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3.2.2.4.3 Testosterone

3.2.2.4.3.2

Testosterone modulation

An interesting recent medical study has come to the conclusion that all successful treatments of erectile dysfunction result in increased testosterone levels.

The study under the title “Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone” was authored by EA Jannini et al. at the Department of Experimental Medicine, University of L’Aquila, Italy. In their abstract, they reported:

The role of androgenic hormones in human sexuality, in the mechanism of erection and in the pathogenesis of impotence is under debate. While the use of testosterone is common in the clinical therapy of male erectile dysfunction, hypogonadism is a rare cause of impotence. We evaluated serum testosterone levels in men with erectile dysfunction resulting either from organic or non-organic causes before and after non-hormonal impotence therapy. Eighty-three consecutive cases of impotence (70% organic, 30% non-organic, vascular aetiology [etiology; the set of factors that contributes to the occurrence of a disease; red] being the most frequent) were subjected to hormonal screening before and after various psychological, medical (prostaglandin E1, yohimbine) or mechanical therapies (vascular surgery, penile prostheses, vacuum devices). Thirty age-matched healthy men served as a control group. Compared to controls, patients with impotence resulting from both organic and non-organic causes showed reduced serum levels of both total testosterone (11.1 +/- 2.4 vs. 17.7 +/- 5.5 nmol/L) and free testosterone (56.2 +/- 22.9 vs. 79.4 +/- 27.0 pmol/L) (both p < 0.001). Irrespective of the different aetiologies and of the various impotence therapies, a dramatic increase in serum total and free testosterone levels (15.6 +/- 4.2 nmol/L and 73.8 +/- 22.5 pmol/L, respectively) was observed in patients who achieved normal sexual activity 3 months after commencing therapy (p < 0.001). On the contrary, serum testosterone levels did not change in patients in whom therapies were ineffective. Since the pre-therapy low testosterone levels were independent of the aetiology of impotence, we hypothesize that this hormonal pattern is related to the loss of sexual activity, as demonstrated by its normalization with the resumption of coital activity after different therapies. The corollary is that sexual activity may feed itself throughout the increase in testosterone levels.”

Note: mol is the basic International System unit of amount of substance equal to the amount containing the same number of elementary units as the number of atoms in 12 grams of carbon-12. Symbol mol. Also called gram molecule; nmol = nanomol; nano- = one billionth (10 -9); pmol = picomol, pico- = one trillionth (10 -12)

What’s interesting about this result is the reversed correlation. Usually, people think that they first need the testosterone, and than have more sex. But to have more sex, according to the above-cited study, is what surely leads to higher testosterone levels. What’s first, the egg or the hen.

Low, or at least very low, testosterone levels clearly will lead to decreased libido and erectile dysfunction. Hypogonadal men are an obvious proof.

However, hypogonadism is definitely not the only possible cause of erectile dysfunction. More often, so says conventional medical wisdom, the cause is vascular.

The treatment of erectile dysfunction with testosterone, however, is usually not successful.

A “not successful” result is something quite common for all singular erectile dysfunction treatments… in medical, scientific studies as well as in personal experiments (not only of this author).

Isn’t it quite obvious that a combination strategy should be applied?

For philosophical reasons, this web site advocates a hypersexual lifestyle. It’s the only state of being worth living in. We advocate a frame of mind, characterized by daily being overtaken by sexual fantasies so strong that they result in spontaneous erections, even orgasms.

Pfizer's Blue alone doesn’t achieve this. Yohimbine as well as some Parkinson’s Disease medications such as bromocriptine come a bit closer to the desired effect.

But with Yohimbine, too, you can’t force the issue (or should we say: the tissue … the corpus cavernosum tissue, this is). Or, you can, but only to a certain extend.

We would like to be as hypersexual as the perpetuators of sex crimes, minus the criminal inclination.

It has been proven in numerous scientific studies that chemical castration works in suppressing criminal tendencies in sex offenders. Such chemical castration entirely works on a hormonal pathway, by suppressing testosterone.

Reported the Washington Post on March 23, 1998: “An Israeli study recently published in the New England Journal of Medicine reports that a new treatment is highly effective in men with long-standing deviant sexual behavior.

