B tier · viable
Nandrolone decanoate holds a genuine FDA-approved indication and has supporting randomised human trials in dialysis and HIV wasting populations, but brand products were discontinued in the US and Canada and the modern evidence base has not been refreshed.
nandrolone
Nandrolone decanoate is a 19-nortestosterone derivative that carried an approved US indication for the anaemia of renal insufficiency and has randomised human trial support for lean-mass gain in dialysis and HIV-associated wasting. It is the only non-testosterone compound in this set with both a formal approved indication and controlled human efficacy data, although the originator product was discontinued in the US in 2002 and no contemporary safety programme exists.
the explanation
Nandrolone is an older steroid that was a real prescription medicine, mainly for anaemia in people with kidney failure, and small proper trials showed it can add lean tissue in seriously ill patients. The brand was pulled from the US market in 2002 for commercial rather than safety reasons, so the human evidence is real but dated and narrow.
regulatory status
Formerly FDA-approved; brand discontinued in US and Canada; DEA Schedule III controlled substance
Nandrolone decanoate injection is labelled as indicated for the management of the anaemia of renal insufficiency and is a Schedule III controlled substance under the Anabolic Steroids Control Act of 1990. Organon notified FDA in May 2002 that it had discontinued marketing DECA-DURABOLIN (NDA 13-132); FDA determined in 2010 that the product was not withdrawn for reasons of safety or effectiveness. The drug remains marketed in some other jurisdictions and is available through some US compounding pharmacies. Prohibited in sport.
how it works · proposed mechanism
Nandrolone is an androgen receptor agonist whose distinguishing feature is what happens to it downstream of the receptor rather than at the receptor itself.
Attenuated 5-alpha-reduction
Unlike testosterone, 5-alpha-reduction of nandrolone yields dihydronandrolone, which binds the androgen receptor less avidly than the parent. This is the accepted pharmacological explanation for the relatively lower androgenic burden on scalp, skin and prostate described in the classical literature.
Progesterone receptor cross-reactivity
Nandrolone retains appreciable affinity for the progesterone receptor, unusual among the compounds in this set. Progestogenic signalling is invoked in the older literature to explain effects on libido and gonadotropin suppression that are not fully accounted for by androgen receptor activity alone.
Erythropoietic and anabolic action
The approved indication rests on stimulation of erythropoiesis, with the label recording increases in haemoglobin and red cell mass in renal anaemia. In parallel, randomised trials in wasting states measured increases in lean body mass by DEXA rather than bodyweight alone.
what’s reported
evidence shape
6 sourcesThe composition of the cited literature by study type. This describes the shape of the evidence, not its quality — and it does not by itself set the grade.
⚠ the catch
The controlled human data are real but come from small trials in dialysis and HIV wasting populations conducted in the 1990s, with 29 and 30 participants respectively and follow-up of six months or less. Nothing in that evidence base speaks to long-term safety, to healthy users, or to the doses reported in non-medical cohorts.
key published findings
- Human trial (randomised, double-blind, Johansen 1999, JAMA): 29 dialysis patients over 6 months; lean body mass rose 4.5 kg on nandrolone decanoate versus 1.9 kg on placebo, with walking and stair-climbing time falling from 36.5 to 32.7 seconds in the treated group while the placebo group slowed.
- Human trial (randomised, Sattler 1999, JCEM): 30 HIV-positive men with CD4 below 400/mm3 over 12 weeks; lean body mass rose 5.2 ± 5.7 kg with nandrolone plus progressive resistance training versus 3.9 ± 2.3 kg with nandrolone alone, with strength gains of 10.3–31% and 14.4–53.0% respectively.
- Human trial (controlled, Hartgens 2004, Br J Sports Med): in a comparison arm, nandrolone decanoate did not significantly alter HDL-C, HDL2-C or HDL3-C at four and eight weeks, in contrast to the large HDL reduction seen with self-administered multi-agent AAS regimens in the same paper.
