How Testosterone Helps the Heart

As it is commonly reported in the media that steroids can cause your heart to blow a ventricle, kidneys to implode, and your liver to disintegrate. But is this actually true? Well in reality, the more you learn about steroids, the more you come to realize that, like all drugs, there is a difference between their intelligent use and outright abuse. So we will take a look at the effects of testosterone on the heart and see how these common conceptions hold up.

For ages now, we’ve all heard the repeated saying that anabolic steroids are bad for the heart. Some physicians will tell you that testosterone raises your risk of heart disease by lowering your good cholesterol and raising your bad cholesterol. It is also reported that steroids are known to induce an enlargement of the heart or even cardiac hypertrophy.

In reality, the dangers of steroids are overstated and may even be good for the heart.

What are the cardiovascular effects of steroids?

In a recent test, bodybuilders had various aspects of the heart measured such as the carotid intima-media thickness, arterial reactivity, left ventricular dimensions to name a few. These measurements indicate whether bodybuilding, steroid usage, or both affect the shape, function, activity and size of the heart.

The doctors found some obvious and not so obvious results. The bodybuilders who used steroids were physically stronger than those who didn’t and the use of steroids was not found to cause any significant changes or abnormalities of arterial structure or function.

In essence, when both groups of bodybuilders were compared with sedentary controls, any changes in heart function were common to both steroid-using and non-steroid-using bodybuilders. So all said and done, what we learn from this study is that bodybuilding itself can alter, not impair, arterial structure or function and steroids do not appear to impair cardiac function.

TRT heart 2Does MRFIT need a T boost?

The Multiple Risk Factor Intervention Trial (MRFIT) is a study that examined changes in testosterone over a 13 year period in 66 men aged 41 to 61 years. The researchers concluded that changes in total testosterone are related to cardiovascular disease risk factors.

The average testosterone levels at the beginning of the study were 751 ng/dl and decreased by 41 ng/dl. Also, men who smoked or exhibited Type A behavior were found to have even greater decreases in T levels. The change in testosterone was also associated with a decrease in in the good cholesterol and an increase in triglyceride levels.

The conclusion stated that decreases in testosterone levels as observed in men over time are associated with unfavorable heart disease risk.

In a similar study, researchers in Poland examined if testosterone replacement therapy in aging men positively affected heart disease risk factors. It noted that twenty-two men with low T levels received 200 mg of testosterone enanthate every other week for one year. Throughout this treatment, total cholesterol, testosterone, estradiol, LDL and HDL were measured. The researchers concluded that T replacement returned both testosterone and estradiol levels back to normal and normal levels. They also found that T replacement lowered cholesterol and LDL, which is the bad cholesterol without altering HDL, which is the good cholesterol and there was no change in prostate size or function.

This study proved that T replacement doesn’t appear to raise heart disease risk – and it may actually lower your risk. There are many physicians out there today that should be prescribing low dose testosterone to middle age and aging men for muscle tone, both libido and for cardiac reasons.

It’s been long shown and proved that men have a higher risk of heart disease. One of the risk factors implicated is testosterone. The recreational use of testosterone can alter lipoprotein levels and in many cases reports exist that describe bodybuilders who’ve abused steroids and have experienced heart disease or even sudden death. But one can still ask, is the causal association one of truth or just an association? Well, researchers at the University of North Texas recruited twelve competitive bodybuilders for a comprehensive evaluation of the cardiovascular effects of steroids. Six heavyweight steroid-using bodybuilders were compared with six heavyweight drug-free bodybuilders.

And sure enough the heavy steroid users had lower total cholesterol and HDL levels as compared to the drug-free athletes. What was unexpected was that the steroid users also had significantly lower LDL and triglyceride levels as compared to the non-steroid users. In addition, the juicers also had lower Apo-lipoprotein B levels, which is a marker for heart disease risk. Thus, the authors concluded that androgens do not appear to raise the risk of cardiovascular disease. Thus the conclusion of this study is that the negative cardiac side effects of steroids are most likely overstated.

We know that as we age, circulating testosterone levels naturally decrease. For most men, the testosterone decrease goes from high normal to mid to low normal. There is also data that shows that there’s an inverse relationship between T levels and blood pressure as well as abdominal.

Testosterone replacement lowers abdominal obesity and restores testosterone levels back to normal. Positive side effects of restored testosterone is correlated with stronger sex drive, better mood, lower cardiovascular, disease risks, better muscle tone, stronger bones and improved memory. It should also be noted that while conservative use gives a pronounced positive health benefit, higher doses might not necessarily lead to further health benefits.