“Thirty men with paraphilia (ranging in age from 24 to 40) were treated with monthly injections of triptorelin, a long-acting drug that blocks the action of gonadotropin-releasing hormone. That is a messenger chemical from the brain that normally stimulates the pituitary gland to release other hormones that control the function of sex organs such as the testes and ovaries.

“Triptorelin treatment produced a dramatic drop in the men’s testosterone levels. All of the men reported a reduction in deviant sexual fantasies and desires, from a mean of 48 per week before treatment to zero during treatment. Similarly, incidents of abnormal sexual behavior decreased from a mean of five per month to zero.

“Triptorelin did produce significant side effects. Bone-mineral density decreased in 11 of 18 men in whom it was measured. The treatment causes temporary infertility and shrinkage of the testes. Many men reported difficulty with erections and lack of sexual interest, and some had hot flashes, decreased facial hair and muscle weakness or tenderness.”

There has been ample testifying by offenders that reducing testosterone levels diminishes compulsory sexual ideas. The following is quoted from an essay by Michael Ross, a death-row inmate convicted for the murder of several women:

“As you might expect, I have been examined by many psychiatric experts since my arrest in 1984. All of them, including the state’ s own expert psychiatric witness, diagnosed me as suffering from a paraphiliac mental disorder called ‘sexual sadism,’ which, in the experts’ words, resulted in my compulsion ‘to perpetrate violent sexual activity in a repetitive way.’

The urge to hurt women could come over me at any time, at any place. Powerful, sometimes irresistible desires would well up for no apparent reason and with no warning. Even after my arrest — while I was facing capital charges — these urges continued.

“I eventually found some relief. Almost three years after I came to death row, I started to receive weekly injections of an anti-androgen medication called Depo-Provera. Three years later, after some liver function trouble, I was switched to monthly Depo-Lupron injections, which I still receive. What these drugs did was significantly reduce my body’ s natural production of the male sex hormone — testosterone. For some reason, testosterone affects my mind differently than it does the average male. A few months after I started the treatment, my blood serum testosterone dropped below prepubescent levels. (It’ s currently 20; the normal range is 260 to 1,250.) As this happened, nothing less than a miracle occurred. My obsessive thoughts and fantasies began to diminish.”

The correlation of increased testosterone levels and sexual thoughts is clear.

So, why has testosterone replacement therapy often been shown to be not effective in restoring sexual function? There are a number of possible reasons.

For example the design of the studies. If the cause of erectile dysfunction is purely vascular, and if the measured effects are just related to cavernosal tissue, not much can indeed be expected.

There is, furthermore, the possibility that the dosage used was just not big enough. The most common test for testosterone is one for plasma testosterone. It measures the presence of testosterone in blood.

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3.2.2.4.3.3

Personal experience with enhancing testosterone as treatment of sexual dysfunction

I am sure that a healthy man at any age can enhance testosterone. I am not sure that it will do much for his libido and sexual function.

I have tried a good number of hormonal supplements, and, based on my own experience and the scientific studies of others, I would say that it’s not the way to go for sexual enhancement. While the dopamine route is not perfect either, medications such as bromocriptine at least have a measurable effect on sexual parameters (if they are applied in the correct manner).

And then there always is yohimbe (or yohimbine, the extracted pharmaceutical), and Pfizer's Blue. Both work. Period.

I haven’t had any pro-sexual effect from testosterone undecanoate (Andriol capsules). To the contrary, the supplemental Andriol has probably weakened my own testosterone production. Testosterone supplementation really only makes sense if the body can no longer be enticed to produce own testosterone.

I have taken DHEA for years. Sites that want to sell DHEA will usually include a statement in their sales pitches that DHEA enhances libido or sexual function. I don’t think DHEA is counter-effective. But from the perspective of sexual enhancement, it’s probably just a strong placebo.

For the whole concept of it, I believe that matters other than supplying hormones or precursors should be emphasized. All hormone supplementation, with Testosterone undecanoate, DHEA or pregnenolone, has not shown to enhance the sexuality of basically healthy men. And enhancing sexuality would be my primary aim anyway.

On the other hand, a combination of clomiphene citrate (Clomid) and anastrozole (Arimidex) results in a character modification that I judge to be testosterone-driven.

The clomiphene citrate stimulates the hypothalamus in a manner that, several steps downwards, results in higher testosterone levels. Anastrozole avoids the conversion of testosterone into estradiol.

