Sustanon Side Effects
Testosterone is probably the safest anabolic steroid as far as side effects are concerned, given that it is a naturally produced anabolic steroid in the human body.
It follows the logic that using a hormone that the body already produces and is already familiar with is much safer and more reliable than using a modified form of testosterone (and all other anabolic steroid analogs).
While most of these modified testosterone analogs work almost identically to the human body's own testosterone, these modifications create an entirely new compound that is inherently foreign to the human body.
As such, some individuals may react worse to certain other anabolic steroids but respond well to testosterone.
However, it is important to clarify that the various esterified testosterone variants in the Sustanon blend are not altered analogs of testosterone itself, and once the attached ester is removed by enzymes in the body, the testosterone chemical structure remains unchanged.
The ester bound to the testosterone structure only serves to increase the rate of release and half-life of the testosterone, and does not affect the actual effects and properties of the testosterone itself.
However, testosterone is not without potential side effects and is likely to cause a variety of undesirable side effects which we will cover here.
Since Sustanon is a testosterone preparation, Sustanon side effects are exactly the same as those commonly associated with testosterone.
Estrogenic side effects
As a mixture of testosterone esters, Sustanon aromatizes into estrogen in the body.
Therefore, sustanon side effects include estrogenic side effects.
The rate at which testosterone aromatizes into estrogen is directly related to the dose used.
As the dose increases, the rate of aromatization of testosterone increases, so bodybuilding doses can and do induce moderate aromatase activity.
Estrogen can cause side effects such as water retention and bloating, increased blood pressure (due to water retention), increased likelihood of fat retention/gain, and gynecomastia.
Taking increasingly higher doses of Sustanon requires the use of an aromatase inhibitor, which acts to neutralize the aromatase enzyme that converts testosterone into estrogen, effectively stopping estrogen production at the source.
As a result, almost all estrogen-related side effects can be effectively controlled and stopped using AI.
Another possible option is to use a selective estrogen receptor modulator (SERM) such as Nolvadex, which works by blocking estrogen from attaching to receptor sites in breast tissue.
SERMs like Nolvadex only help to address estrogen-induced gynecomastia, they do not actually lower serum estrogen levels in the body, which is why an aromatase inhibitor is needed.
Androgenic side effects
Since testosterone is the main male androgen in the body and has moderate androgenic activity on its own (androgenic rating of 100), sustanon side effects include androgenic side effects as well.
However, the more severe and more potent androgenic side effects caused by testosterone are actually due to the fact that testosterone is reduced (or converted) by the 5-alpha reductase enzyme into the much more potent androgen dihydrotestosterone (DHT).
5-alpha reductase is present in large amounts in certain tissues, such as the scalp, prostate, and skin.
When testosterone reaches these tissues, it is rapidly reduced to DHT, the more potent androgenic metabolite.
This conversion to DHT is responsible for most androgenic side effects.
To prevent this conversion, ancillary medications such as proscar or dutasteride can be used, which act to neutralize serum levels of 5-alpha reductase, essentially preventing DHT conversion, but it is important to note that they do not completely eliminate androgenic side effects because testosterone itself has androgenic effects.
Another treatment is to use the shampoo Nizoral topically on the scalp, where the active ingredient in the shampoo, ketoconazole, effectively blocks DHT from binding to receptors on the scalp (or wherever it is rubbed on the scalp), much like the relationship between SERMs and estrogen in breast tissue.
This effectively reduces the likelihood of developing male pattern baldness (MPB) and/or acne.
Overall, androgenic side effects include increased sebum secretion (oily skin), increased acne occurrence (associated with increased sebum secretion), body and facial hair growth, and an increased risk of developing MPB in individuals who have the genetic traits necessary to develop it.
HPTA and Endogenous Testosterone Production Side Effects
All anabolic steroids have the ability to suppress and/or block the body's natural endogenous testosterone production, and sustanon side effects are no exception to this fact.
Sustanon's exogenous testosterone administration will inevitably suppress and in the worst cases block natural endogenous production during a cycle.