Positive Effects of anabolic steroids on the Heart

Anabolic steroids will cause your kidneys to implode, your heart to blow a ventricle, and your liver to squirt out of your arse, fly across the room, and knock the cat off the futon. We read it on the Internet and saw an after school special about it, so it must be true, right?

Actually, the more you learn about anabolic steroids, the more you come to realize that, like all drugs, there’s a difference between their intelligent use and outright abuse. In this article, Doug Kalman takes a look at the effects of Testosterone on the heart. What he found may surprise you.

Over the years we’ve all heard the repeated mantra that anabolic steroids are bad for the heart. Some physicians will tell you that gear raises your risk of heart disease by lowering your good cholesterol (HDL) and raising your bad cholesterol (LDL). In fact, as some docs will tell you, anabolic steroids are known to even induce cardiac hypertrophy (enlargement of the heart). And since you can’t flex your heart in an effort to woo women, who’d want that?

But, as in every story, there’s more than one side. In fact, let it be said, the dangers of anabolic steroids are overstated and, hold onto your seats, may even be good for the heart. Let’s examine some of the scientific studies on the positive effects of Testosterone on the heart.

What are the cardiovascular effects of anabolic steroids?

Cardiologists at the Royal Prince Alfred Hospital in Australia recruited both juicing and non-juicing bodybuilders for a study. Each bodybuilder had various aspects of the heart measured (carotid intima-media thickness, arterial reactivity, left ventricular dimensions, etc.). These measurements indicate whether bodybuilding, steroid usage or both affect the function, size, shape and activity of the heart.

The doctors found some obvious and not so obvious results. Predictably, those bodybuilders who used steroids were physically stronger than those who didn’t. What was surprising was that the use of steroids was not found to cause any significant changes or abnormalities of arterial structure or function.

In essence, when the bodybuilders (both groups) were compared with sedentary controls, any changes in heart function were common to bodybuilders. The take home message from this study is that bodybuilding itself can alter (not impair) arterial structure/function and that steroids do not appear to impair cardiac function.

Does MRFIT need a T boost?

A famous cardiac study was published about 10 years ago. It soon became on ongoing study known as the Multiple Risk Factor Intervention Trial (MRFIT). The present study examined changes in Testosterone over 13 years in 66 men aged 41 to 61 years. The researchers determined if changes in total Testosterone are related to cardiovascular disease risk factors.

The average Testosterone levels at the beginning of the study were 751 ng/dl and decreased by 41 ng/dl. Men who smoked or exhibited Type A behavior were found to have even greater decreases in T levels. The change in Testosterone was also associated with an increase in triglyceride levels and a decrease in the good cholesterol (HDL).

The authors concluded that decreases in Testosterone levels as observed in men over time are associated with unfavorable heart disease risk. (2) Sounds to me like a good reason to get T support/replacement therapy in the middle age years!

In a similar study, researchers in Poland examined if Testosterone replacement therapy in aging men positively effected heart disease risk factors. Twenty-two men with low T levels received 200 mg of Testosterone enanthate every other week for one year. Throughout treatment, Testosterone, estradiol, total cholesterol, HDL and LDL were measured.

The researchers determined that T replacement returned both Testosterone and estradiol levels back to normal and acceptable levels. They also found that T replacement lowered cholesterol and LDL (the bad cholesterol) without altering HDL (the good cholesterol). Furthermore, there was no change in prostate function or size.

The take home message from this study is that T replacement doesn’t appear to raise heart disease risk and it may actually lower your risk. It appears that more physicians should be prescribing low dose Testosterone to middle age and aging men for both libido, muscle tone and for cardiac reasons.

What about younger men?

It’s been long established that men have a higher risk of heart disease. One of the risk factors implicated is Testosterone. Reportedly, the recreational use of Testosterone can alter lipoprotein levels and, in fact, case reports exist describing bodybuilders who’ve abused steroids and have experienced heart disease or even sudden death. But the question remains, is the causal association one of truth or just an association?

To answer this, researchers at the University of North Texas recruited twelve competitive bodybuilders for a comprehensive evaluation of the cardiovascular effects of steroids. Six heavyweight steroid-using bodybuilders were compared with six heavyweight drug-free bodybuilders.

As expected, the heavy steroid users had lower total cholesterol and HDL levels as compared to the drug-free athletes. What was unexpected was that the steroid users also had significantly lower LDL (the bad cholesterol) and triglyceride levels as compared to the non-steroid users. In addition, the juicers also had lower apolipoprotein B levels (a marker for heart disease risk). Thus, the authors concluded that androgens do not appear to raise the risk of cardiovascular disease. The take home message from this study is that the negative cardiac side effects of steroids are most likely overstated.

