Sports Science Dudes

Episode 93 - Dr. Dean St Mart; Muscles, Minds, and Milligrams - Androgens!

• Jose Antonio PhD

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Dr. Dean St Mark, a pharmacologist and product formulator for UK-based brand called Supplement Needs, brings his expertise on testosterone, PEDs, and their health implications to the podcast.

• TRT usage has shifted from older men to being prescribed for men in their mid-20s with hypogonadism
• Many users push beyond replacement therapy (800 ng/dL) into enhancement territory (1200+ ng/dL) 
• Androgens impact brain chemistry, creating psychological dependency through altered dopamine thresholds
• Female athletes face unique risks including potentially irreversible virilization effects like voice deepening
• Polypharmacy and arbitrary dosing based on gym advice rather than science increases health risks
• "FemTest" protocols inappropriately extrapolate safety data from PCOS patients to healthy female athletes
• Excessive size and muscle mass may contribute to early mortality in bodybuilders (40-60 years old)
• EPO can benefit endurance athletes but requires careful monitoring due to blood viscosity concerns

Find Dr. Dean St Mark on Instagram @DeanSTM.


Speaker 1:

Welcome to the Sports Science Dudes. I'm your host, dr Jose Antonio, with my co-host, cassie Evans. Today, our special guest is Dr Dean St Mark. He's got a PhD. A little bit about Dean. He's a product formulator for the UK-based supplement brand called Supplement Needs. A fitness industry-renowned pharmacologist and leading educator, dr Dean's popularity grew from his no-nonsense approach yeah, we don't like nonsense either when it comes to performance-enhancing drug use and testosterone replacement therapy. And we're going to have a fun time talking about TRT, so this will be good. He's the author for the National Academy of Sports Medicine, wherein he is the subject matter expert for dietary supplements and PEDs within their bodybuilding and physique coach qualification curriculum. His interests lie mainly in performance-enhancing drug pharmacology, novel drug design, health and sports dietary supplementation and applying functional medicine to athletes to improve their health.

Speaker 1:

Dean, you and I met for the audience. We met at the Enhanced Games in Oxford, um a few weeks back, a little, several weeks back, and, uh, there were some good and fun conversations at Oxford. Unfortunately, cassie couldn't make it, um, but you know, maybe next time. But before we start, I want to tell you a little bit of a story in background. When, um, when, I was in graduate school this school I'm finishing my PhD. This is roughly 92, 93. I was going to start a postdoc and prior to that time I was friends with a lot of bodybuilders. I was also a writer for a lot of the main fitness magazines here in the United States and we, for whatever reason, we went through Goodman and Gilman's textbook, the Pharmacological Basis of Therapeutics and of course, we read the section on androgens and we were stuck by well, we're stuck by the conclusions made by Goodman and Gilman and in fact I think Gilman's a Nobel Prize winner and the three of us were just snotty grad students. We said you know what these guys are wrong? We just think they're wrong.

Speaker 1:

The time remember this is early 1990s people were making conclusions about androgen use in healthy athletes, but they're taking data from individuals with cancer or heart disease or some other clinical condition and, as you and I know, the first thing you learn in the exercise sciences is you got to know who your subjects are. If you're doing a study on obese people, you can't apply it to people who work out. If you're doing a study on obese people, you can't apply it to people who work out. If you're doing a study on lean athletes, you can't apply it to the obese. So there was that sort of disconnect. But what resulted from that is the three of us again just grad students thought you know what, let's just write a review paper on this. Now it wasn't that hard to write because at the time there really wasn't much literature. Now there's a lot of literature on it.

Speaker 1:

But the crazy part about that is the paper got rejected six times and the comments were as follows. And every journal said this we agree with your science, but we can't publish this because it's politically incorrect, which I thought okay, that's really strange for science the Canadian Journal of Applied Physiology they were, I think, the sixth or seventh one to reject us. And again back then remember, dean, there's no Internet, this is all by paper, they're mailing stuff to us. So we're like God dang. It's taken well over a year, now probably two years but the Canadian Journal of Applied Physiology came back to us like months later because they had to write a letter and mail it. They said you know what? We've decided to publish this because if we don't, someone else will.

