PEDs & Cancer

by /u/iron_therapy

Hi.

I hang around PED groups because of cancer.

In December of 2017, my mother was diagnosed with stage IV breast cancer. That's the kind where the doctors tell you "we'll keep switching treatments for a few years until you die, haha lol sucks to be you lmao." I thus began searching high and low for additional treatments that were backed by science.

To my surprise, there do not appear to be any communities interested in that sort of thing. Either they're the completely insane type that scream "THE CURE IS APPLE PITS PLUS COFFEE AND BLEACH ENEMAS, 10x DAILY", or they're the straight-and-narrow "the standard of care is the only thing you should ever consider thinking about doing" kind that are so jaded by the former that they will steadfastly refuse to think outside of the box.

Except for PED users. Apparently, I found my people.

I'm not a doctor, but I have probably spent upwards of a thousand hours at this point researching cancer. There's a significant overlap between many PEDs and cancer therapies, and people keep asking questions about potential cancer risks, so I'm going to try my best to share what I know on the subject.

Also, shameless plug: I shout into a mostly empty void on a subreddit where I collect my research: http://reddit.com/r/BreastCancerResearch


Bro, I'm in my 20s/30s, and cancer is the last thing on my mind.

Fair point. Cancer traditionally affects older demographics. And, it's no surprise that it affects unhealthy demographics moreso than healthier demographics, such as presumably who's reading this post. Not living like a vaguely human-shaped blob in a Pixar film about dystopian space Wal-Mart is a great first step to avoiding it. And the readers of this sub almost certainly eat more green vegetables than the average Wal-Mart shopper that ends up tragically tipping over their mobility scooter while reaching for the gallon jug of mayonnaise.

But the unfortunate, sad truth is that you're statistically likely to be impacted by cancer at some point in your life. Cancer is the second leading cause of death in males: https://www.cdc.gov/healthequity/lcod/men/2015/index.htm

PED use may impact this further, which is what we're going to dive into now.


But wait, bro, can't my enormous muscles, like, punch the cancer cells in their stupid little faces?

I wish. There are three primary cancer risk factors in PED use:

  1. Increasing the proliferation of an androgen sensitive cancer that already existed in the body.

An example of this is prostate cancer, which is is usually androgen sensitive, meaning that androgens may cause it to grow faster - and removing them may make them grow more slowly, which is why androgen deprivation therapy may be used as treatment: https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html

However, increased levels of testosterone have not been shown to increase the likelihood of getting cancer in the first place. In fact, this story is a lot more complex, so we'll circle back to it in just a moment.

2) Causing cancer as a result of liver toxicity, such as in the case of methylated compounds, such as 'orals'. This has been clinically documented to occur, but usually only after rather intense and prolonged use. However, the reasons why it happen is well understood: they are liver toxic, and will cause inflammation and other bad things. Keep doing it long enough, and your liver will turn into a cancer-riddled sponge cake: https://www.hindawi.com/journals/cripa/2012/195607/

Interestingly, in the case studies that I have looked at, they seem to spontaneously resolve after stopping the use of orals. I don't think we have enough data to say for certain either way here - but I would personally be much more cautious with orals, because your liver is pretty important to keep functioning well and cancer is not something I would mess around with.

3) Causing cancer as a result of some unknown, unproven process. Insert cardarine meme here. In cardarine's specific case, we don't know, but we seem to have enough broscience that it doesn't seem to be an auto-cancer button - there have been human trials and no cancer has been seen in humans. This has already been covered in detail here: https://www.reddit.com/r/PEDsR/comments/815ixw/cardarine_cancer/ and here: https://www.reddit.com/r/PEDsR/comments/akq6gc/cardarine_human_trials/ and especially here: https://www.reddit.com/r/PEDsR/comments/anwr43/cardarine_cancer_growth_through_increased_atp/

Granted, that doesn't necessarily mean that it won't take 20+ years for cancer to eventually crop up as a result. The same can be said for many substances - hello, research chemicals! However, I personally believe that SARMs are very safe in this regard, as the most commonly used ones - Ostarine, LGD, and RAD-140 - are all in clinical trials for cancer patients, either to treat wasting disease, or - even more interestingly - to directly treat the cancer itself, e.g. https://www.businesswire.com/news/home/20161208005320/en/GTx-Reports-Results-Ongoing-Enobosarm-Phase-2 and http://clincancerres.aacrjournals.org/content/23/24/7608

And before you ask, no, I don't think that means that you should blast SARMs yearround as a "cancer preventative".


So what's the risk? I just wanna get jacked!

