A Structured Review and Critical Analysis of RCTs on Nandrolone Decanoate’s Cardiac Effects in Young Exercising Man

Abstract

Aims: The cardiovascular risks associated with anabolic-androgenic steroid (AAS) use, particularly nandrolne decanoate (ND), remain a topic of debate due to conflicting evidence from different types of studies. While observational research frequently reports adverse cardiac effects, findings from randomized controlled trials (RCTs) suggest otherwise. This review aims to critically assess the available RCTs evaluating the impact of ND on cardiac morphology and function, with a focus on their methodological quality and clinical relevance. Study Design: Structured review of randomized controlled trials. Methods: A systematic literature search was conducted to identify RCTs that examined the effects of ND on cardiac function. The analysis included study design, sample size, inclusion/exclusion criteria, cardiac evaluation methods, and reported outcomes. The methodological quality of each study was assessed using the Jadad scale to ensure a rigorous evaluation of the evidence. Results: The two reviewed RCTs, which were of moderate to high methodological quality, did not report clinically significant cardiac dysfunction in healthy individuals after short-term exposure to ND. However, these findings contrast with several observational studies, where users—often exposed to uncontrolled conditions and higher doses—frequently present with structural and functional cardiac changes. A key limitation of the RCTs was their small sample sizes, short follow-up durations, and reliance on conventional imaging techniques, which may not be sensitive enough to detect subtle cardiac alterations. Conclusion: While current RCTs do not provide strong evidence of cardiovascular harm from ND, their methodological limitations underscore the need for further research. Future trials with larger sample sizes, higher statistical power, and more advanced cardiac imaging techniques will be crucial in clarifying the true impact of ND on the heart. Until more definitive data are available, routine cardiac monitoring should be considered for individuals using ND, particularly those on prolonged or high-dose regimens.