What is Winstrol?
Winstrol, also known as stanozolol, is a synthetic anabolic-androgenic steroid which is derived from dihydrotestosterone (DHT), which is a more potent form of testosterone. Therefore, winstrol is a very potent anabolic steroid, which has been approved for human use since 1962, and is used in medicine [1, 2].
Medically, winstrol is used to treat disorders such as aplastic anemia and hereditary angioedema [3]. Its potent anabolic potential (growth-inducing) makes it a good adjunct therapy for vascular disorders, and some types of growth failure. Additionally, there are ongoing experiments aiming to provide insight into the role of winstrol in improving bone growth, with implications for regenerative medicine [1]. Additionally, winstrol can be used to treat dermatological conditions such as urticaria (rashes), Raynaud's phenomenon, cryofibrinogenemia, and lipodermatosclerosis [2].
Due to its anabolic potential, winstrol became one of the most widely-used anabolic steroids in fitness, used to induce muscle growth.
Despite therapeutical benefits, winstrol (and virtually all anabolic steroids) poses a risk of adverse effects, which are fairly common with its use. However, in the case of winstrol, the adverse effects are mostly dose-dependent and can be prevented and/or managed with appropriate follow-up [2]. It is therefore important to only use winstrol when there is a medical indication and the treatment plan is managed by a healthcare provider.
As winstrol is an anabolic steroid, its side effects are similar to other synthetic anabolic steroids which are derivatives of testosterone. These include:
- excessive hair growth (hirsutism),
- weight gain,
- menstrual irregularities or disorders, or postmenopausal bleeding in women,
- alterations of sexual function,
- severe acne,
- psychological adverse effects such as mood changes [3].
Additionally, winstrol has been associated with electrolyte imbalance disorders, leading to conditions including severe alkalosis (condition where the body's pH shifts towards basic) or hypokalemia (severe lack of potassium) [4].
In serious instances, particularly when winstrol is misused (namely with its uses for muscle gain in fitness), severe side effects affecting the liver have been recorded, including intrahepatic cholestasis and liver failure [5]. It has also been associated with neurotoxic effects, including cell death in certain regions of the hippocampus, which is the region of the brain that facilitates memory and learning [6].
What is Gynecomastia?
Gynecomastia is a very common condition in men characterised by benign (not cancerous) enlargement of the glandular tissue in breast. It can occur unilaterally or bilaterally (affecting one breast or both), and can present acutely, as a painful tender mass beneath the areolar region, of chronically as a growth of the breast [7].
Gynecomastia is a very common condition - it is estimated that gynecomastia affects 30 - 60% of men at some point in their life [8, 9]. The primary cause of gynecomastia is imbalance in the ratio of estrogen and androgen (testosterone) levels in tissues. This can be triggered by various factors. An important factor is puberty - a large proportion of adolescent boys experience gynecomastia as a reaction to the rapidly-changing hormonal landscape; this usually resolves by itself.
Other causes include hormonal disorders like hyperthyroidism, chronic liver disease, primary or secondary gonadal failure or androgen resistance syndromes. In many cases, gynecomastia is idiopathic (without known cause) [7]. Furthermore, medication and drug abuse can also lead to gynecomastia [10].
Diagnosis and treatment of gynecomastia
Diagnosis of gynecomastia usually relies heavily on physical examination. Additionally, blood tests for hormonal function can be performed. If breast cancer is suspected, imaging and tissue sampling via a biopsy and subsequent examination of the tissue sample are the gold standard pathway [11]. However, a palpation exam (where the physician feels the mass) is usually sufficient to diagnose gynecomastia [8].
The treatment of gynecomastia varies from patient to patient, however, the main objective of the treatment is cosmetic. The three main courses of treatment are:
- observation - some cases, mainly during puberty, resolve on their own.
- hormonal therapy - the objective is to restore the estrogen / androgen ratios back to physiological. This has a 30% response rate with the acute form, however is not recommended for chronic cases [11].
- surgery - resection of the breast tissue can be performed. This is usually indicated if the condition persists for longer than a year and/or worsens or causes other issues, including psychological discomfort [7].
Winstrol and gynecomastia: Reviewing the evidence
Anabolic steroids, like winstrol, have the potential to distupt the estrogen / androgen balance in the body. This occurs as the body, presented with large doses of a molecule that mimics testosterone, tries to compensate by synthesising larger volumes of estrogens, which can in turn lead to gynecomastia [12, 13].
As for the link between winstrol and gynecomastia, it is recognised as one of the side effects of the drug [14]. There, however, are not many observational studies or large cohort meta-analyses available on winstrol specifically - these studies usually focus on all steroid users. However, it is likely, that such studies, including [15], do include patients that were taking winstrol.
However, it is important to note that not all patients treated with anabolic steroids will develop gynecomastia [12] - this depends on several complex factors including the individual's genetic predispositions, other diseases, as well as the dosage and duration of the steroid treatment / use.
Summary
Gynecomastia is a recognised side effect of winstrol treatment. When taking winstrol, or any other anabolic steroid, it is important to have a medical indication for the drug and be managed by a healthcare professional. It is important to discuss all concerns of potential side effects with a medical professional, and not self-medicate with anabolic steroids based on "evidence" from online forums.