Anadrol

A potent oral steroid developed for anemia; it has been misused for physique and strength enhancement.

Oxymetholone (Anadrol) is a derivative of dihydrotestosterone, which means it cannot be converted to oestrogen by aromatase at all. Despite that it produces pronounced oestrogen-like effects — fluid retention, breast tissue changes — and the mechanism behind them is genuinely unestablished. So is whether anti-oestrogen therapy does anything about them. That double uncertainty is the honest position, and anyone experiencing these effects needs a clinician rather than a self-selected drug. Oral 17-alpha-alkylated steroids share one design feature: a methyl group added at the 17 position so the molecule survives first-pass liver metabolism. That modification is what makes them orally active and is strongly associated with the highest cholestatic risk in this class, though the exact injury mechanism is not settled.

Prescription-era trials in anemia document potent erythropoiesis and weight gain. The same record documents side effects arriving as fast as the weight does — and much of the rapid scale weight is water that leaves when the drug does.

• It has real FDA-approved history for anaemia, which is unusual in this catalogue — it stimulates red-cell production, and that is a genuine documented pharmacological effect.
• MODERATE for short-term weight and body-cell-mass gain in HIV-associated wasting: the principal randomised trial ran 16 weeks in 89 adults. It also found ALT elevations above five times baseline in 27-35% of those treated, which is the other half of that result.
• NONE SHOWN for physique use in a controlled trial in healthy people. Patients with anaemia or wasting do not establish what happens in a healthy body. Note also that appetite SUPPRESSION is not an established effect — the wasting trial measured appetite and reported improvement.
• Its liver record is the serious one: peliosis hepatis — blood-filled cysts in the liver — and hepatic tumours appear in the label, and the label is explicit that these can be silent until life-threatening bleeding or liver failure occurs.
• Normal routine bloodwork cannot exclude peliosis or a hepatic tumour, which is why "my liver values are fine" is not the reassurance it sounds like.

Orally active and 17-alpha-alkylated. It does not aromatise, yet still causes oestrogenic effects — so oestrogen-management drugs address them poorly if at all. It raises erythropoietin, which is the basis of its anaemia indication and also why haematocrit can rise substantially.

Severe on multiple axes at once: pronounced 17-alpha-alkylated liver strain, heavy water retention and blood-pressure elevation, headaches, appetite suppression at higher exposures, edema and gynecomastia-like effects that can occur despite the drug not aromatizing (mechanism not fully established), lipid damage, and marked HPG-axis suppression.

• Class-level severe outcomes reported with anabolic steroids, which no compound here is exempt from: cardiac arrest, heart attack, thickened heart muscle, heart failure and stroke; serious liver injury; and mania, paranoia, psychosis, hostility, aggression, dependence and depression on withdrawal.
• Pregnancy and breastfeeding: androgens can cause fetal harm including virilisation of a female fetus. Avoid in both.
• Anyone with any liver condition, or an unexplained liver enzyme elevation
• Anyone with prostate or male breast cancer, or female breast cancer with hypercalcaemia
• Anyone with nephrosis or nephritic disease, or heart, kidney or liver disease where fluid retention is a risk
• Anyone with existing erythrocytosis or a clotting history
• Children, given premature growth-plate closure
• Women, given virilisation risk, some of which does not reverse

• Anticoagulants — anabolic steroids can substantially potentiate coumarin anticoagulants, and this is a documented major interaction.
• Glucose-lowering therapy, since anabolic steroids can reduce insulin or oral medication requirements — a pharmacist or clinician needs to know, and nothing here is an instruction to change a dose.
• ACTH and adrenal corticosteroids, which the label notes can worsen the fluid retention.
• Alcohol, paracetamol and any hepatotoxic drug or supplement.
• Other oral 17-alpha-alkylated compounds, where liver burden is additive.
• Tell any clinician treating your blood pressure that you are using it — do not adjust prescribed medicines around it yourself.

Documented interactions with other things people research. A compound not listed here does not mean the combination is safe — only that no specific interaction is on file.

• Liver enzymes and bilirubin — while understanding their limit: normal values do not exclude peliosis hepatis or a liver tumour.
• Haematocrit and haemoglobin, which can rise markedly given its red-cell stimulating effect.
• Blood pressure, which commonly rises with the water retention.
• Full lipid panel.
• Any jaundice, dark urine, abdominal pain or abdominal swelling — emergency assessment, since the label warns of silent liver lesions presenting as haemorrhage.

Fluid retention can contribute to the weight gained, though how much of it is fluid rather than tissue, and what happens afterwards in healthy users, has not been established. Liver enzymes generally normalise — but the label's silent lesions are the reason any jaundice, abdominal pain or swelling after stopping still needs assessment rather than reassurance. Endocrine recovery is variable, can take months and can be incomplete.

US: Schedule III anabolic steroid under the CSA. Historically FDA-approved (Anadrol-50); current marketing status should be verified against the Orange Book.

Papers about this compound, not proof of the claims above. A title says what was studied, which is sometimes a negative result or a different question entirely.

• Oxymetholone ameliorates insulin sensitivity in maintenance hemodialysis patients: a randomized controlled trial
  Clin Nephrol, 2009
• Double-blind, randomized, placebo-controlled phase III trial of oxymetholone for the treatment of HIV wasting
  AIDS, 2003
• Oxymetholone therapy in bone marrow insufficiency
  Acta Med Austriaca, 1974

• OxymetholoneRep Carcinog · 2004
• OxymetholoneBETA · 1998
• OxymetholoneRep Carcinog · 2011
• OxymetholoneRep Carcinog · 2002
• Review of oxymetholone: a 17alpha-alkylated anabolic-androgenic steroidClin Ther · 2001
• Synthesis of a human long-term oxymetholone metaboliteSteroids · 2019
• Effects of Platelet-Rich Plasma on the Oxymetholone-Induced Testicular ToxicityDiseases · 2023
• Oxymetholone in refractory anaemiaBr J Haematol · 1969
• Oxymetholone hepatotoxicity enhanced by concomitant use of cyclosporin A in a bone marrow transplant patientClin Lab Haematol · 1994
• Good response to oxymetholone in adult aplastic anemiaAnn Hematol · 2025
• Oxymetholone treatment for sickle cell anemiaBlood · 1975
• Hereditary angioedemaInt J Dermatol · 1983