Oxymetholone vs Methandienone: What to Choose and for Whom
In gyms, oxymetholone and methandienone are considered the «strongest tablets for mass», and the question «which of them to choose» comes up often. The editorial team answers it from a medical standpoint: who actually receives oxymetholone by prescription, whom each of the substances threatens most, which symptoms require an immediate visit to a doctor and how to gain mass without such risks.
Who is the real patient of oxymetholone
Oxymetholone is a rare example of an anabolic steroid with valid official instructions. The drug Anadrol-50 is registered by the FDA for the treatment of anemias caused by insufficient red blood cell production: aplastic anemia, myelofibrosis, hypoplastic anemias caused by myelotoxic drugs.
Thus, the real patient of oxymetholone is a person with a severe bone marrow disease, managed by a hematologist. The doctor selects the dose individually (the instructions indicate a range of 1–5 mg per kilogram of body weight per day), regularly monitors blood tests, liver tests and lipids and assesses whether the benefit outweighs the risks.
Oxymetholone was also studied in patients with HIV-associated wasting (Hengge et al., 2003): it contributed to weight gain but caused an elevation of liver enzymes in some participants. This once again shows that even in medical settings the drug requires close monitoring.
Methandienone has no such «patient of its own» today. In the USA it went out of circulation in the 1980s, and there are no modern clinical recommendations regarding its use. Therefore for methandienone the answer to the question «for whom» in the medical sense is simple — for no one.
Which substance is more of a threat to whom
Both substances are 17α-alkylated, so liver damage and worsening of the lipid profile are a common denominator. However, there are also specific vectors of risk worth knowing.
| Group of people | Oxymetholone | Methandienone |
|---|---|---|
| Prone to thrombosis, with high hematocrit | Very high risk (strong stimulation of erythropoiesis) | High risk |
| Prone to gynecomastia | High risk (estrogenic effects described) | Very high risk (aromatization) |
| With hypertension | High risk | Very high risk (fluid retention) |
| With liver diseases | Very high risk (boxed warning in the instructions) | Very high risk |
| Women | Virilization | Rapid virilization |
| Men who are planning to have children | Suppression of spermatogenesis | Suppression of spermatogenesis |
Separately, it is worth mentioning people who are already taking other drugs. Androgens can enhance the action of indirect anticoagulants — this is directly stated in the instructions for Anadrol-50. Combination with alcohol or other hepatotoxic substances increases the load on the liver.
Adolescents and young people constitute a separate risk group: anabolic steroids can prematurely close bone growth zones, and the formation of dependence at a young age, according to Kanayama and Pope (2018), is a typical scenario.
The table shows that the «choice» between the two substances is only a choice between different combinations of dangers, not between a safe and a dangerous option.
Alarming symptoms: when to see a doctor urgently
People who have used or are using oral anabolic steroids should know the symptoms that may indicate serious complications. Some of them require immediate medical attention.
- Liver:yellowing of the skin or the whites of the eyes, dark urine, light-colored stool, itching of the skin, pain in the right hypochondrium, nausea.
- Heart and vessels:pain or pressure in the chest, shortness of breath, sudden disturbances of the heart rhythm, swelling of the legs.
- Thrombosis:one-sided swelling and pain in the leg, sudden shortness of breath, coughing up blood.
- Cerebral circulation:sudden weakness or numbness of half the body, speech disturbance, facial asymmetry.
- Blood:severe headache, redness of the face, dizziness (possible signs of high hematocrit).
When consulting a doctor, it is important to honestly report steroid use. This is not a question of morality but a question of correct diagnosis: without this information a doctor may misinterpret tests and symptoms.
Even in the absence of symptoms, people with experience of use should undergo examination: liver tests, a lipid panel, a complete blood count, a hormonal profile and blood pressure measurement.
The price of «quick mass»
Both substances are associated with rapid weight gain. A significant part of this gain is fluid and glycogen retention, not just muscle tissue. After discontinuation the weight partially returns, which is disappointing and often pushes toward repeated use.
Added to this is anabolic hypogonadism. When the exogenous androgen is eliminated but one's own hormonal system is still suppressed, a person feels fatigue, decreased libido, depressed mood. The review by Rahnema et al. (2014) describes this condition and approaches to its diagnosis and treatment.
It is precisely the combination of the weight «rollback» and poor well-being that, according to the review by Pope et al. (2014), is one of the mechanisms of forming dependence on anabolic steroids. A person returns to intake not for the sake of progress, but to avoid the unpleasant condition.
The long-term price is cardiovascular. The review by Baggish et al. (2017) shows that long-term users of anabolic steroids more often have reduced myocardial contractile function and a greater volume of coronary plaques. These changes do not disappear along with the gained kilograms.
Legal strategies for gaining mass
Gaining mass without pharmacology rests on several proven principles. The first is a moderate caloric surplus: regular energy intake slightly above expenditure creates the conditions for muscle growth without excessive fat accumulation.
The second is protein. The meta-analysis by Morton et al. (2018) showed that the benefit of protein for lean mass gain during strength training plateaus at around 1.6 g per kilogram of body weight per day. Regularity is more important than the exact timing of intake.
The third is creatine monohydrate. According to the ISSN position stand (Kreider et al., 2017), it effectively increases strength and muscle mass during training and is considered safe for healthy people. A typical maintenance dose is 3–5 g per day.
The fourth is progressive loading and recovery: a gradual increase in working weights or volume, sufficient sleep and planned deload periods. These factors determine long-term progress far more strongly than any «mass tablet».
Editorial conclusions
The real patient of oxymetholone is a person with severe anemia under the supervision of a hematologist. Methandienone has no modern medical indications.
Oxymetholone is especially dangerous for people prone to thrombosis and with liver diseases, methandienone — for those prone to gynecomastia and hypertension. Both harm the liver, lipids, heart and fertility.
Quick mass on these substances partially disappears after discontinuation, while the risks and dependence remain. Legal strategies — a caloric surplus, protein, creatine and progressive training — work more slowly but without a threat to health.
We also recommend reading our materials «Oxymetholone or Methandienone: What's the Difference», on liver tests for athletes and on nutrition for gaining mass.
References
- U.S. Food and Drug Administration. Anadrol-50 (oxymetholone) tablets: prescribing information.
- Hengge UR, Stocks K, Wiehler H, et al. Double-blind, randomized, placebo-controlled phase III trial of oxymetholone for the treatment of HIV wasting. AIDS. 2003;17(5):699–710.
- Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341–375.
- Rahnema CD, Lipshultz LI, Crosnoe LE, et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101(5):1271–1279.
- Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017;135(21):1991–2002.
- Kanayama G, Pope HG Jr. History and epidemiology of anabolic androgens in athletes and non-athletes. Mol Cell Endocrinol. 2018;464:4–13.
- Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18.
- Morton RW, Murphy KT, McKellar SR, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Br J Sports Med. 2018;52(6):376–384.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
