All About Oxandrolone

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The following content comes from the book "Anabolics 2010"

Oxandrolone: An Overview​

Description​

Oxandrolone is an oral anabolic steroid derived from dihydrotestosterone. It was designed to have a strong separation of anabolic and androgenic effects, with no significant estrogenic or progestational activity. Known for being a mild oral steroid, it is widely used for promoting strength and quality muscle gains without major side effects. Milligram for milligram, it exhibits up to six times the anabolic activity of testosterone while maintaining significantly lower androgenicity.

This drug is particularly favored by dieting bodybuilders and athletes in speed/anaerobic sports due to its ability to promote pure muscle tissue gain without fat or water retention.

oxandrolone anavar.webp

History​

Early Development​

Oxandrolone was first described in 1962 and later developed into a pharmaceutical product by G.D. Searle & Co. (now Pfizer). It was marketed under the trade name Anavar in the U.S. and the Netherlands, with various other names in different countries, including:

  • Lonavar (Argentina, Australia)
  • Lipidex (Brazil)
  • Antitriol (Spain)
  • Anatrophill (France)
  • Protivar
The drug was designed as a mild anabolic steroid, safe for use by women and children. Initially, Anavar was prescribed for various medical conditions, including lean tissue growth after surgery, trauma, infection, and osteoporosis.

Discontinuation and Reintroduction​

By the 1980s, the FDA refined oxandrolone's approved uses to include weight gain following surgery, chronic infections, trauma, or unexplained weight loss. However, due to declining sales and growing concerns over anabolic steroid abuse, Searle voluntarily discontinued Anavar on July 1, 1989, removing oxandrolone from U.S. pharmacies.

After several years of absence, oxandrolone returned to the market in December 1995 under the name Oxandrin, produced by Bio-Technology General Corp. (BTG). The company secured orphan drug status for treating AIDS wasting, alcoholic hepatitis, Turner’s syndrome in girls, and delayed puberty in boys, leading to high drug pricing. Generic versions later reduced costs.

Today, Oxandrin is sold under the Savient label, with FDA approval for various conditions. Generic oxandrolone is available in the U.S. and some international markets.

How Supplied​

Oxandrolone is available in select human drug markets with varying compositions and dosages depending on the manufacturer and country:

  • Original Anavar: 2.5 mg per tablet
  • Oxandrin: 2.5 mg or 10 mg per tablet
  • Other brands: Typically 2.5 mg, 5 mg, or 10 mg per tablet

Structural Characteristics​

Oxandrolone is a modified dihydrotestosterone (DHT) derivative with two key alterations:

  1. Addition of a 17-alpha methyl group – protects the hormone during oral administration.
  2. Substitution of carbon-2 in the A-ring with an oxygen atom – increases anabolic potency by making the compound more resistant to muscle metabolism.
Oxandrolone is the only commercially available steroid with this unique alteration, enhancing its anabolic strength while reducing androgenic effects.

Side Effects​

Estrogenic Side Effects​

Oxandrolone does not aromatize in the body and has no measurable estrogenic activity. Consequently, users do not experience gynecomastia or water retention, making it an excellent choice for cutting cycles.

Androgenic Side Effects​

Although oxandrolone has low androgenic activity, some users may experience:

  • Oily skin and acne
  • Increased facial/body hair growth
  • Acceleration of male pattern baldness (in those genetically predisposed)
Women using oxandrolone should be aware of possible virilizing effects, including voice deepening, menstrual irregularities, skin texture changes, facial hair growth, and clitoral enlargement.

Hepatotoxicity (Liver Toxicity)​

Oxandrolone is a C17-alpha alkylated steroid, which means it is resistant to liver breakdown. However, prolonged or high doses can cause liver damage.

Studies indicate oxandrolone is less hepatotoxic than other oral steroids, with about one-third of the drug excreted intact in urine. A study comparing oxandrolone to other alkylated steroids found it caused the lowest liver stress.

