant increase in the aromatization by-products estrone and estradiol was observed in both groups (P =.03). In the dione group, total testosterone levels significantly increased 16% after 1 month of use, but by the end of 12 weeks, they returned to pretreatment levels. This return to baseline levels resulted from increases in aromatization and down-regulation in endogenous testosterone synthesis based on the fact that luteinizing hormone was attenuated 18% to 33% during the treatment period. Neither androstenediol nor androstenedione enhanced the adaptations to resistance training compared with placebo for body composition or muscular strength. However, both androstenediol and androstenedione supplementation adversely affected high-density lipoprotein cholesterol (HDL-C) levels, coronary heart disease risk (representing a 6.5% increase), and each group's respective (low-density lipoprotein cholesterol [LDL-C]/HDL-C)/(apolipoprotein A/apolipoprotein B) lipid ratio (diol: +5.2%; dione: +10.5%; P =.05). In contrast, the placebo group's HDL-C levels increased 5.1%, with a 12.3% decline in the (LDL-C/HDL-C)/(apolipoprotein A/apolipoprotein B) lipid ratio. These negative and positive lipid effects occurred despite no significant alterations in body composition or dietary intakes in the supplemental groups or placebo group, respectively.

Conclusions:  Testosterone precursors do not enhance adaptations to resistance training when consumed in dosages recommended by manufacturers. Testosterone precursor supplementation does result in significant increases in estrogen-related compounds, dehydroepiandrosterone sulfate concentrations, down-regulation in testosterone synthesis, and unfavorable alterations in blood lipid and coronary heart disease risk profiles of men aged 35 to 65 years.

The potential mechanisms through which DHEA and testosterone produce increasedpregnancy rates are still unclear. Androgens play a key role in steroidogenesis,acting as a substrate in the conversion of androgens into estrogens througharomatization (Ryan et al.,1968). Previous studies in nonhumans described greater numbers of primaryand preantral follicles and increased androgen receptor expression (Vendola et al., 1998; Hillier et al., 1997; Hild-Petito et al., 1991).Increased ovarian levels of FSH receptors have also been associated to testosteroneadministration in animal models (Weil etal., 1999). Studies in humans have been limited to small,uncontrolled RCTs with preliminary data, and there is no consensus in the literatureabout the clinical use of transdermal testosterone in poor responders undergoing IVF(Balasch et al., 2006;Fbregues et al.,2009). Different protocols, testosterone doses and pretreatment lengthshave been proposed, but there still is no consensus over the best pretreatmentscheme.

The following rationale was used in the ANDRO-IVF protocol: Testosterone is a steroidhormone thought to increase ovarian response by positively affecting follicularfeedback to gonadotropin stimulation, leading to greater oocyte yield and,therefore, increased conception rates (Nagelset al., 2015). According to the two-celltwo-gonadotropin theory, androgens are essential for the maintenance of adequatefollicular steroidogenesis in humans. Increased levels of androgens in thefollicular intracellular environment are thought to stimulate the recruitment ofpreantral and antral follicles and thus increase folliculogenesis and ovarianresponse to COS.

Intrafollicular androgenization may also be performed with the co-administration ofletrozole, as described by Garcia-Velasco. This author described significantlyhigher levels of testosterone and androstenedione in the follicular fluid ofletrozole-treated patients than in untreated poor responders (Garcia-Velasco et al., 2005). In 2012, the sameauthors described the impact of testosterone and hCG in the positive modulation ofFSH receptor expression in human granulosa cells in vitro (Garcia-Velasco et al., 2012).This study aimed to propose and assess a new protocol to improve the ovarianresponse of poor responders based on three modes of intra-ovarian androgenization(letrozole, transdermal testosterone and hCG).

The phase of ovarian preparation included intra-ovarian androgenization and cyclecontrol. Androgenization was performed with the application of transdermaltestosterone gel AndroGel(r) (Besins Healthcare, So Paulo, Brazil) 25 mgevery other day, starting on the first day of the menstrual cycle. Letrozole 2.5 mgwas administered orally on a daily basis, and patients were given hCG 2500 IUsubcutaneously twice a week. Cycle control was performed with the administration ofestradiol valerate 8 mg daily from Day 3 to Day 14 of the menstrual cycle, followedby estradiol valerate 4 mg daily up to Day 15. Micronized progesterone 400mg wasgiven from Day 15 to Day 24 and suspended to promote a new menstrual cycle, in whichstimulation occurred.

Several clinical trials investigated the role of androgen administration to improveovarian response in poor responders undergoing IVF. Although some studies did notsupport androgen supplementation to improve live birth rates (Sunkara et al., 2011), a recent meta-analysisshowed increased clinical pregnancy and live birth rates in poor responders giventransdermal testosterone (Bosdou etal., 2012). Another Cochrane meta-analysis included 17randomized clinical trials and 1496 patients, mostly poor responders undergoingstandard IVF. The authors found that pretreatment with testosterone correlated withhigher live birth rates when compared to placebo or no treatment (OR 2.60, 95% CI1.30 to 5.20). Women with an eight percent chance of achieving a live birth iftreated with placebo or not offered treatment saw their chances rise to 10-32%(Nagels et al., 2015).Clinical studies also revealed that 25% of clinics worldwide have adoptedco-treatment with androgens for this group of patients (Fouany & Sharara, 2013).

A prospective case-control study from a respected IVF center compared theintrafollicular and serum concentrations of LH, estradiol (E2),progesterone, testosterone, and androstenedione of patients showing poor response totreatment and egg donors with normal response (de losSantos et al., 2013). They observed that LH and androgensecretion in preovulatory follicles was similar in both groups, suggesting that theproblem was related to poor response to COS in spite of normal levels of follicularhormones. They suggested that long-interval androgen pretreatment might potentiallyincrease the recruitment of small pre antral and antral follicles rather thanincreasing the intrafollicular androgen levels in IVF cycles.

A recent meta-analysis initially including 10 papers had to cut the number of papersdown to three because of the large heterogeneity between the studies and androgenadministration protocols. The authors concluded that pretreatment with transdermaltestosterone prior to IVF might improve the clinical outcomes of poor responders,but indicated that the results be analyzed with caution due to the lack of largerand more robust RCTs.

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The Food and Drug Administration said that manufacturers of andro products will have to cease production unless the makers can prove it is safe. Although andro is not a steroid and is marketed as a dietary supplement, the FDA said the health risks are the same.

Andro, or androstenedione, is a hormone that is made naturally in the human body during the production of testosterone and estrogen. Some advocates say higher levels of testosterone will enable athletes to train harder, build bigger muscles and get results faster. Concentrated levels of andro are in the pills and supplements on the market.

But medical studies have shown it can have serious side effects. According to the Mayo Clinic, andro supplement use by males has been responsible for diminished sperm production, shrunken testicles, enlarged breasts, acne and decreased levels of the heart-friendly kind of cholesterol.

Officials said the move against andro also was prompted by concerns that children have been influenced by professional athletes' use of performance-enhancing supplements and the ease with which young people can buy them. Studies have shown such supplements can stunt children's physical and sexual growth.

"Young people, athletes and other consumers should steer clear of andro because there are serious, substantial concerns about its safety," Health and Human Services Secretary Tommy Thompson said in a statement Thursday.

Meanwhile, Sen. Joseph Biden, D-Delaware, has sponsored legislation that would ban the newly discovered steroid THG and andro, which baseball's McGwire admits he used the season he broke the long-standing single season home run record. ff782bc1db

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