Telmisartan is the name of a drug that isn’t in the lexicon of most bodybuilders. The majority of steroid users have no idea what telmisartan is or what it does. But they should. It could very well be one of the most important drugs available to steroid-using bodybuilders who are concerned about their health.
The mass media does a great job of sensationalizing all sorts of negative side effects they would like to attribute to anabolic steroids. Unfortunately, they tend to exaggerate, overstate, and even make up dubious side effects primarily in an attempt to demonize the muscle-building drugs. These rare or non-existent side effects tend to be hyped up in the media while the common side effects tend to be ignored.
There are a few steroid side effects that affect practically all steroid users. These include things like increased estradiol levels (via the conversion of testosterone to estrogen when using aromatizable steroids) and things like anabolic steroid induced hypogonadism aka ASIH (via the suppressive effects of exogenous steroids on the body’s natural production of testosterone).
There are established medical therapies that can readily treat these problems e.g. aromatase inhibitors like Arimidex for elevated estrogen and selective estrogen receptor modulators (SERMs) like Clomid and Nolvadex for ASIH.
Drugs like Arimidex, Clomid and Nolvadex are already commonplace in the bodybuilder’s pharmaceutical toolkit. Where does anti-hypertension medication telmisartan come into play?
A third adverse side effect affecting most steroid users comes involves involves increased cardiovascular risk. An occasional steroid cycle may only cause transient changes in blood lipid values (e.g. triglycerides, HDL cholesterol, etc.) and blood pressure readings. However, the current patterns of steroid use are such that increasing numbers of users are doing multiple cycles per year for several years or even decades. Some bodybuilders are even using steroids continuously (or cruising on supraphysiological dosages of testosterone e.g. 200-400mg/week) for the same extended periods of time. This type of chronic steroid use could lead to more long-term problems.
It’s not so much that steroids cause people to develop cardiovascular disease. Many men already have risk factors and/or may develop problems as they get older, with or without steroids, due to genetics and/or other lifestyle factors unrelated to steroids. But if any of these factors are present, bodybuilding dosages of steroids generally only make matters worse.
High blood pressure (hypertension) is one such cardiovascular risk factors that already affects a huge percentage of the population. The U.S. Centers for Disease Control (CDC) estimates that one out of every three American adults suffers from hypertension with systolic readings greater than 140. Another one out of three has prehypertension levels of between 120 and 140. Normal systolic blood pressure is 120 or less.
This means that tens of millions of Americans at at increased risk for heart attack, stroke and serious cardiovascular incidents due to prehypertension and hypertension. No rational person will suggest that steroids are behind this major health problem. Even though steroids are not the boogeyman they are made out to be, they often add additional risk. Bodybuilders with such pre-existing health risks should appreciate the importance of reducing or at least controlling and managing this risk factor before using steroids.
Telmisartan (brand name Micardis) is an angiotensin II receptor antagonist (angiotensin receptor blocker, ARB) used in the management of hypertension. It may not be the most popular anti-hypertension drug currently prescribed. Doctors may prefer to prescribe other drugs such as lisinopril (brand names Prinivil and Zestril) from the angiotensin-converting enzyme (ACE) inhibitor cateogry; metoprolol (brand name Lopressor) from the beta blocker category; or even losartan (brand name Cozaar) from the same ARB category as telmisartan. However, telmisartan may be the best choice for steroid users particularly those with prehypertension or borderline high blood pressure.
Steroid expert Bill Roberts has advocated the use of a daily once-per-day dosage of 20 to 40mg to reduce the risk of atherosclerosis, cardiovascular disease and/or stroke in steroid-using bodybuilders with prehypertension. This can also lead to improvements in HDL cholesterol levels, insulin sensitivity, mitochondrial activity, endothelial function and cognitive function.
Animal models have also shown that telmisartan reduces left ventricular hypertrophy (LVH) and reduces visceral fat. This should be of particular interest to bodybuilders. LVH is an adaptive response to intense weight training whose effects are amplified by steroid use. LVH is generally benign in highly trained athletes but it is associated with decreased cardiac function particularly as an athlete ages. Reductions in visceral fat are also associated with decrease cardiovascular risk.
A fascinating thing about telmisartan is that it can have performance-enhancing effects well beyond the health-promoting benefits. It is rumored that professional cyclists have been using telmisartan for many years to enhance endurance. Telmisartan’s pharmacological effect of PPAR-delta activation can significantly increase muscular endurance via increased oxidative capacity of type II muscle fibers. But most importantly, it is not included as a banned substance on doping control lists. For the purpose of improving endurance and also reducing visceral fat, Roberts has suggested a dosage of 80-160mg/day.
Some bodybuilders will see telmisartan (and high blood pressure drugs in general) as a drug solely aimed at harm reduction. If it doesn’t build muscle, why bother. These are likely the same bodybuilders who don’t even bother understanding the need for PCT. For the rest of us who use steroids but are interested in maintaining optimal health, telmisartan could be a wonderful drug to minimize the risk of cardiovascular disease, stroke and heart attacks, particular while using steroids, especially if we are one of the hundreds of millions of individuals suffering from prehypertension of high blood pressure.
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