ANABOLIC STEROIDS IN SARCOPENIC OBESITY: A THERAPY WORTH REVISITING

Aims: This narrative review critically examines the literature on sarcopenicobesity (SO), emphasizing its definition, pathophysiology, limitations ofconventional therapies, and the therapeutic potential of anabolic androgenicsteroids (AAS), particularly oxandrolone and nandrolone. Ethicalconsiderations and cardiovascular risks associated with AAS use are alsodiscussed. Study Design: Narrative literature review. Methods: Studieswere identified through PubMed using the following primary search terms:"obesity", "sarcopenia", "sarcopenic obesity", "anabolic androgenicsteroids", and "therapeutics". Additional searches were conducted using the"Find Topics" and "Literature Review" tools within the AI-poweredScispace platform. Relevant citations from key authors were also manuallyscreened for inclusion. Results: Sarcopenic obesity is a multifactorialcondition that significantly compromises functional and metabolic health,particularly in older adults. Conventional therapies—namely diet andexercise—often yield limited efficacy, especially in individuals withhormonal impairments or chronic inflammation. AAS such as oxandroloneand nandrolone have demonstrated beneficial effects on muscle masspreservation and recovery in select clinical settings. Nevertheless, concernsregarding cardiovascular safety and adverse effects persist, especially incases of non-medical use. When ethically prescribed and carefullymonitored, AAS may represent a viable adjunct in the management ofrefractory SO. Conclusion: While further large-scale, controlled studies arewarranted, current evidence suggests that AAS may serve a legitimatetherapeutic role in select cases of sarcopenic obesity unresponsive toconventional interventions. Their inclusion in multimodal rehabilitationstrategies—when clinically justified and closely supervised—should beconsidered. Clear distinctions between medical use and abuse must guideboth clinical decision-making and scientific discourse to ensure rational,patient-centered care.