In a little more progressive study, researchers at the Albert Einstein College of Medicine in the Boogie Down Bronx (the BDB to those in the know) examined Testosterone as a possible therapy for cardiovascular disease. The researchers note that T can be given in oral, injectable, pellet and transdermal delivery forms. It’s noted that injections of Testosterone (100 to 200 mg every two weeks) in men with low levels of T will decrease total cholesterol and LDL while raising the HDL.

In fact, Testosterone therapy has been found to have antianginal effects (reduces chest pain). Low levels of Testosterone are also correlated with high blood pressure, specifically high systolic pressure. The researchers determined that returning T levels back to normal and even high-normal levels have positive cardiovascular effects and should be considered as an adjunctive treatment for maintaining muscle mass when someone has congestive heart failure.

Putting it all together

Strong research demonstrates that the risks of negative cardiovascular effects of steroids are overstated. In fact, a recent paper published in the Canadian Journal of Applied Physiology questioned the whole risk of using steroids. (6) Joey Antonio, Ph.D. and Chris Street MS, CSCS published strong data showing that the risks of steroid use are largely exaggerated, much like scare tactics used by your parents while you were a kid. Of course, it goes unsaid that abuse of anything will lead to unwanted consequences.

We know that as we age, circulating Testosterone levels naturally decrease. For most people the Testosterone decrease goes from high-normal to mid to low normal. Data shows that there’s an inverse relationship between T levels and blood pressure as well as abdominal obesity (that paunch we see on so many middle age males).

Testosterone replacement lowers abdominal obesity and restores Testosterone back to normal levels. Restored Testosterone is correlated with better mood, better muscle tone, stronger sex drive, lower cardiovascular disease risks, stronger bones and better memory. It’s important to note that while conservative use gives a pronounced positive health benefit, higher doses may not necessarily lead to further health benefits.

What to do

If you see your body composition changing (your gut starts looking like your Uncle Lester’s), your strength or muscle tone diminishing despite your hard training and good diet, and your sex drive not matching up to TC’s columns, have your Testosterone levels checked. The acceptable normal range for Testosterone to physicians is 300 mg/dl to 1100 mg/dl. Yes, that’s a pretty wide range.

In the clinic, we see people with the complaints consistent with “andropause” (a term for male menopause) and/or increased cardiovascular risk having Testosterone levels between 300 mg/dl and 550 mg/dl. Bringing it up to the mid to high-normal level is what gives the health and “youthful” benefits. Traditionally 200 mg/dl of supplemental Testosterone given every one to two weeks improves body composition, lowers total cholesterol and LDL, while raising HDL.

It appears that supplemental T is a healthier and safer way to go than many of the drugs used to treat poor lipid profiles. The data presented in this article applies for males over 35, not those who are 18. If you think that you can benefit from Testosterone therapy look for physicians who market themselves as “anti-aging” or “longevity physicians” as well as the more progressive endocrinologists or cardiologists.

Erectile Dysfunction.Tadalafil (Cialis)

Tadalafil (Cialis) is the third oral medicine approved by the U.S. FDA for the treatment of erectile dysfunction. Like sildenafil (Viagra) and vardenafil (Levitra), tadalafil inhibits PDE5 (as described earlier).

How effective is Tadalafil (Cialis)?

The safety and efficacy of Tadalafil in the treatment of erectile dysfunction was evaluated in 22 clinical trials involving more than 4,000 men. Seven of these trials were randomized, prospective, placebo-controlled studies of 12 weeks' duration. Two of these studies (involving 402 men) were conducted in the United States, and the other five studies (involving 1,112 men) were conducted outside the United States. Two of these trials were conducted in special populations with erectile dysfunction; one in men with diabetes mellitus, another in men who developed erectile dysfunction after nerve-sparing prostate cancer surgery.

Effectiveness of Tadalafil in these studies was assessed using a sexual function questionnaire. Study participants also were asked if they were able to achieve vaginal penetration and to maintain erections long enough for successful intercourse.

In all seven trials, Tadalafil was significantly better than placebo in improving men's ability to achieve and maintain erections. Improvements in erectile function was observed in some patients at 30 minutes after taking a dose; and improvements can last for up to 36 hours after taking Cialis when compared to placebo.

How should Tadalafil (Cialis) be administered?

The recommended starting dose of Tadalafil for most patients is 10 mg taken orally approximately one hour before sexual activity. The dose may be adjusted higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The maximum recommended dosing frequency is once per day, although for many patients Tadalafil can be taken less frequently since the improvement in erectile function may last 36 hours. Tadalafil may be taken with or without food. Tadalafil is also available in 2.5 mg. or 5 mg. dosages for daily use

What are the side effects of Tadalafil (Cialis)?

Tadalafil is generally well tolerated with only mild side effects.