Speaker 1:

Even though their initial reason for rejecting it was because it was politically incorrect. Let's fast forward. That same year Shalinder Basin publishes the 1996 paper in New England Journal of Medicine showing that 600 milligrams a week of testin anthe in normal, healthy males makes you bigger, makes skeletal muscles grow, you get a little stronger and you don't even have to work out, which is really kind of strange. So with that background, tell us a little bit about what got you interested in and how you framed the use of androgens, because now bodybuilders are taking a hell of a lot higher doses than back in the 90s.

Speaker 2:

So give us your thoughts yeah, I guess I was thrown into the deep end by my wife of all of all people. Yeah, I met my wife in 2015 and I had a huge interest in performance enhancing pharmacology all throughout my synthetic chemistry degree Just reading into like the intricacies of what they've done on the body and then taking the aside of like what we spoke about there of dosages, taking the aside of like what we spoke about there of dosages, looking at what was being spoken about online and there's just a complete disconnect between what was happening in reality and what was happening in the literature, and so I just started to gain an appreciation then of like functional medicine and, more so, the questions that functional medicine proposed.

Speaker 1:

Sorry to interrupt you, Dean, but you got to explain why your wife pushed you. That's kind of interesting.

Speaker 2:

What ended up happening was I sort of started to question the whys with functional medicine, like, why do steroids cause certain health implications, what can we do to prevent them, or what can we do to educate ourselves a little bit better. And with that knowledge, I guess I was quite well known in, like the gym circles of Ireland. Someone would come up and speak to me and ask me questions and eventually my wife just said to me you can't be like this silent person. You need to get on Instagram, you need to get you know online and get your voice out there and, as sort of like a, an introverted extrovert, if you sort of put it that way, you're sort of thinking does anyone really want to listen to what I have to say? And I guess, uh, eight or nine years later, I'm still here with, you know, quite a big following of just really trying to make the science of it as interesting as possible whilst debunking some bro myths or bro science theories.

Speaker 2:

Um, you know, like detoxing your androgen receptors and having to uh take it like we're laughing here, but these are some sort of common things you read online. You know, having to do a PCT to give your, your body a break and detox. It was just certain things like that were probably causing more detriment than positive in certain individuals. Talking about what perhaps is occurring when anabolic steroid users develop cardiovascular disease, what are some of the root cause mechanisms? It's not that you take androgens or trt and you are going to develop cardiovascular disease. There's a there's intricacies in terms of the root cause mechanisms surrounding oxidative stress, foam cell production from an immune perspective, nutrient deficiencies there was all these questions that sort of played into the bigger how and why and so I you know, just just out of curiosity, because you guys both have mentioned like androgens.

Speaker 3:

Like are we talking about? Like just testosterone or like I know, limited from? Like the bodybuilding scene there's and I'm probably going to say it in incorrectly, but like well, the nickname maybe for it like D-ball windstraw, like is that also included in like the androgen category of things that get used and are studied?

Speaker 2:

of things that get used and are studied. Yeah, I mean, when we consider what an androgen is, it's a C19 steroid, so it's a cholesterol derivative that basically then infers activity at the androgen receptor. So that could be, like you said, dht-derived androgens like anavir, oxangrolone, or methylated oral steroids like dianabol or d-bol or anadrol. These compounds that were, I guess, studied to try and derive some level of anabolic effect, but also, in certain individuals, the androgenic effect as well, depending on what was lacking or needed to be addressed from a characteristic development perspective. So when we're like looking at androgens, yeah, you have the full umbrella of both anabolic and androgenic steroids in that complete umbrella and then, depending on how you sort of subclass them, there are like mild subclasses in terms of testosterone derivatives, 19-nor testosterone derivatives like nandrolone and tremblone, where the C19 has been removed, the metal group there, or you have the, I guess, 70 and alpha alkylated oral steroids. So you have the sort of three branches that we discuss when we're talking about androgens.

Speaker 2:

But I guess historically the literature focuses quite a lot on testosterone by itself. Then we're sort of limited to very sparse I, I guess human studies surrounding the other anabolic androgenic steroids, which can be a little bit difficult if we're trying to produce exact science in a discussion of, for example, what benefit perhaps Winstroll has over straight testosterone or what benefit oxangalone anavar has it. We're very limited by, I guess, ethics now, knowing that they do cause harm. So to generate a study, like jose said, it's very difficult to get ethical approval of. Well, let's see what happens if we give a male 150 milligrams of Winstroll, which is something that is done by amateur bodybuilders. But knowing the harm surrounding what 25, even 10 milligrams can do from historical medical studies, it's very difficult to get approval on a study that is knowingly going to harm the subjects and, for all intents and purposes, maybe irreversible damage if it was cardiovascular disease. So your ethic approval when it comes to steroid design or study-strained steroid design pretty much will never go past human ethics approval.