I have also experimented with tribulus terrestis and tongkat ali, both herbs that is said to increase testosterone levels on a pathway similar to clomiphene citrate.

Especially the tongkat ali has an effect similar to the combination of clomiphene citrate and anastrozole: a testosterone-driven character modification.

I both cases, I feel the testosterone by becoming aggressive more easily. Upon being provoked (for example in road traffic) I could spend minutes on imagining how I would maltreat a fellow driver who obstructed my path. I’d cut his ears, shoot his kneecaps, smash his balls, and drown him in a bathtub of human excrements.

But do I want to become more aggressive? Not really. I’m on the search for real great sex. I’m not a boxer or race driver, both of whom probably need aggressiveness to increase their chances of winning. Nor am I a body builder who would benefit from the anabolic component of an increased testosterone level.

Sadly enough, the character modification I had in mind (a general enhancement of libido and sexual performance) did not occur on any testosterone enhancement schedule.

I, for myself, have to make sense of my personal experience with testosterone-enhancing medications, especially when comparing them with scientific information on the same topic.

My current hypothesis (not a theory I would have invented myself) is that in the hormonal system, testosterone levels are not the crucial factor for enhanced libido and sexual performance. You probably have to have the appropriate receptor sites for the pro-sexual effect of testosterone, and the receptor sites have to be activated.

Apart from trying to be a good lay man, I’m also a layman. And like most laymen studying the endocrine system, I have initially strongly focused on hormones, and neglected the importance of receptors.

However, hormones exert their effects not just on tissue of any kind but only on tissue that has a chemical surface which is receptive to the hormone.

I assume that the effects of testosterone on libido and sexual performance are strongly correlated to certain receptor tissue in the brain (for the libido) and the reproductive organ (for erections). If you want to enhance, you will have to enhance both, hormones and receptor tissue.

Let’s compare this to a concert ensemble. To start with, I have 4 musicians. That’s ok for playing some famous Mozart melodies. But if I want to play a Beethoven symphony, I will have to upgrade. How?

By hiring more musicians? Of course. But if they don’t have any instruments to play, they just stand around.

It’s just the same as with testosterone.

Sexual intercourse is a concert. The musicians are the testosterone, and the musical instruments are the receptor sites.

All is set and running at the concert hall. They play Mozart melodies. If I take away the musicians, there will be silence (if I totally inhibit testosterone, no sex will happen, and my libido is dead).

However, such an experiment is no proof that liberally sending more musicians onto the stage will make for a full orchestra, capable of presenting that Beethoven symphony. I have to supply the additional violins, drums, and trumpets as well.

But enhancing testosterone (by supplying it exogenously, or by stimulating the hypothalamus, or by inhibiting aromatase) is just like sending empty-handed musicians onto the stage. They can’t do much if you don’t supply the musical instruments.

On the same level, testosterone can only have a pro-libido and pro-sexual-performance effect if there are specific tissue receptors where it can dock on. On other tissue, testosterone has no effect.

As far as I understand it, I (and probably most other men) don’t suffer from a lack of aggression receptor sites that can be influenced by increasing testosterone. With testosterone receptor sites for sexual prowess, however, I seem to have a number of receptor sites that largely correlates to my own testosterone production.

For a sexual effect from enhancing testosterone, both would have to be increased: testosterone AND receptor sites. Sadly enough, I have not come across any medication that claims to increase the number of sexual testosterone receptor sites.

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3.2.2.4.3.5

Testosterone – a second opinion

I have recently received a series of emails from a person who apparently has more experience with the use of testosterone for sexual enhancement than I do. That he does have more experience with testosterone is a direct result of his being able to affect sexual enhancement with testosterone medications, something I have so far not been able to achieve. The reader’s approach has been rather different from mine.

I read that you did not have good results with testosterone. Testosterone is better than the other things you research if used correctly. I recommend straight testosterone as it is natural and cheap. It is active orally, sublingually, or by injection, but I strongly recommend topically, either suspended in olive oil or any oil or in a gel or in alcohol. It can be rubbed on thin skin or mucous membrane in an area where it will not get rubbed off. One drop may suspend 2 to 4 mg. If you apply it about 2 to 4 times a day, in about 4 days you will notice being quite mentally horny and more spontaneous erections and more sexual fantasy and better performance. This desired state will only last a few days. Then it is desirable to stop for a few days and the whole procedure can work again. It is possible to take a couple drops per day continuously for somewhat constant more sexual arousal but with much less intense peaks. This works identically if not better for women but their dosage can be a bit less.