The most common side effects reported include:

• headache
• indigestion 
• back pain 
• muscle aches 
• facial flushing
• nasal congestion.

Back pain and muscle aches occurred in less than 7% of patients and usually occurred 12-24 hours after taking Tadalafil. The back pain and muscle aches associated with Tadalafil were characterized by mild to moderate muscle discomfort in the lower back, buttocks, and thighs, often aggravated by lying down. The back and muscle aches resolved in most patients without treatment within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Advil, or Aleve were effective. Approximately 0.5% of all the patients using tadalafil discontinued the drug due to back pain or muscle aches.

Reports of abnormal vision were rare; it occurred in less than 0.1% of patients using Tadalafil.

There have been rare reports of priapism (prolonged and painful erections lasting more than six hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil, and tadalafil. Men with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Untreated priapism can cause injury to the penile tissue and lead to permanent loss of potency. If there is prolonged erection (longer than four hours), immediate medical assistance should be sought.

Who should not use Tadalafil (Cialis)?

Tadalafil can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily should not take tadalafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers."

Tadalafil should not be used with alpha-blockers, medicines used to treat high blood pressure and benign prostate hypertrophy (BPH) because the combination of Tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting.

Tadalafil is not recommended for men with the following conditions:

• unstable angina (chest pain due to coronary artery disease that occurs at rest or with minimal physical exertion),
• low blood pressure (a resting systolic blood pressure less than 90mm Hg),
• uncontrolled high blood pressure (greater than 170/110 mm Hg),
• recent stroke or heart attack (within six months),
• uncontrolled, potentially life-threatening abnormal heart rhythms,
• severe liver disease,
• severe heart failure or disease of the heart valves, for example, aortic stenosis,
• retinitis pigmentosa.

Therefore, men with these conditions should not use Tadalafil without having these conditions evaluated and stabilized first. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled.

When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing.

What precautions should be taken when using Tadalafil?

In most healthy men, some of the drug will remain in the body for more than two days after a single dose of Tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows Tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, the dose and frequency of tadalafil has to be lowered in the following examples:

Men with severe liver disease should not take Tadalafil. Men with mild to moderate liver disease should not exceed Tadalafil dose of 10 mg once daily.

Body weight heavily influenced by gut microbes: Genes shape body weight by affecting gut microbes

Our genetic makeup influences whether we are fat or thin by shaping which types of microbes thrive in our body, according to a new study. Scientists identified a specific, little known bacterial family that is highly heritable and more common in individuals with low body weight. This microbe also protected against weight gain when transplanted into mice. The results could pave the way for personalized probiotic therapies that are optimized to reduce the risk of obesity-related diseases based on an individual's genetic make-up.

By studying pairs of twins at King's Department of Twin Research, researchers identified a specific, little known bacterial family that is highly heritable and more common in individuals with low body weight. This microbe also protected against weight gain when transplanted into mice.

The results could pave the way for personalised probiotic therapies that are optimised to reduce the risk of obesity-related diseases based on an individual's genetic make-up.

Previous research has linked both genetic variation and the composition of gut microbes to metabolic disease and obesity. Despite these shared effects, the relationship between human genetic variation and the diversity of gut microbes was presumed to be negligible.

In the study, funded by National Institutes of Health (NIH), researchers sequenced the genes of microbes found in more than 1,000 fecal samples from 416 pairs of twins. The abundances of specific types of microbes were found to be more similar in identical twins, who share 100 per cent of their genes, than in non-identical twins, who share on average only half of the genes that vary between people. These findings demonstrate that genes influence the composition of gut microbes.

The type of bacteria whose abundance was most heavily influenced by host genetics was a recently identified family called 'Christensenellaceae'. Members of this health-promoting bacterial family were more abundant in individuals with a low body weight than in obese individuals. Moreover, mice that were treated with this microbe gained less weight than untreated mice, suggesting that increasing the amounts of this microbe may help to prevent or reduce obesity.

Professor Tim Spector, Head of the Department of Twin Research and Genetic Epidemiology at King's College London, said: 'Our findings show that specific groups of microbes living in our gut could be protective against obesity -- and that their abundance is influenced by our genes. The human microbiome represents an exciting new target for dietary changes and treatments aimed at combating obesity.

'Twins have been incredibly valuable in uncovering these links -- but we now want to promote the use of microbiome testing more widely in the UK through the British Gut Project. This is a crowd-sourcing experiment that allows anyone with an interest in their diet and health to have their personal microbes tested genetically using a simple postal kit and a small donation via our website (www.britishgut.org). We want thousands to join up so we can continue to make major discoveries about the links between our gut and our health.'