Speaker 3:

And then if you do subjective reporting of what they're doing, then you know. How do you know exactly what they're taking? How do you know everyone's taking the same quality? I mean, there's a lot of issues with that. I'm sure people would have no problem in anonymously disclosing what they do in a gym setting, but then trying to, you know, regulate that and make that the same would be challenging yeah, we, like we do have quite a lot of cohort studies of like anonymous questionnaires where bodybuilders will disclose what they've done.

Speaker 2:

But then you end up, like what you said there, with polypharmacy where you could be taking four, five, six different compounds and steroids, and that makes it very difficult to critically analyze. Well, what is one steroid doing over another? Where exactly are we seeing some of the health detriments coming from? Is it everything is a combination of a plus b plus c? It's very difficult to derive a correct conclusion other than what seems to be like the umbrella consensus is they, they cause harm and they should not be used. So it's it the way I was framed it when I viewed it from like a drug design, like my background, being in drug design and pharmacology, was these were medicines, for I guess most of them intently, were developed as medicines. You can have anadrol designed to help with red blood cell production, or anemia factors, or even cacaxia with cancer. They had medical. I guess they wanted to have good intentions medically with the use of these compounds.

Speaker 2:

And then, obviously, if anyone's familiar with the history of anabolic steroids and performance enhancing drugs, the most notable one being obviously between the Russians and the Germans with the Olympics. And then you know the underground potential testosterone use and then that led into the development of dianabol as an oral steroid. And then from there you have, you know, a slippery slope of medical doctors unethically prescribing it to athletes knowing that they have positive benefits on performance, but slowly, over you know, 15 year period, start to realize these are actually quite dangerous compounds. From a realization perspective, like we can look back at, I guess, the horror of science, if you want to put it that way of you know we learn from mistakes as time moves on. But prescribing dianabol to a female and then you know, unfortunately, seeing six, eight months later they've developed virilized characteristics that are unfortunately for most, irreversible. And there are case studies, if you go back and look of um, from what I remember now off the top of my head, there was one case study of a female teenager who was prescribed the Anabol. As far as I remember it was the counteract acne development. It was something crazy in the literature. Counteract acne yeah, as far as I can remember that's crazy. But basically in it the poor girl developed a deeper voice, had verbalization characteristics that in hindsight they then realized okay, this was not the right thing for us to prescribe and you know, slowly, over time, that is where these compounds have become, I guess, villainous.

Speaker 2:

I guess my main thing when it came to educating on these compounds was getting rid of the statement that these things can be used safely, because we know full well from the research that the word safe alongside these compounds doesn't really coexist. But what we can do is risk mitigate. So the athletes or the person who chooses to use these substances are fully aware that they cause harm, that there are health implications. But what potential strategies whether they are lifestyle, nutrition supplementation, antioxidants, etc. That could offset some of the risks that may develop from using them.

Speaker 2:

And that was where my sort of ethos or mission came into of trying to remove some of the stigma which I can see over the last five years has slowly shifted away with testosterone replacement therapy. No longer is testosterone replacement therapy being viewed as a, I guess, a later stage in life prescription, that there are males in their mid-20s into their early 30s who are being diagnosed with hypogonadism and being medically prescribed TRT. But like everything, um, when you give sort of an inch, some people take a mile. And with testosterone replacement therapy there is a slow shift where the boundaries of what it's designed to do by correcting, um, I guess hypergonadism low testosterone production is slowly moving into a pattern where males are utilizing it, um in a dose that's, in my view, abused. That we're not now in that sort of medical umbrella of a strict physiological replacement of testosterone. You're slowly inching your way up into the well.

Speaker 2:

In terms of the UK it would be about 40 nanomole, which I believe, with US measurements, about 12-1300 nanogram per deciliter, when the British Society of Sexual Medicine's guidelines for testosterone replacement therapy is a level of 25 nanomole, which is, I think, 800 nanogram per deciliter. And that's like the strict range of where you should aim to fall with TRT. And over time guys are getting a little bit more greedy and even you know it's sort of becoming a social norm that guys are openly talking about being on TRT and when they disclose what they use for TRT I mean a relative dose for a level of 25 nanomole is approximately 125 milligrams of testosterone and antates in a normal metabolizing individual in a normal metabolizing individual. And yet we have guys who report using 250 or 300 milligrams of testosterone per week which they may require depending on their genetics. You do have guys who will have a fast CYP metabolism so their liver will clear the drug quicker and you might need a higher dose of a drug.