To minimize liver strain, users should:

  • Limit use to 6-8 weeks per cycle
  • Undergo regular liver function tests
  • Use liver-support supplements like Liver Stabil, Liv-52, or Essentiale Forte

Cardiovascular Side Effects​

Oxandrolone negatively affects cholesterol levels, reducing HDL (good cholesterol) and increasing LDL (bad cholesterol). Studies show:

  • 20 mg/day caused a 30% reduction in HDL.
  • 40 mg/day reduced HDL by 33%.
  • 80 mg/day led to a 50% HDL reduction and 30-33% LDL increase.
Other cardiovascular risks include increased blood pressure, reduced arterial function, and left ventricular hypertrophy.

To reduce cardiovascular strain, users should:

  • Engage in regular cardiovascular exercise.
  • Limit saturated fats, cholesterol, and simple carbs.
  • Supplement with fish oils (4g/day) and cholesterol-supporting supplements.

Testosterone Suppression​

Like all anabolic steroids, oxandrolone suppresses natural testosterone production. Studies show:

  • 20-40 mg/day reduces testosterone levels by 45%.
  • 80 mg/day suppresses testosterone by 66%.
  • LH levels also decline by 25-50%, depending on the dose.
After stopping oxandrolone, testosterone levels typically recover within 1-4 months, but long-term abuse may cause prolonged suppression requiring medical intervention.

Administration​

General Administration​

Taking oxandrolone with food may reduce absorption, so it should be taken on an empty stomach for maximum bioavailability.

Dosage for Men​

  • Medical dosage: 2.5–20 mg/day for 2-4 weeks.
  • Performance-enhancing dosage: 15-25 mg/day for 6-8 weeks.
  • Bulking cycles: Combined with 200-400 mg/week of testosterone.
  • Cutting cycles: Stacked with 150 mg/week trenbolone or 200-300 mg/week Primobolan.

Dosage for Women​

  • Performance-enhancing dosage: 5-10 mg/day for 4-6 weeks.
  • Stacking options: Winstrol, Primobolan, or Durabolin (with increased risk of side effects).

Availability​

Oxandrolone is increasingly produced in less regulated markets in Asia, as availability in Europe and the West declines.

  • In the U.S., generic oxandrolone is available from Par Pharm, Sandoz, Upsher Smith, and Watson.
  • Brand-name Oxandrin (Savient) was available in 2.5 mg and 10 mg tablets.
  • Italian Oxandrolone (SPA) is no longer available.

Note: The pharmaceutical brand is no longer available in the US. It is still compounded by Empower Pharmacy, though.



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Oxandrolone

Oxandrolone is characterized by a modification in the basic structure of testosterone to include a substitution of an oxygen atom in place of the methylene group at the C2 position in the steroid ring, this molecule has a 17-alpha-alkylated group at the C17 position that prevents deactivation of this steroid by hepatic first-pass metabolism - allowing for oral administration. Given these alterations, oxandrolone also shows resistance to hepatic metabolism further enhancing action [20]. While mild elevations in hepatic transaminases have been noted [45], oxandrolone is not known for significant hepatic side effects such as cholestasis, peliosis hepatis, hepatic adenomas, and hepatocellular carcinomas. Minor adverse events have been noted in clinical trials on oxandrolone including alterations in cholesterol levels [20].

Similar to nandrolone, oxandrolone has marked anabolic activity, with a myotrophic/androgenic ratio of 10:1 [46]. It has shown clinical efficacy in acute catabolic disorders such as severe burn injuries, after extensive surgery, and severe trauma. There have also been positive clinical outcomes in chronic catabolic disorders such as the treatment of HIV/AIDS-associated wasting [47], neuromuscular diseases such as Duchenne muscular dystrophy [48], amyotrophic lateral sclerosis [45], and COPD [49]. Oxandrolone is also used to offset the protein catabolism associated with long-term corticosteroid use and relief of the bone pain accompanying osteoporosis [20].

As with nandrolone, the reproductive effects of oxandrolone are not well studied. Several case reports note reversible steroid-induced azoospermia with oxandrolone use in combination with other AAS [50, 51]. Caution should be employed in all men of reproductive age given known effects on the LH/FSH axis and the potential resultant effects on spermatogenesis.

Source:
Wu, C. & Kovac, J.R. Curr Urol Rep (2016) 17: 72.


-------------------------------------------------------------


Summary from attached paper.

1. Oxandrolone is an anabolic androgenic steroid (AAS) that has been used for over 30 years in the treatment of various catabolic disorders, HIV and AIDS-related wasting, neuromuscular disorders, and other conditions.

2. The drug shows significant improvements in body composition, muscle strength and function, status of underlying disease or recovery from acute catabolic injury, and nutritional status.

3. Oxandrolone has not yet been studied in sarcopenia, a condition characterized by the loss of skeletal muscle mass and function, commonly seen with advancing age.

4. The use of AASs like oxandrolone as an alternative treatment to promote anabolism in diseases and disorders characterized by sarcopenia is currently under investigation.

5. Oxandrolone is a synthetic, non-reducible or non-aromatisable AAS derived from testosterone but possesses a novel chemical configuration.

6. Unlike other orally administered C17α-alkylated AASs, the novel chemical configuration of oxandrolone confers a resistance to liver metabolism as well as marked anabolic activity.

7. Oxandrolone does not exhibit the serious hepatotoxic effects attributed to the C17α-alkylated AASs. The most common adverse effects are transient elevations in transaminase levels and reductions in high-density lipoprotein cholesterol level.

8. High dosages of oxandrolone did not exacerbate liver function abnormalities or cholestasis in patients with alcoholic hepatitis.

9. Oxandrolone has been shown to decrease visceral fat stores and total body fat.

10. The drug has been used in the treatment of Turner’s syndrome and constitutional delay of growth and puberty.

11. Adverse hepatic events were investigated in 36 (84%) of the 43 studies and 14 (39%) of these reported adverse hepatic events.

12. Androgenic effects were assessed in 27 of the 43 studies. Amongst the approximately 1000 patients in these 27 studies, androgenic adverse effects were reported in only 14 individuals.

13. The low incidence of androgenic adverse effects reported with oxandrolone attests to the more favorable ratio of anabolic: androgenic potency of the drug compared with many other AASs which have been used clinically.

14. Oxandrolone has the potential to exhibit many of the adverse effects associated with AASs, affecting the blood, cardiovascular, central nervous, musculoskeletal, gastrointestinal, renal, reproductive/endocrine, and dermatological systems, as well as psychological and behavioral effects.

15. No cases of prostate cancer have been reported with oxandrolone in the studies reviewed, but longer-term follow-up is required.

16. Oxandrolone is 95% protein bound and its potency can be attributed to its unique structure – an oxygen rather than a carbon atom at position 2 in the A ring.

17. In animal studies, oral oxandrolone had ≤24% of the androgenic activity of methyltestosterone and was demonstrated to be of very low toxicity to mice and rats.

18. The use of AASs in the athletic community, for AASs in this class include oxymetholone, stanozolol, methyltestosterone, metandienone (methandrostenolone), danazol, norethandrolone, and fluoxymesterone.

19. Optimal risk: benefit ratios for oxandrolone and other agents in its class will need to be refined before widespread clinical acceptance of AASs as a therapeutic option in sarcopenia and other chronic wasting conditions.

20. Future studies should follow standardized and rigorous reporting methods for all of the common adverse effects of this medication, so that a more complete profile of the prevalence of these adverse events can be compiled.
 

Attachments

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History:

Oxandrolone was first described in 1962. It was developed into a medicine several years later by pharmaceutical giant G.D. Searle & Co. (now Pfizer), which sold it in the United States and the Netherlands under the Anavar trade name. Searle also sold/licensed the drug under different trade names including Lonavar (Argentina, Australia), Lipidex (Brazil), Antitriol (Spain), Anatrophill (France), and Protivar. Oxandrolone was designed to be an extremely mild oral anabolic, one that could even be used safely by women and children. In this regard Searle seems to have succeeded, as Anavar has shown a high degree of therapeutic success and tolerability in men, women, and children alike. During its early years, Anavar had been offered for a number of therapeutic applications, including the promotion of lean tissue growth during catabolic illness, the promotion of lean tissue growth following surgery, trauma, infection, or prolonged corticosteroid administration, or the support of bone density in patients with osteoporosis.

By the 1980's, the FDA had slightly refined the approved applications of Anavar to include the promotion of weight gain following surgery, chronic infection, trauma, or weight loss without definite pathophysiologic reason. In spite of its ongoing track record of safety, Searle decided to voluntarily discontinue the sale of Anavar on July 1, 1989. Lagging sales and growing public concern about the athletic use of anabolic steroids appeared to be at the root of this decision. With the Anavar brand off the market, oxandrolone had completely vanished from U.S. pharmacies. Soon after, oxandrolone products in international markets (often sold by or under license from Searle) began to disappear as well, as the leading global manufacturer of the drug continued its withdrawal from the anabolic steroid business. For several years during the early 1990's, it looked as if Anavar might be on its way out of commerce for good.

It would be approximately six years before oxandrolone tablets would be back on the U.S. market. The product returned to pharmacy shelves in December 1995, this time under the Oxandrin name by Bio-Technology General Corp. (BTG). BTG would continue selling it for the FDA approved uses involving lean mass preservation, but had also been granted orphan-drug status for the treatment of AIDS wasting, alcoholic hepatitis, Turner's syndrome in girls, and constitutional delay of growth and puberty in boys. Orphan drug status gave BTG a 7-year monopoly on the drug for these new uses, allowing them to protect a very high selling price. Many patients were outraged to learn that the drug would cost them (at wholesale price) between $3.75 and $30 per day, which was many times more costly than Anavar had been just several years back. The release of a 10 mg tablet from BTG several years later did little to reduce the relative cost of the drug.

Source


Oxandrolone: A Comprehensive Analysis of Clinical Applications, Safety, and Regulatory Considerations

Oxandrolone, a synthetic anabolic-androgenic steroid derived from testosterone, has been extensively studied and utilized in clinical settings for over three decades. With its unique pharmacological profile characterized by high anabolic activity and relatively low androgenic effects, oxandrolone has been employed in the management of various catabolic and wasting conditions, including severe burns, HIV-associated muscle wasting, and post-traumatic recovery.

Despite its therapeutic potential, the drug has faced significant regulatory scrutiny due to safety concerns, culminating in its recent removal from the FDA's Orange Book. This report synthesizes evidence from clinical studies, regulatory documents, and real-world usage patterns to provide a nuanced understanding of oxandrolone's role in modern medicine, balancing its demonstrated benefits against emerging safety challenges and evolving prescribing paradigms.


Pharmacological Profile and Mechanism of Action

Structural Modifications and Anabolic Activity

Oxandrolone (17β-hydroxy-17α-methyl-2-oxa-5α-androstan-3-one) is distinguished by structural modifications that enhance its anabolic properties while minimizing androgenic effects. The introduction of an oxygen atom at the 2-position and methylation at the 17α position confer resistance to hepatic metabolism, allowing oral bioavailability with a plasma half-life of approximately 10.4 hours in adults [5].

These alterations reduce the compound's affinity for the androgen receptor while maintaining strong binding to anabolic pathways, resulting in a therapeutic index that favors lean mass accrual over virilization [2][5].

Pharmacokinetic Considerations

In elderly populations, oxandrolone demonstrates prolonged elimination kinetics compared to younger adults, necessitating dose adjustments to mitigate accumulation-related toxicity [5]. The drug undergoes hepatic metabolism primarily via CYP3A4, with renal excretion of inactive metabolites. Notably, concomitant administration with CYP3A4 inhibitors or inducers may significantly alter plasma concentrations, though formal interaction studies remain limited [5].


Clinical Applications in Catabolic States

Burn Injury Management

Oxandrolone has demonstrated particular efficacy in severe burn patients, where hypermetabolic states lead to profound muscle catabolism. A meta-analysis of pediatric burn trials revealed that oxandrolone (0.1 mg/kg/day) combined with exercise therapy increased lean body mass by 12-15% compared to standard nutritional support alone [2].

The drug's ability to upregulate hepatic acute-phase proteins while preserving muscle protein synthesis makes it uniquely suited for this population [5]. In adults with >40% total body surface area burns, oxandrolone reduced hospitalization duration by an average of 18 days through accelerated wound healing and functional recovery [2].

HIV-Associated Wasting Syndrome

During the pre-HAART era, oxandrolone emerged as a cornerstone therapy for HIV-related cachexia, increasing body weight by 3-5 kg over 12 weeks in clinical trials [1][2].

Its mechanism in this population appears multifactorial, involving both direct anabolic effects and suppression of pro-inflammatory cytokines like TNF-α and IL-6 [2]. Recent studies suggest potential synergy between oxandrolone and modern antiretroviral regimens, though hepatotoxicity risks require careful monitoring [1][5].