As you have learned of the erotic potential of jealousy, I suggest you learn the erotic potential in yourself when faced with a very horny woman (created by testosterone). There are some individual variations and other things you will notice but you can discover them all by using this information. Of course the user will also notice a sense of well-being, energy, confidence, and a little more strength and muscle.

In women after a month or two of continuous use, there will be a little more and darker hair coming in and perhaps a slight deepening of the voice and perhaps a bit of acne. At that point one may choose to continue or stop for a few weeks to let those effects subside. There will also be a noticeably bigger and more sensitive clitoris, which is perhaps the most wonderful effect of all.

Fortunately testosterone as a powder or in oil is very cheap. This sexual enhancer can be used compatibly with all your other enhancers. Unfortunately testosterone is a scheduled drug in the US but fairly easy to get by prescription for the mature man. Contrary to all the propaganda it is very safe. Do not hesitate to ask me if you need any more information or run into any problems with this. I guarantee you this will work.

I was very sad to learn from you that Amineptine does not really often create greater euphoria and sex drive and spontaneous orgasms. There is much more research to be done and I respect your effort to share your results. Experimenters in this area are fragmented and not in communication, which slows progress immensely. Briefly, I find that Yohimbine is mildly sexually enhancing but with notable side effects. Pfizer's Blue does work to promote ease of erection and staying hard much as the intracavernousally injectable Papaverine and Phentolamine Mesylate.

I find that GHB is a fine euphoric and sexual enhancer when used correctly. MDMA is the best enhancer for love, but GHB is usually better for sex. MDMA interferes with erection and orgasm a lot. The trick [with] MDMA is to be erect before the effects begin and then erection will be maintained without difficulty! You may be aware that MDMA is wonderful and nearly free of side effects at first and with use becomes downright awful in after-effects. It seems the chemists have not found a good way to control these after-effects.

Arginine is a mild sexual enhancer when taken an hour or more previous to sex. DMAE is similarly weak and can feel a bit adrenergic. Lecithin works but is mild. I have not yet experientially learned Bromocriptine or Apomorphine. I do like dopamine agonism for the euphoria and the sexual enhancement. I am not yet clear experient.

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3.2.2.4.3.6

Testosterone up-regulation, a tricky issue

There is sample of evidence that a sufficiently high testosterone level is absolutely essential to a sexualized lifestyle. Testosterone, the hormone primarily synthesized in the testicles (but not only there), is necessary both for sexual appetite and performance (e.g. achieving a good erection). Men whose testosterone levels are low will be lacking in both.

But there are oral testosterone medications. The best-known one is Andriol. Andriol is not just testosterone but testosterone undecanoate, a chemical alteration of testosterone of which a small percentage will, in most subjects, make it past the liver into the blood stream.

Animal testicles have a reputation as aphrodisiacs, but this, too, is based on an overly simplistic logic. If any, there is very limited benefit on the same level on which eating liver benefits anemic patients. Of course, iron is a major mineral in blood, and often anemia is one of iron-deficiency. Eating blood products such as liver will make available to the organism some additional iron to be used in the body's own synthesis of blood, provided it's not a disturbance to this process that is at the root of the iron-deficiency anemia in the first place.

In the US, Andriol is not a licensed medication. For the serious treatment of hypogonadism, it would just be the second-best choice anywhere in the world. It's not only that it is hard to predict how much testosterone of the 40 milligram of testosterone undecanoate each capsule supplies actually makes it into the blood stream. Estimates are 2 to 3 milligram. But there will be variations from person to person, and in a single person from day to day, depending on the diet the liver has to deal with apart from the testosterone undecanoate.

But even in subjects in whom oral testosterone medications do work, such medications are not an aphrodisiac like yohimbine. Taking for granted that testosterone undecanoate capsules do raise blood levels of free testosterone, the person taking this medication will not feel a sexualisation an hour or so after ingesting the capsules. If raising testosterone levels does work, it seldom does so immediately. There will be a good measure of unpredictability. For men on testosterone replacement therapy (several daily doses over some time), the sexualizing effect will arrive sporadic every now and then. Why it is like this, has, to the best of my knowledge, so far not been conclusively explained.

