Oxandrolone for Muscle Preservation - Quick Reference Sheet
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Oxandrolone for Muscle Preservation

Created on 09/18/2026 – Quick Reference based on Evidence Review created using AI4L / Opus 5 – Audit

A man-made relative of testosterone, given as an oral medication, that adds lean tissue in older adults, blunts muscle loss after severe burns, and raises lifting strength in the untrained but not in those already training. Gains fade within about three months of stopping. Liver strain, worsened blood fats, suppressed natural testosterone, and masculinising changes in women are routine costs. (Full Review)

Protocol

Research regimen used for muscle outcomes
20 mg daily
As 10 mg twice daily for six to twelve weeks, the exposure behind every reported lean-mass and strength figure in older adults. Licensed adult range 2.5–20 mg daily.
Single versus split dosing
Split, with food
Twice-daily dosing, morning and evening, maintains receptor occupancy across the day; single daily dosing has never been used in a trial reporting a muscle outcome.
Sex-based differences in dosing
5–10 mg daily in women
Women in trials reached a comparable protein-synthesis response at 15 mg daily versus 20 mg in men, and the female virilisation ceiling is lower.
Time to effect
Lean Body Mass
6 weeks
Most of the twelve-week lean-mass gain is already present at six weeks. Gains reverse after withdrawal, returning to baseline about twelve weeks after stopping.
Maximal Muscle Strength
6 weeks
74% to 96% of the twelve-week gain arrives by six weeks in untrained older men; no added strength where a real training stimulus already exists.
Muscle Protein Synthesis
5–14 days
The fractional synthetic rate of muscle protein rises by roughly half within five days in older men and two weeks in older women.

Benefits

Contraindications
  • Vitamin K antagonists (warfarin, acenocoumarol) without dose reduction and international normalised ratio checks every 2–3 days
  • Pregnancy, attempting conception, or breastfeeding
  • Known or suspected prostate carcinoma, or carcinoma of the male breast
  • Women with breast cancer and hypercalcaemia (serum calcium above 10.5 mg/dL)
  • Advanced kidney disease (estimated glomerular filtration rate below 30 mL/min/1.73 m²) or nephrotic syndrome
  • Active liver disease, Child-Pugh Class B or C cirrhosis, or baseline ALT or AST above three times the upper limit of normal
  • Severe heart failure (New York Heart Association Class III–IV)
  • Venous thromboembolism within the last 90 days, or a known inherited clotting disorder
Key Interactions
  • Insulin and oral glucose-lowering drugs (metformin, glipizide, glimepiride)
  • Corticosteroids and corticotropin (prednisone, dexamethasone)
  • Hepatotoxic medications (amiodarone, methotrexate, isoniazid, high-dose acetaminophen)
  • Over-the-counter analgesics (acetaminophen, ibuprofen, naproxen)
  • Androgenic supplements (DHEA, androstenedione, Tribulus terrestris preparations)
  • Hepatically burdensome supplements (red yeast rice, high-dose green tea extract, kava)
  • Creatine monohydrate
  • Testosterone therapy and growth hormone
    •

Risk & Side Effects

  • High: Hepatic transaminase elevation; adverse shift in blood lipids; virilisation in women
  • Medium: Suppression of endogenous testosterone and gonadotropins; prolonged mechanical ventilation in critical illness
  • Low: Venous thromboembolic events; fluid retention and peripheral oedema; mood disturbance, dependence, and sleep disruption; decreased glucose tolerance
  • Speculative: Androgen-driven erythrocytosis; cholestatic hepatitis and jaundice; peliosis hepatis and hepatic tumours; prostate stimulation in men; gynaecomastia and priapism in men; androgenic scalp hair loss; long-term atherosclerotic risk from sustained lipid shift

Monitoring

Marker Target Why
ALT Men <25 U/L, women <20 U/L Earliest and most frequent signal of hepatic stress
AST <25 U/L Confirms hepatic origin when paired with ALT
GGT <20 U/L Distinguishes drug-related cholestasis from muscle-derived enzyme rise
Total bilirubin 0.3–1.0 mg/dL Detects the shift from harmless enzyme rise to actual liver dysfunction
HDL-C Men >50 mg/dL, women >60 mg/dL The lipid fraction oxandrolone suppresses most sharply
Apolipoprotein B <80 mg/dL, or <60 mg/dL at high cardiovascular risk Counts atherogenic particles, the endpoint that matters as LDL-C rises
Total and free testosterone Total 600–900 ng/dL, free 15–25 pg/mL (men); women, no established target — track change from personal baseline Quantifies suppression of the gonadal axis and its recovery
LH 2–8 IU/L Confirms whether suppression is central and whether it has resolved
Haematocrit Men 40–48%, women 36–44% Detects androgen-driven thickening of the blood, which compounds the clot signal
PSA, men over 40 <1.0 ng/mL under 60; <2.0 ng/mL over 60 Androgen exposure can accelerate existing prostate pathology
Lean body mass by DEXA No established target — track change from the individual's own baseline, aiming for a gain of 1 kg or more over 12 weeks The primary success measure for the stated goal

Cadence: Front-loaded. Liver enzymes at 2 and 4 weeks, then monthly while dosing continues; lipids at 4 weeks and at the end of the cycle; hormones and body composition at the end of the cycle and again 8 to 12 weeks after stopping.

Qualitative Assessment

  • Training performance: session-to-session load and repetition progression on two or three fixed compound lifts
  • Recovery quality: perceived soreness duration and readiness to train hard again
  • Sleep quality and continuity: nights to sleep onset and night-time awakenings
  • Mood and drive: irritability, restlessness, and shifts in libido in either direction
  • Voice and skin in women: any hoarseness, new acne, or accelerated facial hair growth, checked weekly
  • Ankle and finger swelling and morning body weight, which distinguishes fluid retention from genuine tissue gain
Not medical advice. Educational distillation of a single evidence review. Confirm any decision with a qualified clinician, especially in the presence of prescription drugs or chronic conditions.