Greg doucette should not have gone off of TRT in order to heal his tendon and here’s why:
“Specialist” told greg to go off TRT at 140mg because he looked at some research. Identified only 18 heterogeneous (vastly different) studies (most of them in animals, and most of them studying the Achilles tendon in rats).
Contradictory results were reported frequently, despite the fact that most of the studies hypothesized that AAS negatively affected tendons.
Data suggests that when AAS are administered immediately after tendon injury, long term damage is either mitigated and/or functionality is restored. Data also suggests that the damage to the tendon suffered following AAS use is transient (meaning it resolves after approximately 12 weeks of AAS use, once the tendons adapt to the increase in muscle mass/strength).
A csae of science getting it wrong: correlation =/= causation.
The implication: Tendon rupture increases with AAS use, therefore AAS use causes tendon rupture.
Major hypothesis (and what I believe is actually happening): AAS use increases muscle size and strength faster than tendon size and strength, putting a greater load on the tendon before it can adapt to the changes in muscle tissue.
Tendons are mostly made up of collagen type 1 fibers. As a result, they do not heal/regenerate as quickly/efficiently as muscle cells do.
Recovery from tendon injury is different than recovery from other injuries in that the “inflammation” phase is relatively short, thought to be only around 24 hours. The second phase, regenerative, is thought to take 6-8 weeks in untrained individuals (less in trained athletes who use AAS – my speculation) and the final stage remodeling can take up to a year.
Greg Doucette’s unique situation:
1. World record holding powerlifter in the bench press (puts a lot of stress on the triceps tendon)
2. IFBB pro bodybulider (abuses PEDs in order to train hard, puts even more stress on tendons)
3. Self-admitted workaholic (increases cortisol)
4. Claims to not take any additional PEDs (reduced rate of healing)
All of these combine to create a chronic state of inflammation to the triceps tendon, preventing him from getting beyond stage 1 of the healing process.
Greg Doucette is not a small guy. 5’6″ at 200 lbs he must train pretty hard (even with TRT) to maintain that level of muscle mass year round.
“excessive mechanical loading is capable of inducing differentiation of tendon stem cells and is associated with degenerative tendinopathy.76 Physical loading also influences the expression of both tenomodulin and type I collagen,77, 78 and appears to induce morphological, mechanical, and biochemical changes in tendon.79”
Problems with the literature:
Most groups injecting supraphysiologic doses of nandrolone decanoate (corresponding to the commonly prescribed dose in humans). Achilles tendons in rats were studied the most commonly (10 studies). Only a few studies have investigated the effects of “stacking,” which refers to taking of two or more anabolic steroids at the same time (a common practice among AAS abusers99), and no studies have investigated the effects of orally administered AAS on tendon, despite the fact that oral preparations are already being investigated clinically as an aid to post‐operative recovery and rehabilitation in patients following rotator repair surgery.100
NONE OF THE STUDIES WERE ON TESTOSTERONE ALONE
Only one of the studies used testosterone, but it was stacked with nandrolone and only included 4 (human) participants
Most of the studies used Methandianone (dbol), nandrolone, or winstrol (which is notorious for being bad for your joints (and presumably tendons)
The idea that AAS negatively affect tendons is based on two studies from the 80s/90s. In the first study, rats were given a STACKED anabolic regimen which negatively affected their tendons (specifically the ultimate force at failure, toe-limit elongation, and elongation at time of first failure).
However 1) this was not done with only testosterone, 2) it was done on rats, 3) it was done on the Achilles tendon.
The second study was done on rats as well, but they were given stanozolol followed by nandrolone for 6 weeks. These rats were sacrificed at either 6 weeks or 12 weeks.
In the second study, the tendons of hte rats were also negatively affected. But researchers noticed that by 12 weeks, there was NO DIFFERENCE between the control or experimental groups of rats in tendon elasticity:
However, Inhofe et al. did not find differences between the AAS‐treated animals and controls at week‐12, which has potentially important implications for clinical translation, as it suggests that the short‐term biomechanical effects of AAS may be reversible.
Studies found “collagen dysplasia” (stretchy, saggy skin, like an extreme version of the skin on a cat’s back) after dosing mice with 3.2mg/kg of metandianone (dbol) – but the effects were only temporary. However they also found qualitative changes in the organization of tendon collagen fibrils, and dramatic ultrastructural anomalies in the texture of individual fibrils after 10 weeks of administration.
A year later, a report was published showing increased crimp angles and reduced collagen fibril length – especially when combined with physical exercise.
Two conflicting studies were published later that year – one of them showing an INCREASE IN collagen fibril length when examined through electron microscopy, while the other showed no difference in fibril length whenn examined through either electron or light microscopy.
The two human studies:
The first human study only had 4 participants, but they found no difference between users who abused AAS vs those who didn’t. They were studying tears in the distal biceps tendon.
The second clinical study compared the cross‐sectional area (CSA) of trained AAS abusers to trained and untrained individuals that had not used AAS previously.82 When normalized to quadriceps maximal isometric torque, CSA was similarly reduced in both trained groups. However, the authors were careful to point out that maximal tendon stress was considerably higher in the trained group that had taken steroids, which suggests that tendon hypertrophy in AAS users may be insufficient to meet the increased demands. However, because dosing was not specified, it is difficult to draw meaningful conclusions.
3 non-mutually exclusive hypotheses:
1. AAS reduce tendon elasticity
2. Muscular hypertrophy, without corresponding strengthening of the associated tendons, explains tendon‐associated rupture.
3. At high doses, particularly in conjunction with physical exertion, AAS damage the structure of the tendons and makes them more vulnerable to rupture, even in the absence of excessive stress.
Finally: some AAS help tendons if administered immediately after injury
Nandrolone administered immediately after a rotator cuff tear in rabbits reduced functional muscle impairement AND reduced fatty infiltration (aka muscular atrophy) – both of which influence disease progression.
In another study on sheep, 150mg of nandrolone administered immediately after tendon release caused the same effect – but NOT when administered at the time of surgical repair. This implies that AAS (or at least nandrolone) can have a beneficial effect on tendon healing and recovery if administered immediately after an injury.
So what does this have to do with Greg Doucette?
The point is that coming off TRT is not going to positively affect his rate of recovery for his tendon for a few reasons.
1) he has been on TRT (or some form of anabolics) for years and his tendons have had time to “adjust” to his increased muscle mass.
2) What would be more effective would be to change his style of training to relieve stress on the tendon itself – either through stretching, yoga, or less hypertrophy-intensive training styles
3) Finally, many studies have looked at the effect of AAS on tendons themselves – but they need to be studied in relation tot he muscles they attach to. Tendons do not exist in a vacuum, and when you do something that affects one area of the kinetic chain, additional areas will be affected as well INDIRECTLY.
1. 50%+ of all studies of the effects of AAS on tendons were done on the Achilles tendon in rats
2. Different tendons bear different loads and are not all the same (rotator cuff vs Achilles)
3. Tendons don’t exist in a vacuum, they are connected to muscle and must be examined as such
4. Negative effects on tendons on animals treated with AAS are only noticed when physical exercise is added
5. TRT improves protein synthesis, muscle repair, and overall quality of life – implying a faster rate of overall recovery
6. Additional supplements/peptides should be tried before discontinuing TRT – mk677, bpc157, tb500
7. Exercise regimen shoulud be changed to relieve stress on the tricep (yoga, stretching)
8. Modalities like cupping + massage should be introduced