Speaker 3:

But the other side of is just greediness and then we start to see that that can turn into long-term abuse potentially so you can definitely see that down here with uh, I don't know if med spa is the right word or these like long longevity clinics, um, where you know they shoot, like you said, like the normal range being, you know, starting at 800. And you hear some of these you know doctors saying, hey, let like you said, like the normal range being, you know, starting at 800. And you hear some of these you know doctors saying, hey, let's get you to like 1000. And people are like, yeah, let's do it, you know Florida is famous for that A little bit, a lot better.

Speaker 1:

So yes.

Speaker 1:

How about this? The way a lot of guys have framed this. They would say, yeah, there's more of a risk if you're over 1200. However, there are women that you see in Miami who routinely get their face done, who get liposuction, who get Botox, and they would argue that's just as risky as testosterone replacement. So why is it okay for women to do this to make themselves beautiful, but not okay for a guy who just wants to put on muscle? That's sort of the, I guess, ethical argument for higher doses. What are your thoughts on that? I don't know if it's like that in Ireland, but in South Florida everyone's trying to look pretty.

Speaker 2:

Yeah, I mean TR to we. I guess it's it's sort of the nature of irish people. Testosterone replacement therapy has really only become a socially accepted norm here in the last two or three years. Up until that point you had maybe at maximum two or three clinics off the top of my head that were doing male testosterone prescription, and even then it was very, very regulated to the point where the first sort of point of call with testosterone replacement therapy is testosterone gel in Ireland. So compounded injections have really only become a relatively new thing, I guess.

Speaker 2:

Yes, the right to bodily autonomy, like what we had sort of a discussion in Oxford, most definitely that's a case for argument, I guess having a level over 1,000, we sort of know do? I always view it as, once you sort of enter into that super physiological range that like basin study sort of showed, or even historically when we look at the lipid impacts, it's not that as soon as you go into a super physiological level that these detriments like dyslipidemia and potential issues with liver kidney get worse and worse as the dose titrates up. It's almost like there's just a genetic switch of you go into this super physiological range and now things start to change of themselves. But they tend to hold relative consistency or relative constant once you're in that super physiological range. So if they're able to, I guess, accept some of the risks that will manifest from being in a super physiological range, then they're, at the, I guess, master of their own destiny. Do I often put it? Even even more so and this is always a nice question to frame would be let's just say, you have an individual who has a testosterone level of 280 or in UK measurements like eight nanomole, very, very bottom of the range, and you bring them to 25 nanomolar, you bring them to 800. You've effectively, you know, two and a half almost tripled their natural testosterone production or exposure. That I often ask the question what's the difference between there and that tripling, versus someone being at 800 and going to 2400, who have tripled their testosterone exposure? You're still, I guess it really comes back to.

Speaker 2:

Another argument that I have to make is we don't know the exact number of androgen receptors in the body.

Speaker 2:

So, like most medications, there's almost a a dose response curve of you give a dose and you observe for positive and negative effect or you check health markers to see what changes.

Speaker 2:

It's not that we know this perfect equation of X amount of milligrams of testosterone will interact with Y receptors, androgen receptors, to give a positive benefit, and that's where I guess the selective androgen receptor modulators or some of these new non-androgenic compounds that are trying to be developed for muscle building are trying to be pursued.

Speaker 2:

If we could, I guess, dose on a milligram per kilogram basis, which again was another completely flawed assumption within the amateur bodybuilding community of oh, I'm taking three milligrams per kilogram of testosterone, which, again, again, we don't have the number of androgen receptors in lean tissue, so you're really creating something fancy as a selling term that has no founding in science. If we did know the number of androgen receptors in a given body weight, then it would be very easy to utilize a dose whereby you're not what I call spilling over into the under androgen receptors of the body. Because if we sort of view in a simplistic or reductionist fashion of what happens in the negative consequences of these compounds, it is spillover where you're interacting with androgen receptors and other tissues outside of muscle, where you want to deposit benefit. So androgen receptors within the heart, the skin, prostate, you name it, anywhere outside the muscle is where we potentially see these side effects.

