Oxandrolone (Anavar) is an androgen and synthetic anabolic steroid (AAS) used for several purposes. It helps with weight gain in specific situations, counters protein breakdown from long-term corticosteroid use, supports recovery from severe burns, treats bone pain caused by osteoporosis, and aids in the growth of girls with Turner syndrome, among other uses. Of particular interest is its treatment of burn injuries, which overlaps in many ways with injuries through weightlifting.

Anavar has both direct and indirect anabolic activity. Through binding to intracellular androgen receptors (ARs) in skeletal muscle, it increases muscle protein. Through its competitive antagonism of glucocorticoid receptors, it indirectly aids anabolism by decreasing cortisol-medicated muscle catabolism.

Anavar is believed to promote faster and more complete recovery from injuries. Some proponents of Anavar use for injury recovery claim that it can ‘double the speed of recovery’ compared to individuals not using the drug. It can also help individuals achieve a more complete recovery, reducing the likelihood of long-term or permanent damage from injuries. 

Anavar is thought to be particularly effective for recovery due to its relatively low toxicity to the liver and its lack of estrogenic effects. While other steroids might offer similar benefits for injury recovery, Anavar stands out due to its milder side effect profile. 

Oxandrolone upregulates ribosomal activity and enhances mRNA translation, leading to increased muscle protein synthesis (MPS), which helps repair damaged myofibers in musculoskeletal injuries.

Anavar Modulates cytokine signaling (TNF-α, IL-6, IL-1β) to reduce chronic inflammation,

Contrary to popular belief, anavar is likely not able to significantly promote angiogenesis. 

The ability to promote angiogenesis may be a unique characteristic of 19-nor-Testosterone derivatives only as they act as progestigens. 

According to the above study found that synthetic progestins may regulate VEGF, especially since recent evidence links the use of estrogen/progestin use with a higher incidence of breast cancer than just estrogen alone.

Vascular endothelial growth factor (VEGF), which aids in the repair and remodeling of blood vessels. Improved blood supply to the injured area is deemed crucial for faster healing. This is how BPC-157 uniquely promotes injury recovery.

Anavar supports the healing of tendons and ligaments by stimulating collagen synthesis, a crucial factor in the repair of connective tissues.

Additionally, Anavar is believed to stimulate osteoblasts, cells responsible for bone formation, potentially contributing to faster bone healing.

Anavar taken at low doses may be beneficial because of its low suppressive nature, making it suitable for use in injury recovery protocols without completely shutting down the body’s natural testosterone and estrogen production. It’s impossible to downplay the importance of estrogen for joint lubrication and injury prevention, but androgens play a more crucial role in bone and wound healing. However taken at higher doses, without a Testosterone base, will crush E2 levels and may possibly be counterintuitive for injury treatment, however it seems that E2 plays more of a preventative role. 

When it comes to injury prevention the 19NorTestosterone derivatives may be more effective. Trenbolone is a synthetic progestigenic and thus may upregulate VEG-F and promote angiogenesis and Trenbolone upregulates collagen synthesis. However it also uniquely promotes insomnia which may in itself indirectly  harm injury recovery. 

Dosages of Anavar for injury recovery are typically lower than those used by bodybuilders. A common dosage is 25 milligrams per day for individuals who are actively lifting weights and as low as 10 milligrams per day for those not engaging in weightlifting. Because of its half life ~ 10 hours, its common to split the daily dosage into two separate administrations. 

However it is common for Anavar to be underdosed from UGL. True Pharma-grade Anavar is not commonly well tolerated over 40-50mg per day. 

So why is Anavar preferred in the context of treating burn victims? Particularly over something like Testosterone but also other synthetic androgens. 

Well lets first compare Anavar with Testosterone. Anavar (and maybe some of its metabolites) is certainly responsible for the activation of more growth pathways than Testosterone itself. This was the entire point of the development of synthetic androgens to begin with. As such milligram for milligram it will be preferable for the treatment of injuries and general catabolic states of which burn victims particularly suffer from. 