Ruth Ley, Associate Professor at Cornell University in the United States, said: 'Up until now, variation in the abundances of gut microbes has been explained by diet, the environment, lifestyle, and health. This is the first study to firmly establish that certain types of gut microbes are heritable -- that their variation across a population is in part due to host genotype variation, not just environmental influences. These results will also help us find new predictors of disease and aid prevention.'

How to Train Through Injuries

Don't assume that medical practitioners will tell you everything you need to do to recover. Recovery is your responsibility. Spend your downtime focusing on the basics and dialing in movement patterns. All recovery is aerobic in nature. Do aerobic conditioning to speed recovery. Move every day, even the injured area if possible. Work around specific injuries. Upper body injuries are the easiest to train around. Taking a month off from squats and deadlifts isn't a bad idea. If you concentrate on posterior chain and core work, you'll hit new PR's when you resume squatting and deadlifting. Lower body injuries can be difficult to work around, but with a few good strategies you can continue to train and retain most of your strength.

The most important element of training through any injury is mindset. You have two options:

Wallow in self pity and allow yourself to regress while you slowly recover to your new, lower baseline. See the injury as an opportunity and challenge to correct weaknesses and recover as quickly as possible. I suggest number two. Your mindset will dictate how successful your recovery is.

Recovery is Your Responsibility
Don't assume that the medical practitioners you're working with will be instructing you on everything you can do to recover as quickly as possible. This isn't a knock on doctors or physical therapists. Most of them spend an extremely limited amount of time with patients and can hardly get them to do the minimum amount of rehab.

In fact, studies have shown that most people are so apathetic that they won't even take life-saving drugs more than 50% of the time, let alone do anything that involves more than stuffing a pill in their mouth.

Having a successful and speedy recovery is your responsibility, no one else's.

How Injuries Affect Training
Your immune system is intricately tied into your body's response to exercise. When you lift a heavy weight or smoke a conditioning workout, cellular damage occurs. This causes a cascade of other responses that end with you becoming bigger, faster, or stronger. This dynamic interaction means that your body's response to the same stimulus is constantly changing.

Any injury that causes a large systemic immune response will disrupt your body's response to training and ability to tolerate stress. You need to modify your training to account for how stressed your immune system is throughout the recovery process. Exercise beyond your body's ability to recover is a "pathogenic" stressor and slows recovery instead of stimulating it.

Basics of Recovery
ouch
Work on your weaknesses
Training what you suck at, well, sucks. But take this as an opportunity to improve. If you're like 99% of lifters, you need better aerobic capacity, movement, and breathing. In addition to that, you'd likely benefit from spending some time focusing on the basics and dialing in movement patterns again.

If you don't know what you suck at, just ask yourself what you dread training the most. Better yet, ask a training partner or friend who isn't afraid to hurt your feelings about what your weaknesses are.

Figure out weaknesses and attack them. Common weaknesses include:

• Conditioning
• Movement
• Breathing
• Exercise Technique
• Don't ignore conditioning

All recovery is aerobic in nature. Blood flowing around an injured site as well as throughout the body promotes exchange of waste and the rebuilding of cells and speeds recovery.

Aerobic conditioning also develops the fat oxidation capacity of your liver, which allows it to clear out immune system waste products more quickly. In addition, aerobic conditioning allows for greater parasympathetic tone, which promotes rest and recovery.

I can hear the excuses now. "I'm trying to gain muscle." "I don't want to get weak." These bullshit excuses are the plaintive cries of mediocrity. Unless you're an elite-level power lifter, Olympic lifter, or bodybuilder, you have no excuse to be deconditioned.

Let's clarify what I mean by "elite" because that's a term that gets bandied about almost as ridiculously as "warrior" lately. Nobody who deadlifts twice their own bodyweight is strong. A double bodyweight deadlift just means that you aren't weak. At my gym the strength standard for endurance athletes is a double bodyweight deadlift.

Similarly, no one who weighs 200 pounds is too heavy to have a decent aerobic capacity. I work with multiple athletes that weigh 200-220 pounds who regularly place well in endurance events (triathlons, marathons). You have no excuse. Get to work.

So, do your aerobic conditioning. Work up to 2-3 times per week for 60-90 minutes. Circuits of various low threshold movements can be a substitute for steady state aerobic work.

Movement is nutrition
Whenever you injure a soft tissue (muscle, ligament, tendon), movement is your best friend. As long as you use common sense and stay within the range of motion and loads your medical practitioners outline, you'll be doing your body a favor. Movement stimulates increased blood flow around the injured site, thus feeding nutrients and getting rid of waste byproducts.

Movement is also a stress (a positive one when you listen to your body) and it stimulates scar tissue formation. This is important because scar tissue develops in specific formations to handle the stress that it's placed under.

