Chat transcript: Androstenedione supplements and sports medicine

June 11, 1999
Web posted at: 2:07 p.m. EDT (1807 GMT)

(CNN) -- The following is an edited transcript of a health chat with Dr. Robert Gotlin, a sports medicine specialist at Beth Israel Medical Center in New York. Dr. Gotlin, who discussed with us a new study which disputes the benefits of androstenedione supplements, joined our chat room via phone from New York.

Chat Moderator: Welcome, Dr. Gotlin. Please tell us, what is your expertise?

Dr. Gotlin: I am the director of Orthopedics and Sports Rehabilitation at Beth Israel Medical Center, and reviewed the recent JAMA article on the effects of androstenedione. Caring for a large population of people on the forefront of training, the impact from the information in this study is of great magnitude.

Chat Participant: Can this study really have value with only 30 subjects involved?

Dr. Gotlin: The study size of 30 people is a small sample size. However, the result showing statistical significance for the lack of benefit in increasing testosterone levels or a positive benefit of weight training with or without androstenedione does have value. Of course, this is only one study, but it is the only study. So the information within is simply that -- information -- and as always, education and good judgment should be the guide for using this or any other supplement.

Chat Participant: Dr. Gotlin, is there any information on what the subjects' diet consisted of?

Dr. Gotlin: No. There was no information as to the diet that was consumed during the study period.

Chat Participant: Were the subjects on any other kind of protein supplements, or creatine-type supplements?

Dr. Gotlin: No. The subjects were only taking their usual diets, without any other supplements added.

Chat Participant: What is your opinion of the test, Dr. G.?

Dr. Gotlin: Well, for one, a test such as this raises questions as to, No. 1, if a supplement which has documented adverse effects, such as androstenedione in raising the bad cholesterol and lowering the good cholesterol, and potentially causing enlarged breasts in males and most importantly not producing the effects it was supposed to, i.e., increasing testosterone and improving strength, then the question of using it at all has great implications. As a health care provider, this study tells me: 1.) more research is needed, and 2.) the supplement has not shown to be more effective than good ol' weight training. The implication, since the use is potentially widespread amongst those working out, is that more dollars are needed to conduct good research.

Chat Participant: Dr. Gotlin, is your personal interest in your studies to find the adverse effects, or are you actually interested also in the benefits?

Dr. Gotlin: My intentions in medical research are to evaluate the effects of an intervention, i.e., supplement, such as androstenedione, without a predetermined opinion as to proving it beneficial or harmful. The obligation I have is to evaluate research and offer sound medical judgment, taking into account one's health along with one's goals.

Chat Participant: How many women were involved in this test? Were the effects on different genders studied?

Dr. Gotlin: No. All males. This study consisted of all males.

Chat Participant: Are women or men more prone to injuries in sports?

Dr. Gotlin: The injury rates for males and females in the late 1990s is running much more parallel, largely due to factors such as increased participation in organized sports by females, and the anatomic differences between males and females who are playing the same sports.

Chat Participant: Dr. G., what in your opinion is the best supplement to take to increase strength among athletes?

Dr. Gotlin: The best supplement, in my opinion, if there is a need for taking a multivitamin, is a multivitamin. The best supplement in reality is probably weight training.

Chat Participant: Did you find any benefits in the study for bodybuilders?

Dr. Gotlin: With respect to increasing strength, muscle girth or muscle fiber type, there was no difference between controls and those taking androstenedione.

Chat Participant: Is it plausible that the diet consumed by the subjects could have been counterproductive to someone trying to gain muscle ... thus negating the benefits of Andro?

Dr. Gotlin: Diet could feasibly have some role; however, the only criteria was to maintain one's normal diet, and observation was made that all subjects were "equivalent" in daily protein intake.

Chat Participant: Can you answer my question about whether, in your opinion, norandro and androdiol would have the same effects in a test study?

Dr. Gotlin: No. And the reason is the exact reason of this study: A study must be done with control subjects to make a fair analysis of the effects of this or any supplement. That study has not yet been done.

Chat Participant: Was strength increased, though, but more so related to something else, if it was increased?

Dr. Gotlin: As the variable in this study to assess changes in strength was the addition of androstenedione, as subjects in both the control and androstenedione group showed increases in strength, the only variable that will let this happen is actual weight training. So, the gains in strength that we saw were most likely due to this simple fact.