Once a cycle has ended, it is highly recommended that the user engage in a proper Post Cycle Therapy (PCT) protocol that includes the use of testosterone production boosting ancillary compounds such as Nolvadex and/or Human Chorionic Gonadotropin (HCG) during the typical PCT period of 4-6 weeks after the end of the cycle.
Failure to do so may result in permanent damage to the HPTA (hypothalamic-pituitary-testicular axis), resulting in an inability to produce adequate levels of testosterone throughout life, ultimately requiring medical intervention in the form of TRT (testosterone replacement therapy).
Hepatotoxicity side effects
Sustanon side effects do not include hepatotoxicity (liver toxicity) side effects.
Testosterone does not have structural modifications (e.g., C17-alpha alkylation of oral anabolic steroids) that can cause hepatotoxicity.
One study investigated the potential for hepatotoxicity in several male subjects using testosterone at high doses (400 mg daily, equivalent to 2,800 mg weekly) for 20 days, where the route of administration was oral rather than intramuscular injection.
The purpose of the experiment was to saturate the liver with high doses of testosterone (all substances taken orally go through a “first pass” through the liver, interacting with it at a much faster rate than the injectable route of administration).
No changes were observed as a result of the study [1].
Cardiovascular side effects
Cardiovascular tension and negative cholesterol changes are on the list of Sustanon side effects, which are also common with all anabolic steroids, especially oral anabolic steroids.
These include a decrease in HDL (good cholesterol) and an increase in LDL (bad cholesterol).
As a result of these changes, the risk of atherosclerosis increases, and the degree to which these changes worsen is generally dose dependent (higher doses increase the negative changes and risk). Other factors that influence these negative cholesterol changes include duration of use and route of administration.
Testosterone itself actually has a much smaller effect on cholesterol levels than all other anabolic steroids, due in part to the liver's ability to metabolize testosterone freely and the fact that it is not very resistant to hepatic breakdown and metabolism.
Most of the problems associated with hepatotoxicity stem from certain anabolic steroids that are more resistant to hepatic metabolism than testosterone.
This is one of the main reasons why oral anabolic steroids exhibit varying degrees of hepatotoxicity, as C17-alpha alkylation makes anabolic steroids more resistant to being metabolized or broken down by the liver.
The concern of whether an anabolic steroid is more or less resistant to hepatic metabolism is a factor in how much a particular anabolic steroid affects the liver's ability to manage cholesterol.
Testosterone, in particular, was shown in one clinical study to have only a minor effect on HDL cholesterol when 280 mg of testosterone enanthate was administered weekly for 12 weeks.
Subsequent administration of an aromatase inhibitor resulted in a more favorable change in cholesterol profile, with a significant 25% reduction in HDL cholesterol [2].
Conversely, another study using 300 mg of testosterone enanthate weekly for 20 weeks without the use of an aromatase inhibitor showed a 13% reduction in HDL cholesterol, but when the testosterone dose was increased to 600 mg weekly, the HDL cholesterol reduction dropped to 21% [3].
It is very clear from the data examined that the increase in estrogen through aromatization and hepatic metabolism actually helps to offset the negative cholesterol changes caused by the use of supraphysiological amounts of anabolic steroids.
This is not surprising considering that estrogen itself is known to have a positive effect on cholesterol levels.
Therefore, the use of aromatase inhibitors and their impact on the cholesterol profile should always be kept in mind when considering adding an aromatase inhibitor to a cycle.
It is recommended to use the lowest dose of an aromatase inhibitor for a cycle with the goal of controlling estrogen rather than eliminating total estrogen levels.
The idea in this case is to keep estrogen levels within the normal range, preventing them from spiking due to aromatization, while at the same time preventing them from dropping to near zero due to the use of a full dose of aromatase inhibitor.
Sustanon References
[1] Induction of enzymes by oral testosterone. Johnsen SG, Kampmann JP, Bennet EP, Jorgensen F. 1976 Clin Pharmacol Ther 20:233-237
[2] Administration of aromatized androgens does not decrease high-density lipoprotein cholesterol. Friedl K, Hannan C et al. Metabolism 39(1) 1990;
[3] Testosterone dose-response relationship in healthy young men. Bhasin S, Woodhouse L. et al. Am J Physiol Endocrinol Metab 281:E1172-81, 2001