Speaker 1:

What do you think I mean? Recently, I was just looking at a bodybuilder named Vittorio Curbazzari. He's 44 years old. He collapsed and died while running or walking on a treadmill.

Speaker 1:

So a fairly muscular guy, but one of my good friends down in Florida. We've sort of had this on and off text conversation about seem to be a lot of bodybuilders dying young. Young meaning like 40, 50, even if you're 60 years old, to me that's young. You shouldn't be dying at 60. And we've always thought, okay, it's got to be a couple things. And then I want your thoughts on it. One it's got to be polypharmacy, because you don't know what they're taking. They're probably on GH as well, probably EPO. The dosing's got to be EPO, the dosing's got to be. Certainly it's not therapeutic. But also the other thing we came up with is they're large. Large people don't live long. So and that's the part that no one ever mentions it's like you don't see large, muscular people living into their late seventies. It's rare. You don't even see tall people living into the late seventies. So what are your thoughts on that?

Speaker 2:

tall people living into the late 70s. So what are your thoughts on that? Yeah, that is a very good observation, um, and I guess that's sort of one of the arguments when it came to longevity of, on one side of the equation, they suggest having higher amounts of muscle mass equates to better metabolic efficiency and everything else. And then the other side is you almost want to limit mTOR and starve methionine of the body as we age, to try and slow down or improve sirtuin activity to preserve our DNA, to speak. Um, I definitely think science has something to do with it.

Speaker 2:

The other side of I it I guess that plays off the science is psychology and this is one aspect that I spent a lot of time educating on where we don't necessarily have any data to say that these are physically causing in terms of their dependency, whereby we have psychological dependency causing physical interactions, but most definitely in what they do to our brain chemistry of driving dopamine synthesis.

Speaker 2:

That the longer you are being exposed to these androgens, we know that our neurons have a gating voltage threshold that gets polarized for excitation, that the longer we're exposed to these higher levels of androgens, the higher that resting gating voltage goes, and then you need these higher dosages in order to have that dopamine, I guess, transmission or dopamine excitation.

Speaker 2:

And what you find is if someone lowers their dose or comes completely off and restores normal physiological function, their brain chemistry or that gating voltage takes a long time to come back to a normal resting potential.

Speaker 2:

That on paper they may have a normal physiological looking panel of blood work, so their total testosterone could be back to 700 or 800, which you'd consider normal, but their brain is still seeking a high level of androgens in order to create that dopamine threshold. And so there's this slippery path of guys exposing themselves to chronically high dosages longer into life because it is effectively driving their neurochemistry and that that aspect is something that we have not really touched on in the scientific community of we have we have a couple of papers that establish some level of dependency from a dopamine perspective, but nothing really conclusive to sort of hold off or caution. It's um caution as a side effect of trt. You see, even that you take these compounds and there's going to be a psychological dependency in 10 or 15 years time that you have to stay on trt in order to feel quote, unquote normal psychologically objectively.

Speaker 3:

I mean, I've heard a ton of men state that one of the reasons why they don't want to go off is because they feel depressed or down low mood, low energy while coming off of it, and for many they might try but then end up going back on it. So you? You mentioned a little earlier something about alternatives. So do you think things like SARMs and peptides are why they're growing in popularity? Because people think that they're safer, maybe, than your classic androgens?

Speaker 2:

It does appear that way. I guess, with something like a peptide being like a short chain of amino acids that creates a cell signaling event, the impact that it has long-term, I guess, versus an organic molecule and I guess a nuclear steroid interaction is probably a little less benign to speak. But they still have their own potential side effects and still have their own cautions. I guess, like jose said it, it is sort of that chase for vanity for some people, as opposed to even the um performance enhancing aspect of you know, how can we have better skin, how can we have bigger muscles, better strength, better vitality, cognitive benefits, the the side effect of the low dopamine. I've seen it classically with guys who have come to me um from a functional health perspective, where they've done, you know, post-cycle therapy, they've recovered their natural hypothalamic, testicular pituitary axis, but they just complain of having like no libido, no drive, no ambition, just classical low dopamine sort of symptoms. And when they do an organic acid test, a urine based test for checking some of the neurotransmitter metabolites, like homo vanillate being the dopamine metabolite, you see low hva in their urine, indicating that in theory they're not making a lot of dopamine. And so to me this side effect is wholeheartedly one of the reasons why I try and remove it from the discussion of young adults is probably the best way to describe it. Like 18 to mid-20s of. Don't even consider androgen use until your, your brain is in a fully developed position and then understanding this consequence.

