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Oxandrolone is a type of anabolic steroids that promote weight gain after losing weight following surgery, infections, severe trauma and some patients who fail to gain or to maintain normal weightafter the procedure. It can also be a cause of weight loss due to hormonal deficiency (such as adrenal insufficiency). It has been reported to cause increased blood fat accumulation and muscle hypertrophy, which is associated with increased risk of diabetes mellitus. Adrenal insufficiency can cause severe fatigue and reduced quality of life. It can also lead to depression in patients who are obese and develop the most severe depression at age 50 (Dietz and Lea, 1999). Effects of Adrenal Insufficiency Inadequate cortisol levels occur in many people with anabolic steroid use, primarily for psychological effects such as depression and lethargy. Cortisol levels in normal healthy subjects do not cause serious medical issues or serious side effects when administered consistently and safely under a medical supervision in most cases. However, the low cortisol levels usually result in psychological issues that can lead to depression, lethargy, and inability to perform at work as well. The effect of excessive or poorly controlled cortisol levels can also lead to depression. Adrenal insufficiency contributes to depression via the hypothalamic–pituitary–adrenal axis, which causes the adrenal gland to release cortisol. In response to the cortisol, the pituitary gland sends a cascade of hormones that have a wide array of effects such as appetite stimulation, increased production of gonadotrophins, decreased cortisol levels in the adrenal glands, and decreased energy reserves. Dietz and Lea (1999), evaluated the long-term effect of adrenal insufficiency on weight loss with patients after the weight loss surgery. After 7 months of follow-up, weight loss was 4.3 lbs (1.2 kg) in those having low cortisol and 12.6 lbs (5.1 kg) in those having normal cortisol levels (normal for the weight loss surgery); after 11 months of follow-up, the average weight loss was 23.3 lbs (10.2 kg) in those having low cortisol and 19.4 lbs (10.6 kg) in those having normal cortisol levels. In addition to these psychological effects, adrenal insufficiency can also cause weight gain to the extent of obesity, due to increased fat accumulation and muscle hypertrophy (Dietz and Lea, 1999). Weight gains after the surgical procedure are often transient, due to the inability to sustain the increased caloric expenditure, or lack of the ability to exercise at the Similar articles: