Characteristics

• oral 17 alpha analog
• metabolized mainly by kidney
• not hepatotoxic
• readily absorbed by intestine with 99% bio availability
• biologic life of 9-12 hours
• highly anabolic
• minimal androgenic effects

Metabolic Effects

• increases nitrogen retention and protein synthesis
• acts on androgenic receptors
• no effect on glucose metabolism
• decreased urea formation

Clinical Effect

• increases muscle formation
• increases protein synthesis in entire lean mass compartment
• shown to be effective in burn patients in increasing lean mass, and improving wound healing
• alters coumadin activity

Clinical Indications

• any involuntary weight loss
• in presence of catabolic insult
• to more rapidly restore lost lean mass
• may improve wound healing

Contraindications

• presence of androgenic tumor namely prostate, male breast
• presence of hypercalcemia

Insulin

• potent anabolic activity
• increases amino acid influx into cells
• necessary for carbohydrate metabolism to energy
• decreases fat mobilization for fuel-lipogenic
• improves healing in burns
• no studies in burns or role of insulin and LBM

Insulin-like Growth Factor (TGF1)

• mild systemic anabolic effects
• mild benefit in wound healing
• released endogenously by growth hormone
• needs to be given as subcutaneous injection once or twice a day
• induces hypoglycemia

Dehydroepiandrosterone (DHEA)

• naturally produced by adrenals; precursor for testosterone and estrogen
• increases testosterone in non-stressed state
• has some anti-cortisol activity
• has some effects on wound healing
• can be taken orally; inexpensive
• no data available on stressed man

Creatine Monohydrate

• natural occurring compound in muscle
• component of creatine phosphate, used for energy in muscle
• increases muscle mass mainly by increasing muscle water
• increased short term strength reported in normal man
• response appears to be due more to increased high energy bonds than increased muscle size
• may decrease stress induced catabolism but no human data at present
• taken orally usually 5 grams b.i.d. and is inexpensive

Alpha Keto Glutarate

• a salt of ornithine
• has anabolic activity by unknown mechanism
• appears to ehnance secretion of growth hormone and synthesis of glutamine
• given orally, inexpensive
• no studies on stressed or burn injured humans