Chronic Obstructive Pulmonary Disease (COPD) and Respiratory Failure

Emerging evidence positions oxandrolone as an adjunct in COPD-related muscle wasting, where it improves diaphragmatic strength and exercise tolerance. A 24-week trial demonstrated a 14% increase in 6-minute walk distance compared to placebo, potentially reducing mechanical ventilation requirements in acute exacerbations [2].

The drug's ability to enhance respiratory muscle mass without significant fluid retention makes it preferable to other anabolics in this setting [5].


Safety Profile and Risk Mitigation

Hepatotoxicity Spectrum

The 17α-alkylated structure of oxandrolone renders it hepatotoxic at supratherapeutic doses, with a 9% incidence of transaminase elevation in clinical trials [5].

Rare but severe complications include:

  • Peliosis hepatis (blood-filled hepatic cysts)
  • Hepatocellular carcinoma, typically associated with prolonged use (>6 months) at doses exceeding 20 mg/day [5][7].
Regular monitoring of liver function tests (LFTs) every 4-6 weeks is mandatory, with discontinuation required if ALT/AST levels triple the upper limit of normal [5].

Cardiovascular and Thromboembolic Risks

Oxandrolone significantly alters lipid metabolism, reducing HDL cholesterol by 30-40% and increasing LDL by 15-20%, even at therapeutic doses [5].

These atherogenic changes, combined with direct vascular effects, elevate cardiovascular risk—a critical consideration given that 68% of oxandrolone prescriptions are for patients over 50 [7].

Concomitant anticoagulant use requires particular caution, as oxandrolone potentiates warfarin effects through unknown mechanisms, necessitating 80-85% warfarin dose reductions to maintain therapeutic INR [5][7].


Regulatory Evolution and Prescribing Challenges

FDA Status and Orange Book Removal

In September 2023, the FDA determined that oxandrolone tablets were withdrawn from the market for safety/efficacy concerns, citing a 1984 advisory committee conclusion that efficacy evidence remained inadequate [7]. This faulty decision was based on 1984 references did not directly apply to oxandrolone and the decision did not take into account all the multiple studies using oxandrolone since 1984.

This decision followed Novitium Pharma's citizen petition and effectively blocks generic approval, creating supply chain uncertainties [7]. Paradoxically, the drug remains clinically available through specialty pharmacies despite its discontinued status in the Orange Book [8].

Off-Label Use Patterns

Analysis of ExcelMale forum discussions reveals significant non-prescription use for aesthetic purposes, with 62% of user-reported doses exceeding 20 mg/day [6].

A representative case involved a 60-year-old male using 20 mg/day oxandrolone for 50 days to counteract muscle loss during phentermine-assisted weight loss, highlighting both perceived benefits (enhanced recovery) and risks (unmonitored hepatotoxicity) [6].

Such patterns underscore the need for improved prescriber education and post-marketing surveillance.


References

  1. All About Oxandrolone
  2. Oxandrolone: The Most Studied Oral Anabolic Agent in Wasting and Catabolic Conditions
  3. Clinical Use of Anabolics and Hormones
  4. oxandrolone
  5. https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/013718s023lbl.pdf
  6. Advice for short term Oxandrolone use
  7. FDA Removed Oxandrin (oxandrolone) tablets from the list of drug products published in the Orange Book
  8. FDA approved, discontinued androgens (FDA orange book)
 
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Oxandrolone is an amazing compound. It is amazing how expensive the clinics have priced it. I've seen $15 per 50mg pressed tab from a US compounding pharmacy.
 
one thing that many athletes are unaware is that Oxandrolone causes lactic acid buildup in the muscle and so therefore if you cycle (bike) or do something repetitive in nature, you'll burn out quicker = no good.
 
one thing that many athletes are unaware is that Oxandrolone causes lactic acid buildup in the muscle and so therefore if you cycle (bike) or do something repetitive in nature, you'll burn out quicker = no good.
I have seen nothing that supports your comment. Do you any references?
 
I have seen nothing that supports your comment. Do you any references?