Moreover, in the prevention of injuries Estrogen is particularly important. This is attributed to its ‘lubrication’ of joints and connective – which by the way is not a concept particularly well understood – the term lubrication is used but is not necessarily indicative of what is actually happening. But certainly it helps prevent injuries. But in the treatment, and healing of injuries, androgens are significantly more beneficial. Anavar is non-aromatasable and when used in a high enough dose will lead to HPTA shutdown, leading to an androgen dominant state (lack of estrogenic activity from Anavar only). An androgen dominant state will be very helpful in the context of treating injuries.

So then why is Anavar preferred over other synthetic androgenic compounds, particularly progestigenic compounds such as 19-nor derivatives which have a theoretical backing to be more beneficial to treating injuries.

The overarching reason is Anavar is a compound that doesn’t have particularly harmful unique side effects typical of other anabolic steroids.

Firstly, Anavar is unique among the currently available anabolic androgens, as it is resistant to metabolism by the liver, and has far less hepatotoxicity than other synthetic androgens.

Secondly, Anavar has less androgenic activity relative to other synthetic androgens. Making it a more preferable choice particularly as burn victims are both male and female, and women tend to be more adverse to suffering from androgenic side effects. However Anavar is by no means disassociated with androgenic side effects, in fact 12 studies involving 650 patients (369 controls; 281 Oxandrolone) explicitly stated if virilisation was observed, with 9 reporting possible hirsutism (body hair growth). But no other virilising effects were seen and hirsutism was resolved after treatment cessation which is different to what is typically seen. 

Also, Oxandrolone has indirect anabolic activity through competitive antagonism of glucocorticoid receptors, which decrease cortisol-medicated muscle catabolism in a catabolic state seen in burn victims, and thus an increase in IGF-1 production. This led to an increase in skin graft donor site healing time. 

Although other synthetic androgens such as Trenbolone may have a greater affinity for the glucocorticoid receptor, again it comes with many unique side effects making it difficult in clinical applications. This is the main point. The weigh-up of pros:cons of Anavar in the context of treating burn victims is far greater than other androgens including Testosterone. 

Refrences:

Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R. Estrogen-progestin replacement and risk of breast cancer. JAMA. 2000 Aug 9;284(6):691-4. PMID: 10927819.

Hyder SM. The role of steroid hormones on the regulation of vascular endothelial growth factor. Am J Pathol. 2002 Jul;161(1):345-6. doi: 10.1016/s0002-9440(10)64186-7. PMID: 12107119; PMCID: PMC1850674.

Ahmad, A., Herndon, D. N., & Szabo, C. (2018). Oxandrolone protects against the development of multiorgan failure, modulates the systemic inflammatory response and promotes wound healing during burn injury. Burns. doi:10.1016/j.burns.2018.10.006 

The Influence of the Anabolic Agent, Oxandrolone, upon the Expression of Procollagen Types I and III mRNA in Human Fibroblasts Cultured on Collagen or Plastic

G. C. Saggers, G. M. Allison, H. Levinson, T. Kramer, Donald Mackay, H. P. Ehrlich

Department of SurgeryDivision of Plastic SurgeryDepartment of NeurosurgeryDepartment of Orthopaedics and RehabilitationDepartment of Pediatrics

Bi LX, Wiren KM, Zhang XW, Oliveira GV, Klein GL, Mainous EG, Herndon DN. The effect of oxandrolone treatment on human osteoblastic cells. J Burns Wounds. 2007 Mar 7;6:e4. PMID: 17364004; PMCID: PMC1828036.

Ring J, Heinelt M, Sharma S, Letourneau S, Jeschke MG. Oxandrolone in the Treatment of Burn Injuries: A Systematic Review and Meta-analysis. J Burn Care Res. 2020 Jan 30;41(1):190-199. doi: 10.1093/jbcr/irz155. PMID: 31504621.

Orr R, Fiatarone Singh M. The anabolic androgenic steroid oxandrolone in the treatment of wasting and catabolic disorders: review of efficacy and safety. Drugs. 2004;64(7):725-50. doi: 10.2165/00003495-200464070-00004. PMID: 15025546.