Chat Participant: How much of an estrogen increase was there?

Dr. Gotlin: The increase in estrogen was from 220 to 310 pmol per nitre.

Chat Participant: Doc, were the individuals who participated in the study people who have trained seriously with weights for at least a year, or were they new to resistance training as well?

Dr. Gotlin: Good question. Of the males enrolled, only two had ever engaged in resistive training in the past, and that was more than one year prior to the study. This does raise a key point. The large strength gains seen across the board could overshadow the potential gains from androstenedione.

Chat Participant: Isn't it true that an excess of testosterone can lead to increased estrogen levels in men -- regardless of the cause of the increase in testosterone?

Dr. Gotlin: Androstenedione is a precursor to both testosterone and estrogen. It is true that elevated levels of testosterone, from whatever reason, could regulate androstenedione to produce more estrogen.

Chat Participant: Why do people seem to want to "believe" that there is some magic elixir, despite the evidence?

Dr. Gotlin: It's not uncommon for many people to choose the path of least resistance. If there's a way to get there faster, build it bigger, or pile it higher, most of us tend to do that. And this is just exactly the problem when one looks for the quick fix. The obvious message: For every positive, there may be two or three negatives.

Chat Participant: Can increases in physical exertion cause increases in testosterone levels?

Dr. Gotlin: Testosterone is a hormone. Our body is regulated by the interaction of many hormones. It is true that increased physical exertion, fear, or stresses to the body can increase those hormones involved in protecting us. Testosterone is one of those hormones.

Chat Participant: Dr. Gotlin, do you have an opinion on cortisone injections for chronic pain and whether or not they affect one's personality? A sports medicine specialist in my area is using this method to treat my husband.

Dr. Gotlin: Cortisone steroid injections are beneficial in treating acute inflammations such as bursitis and bad strains. In rare events, they're helpful for chronic pain, but usually only in conjunction with other interventions such as exercise and pain management. The heightened "personalities" that some people see after receiving cortisone is a normal side effect of its use. If it persists, the medication should be re-evaluated and probably discontinued.

Chat Participant: Based on your reading of the results of this single study, would you discourage your patients from using this supplement?

Dr. Gotlin: At this time, I would put on hold any recommendations that I may have considered in utilizing this supplement and would await further research with most emphasis on the potential negative effects of such a supplement. Undoubtedly, this study will spark further research, and at future national meetings such as those of the American College of Sports Medicine, American Academy of Orthopedic Surgeons, and the American Academy of Physical Medicine, papers and ideas will be presented, debated and discussed.

Chat Participant: How does chicken reduce the harmful effects of Andro?

Dr. Gotlin: No. I'm not aware of that.

Chat Participant: Was there anything in the report about recovery time between the two groups? Or injury percentage?

Dr. Gotlin: No reports of injury, but what do you mean about recovery time? Androstenedione was given cyclic fashion, that is, dosed during weeks one to two, four to five and seven to eight. A dose of 300 mg a day was used.

Chat Participant: Dr. Gotlin, don't you think that this study is way too simple to get any type of conclusion?

Dr. Gotlin: While this was a small sample size, there was statistical significance. However, larger sample sizes -- but more importantly, further studies -- are required to fully and scientifically evaluate the effects of this supplement.

Chat Participant: Surely, 300 mg would not be an adequate dosage for a 6'2" 220-pound person. Was there an average height and weight of the males in the study?

Dr. Gotlin: No. Average height and weight was not given, although the mean age of participants was 19 to 29 years of age.

Chat Moderator: Any final comments?

Dr. Gotlin: In conclusion, this study and many like it shed light on those looking for the quick fix and should open up avenues for achieving gains (in this case, strength gains) by incorporating sound knowledge utilizing many documented training programs to increase strength and being careful when being tempted to join the bandwagon for taking a supplement without an established, sound track record. This is not to say that supplements are bad, nor should they be frowned upon and not consumed. Rather the message here is to educate and make us aware to not be pulled to the positive side of any supplement and ignore the potential negative side. There are indeed many times when not only are supplements recommended, but required, specifically for people who are deficient in many of the body's hormones or enzymes.

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