If you don't stress the injured site during recovery, you won't develop scar tissue that can handle the movements and types of stress that it'll be under when you're healthy and return to full speed. Known movements, performed at a low intensity for reasonable volume, speed up recovery.

Within the context of your specific limitations, move every day, even the injured area if possible.

Breathing matters

Breathing stimulates the lymphatic system, digestion, blood flow (oxygenation of tissues), immune system, and helps "clean" the organs. All of this stimulates faster recovery.

Opioid intake (pain killers), pain, and anxiety due to injury or surgery all have significant effects on your autonomic nervous system, which disrupts breathing patterns. If not addressed, this disruption can compromise recovery due to suboptimal acid-base balance in the body and the cascade of ensuing negative effects.

Most of the immune cells in your body are created by the bone marrow in the heads of the ribs. Proper breathing stimulates blood and lymph flow around the ribs, supporting optimal immune cell production. Non-optimal breathing also affects cognitive function. This impairs your ability to make good decisions and changes your perception of everything.

Learn how to breathe properly and practice every day.

Working Around Specific Injuries
Here are some basics for working around injuries. Apply these within the context of your specific situation. Be smart and do what works for you. These strategies are suggestions, not instructions. Don't do something just because it's listed here.

Shoulder, Hand, Wrist, and Elbow Injuries
Upper body injuries are the easiest to train around. You still have your lower body, core and one unaffected arm to train.

Train the other arm. Just because one of your arms is injured doesn't mean the other one can't be trained.

Try:

• Single Arm Dumbbell Rows
• Single Arm Dumbbell Bench Presses
• Single Arm Dumbbell or Kettlebell Overhead Presses
• Single Arm Pulldowns

Give your spine a break. Taking a month or two off from squats and deadlifts isn't necessarily a bad idea. I did that following my most recent shoulder surgery and after a few months of hip lifts, belt squats, and lots of posterior chain and core work, I returned to squatting and deadlift. I was hitting PR's a few months later because I fixed my weaknesses. My back also thanked me. Spine deload exercises include:

Rear-Foot Elevated Split Squat (weight in one hand + weighted vest)
Lunge Variations (weight in one hand + weighted vest)
Hip Thrust

Incorporating dynamic work is a great way to overload the lower body without having a lot of weight on the spine. Examples of dynamic exercises:

• Box Jumps
• Hurdle Jumps
• Depth Jumps
• Split Squat Jumps
• Squat Jumps
• Knee, Ankle, and Foot Injuries

Lower body injuries can be difficult to work around, but with a few good strategies you can continue to train and retain most of your strength throughout your recovery period.

Train the Upper body. This may seem obvious, but most people think any injury means no training. You can still train the upper body with very few modifications and a good training partner.

Train the uninjured leg. Some options:

• Single Leg Squats
• Single Leg Hip Lifts
• Single Leg Deadlifts

Core Training. A lot of core training involves the lower extremity and without one leg, finding core exercises to do can be difficult. Some of my favorite core exercises for clients with a lower body injury:

• Dead Bugs
• Leg Lowering Exercises
• Straight Leg Sit Ups
• Hanging Unilateral Leg Raises

Lower Back, Hip, and Abdomen Injuries
Injuries around the middle of the body are the hardest to train around. However, that doesn't mean that you can't continue to train.

Train the Upper Body
When I have clients with lower back and abdominal injuries we start with a lot of low intensity upper-body work that doesn't stress the injured area. This usually means simple exercises such as floor presses and chest supported rows. Experiment with supported variations that require less core involvement until you find something that works for you.

Replace intensity with volume and density. It's unlikely you can lift heavy while recovering from this type of injury, so instead focus on doing a lot of high quality, low intensity work in short periods of time. The formula outlined below stimulates blood flow and parasympathetic (rest and recovery) activation.

Movement Work – Light-Weight Lunges, Squats, Deadlifts
Breathing exercises between sets
Here's an example of a circuit combining these different principles:

Kettlebell Romanian Deadlifts (very light with slow lowering phase)
Dumbbell One-Arm Bench Presses
Half-Kneeling Cable Rows (hold at top for 3 seconds)
Deep Breathing Squats
Four sets of 5 reps of all exercises. No rest between exercises; the breathing exercise is the rest between sets.

Stages of Recovery
Initial
The initial recovery period will range in length from weeks to months depending on the severity of the injury. During this time your body is in a constant state of systemic inflammation and recovery. The goal during this period should be to feed the recovery process and correct weaknesses without doing too much and inhibiting recovery.