Speaker 2:

That could be a long-term consequence, because the most difficult part there is once you've established that that brain has low dopamine. Sure, you can do stuff nutritionally, you can try and improve l-dopa synthesis and whatever else, but there's nothing we can do to like reset the electrical potential of that neuron to make it sensitive again, other than abstaining from dopamine activities to allow the resting potential to fall back to a relatively normal place. Though, when someone has these symptoms low libido, low drive, etc. They make a classical assumption of well, I felt good when I took these compounds, so I'm going to go back to either taking TRT or taking even higher dosages of PDs in order to feel good mentally. And then you make the potential distinction that are these compounds then good, inducing psychological dependency? Um, they may not be the same withdrawal in terms of physical side effects, like an opioid for example, but if they require that higher level of testosterone in order to drive dopamine transmission in their brain. Their brain is, in theory, having a dependency on that androgen to drive their dopamine metabolism.

Speaker 2:

Dean clinically what are the most researched androgens and also sort of dovetail that with what are the most often used androgens let's say in sport or bodybuilding, I guess the most studied, probably the two, would be testosterone and 19, or testosterone and angiolone there the two that if you've done a PubMed search would probably return the most results. And then below those two, I would say either oxangolone or anadrol. So anavir and anadrol is the two um oral steroids. I guess when we look at what is used from a pd perspective, well, that's just an open book really. Um, you know, you're probably at the very top again.

Speaker 2:

You would have testosterone being the main used androgen, just due to being bio-identical to the human body and then, depending on what would happen from a non-androgen receptor interaction perspective. So all androgens will interact with all nuclear steroid receptors. So it's not just the androgen receptor um anabolic steroids or androgens in theory can interact with the glucocorticoid receptor or the mineral corticoid receptor. And this is where we start to establish some side effects, or some positive effects, if you want to even frame it that way. Um, anecdotally, you'll have um strong men or power lifters utilize nandrolone for its um joint protective properties is what is case reported and it is, in to certain degree, also medically described and that comes as a an artifact of them interacting with the mineralocorticoid receptor to retain potassium and sodium what kind of dosing with are these strong men using for these androgens?

Speaker 2:

so again, anywhere from, I would say, a benign, socially accepted setup.

Speaker 2:

If we were to put it that way, it'd be maybe 500 milligrams of testosterone and an equal dose of an angelo, and that would be that's per week, per week, per week, so 500 of each. That would be a very basic setup like what we've alluded to. There is quite a lot of polypharmacy where that would be considered. In my view, that would be considered quite a moderate steroid cycle at 500 milligrams of testosterone and 500 milligrams of nandrolone. It would not be uncommon for that 1000 milligram weekly dose to quickly escalate to 1500 or 70 and 50, with the addition of other, I guess, non-aromatizing androgens like primobolin or what is slowly becoming quite popular would be masteron, which would be something that historically, 90s bodybuilders would have used as a cosmetic compound. I guess where we sort of have to establish when it comes to these dosages is for a lot of the time they're just arbitrary, picked numbers. There's never any, there's never any logical reasoning behind why someone picks, you know, 500 milligrams of testosterone, 500 milligrams of nangolone, other than someone told me this is a good steroid cycle.

Speaker 1:

That's what I'm going to do well, those are easy numbers to remember too and and knowing well that certain compounds are dosed 250 milligrams per ml.

Speaker 2:

Um, what becomes quite horrifying from a pharmacology side of things is you get guys dosing things in milliliters as opposed to drug concentrations, which we will laugh at. But you will get someone who will say oh, I'm taking five milliliters of testosterone per week and you're sort of going. Well, what dosage is that? 200 milligrams per milliliter, 250, I don't know, five milliliters. So you, you run into these like horrifying things. Where it's, it's not even standardized drug dosaging, it's an arbitrary number. Again, someone told me five milliliters of testosterone was a good dose. So that's what I'm going to take and this is what we're trying.

Speaker 2:

Oh sorry well, I was going to, I'm going to take and this is what we're trying oh sorry, I was going to say that's what we're trying to educate towards, then is you know, just because some big guy at your gym has told you these numbers, trying to give you know, try and give some basic understanding of science, not that everyone has to be a pharmacy expert, but to just take a step back and try and view well, what, what am I actually doing here?