I have mentioned that testosterone as drug is not a medication of which one would feel much within an hour or so. Unless it is hugely overdosed. And the effect of an overdose is not just a potentiation of the desired effect of a normal dose.

The desired psychological effect of a normal dose may be increased sexual appetite, a good erection that doesn't break down, and a powerful orgasm. Tetosterone-deficient men will be lacking in all three. Testosterone supplementation in testosterone-deficient men will restore all three. But not in the manner that desire, performance, and orgasms will be enhanced an hour or so after popping an oral testosterone medication. It may well take a few days for the effects to set in in the first place. Increased desire may arrive rather surprisingly, not at a moment it was planned for. It's not as direct an effect as for aspirin or yohimbine.

Increased desire is also not a direct correlation to increased testosterone plasma levels. The endocrine system really is rather tricky. And anyway, increased plasma levels only peak a long time after an oral testosterone medication has been applied. For Andriol, they are supposed to occur some five hours after a dose has been ingested.

While the supplementation of regular or even high dosages will normally not be felt within hours after they have been ingested, it's a different story with huge overdoses. Use in women more than in men provides a clear indication to this end.

Of course, Andriol, as well as other testosterone products on the market, are entirely not intended for use in women. But testosterone is the hormone for sexual appetite not just in men but also in women. However, normal testosterone levels in women are much, much lower than in men.

Though not intended for the use in women, women, too, are among those taking Andriol and other testosterone medications. The objective is usually to raise performance levels in sports.

Women on steroids usually exhibit an increased sexual appetite but it's again something that sets in with constant use, not as the effect of a single dose. The most likely effect of a single overdose is extreme anger. It's something more likely to happen in overdosed women, rather than men.

Contrary to the bad reputation of testosterone in this respect, high active levels of this so-called male hormone are not associated with an anger-prone personality, but rather the other way around. High plasma-levels of testosterone will usually give men a positive outlook, make them friendly, understanding, and willing to learn. Abnormally low levels go hand-in-hand with bad moods and depression. As previously mentioned, only extreme overdoses may result in anger, even rages.

We have pointed out above that endocrine matters are rather complicated. This is the case because the endocrine system is one of multiple balances by which hormones are kept in check.

Because of this, blood testosterone levels are only an indicator of limited value if one is to judge whether there is enough testosterone activity in one's organism in order to get the best out of sex.

The bioavailability of testosterone is kept in check by a blood-stream protein called sex hormone binding protein (SHBG). Testosterone molecules that have been captured by SHBG are rendered absolutely ineffective until they are anyway discarded from the organism.

Many men who are given the advice to undergo a testosterone test, are simply fooled. These test measure overall testosterone, both testosterone which is bound to SHBG as well as free testosterone.

These tests are useless when it comes to assess whether a man should undergo testosterone replacement therapy or not. The determining factor would be whether a man is sufficient in free, bio-available testosterone.

Compared to meaningless lab results on overall testosterone, plain logic is the smarter approach to decide on the need for testosterone replacement therapy. For all men, the process of becoming older is accompanied by a decline in the synthesis of testosterone.

But not only does the production of testosterone decline. The amount of bio-available testosterone is further reduced by the fact that older men typically "suffer" from increased levels of sex hormone binding globulin.

The decline in bio-available testosterone is largely proportional to all those other symptoms of advancing in age, such as bones becoming brittle, sacking skin, loss of lean body mass, decrease of muscle tone, obesity, and a decline in sexual desire and performance.

This all smells like a ploy of nature to get rid of older specimens of the species homo sapiens by having genetically programmed a decline in the availability of testosterone.

And indeed, there is little doubt in the scientific literature that testosterone supplementation not only works to avoid the onset of these events of aging. Testosterone supplementation has the power to reverse these developments.

Older men undergoing testosterone replacement therapy will practically always develop stronger bones and exhibit more lean body mass while carrying less fat. They will usually have a more active and satisfying sex life, though this cannot be measured as easily as lean body mass and fat.

So, why do doctors not recommend that all men from about the middle of their 40's undergo testosterone replacement therapy?