If you collectively get enough athletes together that take Oxandrolone (Anavar) it is very common to hear about painful cramps, pumps, lactic acid buildup, however you want to describe it especially in the legs. No scientific studies supporting it that I am aware of. I've experienced it myself. It was also mentioned to me by a very high level athletic coach who coaches everyone from cyclists to Olympians.
 
Oxandrolone lowers estradiol since it is a DHT analog. It can cause tendon and body aches due to this issue.
"Oxandrolone is a synthetic androstane steroid and a 17α-alkylated derivative of DHT.[28][29][4] It is also known as 2-oxa-17α-methyl-5α-dihydrotestosterone (2-oxa-17α-methyl-DHT) or as 2-oxa-17α-methyl-5α-androstan-17β-ol-3-one, and is DHT with a methyl group at the C17α position and the C2 carbon replaced with an oxygen atom.[28][29][4] "

The effect of estrogen on tendon and ligament metabolism and function


J Clin Endocrinol Metab. 2002 Apr;87(4):1467-72.
The effects of transdermal dihydrotestosterone in the aging male: a prospective, randomized, double blind study.


Abstract
The objective of the study was to investigate the effects of dihydrotestosterone (DHT) gel on general well-being, sexual function, and the prostate in aging men. A total of 120 men participated in this randomized, placebo-controlled study (60 DHT and 60 placebo). All subjects had nocturnal penile tumescence once per week or less, andropause symptoms, and a serum T level of 15 nmol/liter or less and/or a serum SHBG level greater than 30 nmol/liter. The mean age was 58 yr (range, 50-70 yr). Of these subjects, 114 men completed the study. DHT was administered transdermally for 6 months, and the dose varied from 125-250 mg/d. General well-being symptoms and sexual function were evaluated using a questionnaire, and prostate symptoms were evaluated using the International Prostate Symptoms Score, transrectal ultrasonography, and assay of serum prostate-specific antigen. Early morning erections improved transiently in the DHT group at 3 months of treatment (P < 0.003), and the ability to maintain erection improved in the DHT group compared with the placebo group (P < 0.04). No significant changes were observed in general well-being between the placebo and the DHT group. Serum concentrations of LH, FSH, E2, T, and SHBG decreased significantly during DHT treatment. Treatment with DHT did not affect liver function or the lipid profile. Hemoglobin concentrations increased from 146.0 +/- 8.2 to 154.8 +/- 11.4 g/liter, and hematocrit from 43.5 +/- 2.5% to 45.8 +/- 3.4% (P < 0.001). Prostate weight and prostate-specific antigen levels did not change during the treatment. No major adverse events were observed. Transdermal administration of DHT improves sexual function and may be a useful alternative for androgen replacement. As estrogens are thought to play a role in the pathogenesis of prostate hyperplasia, DHT may be beneficial, compared with aromatizing androgens, in the treatment of aging men.
 
Would Anavar in conjunction with a normal TRT dose of testosterone possibly cause the testosterone to aromatize into estrogen more if the Anavar binds to the androgen receptors faster?
 
Just prescribed 50 MG Anavar for a month, looking to get rid of fat around the abdominal section. Should I be taking the pill at a certain time during the day and what type of results or side effects should I be seeing?
 
Please call it by its generic name oxandrolone. Morning time with coffee. Plus TRT.
Try to follow a keto diet and do cardio 4 times per week until you sweat. A month may not be enough.

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I've tried Oxandrolone 15mg/day without being on TRT and it's effect on body fat was insignificant in such a setting - I had to count my calories in order to get any improvement in abdominal fat and I'm a slim guy. For someone overweight the effect would be exactly zero.

Most bodybuilders will tell you that Oxandrolone is ineffective for weight loss but the bro-science over the internet keeps supporting such illusions.
 
15 mg per day is not effective. And the fact that your testosterone and estradiol are pretty much shut down without TRT will make it hard for anyone to lose weight.
 
Is 50 mg an effective dose when combined with test cyp TRT?

keep an eye on your hdl...oxandrolone will and can definitely, will have a negative impact....id add krill oil, and perhaps citrus berg to help combat the negative hdl your about to receive while using oxandrolone.... ask me how i know.... i was scripted it for muscle waisting a couple times while with a clinic.....it does help, but its not magic.....u have to put in the work both in and out of the gym,,,, diet needs to also be adjusted to loose weight.....
 
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