Page 104 - JSOM Spring 2020

TABLE 4 Effects of Testosterone or Anabolic Androgenic Steroid on Body Mass, Lean Body Mass, and Strength in Patients with Disease or
Muscle Wasting
Subjects Treatment Description Treatment Group Control Group
T or Resistance Dosage Duration %Δ %Δ %Δ %Δ %Δ %Δ
Source Age (y) n AAS Training (mg/wk) (wk) Disease BM LBM Strength BM LBM Strength
Casaburi 40 66.6 ± 7.5 12 T No 100 10 COPD 1.7 4.4 12.1 –0.4 –0.4 2.2
Casaburi 40 66.4 ± 7.2 11 T Yes 100 10 COPD 2.4 6.3 21.9 0.1 0.4 16.2
Gold 35 40.4 ± 9.4 66 T No 125 12 HIV 1.5 1.5 NA 0.8 0.4 NA
Knapp 36 43.7 ± 7.4 30 T No 300 16 HIV 2.3 4.4 4.2 0.5 0.3 1.6
Mean 156.3 12.0 2.0 4.1 12.7 0.3 0.2 6.7
Gold 35 41.7 ± 8.8 157 AAS No 75 12 HIV 3.4 2.9 NA 0.8 0.4 NA
Grunfeld 37 41.1 ± 9.0 64 AAS No 140 12 HIV 2.7 NA NA 1.7 NA NA
Johansen 41 55.7 ± 13.4 19 AAS No 152 12 DIA 3.9 7.2 10.8 0.0 –0.4 4.2
Johansen 41 55.5 ± 12.5 20 AAS Yes 165 12 DIA 2.6 6.1 49.1 2.0 –0.8 61.4
Grunfeld 37 40.1 ± 7.5 65 AAS No 280 12 HIV 4.3 NA NA 1.7 NA NA
Grunfeld 37 39.5 ± 7.5 68 AAS No 560 12 HIV 3.5 NA NA 1.7 NA NA
Hengge 38 41.4 30 AAS No 700 16 HIV 5.3 5.1 NA 1.6 1.0 NA
Hengge 38 37.3 31 AAS No 1050 16 HIV 4.5 3.3 NA 1.6 1.0 NA
Ferreira 39 70.3 ± 1.5 10 T&AAS No 110 9 HIV 3.9 6.8 NA –0.9 1.5 NA
Mean 49.2 359.1 12.6 3.8 29.9 1.1 0.4 32.8
Abbreviation: DIA, dialysis.

study of patients suffering from COPD. Strength increased training exercises in Norwegian cadets reduced circulating
40
in both treated and control subjects, 21.0% and 16.2%, re- testosterone 84%. The caloric expenditure of these combat
spectively. However, LBM increased 6.3% in the testosterone exercises was estimated at >10,000 kcal/day. Roberts and col-
group but was unchanged in the control group (Table 4). leagues studied the effect of acute overtraining on testicular
function in highly trained men (maximal oxygen consump-
12
Anabolic Androgenic Steroids tion of 65.4 ± 3.6mL/kg/min). The subjects’ level of fitness
Numerous investigations have studied the effects of AAS ranks in the top 1% according to the American College of
(~359mg/week) to increase LBM and strength in patients with Sports Medicine. A 2-week doubling in their training volume
42
HIV or COPD or in those undergoing dialysis (Table 4). Collec- dramatically reduced testosterone levels (36%). The fitness
tively, these studies indicate that ~12.5 weeks of AAS increased level of elite SOF is reportedly comparable to that of highly
LBM 5.2%. Independent of dose, research in patients living trained endurance athletes. Therefore, even in very fit individ-
1
with HIV indicates that AAS consistently increased both body uals, highly stressful physical demands appear to reduce HPG
mass and LBM. To date, little information is available with re- function, and collectively the data suggest that the demand-
gard to the functional outcomes (e.g., increased strength) when ing physical nature of SOF training and SUSOPS can reduce
attenuating cachexia in these subjects; however, given the in- testosterone levels, particularly when coupled with a negative
crease in LBM, it is reasonable to infer an increase in strength. energy balance and sleep deprivation.

Discussion/Conclusions/Implications Negative Energy Balance
Evidence clearly points to a large energy deficit during SOF
Both SOF training and SUSOPS involve sustained and cumula- training (Table 1). A negative energy balance averaging more
tive high levels of physical demand accompanied by a negative than 3,000kcal/day during SOF training is consistent with
energy balance and sleep deprivation, compounding risk for weight loss of nearly 7 kg (Table 1). It should be noted that the
cachexia and fatigue that may impair mission success. Reports negative energy balance results not just from a reduction in EI,
have indicated that SOF training, simulating conditions expe- but primarily is due to the very large EE of SOF training that
rienced during SUSOPS, results in an average 6.7kg decrease may exceed 10,000kcal/day. During SOF training, EI varies
in body mass after an average of 44 days of operations (Table from as little as 1,600kcal/day to ~3,000kcal/day but does not
1). High daily energy expenditures coupled with reduced daily match EE. It is therefore unlikely that food could be supplied
caloric intake result in a large negative energy balance (>3,000 and consumed at a rate to match this level of EE, making a
kcal/day) consistent with decreased body mass (Table 1). These negative energy balance inevitable.
operational conditions and resulting anthropometric changes
bear similarity to the experimental conditions of overtraining Acute caloric restriction (fasting) in men has been shown to
and caloric restriction which, specifically in males, impair the disrupt endocrine function. For example, a fast of 48 hours
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HPG axis and marked decreases in testosterone. In addition, can result in significant depression of testosterone without sig-
reductions in sleep averaging 3 hours/day likely compound re- nificant changes in body mass or body composition. It appears
duction in HPG function from physical demand and negative that the decrease in testosterone resulting from a negative en-
energy balance. ergy balance precedes alterations in body composition. Due to
the profound effect of testosterone on protein synthesis, it is
Physical Demand logical to conclude that the decrease in testosterone resulting
Sustained and cumulative high levels of physical demand re- from a negative energy balance is at least partly responsible for
portedly suppress testicular function. Five days of combat diminished LBM and musculoskeletal function.

98 | JSOM Volume 20, Edition 1 / Spring 2020