There are a number of reasons why physicians and other health care professionals have been slow in prescribing testosterone replacement therapy.

Testosterone has substantial potential as doping drug in sports. Testosterone supplementation during training periods, long before competition, will lead to increased muscle mass, an asset in many sports. It will also enhance performance during competition, which is why doping controls for testosterone are undertaken at all major events.

The tendency among those who take testosterone supplementation, or use anabolic steroids, is for huge overdoses. And these are obviously not healthy. Therefore, sports and healthcare administrations around the world have run public awareness campaigns to the effect that anabolic steroids, or hormone supplementation sports in general, pose a serous health risk. Testosterone is not really an anabolic steroid, but it's a steroid hormone with an anabolic effect (the more important component being testosterone's androgenic characteristics),

Sure, mice that are given huge overdoses of testosterone for most of their lives have shorter ones (lives, that is). But we are not talking huge overdoses here. We are talking about high, youthful levels as everyone healthy has them at the beginning of the 20's. And a good number of studies have show that testosterone supplementation to achieve such levels is no major health risk

Horror stories about dreadful deaths as a consequence of the abuse of synthetic anabolic steroids are good copy but bad science. They don't apply to testosterone supplementation with the aim to achieve youthful levels of the hormone.

Apart from the doping issue. Testosterone has long been associated with two health risk: heart attacks and prostate cancer.

Women up to the age of about 50 have a much lower heart attack risk than men, primarily, so it seems, because they are protected by estrogens. Men with reduced testosterone levels have been shown to be less prone to heart attacks than men with high levels of the male hormone. In spite of this, I for myself, am in favor of a lifestyle of a high testosterone level. But I take the scientific studies that associate high testosterone levels with heart attacks as a reminder not to expose myself to additional heart attack risks, such as smoking or obesity.

In case of a second health risk, testosterone may have been the wrong suspect for many years. Testosterone has for many years been considered the main culprit in prostate cancer. Actually, not testosterone but its more powerful metabolite dihydrotestosterone.

Testosterone is transformed by the enzyme 5-alpha-reductase into dihydrotestosterone. Actually, dihydrotestosterone is the form of testosterone, which is the major hormonal player in sex matters.

Levels of dihydrotestosterone, not testosterone itself, are what make a difference for the number of orgasms per week. Dihydrotestosterone is also the form of testosterone, which is at work in mediating erections.

And dihydrotestosterone is the form of testosterone that seems to increase the susceptibility for prostate cancer. But the truth of this assessment has already been questioned.

If on has arrived at a decision to undergo testosterone replacement therapy, one will have to decide by which means to supplement testosterone. Most people would feel most comfortable with an oral testosterone drug such as Andriol. Indeed Andriol would be the medication of choice in most countries around the world. But Andriol is not licensed in the US.

And while Andriol is convenient for the patient, there are some disadvantages, both medical and practical. Testosterone undecanoate burdens the liver, an effect that can be avoided by both testosterone injections and transdermal patches, the application of choice in the US.

A practical shortcoming of Andriol is that it has to be stored at a temperature of between 2 and 8 degree.

Though not Asian by birth, I have been living in various countries of Southeast Asia for about 20 years. In most countries here, all kinds of prescription medication are sold over the counter. No question asked, no prescription required.

Body builders and pharmaceutical addicts buy their drug supplies during trips to Bangkok for months ahead.

Too bad that in the case of Andriol capsules which they intend to use for testosterone's anabolic properties, what they buy is often enough just empty liver ballast. For while anybody can buy prescription drugs without prescription, it seems that, furthermore, almost anybody also can sell them. Not much of professional qualification seems to be required, and even if qualification is present, it seems to be lacking in the understanding that some medications ought to be stored in the refrigerator. Andriol is among them.

What you find in Southeast Asia are drugstores, many of them not even air-conditioned, where the Andriol lies in the cabinet, at 30 or more degrees, for months on end. The package still says "Andriol" but there is not much testosterone undecanoate left inside the capsules. That Andriol is often considered worthless as steroid among body builders may have its roots in the fact that body builders often will get their Andriol capsules not from an ordinary licensed pharmacy in an industrial country but on the black market or in countries like those in Southeast Asia where a prescription is not needed but appropriate storage is also not guaranteed.