Use the following guidelines to craft a training plan:

Perform aerobic activities at least 2-3 days per week.
Do some type of movement (squats, hip hinges, rows, presses) every day, but keep the intensity and volume fairly low.
Perform breathing exercises daily.
Focus on correcting weaknesses.
Eat a clean diet. Gut health contributes to sleep quality, immune response, and your overall internal health.
Perform soft tissue work daily over the entire body including around the injured site.
Sleep a lot.
Move throughout the day. My favorites are going on five minute walks or performing short sets of 20-25 air squats, light kettlebell swings, push-ups, and pull-ups every one or two hours (or whatever movements I can do).
Avoid heavy lifting, anaerobic conditioning, or crushing yourself in any other way during a training session.
Middle
The middle stage of recovery begins when you're off all pain meds and are able to start more aggressive physical therapy or training without feeling awful for several days. The systemic hormone response from these days should actually speed the recovery process. Aerobic and other low intensity work should be performed on all "off" days.

Use the following guidelines for the middle part of your recovery:

Alternate between moderately difficult and easy training days.
Easy training days should consist of movement and aerobic work.
Hard training days should follow the set/rep/intensity/rest scheme outlined below because it stimulates a large GH and testosterone response but won't crush your nervous system:

Perform variations of the big lifts: squats, deadlifts, presses, rows, pull-ups.
Do full body workouts, 3-5 main exercises, 3-5 sets per exercise, sets of 5-10 reps.
Perform supersets of 2-4 exercises allowing full recovery between sets.
Use moderate intensity. Leave at least 2-3 reps in the tank and focus on perfect technique.
Light sprints (10-15 seconds) can be performed 1-2 times per week. These are not "all out" days but more like 80-90% effort.
You shouldn't accumulate fatigue over the course of the week. You should feel close to 100% before you perform another strength session.
Back to Normal
dip
The final 10-20% of recovery is always the most frustrating. Working with skilled practitioners can help restore movement and function much faster than if you decide to go at it alone. Key tactics of the final stage of recovery:

Slowly return to full intensity workouts.
Focus on restoring proper mechanics and movement up and down the chain from the site of the injury.
Listen to your body and have training partners critique form or record form on all big lifts to ensure proper movement.
Have a long-term mindset. One training session or season is meaningless in the context of a lifetime. Don't take unnecessary risks in the name of short-term satisfaction.
Now, these are just recommendations and are far from comprehensive. Develop a relationship with the team of people you're working with and make a plan that works for you. It's your body and it's your responsibility to make the best of the situation. Be creative, listen to your body, and most importantly, buy in to the fact that you're in control of how you recover from an injury.

Combating hair loss

In the study, 416 men with male pattern hair loss ages 21 to 45 years old, were randomized to receive dutasteride 0.05, 0.1, 0.5 or 2.5 mg, Finasteride 5 mg, or placebo daily for 24 weeks. The results of the study showed that dutasteride increased hair counts in a dose-dependent fashion and dutasteride 2.5 mg was superior to finasteride 5mg at 12 and 24 weeks.

Although testosterone is the major circulating androgen, to be maximally active in scalp hair follicles it must first be converted to dihydrotestosterone (DHT) by the enzyme 5α-reductase. The importance of DHT as a causative factor in male pattern hair loss is shown by the absence of this MPHL in men with a congenital deficiency of the type 2 5α-reductase enzyme. A type 1 5α-reductase, which also metabolizes testosterone to DHT, differs in its location and amount in different tissues. In the skin, type 1 5α-reductase is the principal isoenzyme in sebaceous and sweat glands. There is no recognized genetic deficiency of type 1 5α-reductase in humans to assess its role in male pattern hair loss.

Dutasteride (Avodart) inhibits both type 1 and type 2 5α-reductase and is approved at the 0.5-mg dose for treatment of symptomatic benign prostatic hyperplasia (BPH). It is about 3 times as potent as finasteride at inhibiting type 2 5α-reductase and more than 100 times as potent at inhibiting the type 1 5α-reductase enzyme.
Dutasteride caused scalp and serum dihydrotestosterone levels to decrease and testosterone levels to increase in a dose-dependent fashion. Whereas 5-mg finasteride decreases serum DHT by about 70%, dutasteride can decrease serum DHT by more than 90%.

Results

In this phase II, dose-ranging study, 2.5-mg dutasteride was superior to 5-mg finasteride in improving scalp hair growth in men between ages 21 and 45 years with male pattern hair loss as judged by target area hair counts, expert panel assessment, and investigator assessment at 12 and 24 weeks.