Speaker 3:

What about? For cause? You, you know we've obviously, I would say, a lot of the people that I know in South Florida that are doing performance enhancing drugs or or anabolic steroids are not athletes. They're just people that want to look better, or we could say, athletes for bodybuilding. But what about for women? I mean, are these the same? Would you consider them just as safe for women? Should women use more caution? Are there ones that women should absolutely not do at all costs? I mean, I know definitely in the bikini world of competitive bodybuilding, even in other categories like physique, are are really prominent. So just your thoughts on should, should we as women, be taking them at all, or are there ones that might be a little bit better tolerated?

Speaker 1:

um, definitely, the effects are going to be different cassie wants to know what cycle she should go on no, yes, put me on a cycle I mean no, that's a great question

Speaker 2:

for a long period of time. My stance was to not get involved and that sort of speaks volumes that if I have the background knowledge to speak in terms of pharmacology and I'm not willing to have the conversation with these compounds, it is pure, 100% caution and that's where we're fortunate Victoria Felker, who was with us in Oxford as well, who's a very good friend of mine, I'd be very cautious when someone asked me my opinion on androgens and women, because with men there is a bit of push and pull. That okay if you want to put what's the biggest risk for a male taking these compounds, absolutely your HPTA gets shut down, so your sperm production will fall to a relatively low number and you might end up with high blood pressure with impacts to your kidneys and heart. But relatively speaking from studies like the Harlem and other cohort analysis, quite often these side effects in males are reversible to an extent with some level of either therapeutic management or abstinence from the drug. Some of the side effects will reverse themselves.

Speaker 2:

With women it's a completely different question and because of the fact of, like what I said about the teenage girl taking dianabol and verilizing, you now have a, a female or, as a much deeper voice or a male characteristic voice that cannot be really changed physiologically. So they're again stuck with that voice pattern, which certain competitors female competitors will accept that as a risk. They will accept verilization, um, even verilization of um sexual organs as a side effect that they will accept as part of what their choice is, which is is crazy. For others, it can be a slow progression over time whereby they don't even notice their voice pattern changing until again it's too late and you get all these risk reduction strategies of using um vocal tone analyzers to keep check of your vocal tone whilst using these compounds that will tell you your vocal tone is changing oh, wait a minute.

Speaker 1:

I've never heard of this.

Speaker 2:

Yeah, familiar with his vocal tone analyzers and so you have, you have, um, certain programs that you can download and a female can speak into it and it will basically monitor the pitch change in their voice. So you can, you can then detect small changes to pitch and then obviously it's telling you you are heading towards verilization, you're becoming a dude. Yes, it reminds me Dean, but sort of.

Speaker 1:

I used to go to the Arnold Classic quite regularly and I probably quit doing that, you know, 15 or so years ago. But I recall many times I'd be in an elevator towards the back and then people would come in fill the elevator. And then people would come in, fill the elevator and you'd start hearing voices and you'd swear to God you thought it was a guy talking and when you step out you're like holy smokes, it's just large women with deep voices and we're not talking like it's a woman who sounds like a man.

Speaker 1:

It sounded like a man it was.

Speaker 2:

It was crazy, crazy yeah, and I mean, like what cassie said, to divisions that were brought into bodybuilding to sort of exemplify health, vitality, like bikini etc. These were brought in to try and deter away from some of the PD usage that was becoming prevalent in figure or fitness and those sort of divisions. And now you have bikini athletes in you know olympia caliber, using quite harsh compounds because of the, the criteria on muscularity and hardness it's changed.

Speaker 2:

The bikini divisions changed a lot and and that's why they brought in as a fit model, I think is the new they keep adding these new divisions fit, so they have a new female one. That's that sort of tried to circle it back to how bikini began 15 years ago, and I guess it. If we introduce these new divisions and then over time the criteria changes surrounding drug usage, it just becomes a perpetual cycle. So I guess, when it comes to female PD use, I had to draw a line in the sand about two years ago.