Credit to /u/pedsaccountonreddit for sparking the discussion:

"One interesting note is that men in general have higher rates of cancer than women, even when you adjust for non-sex specific cancers (prostate, breast, etc). There's some kind of mechanism there and it may be androgens / estrogens, may be lifestyle or may be something else entirely. So compared to baseline men here may be little difference between AAS users and men but there could still be some small difference.

Given the low general rates of certain cancers and the small AAS population size in studies it's not surprising it wouldn't have been detected if it was there, even if it was statistically significant.

My personal opinion is that it's pretty unlikely it increases cancer risk much or we'd have noticed something"


I agree with his assessment in general. I can also shed a bit more light on the topic:

  1. Historically, men led slightly riskier lifestyles, in terms of obesity, alcohol consumption, smoking, and others that increase the risks of cancer.
  2. There's generally more emphasis on early detection in females with things like much more common cervical cancer screening and breast cancer awareness compared to males.
  3. Most interestingly, there's a set of gene mutations that are responsible for some increased cancer rates in men - https://blog.dana-farber.org/insight/2018/10/men-likely-women-develop-cancer-course-lives/

Another interesting anecdote that an oncologist related to me was that based on his experience, men were usually more reluctant to see a doctor when something felt off. I'm not sure how much I would put stock into this, but the logic does make some amount of sense - generally, men are usually more stoic. And hey, just the other day I was reading a post on /r/peds about a guy going "hey, this drug gives me intense chest pain" and how his brother told him to suck it up and keep taking it. And so he did.


Wait, what was that about androgens? I really like testosterone.

Circling back to an earlier point:

There's something fascinating about prostate cancer in general, as an extremely high percent of men are likely to have it in their lifetime (https://www.ncbi.nlm.nih.gov/pubmed/2479160) - it's just that they usually die from other causes before it can kill them. Whether that's triggered by androgens is another matter - and, even more interestingly, there is mounting evidence that it may even be protective:


"After adjusting for previous biopsy findings as an indicator of diagnostic activity, TRT remained significantly associated with more favorable-risk prostate cancer and lower risk of aggressive prostate cancer.


Conclusion

The early increase in favorable-risk prostate cancer among patients who received TRT suggests a detection bias, whereas the decrease in risk of aggressive prostate cancer is a novel finding that warrants further investigation." - https://ascopubs.org/doi/full/10.1200/JCO.2016.69.5304


Adding to the increasingly likelyhiood of androgen safety, even in patients with existing or previous prostate cancer, is the recent work in the saturation model:

"A new paradigm gaining momentum to replace the traditional testosterone dependent theory has been termed the saturation model [14,21]. According to this model, testosterone and its intracellular metabolite 5α-DHT are critical for the growth of prostate tissue, but are in excess at physiologic concentrations. The theory maintains that serum testosterone concentration has limited ability to stimulate prostate growth. A hypothesized saturation point occurs at near-castrate levels where the low androgen concentration would be rate-limiting in prostate tissue proliferation [14]. The saturation model is supported by evidence derived from both animal and human studies. In rats, the half-maximal prostate growth occurs at approximately 36 ng/dL, which correlates to near-castrate levels of testosterone [22]. In human prostate tissue, the AR has been reported to become saturated at approximately 120 ng/dL in vitro, and 240 ng/dL in vivo [23,24]. A 6-month study of TRT in men with LOH revealed that despite administration of exogenous testosterone, which substantially increased serum testosterone, there was no increase in testosterone or DHT within the prostate itself [25]. This has led some to believe that a mechanism of the saturation model could be a lack of prostatic uptake of exogenous testosterone protecting the prostate from large serum androgens changes." -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924951/


Also of note, from the same study:

"The Endogenous Hormones and Prostate Cancer Collaborative group analyzed existing worldwide epidemiological data representing over 95% of published data and found no associations between prostate cancer and prediagnostic serum levels of free testosterone, total testosterone, DHT, or any other endogenous sex hormones [26]."

This is opening up TRT to prostate cancer patients: https://www.renalandurologynews.com/home/conference-highlights/aua-2018-coverage/testosterone-therapy-safe-despite-prostate-cancer-history/


All of that said - these studies were on TRT doses, not supraphysiological doses of androgens or more exotic compounds commonly seen in bodybuilders. So, I think that caution is still very much wise in this area. But, it backs up my suspicions that in general, most PEDs/AAS do not increase the risk of spontaneously acquiring cancer.


Conclusion

In my mind, a responsible PED user is unlikely to have an elevated risk of cancer as a result of their use, but, I am not a doctor and we do not have hard, concrete data backing up that opinion. Be smart, stay safe. Get regular screening for cancers based upon your age and risk factors, live a healthy lifestyle, and educate yourself on the risks of anything you take.