Dutasteride 2.5mg vs. 0.5mg

The 2.5-mg dutasteride dose was consistently superior to 0.5-mg dutasteride in promoting scalp hair growth. The 2.5-mg dose was also better than the 0.5-mg dose at suppressing scalp DHT (79% vs. 51%), whereas it was only marginally better at suppressing serum DHT (96% vs. 92%). This difference in the dose-response of serum and scalp DHT to inhibition with dutasteride is likely to be due to the greater contribution of type 1 5α-reductase to scalp DHT concentrations.
Finasteride 5mg vs. Dutasteride 0.1mg

5 mg finasteride suppressed scalp DHT to a similar degree as 0.1 mg dutasteride group (41% and 32%, respectively). Many of the clinical effects (hair count changes, global panel assessment, and investigator assessment) were also similar in these two groups, supporting the similarity in scalp suppression between 5-mg finasteride and 0.1-mg dutasteride.

Adverse Effects

Both Dutasteride and Finasteride were well tolerated in this phase II study, and no new safety concerns have arisen in any of the phase II and phase III studies of Dutasteride given at doses up to 5 mg daily (the 5-mg dose was used in a phase II study for BPH).

There were no significant differences in side effects, serious adverse events, or withdrawals due to adverse events among any of the treatment groups, including placebo. In total, 11 subjects withdrew because of adverse events: 3 were in the placebo group (irritable bowel syndrome and impotency), 7 in the Dutasteride 0.1 mg group (decreased libido, malaise and fatigue, mood disorders, skin disorders, injuries caused by trauma, and gastrointestinal- and neurology-related complaints) and 1 in the Dutasteride 0.5 mg group (gastrointestinal discomfort and pain).

Decreased libido was noted in:

2 subjects in the placebo group
2 subjects in each of the 0.05-mg and 0.1-mg Dutasteride groups
1 subject in the 0.5-mg Dutasteride group
9 subjects in the 2.5 mg Dutasteride group
3 subjects in the Finasteride group

Of the 9 subjects with decreased libido in the 2.5-mg Dutasteride group:

4 resolved while receiving therapy
1 resolved within 3 weeks
1 resolved within 8 weeks of stopping drug therapy
1 subject, decreased libido continued after therapy had been stopped and was presumed by the subject to be unrelated to the trial or drug therapy

Concerning possible sexual adverse events, there was no evidence in the present study that either Dutasteride or Finasteride was associated with impotence. However, 9 men in the 2.5-mg dutasteride group complained of decreased libido, compared with 1 man in the 0.5-mg dutasteride group and 3 men in the Finasteride group. As with previous studies with finasteride, this adverse event was characterized as either mild or moderate in severity and often resolved with continuation of the medication. In the 4-year follow-up of the phase III trials in BPH, dutasteride (0.5 mg) was well tolerated and the incidence of the most common sexual adverse events was low and tended to decrease over time. The only subject to develop gynecomastia was in the placebo group.

Duration of Effects

The serum half-life of Finasteride is 6 to 8 hours. Dutasteride has a serum half-life of approximately 4 weeks, and this long half-life was evident in the persistent suppression of DHT with the 0.5-mg and 2.5-mg doses after Dutasteride treatment was stopped. Because of this long half-life, men being treated with Dutasteride should not donate blood until at least 6 months past their last dose to prevent administration to a pregnant female transfusion recipient.

Who should avoid using Clenbuterol?

Performance enhancing drugs such as Clenbuterol should be used sensibly and collecting as much qualified information as possible is the key to optimizing and reaping complete benefits of Clenbuterol, which is also known as Clen.

Clenbuterol is not to be used by those having a sensitivity to the medication or any of its substances or those experiencing hyperthyroidism, tachycardia, tachyarrhythmia, heart or thyroid diseases, high blood pressure, coronary artery disease, congestive heart failure, prostatic hypertrophy, hyperthyroidism, urinary retention, glaucoma, ischemic heart disease, myocardial infarction (acute period), and hypertrophic obstructive cardiomyopathy. Long-term use of this medication can decrease stamina stages to a considerable level. The medication is also not suggested for expecting and breast feeding females and kids. People with diabetic issues should seek healthcare guidance before starting use of this steroid.

Moreover, Clenbuterol should not be taken by those who are using cardiac glycosides, beta-blockers, sugar lowering drugs, insulin, CNS stimulants, MAO inhibitors, and sympathomimetic agents. It should not be taken by those already administered with or using terbutaline, oxytocin, propanolol and other beta-blockers, digoxin, dinoprost (Lutalyse, Prostamate), monoamine oxidase inhibitors, or inhaled anesthetics.  Under no situation, Clenbuterol should be used or taken through recycled or distributed needles as such a practice increases the chances of injection site pain and sexually-transmitted diseases such as HIV and AIDS. Most of these adverse reactions are extremely rare and most subside by themselves in over seven to ten days.