Speaker 2:

What was starting to develop within the fitness community online was FemTest is what it's called. I'm not sure if this is something that has become sort of known, but FemTest was basically testosterone HRT prescription, but for athletes. So what you'd get is a coach, a physique coach, um, advising a female competitor to utilize anywhere from three to five milligrams of testosterone per week in order to have their testosterone level um, horrible now with us numbers, but basically have them sit in the very top physiological range. So for the uk it's about 1.8 nanomole to 2 nanomole, and the assumption here and god bless them with trying to make correlative assumptions from science was you had athletes with certain diseases, like polycystic ovarian syndrome, who would have testosterone levels of 2.5 to 3 nanomoles, so almost double the natural range. And the reasoning there was well, there isn't really any health detriments to speak of with that high level of testosterone, naturally, so therefore it's safe for everyone to do so.

Speaker 2:

I had to you know, come out yeah, I had to come out and make you know this sort of education standpoint that, yes, like TRT, hrt in females has its purposes, but we cannot just start bending bias based off one population that has a health detriment, like PCOS, that you then start applying that to normal populations of use. And the whole side of it was that this is a safe way to use testosterone. Is this low dose of testosterone replicative of a physiological diseased state, to speak? And it was just horrifying that they were making these recommendations. Um, where general population perhaps no background in science or drug pharmacy etc. We're basically taking, you know, gospel truth to what was being told to them. Oh, three milligrams of testosterone is safe. Everyone is doing it in the bikini world to gain muscles. So I'm going to do it myself. And there is a lot more to that conversation than what was being led to believe.

Speaker 1:

Dean, we're a little short on time. I want to be respectful of your time. I have one final question, not related to androgens, but related to EPO, which seems to be a favorite performance enhancing drug amongst athletes, especially endurance athletes, but I think I think a lot of people could benefit from it from a performance standpoint. So what are your thoughts on it in terms of what's published clinically and the dosing used uh with elite or competitive athletes?

Speaker 2:

I. I think it does have a a level merit, but it's very sports specific and what you will find is like, for example, we've had the discussion mainly around bodybuilding. You'll get bodybuilders. Look at the research on EPO and make an assumption of well, epo makes more red blood cells. More red blood cells means more potential nutrients or more of these carrying molecules in our body. So therefore more must be better and the range to speak of blood viscosity or hematocrit, the percentage of red blood cells is probably already on the high side of normal in androgen users because they drive EPO synthesis themselves.

Speaker 2:

That I've always been heavily cautioned towards EPO use in a strength athlete who's already utilizing something that increases EPO as a secondary side effect. But if we're looking at endurance based sports or perhaps a combat sport athlete who isn't using androgens, then it does derive some merit to speak from a endurance capacity. But it's still. It's still one compound that you need to be very sure of at your own blood work pre, during and post use and intervening appropriately, which is what we sort of see in historically with cyclists using it, monitoring blood viscosity, doing therapeutic phlebotomy as required and, if not, blood doping, and so there's quite a lot of nuance to the the compounds use that I. I do think it has some, some good merit from an endurance perspective, but it it does have some side effects that can get out of hand quite quickly if you don't know what you're doing by yourself.

Speaker 1:

Cassie, you have any final questions for Dr Dean?

Speaker 3:

Where can we find you on social media, because you do have so much information? I feel like we could talk for a really long time.

Speaker 2:

I'm on Instagram. That's my main platform, so DeanSTM, d-e-a-n-s-t-m is where any listeners can reach out. And then we have our education platform. Sn Education is part of our company and there's over 500 videos there and like a lecture PowerPoint profile perspective that I felt the requirement to almost take people back to university days and start at like a foundation level and build on the curriculum of more advanced topics.

Speaker 1:

Are you on Twitter or X by chance?

Speaker 2:

I'm not on Twitter or X.

Speaker 1:

I have a Twitter, probably from a long long time ago, which is obviously an X account now, but I never post time ago, which is obviously an x account now, but I never, I never post, it seems to me, for whatever reason, that seems to be where a lot of people post information. I don't know, you get more eyeballs or something, but, um, it's a good platform. If it's, I think it's underutilized. Instagram seems to be where most fitness related people post information. Um, but uh, but certainly I appreciate your time for coming on the Sports Science Dudes. It's really provided a lot of interesting information and everyone's a fan of hearing, especially in Florida. We love hearing about drugs, performance enhancing drugs, anything to make you bigger, faster, stronger and prettier. We're into that. So appreciate your time, dean, and hopefully, hey, if you make it to south florida, let me know.

Speaker 2:

Um, the beaches are beautiful and uh I don't think you'd have to convince my wife otherwise. All right, thanks a lot, appreciate it.