- Regulatory (FDA labelling): the approved indication is the management of the anaemia of renal insufficiency, with demonstrated increases in haemoglobin and red cell mass; the label carries warnings for peliosis hepatis, benign and malignant hepatic tumours, decreased HDL with sometimes increased LDL, and virilisation.
- Human observational (Rasmussen 2016, PLoS One): among current AAS users, severely decreased anti-Müllerian hormone and inhibin B indicated impaired spermatogenesis with markedly suppressed gonadotropins, a class effect that applies to nandrolone.
limitations of the evidence
- Both supporting randomised trials were small, short and conducted in specific disease populations, and neither was powered for cardiovascular or hepatic endpoints.
- The originator product left the US market in 2002, so there has been no modern postmarketing safety surveillance programme and no contemporary comparative trial.
- Long-detectable metabolites and the well-documented endogenous 19-norandrosterone question complicate interpretation of doping-control and observational literature.
documented safety signals
- Peliosis hepatis, a condition in which blood-filled cysts replace hepatic tissue, which may be silent until life-threatening liver failure or intra-abdominal haemorrhage occurs (FDA label).
- Benign and malignant hepatic neoplasms that are highly vascular and may remain clinically silent until catastrophic bleeding (FDA label).
- Decreased HDL and sometimes increased LDL, which the label states substantially elevates the risk of atherosclerosis and coronary artery disease.
- HPG-axis suppression with reduced LH and FSH, testicular atrophy, impaired spermatogenesis and infertility; the progestogenic component may contribute to suppressed libido that persists into the post-exposure period.
- Virilisation in women including voice deepening, hirsutism, acne and clitoral enlargement, some of which becomes irreversible if exposure continues after virilism appears.
- Accelerated bone maturation without compensatory linear growth in children, potentially compromising adult height.
- Polycythaemia: the same erythropoietic action that underpins the approved anaemia indication raises haematocrit and blood viscosity when exposure is not clinically monitored.
- Cardiomyopathy and accelerated coronary atherosclerosis documented across long-term AAS users generally (Baggish 2017), with nandrolone esters among the agents commonly reported in those cohorts.
- Injection-site infection, abscess and bloodborne virus exposure documented in harm-reduction literature on people injecting image- and performance-enhancing drugs (Hope 2015: 42% ever reported injection-site redness, swelling and tenderness; 6.8% ever had an abscess or open wound).
identity
| full name | Nandrolone (19-nortestosterone), decanoate and phenylpropionate esters |
| category | Anabolic & Androgenic |
| modality | steroid |
| formula | C18H26O2 |
| molar mass | 274.4 g/mol |
| cas | 434-22-0 |
| half-life | Reported at approximately 6 to 12 days for the decanoate ester given intramuscularly; the phenylpropionate ester is considerably shorter-acting. Published human pharmacokinetic characterisation is thinner than for testosterone esters. |
laboratory handling
| storage | Oil-based injectable solution stored at controlled room temperature, typically 20–25 °C, protected from light in the original carton; not refrigerated. |
| solubility | The free steroid is practically insoluble in water; the decanoate and phenylpropionate esters are oil-soluble and are formulated in vegetable oil vehicles such as sesame or arachis oil with benzyl alcohol. |
| co-studied with | Reference note only, not guidance: nandrolone is one of the most frequently co-reported agents in observational AAS cohorts, so nearly all observational harm data attributed to it describe multi-agent regimens. The HAARLEM cohort reported an average 901 mg per week of AAS equivalents across multiple compounds, and only 47% of submitted product samples contained the labelled substance, meaning composition of illicit product is itself an unmeasured variable. |
Handling information describes laboratory practice for a research reagent. It is not a preparation guide for use in humans.
the receipts
6 citedDailyMed / US FDA · 2024 · official
Federal Register (US FDA) · 2010 · official
JAMA · 1999 · randomized
Journal of Clinical Endocrinology & Metabolism · 1999 · randomized
British Journal of Sports Medicine · 2004 · randomized
others in Anabolic & Androgenic