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However it must be stated that due to the lack of androgenicity, muscle hardness and overall results are not as prominenant as with the SARM S-4inhibitors. It could be argued in favour of this in view of the reduced risk of hypogonadism and prostate hyperplasia if muscle hardness is the predominant endpoint. For women, despite a significant reduction in muscle mass and a reduction in muscle strength, there are only significant increases in bone density. In addition there will be a reduction in the bone mineral density in women. As with the men, the incidence of bone fractures is significantly increased in the SARM S-4 inhibitors (17%) but not when SARM S-4 alone is taken (5%). Phenylbutazone increases bone mineral density in postmenopausal women. There is evidence from the MRC Collaborative Unit that SARM may increase the risk of osteoporosis. Although this is primarily due to the increase in body weight, it is possible that SARM might also change the bone density of muscle tissue through alterations to bone resorption. However, further investigations are required to investigate this. The evidence base surrounding the effects of SARM on bone disease is still relatively limited. The evidence base on osteoporosis seems to be weak, particularly in young women and older women. There is only some evidence for SARM and S-4 antagonists (but not S-4 alone) but not for SARM and S4 inhibitors (with the exception of two recent trials). This limited basis for the evidence, particularly among the elderly, could explain the lack of clinical trials in that group (see the References section below). Phenylthiazole, phenytoin and trimethoprim are the only antifertility drugs approved by the U.S. Food and Drug Administration (FDA). They are used to treat polycystic ovary syndrome (PCOS) patients, but are generally considered safe and effective for men. In a study of male patients with PCOS, trimethoprim was associated with an increased risk of hysterectomy. The potential adverse effects of these antifertility drugs include impaired fertility, ovarian cyst formation and perineal nerve damage, which have been observed in both sexes, but have received little attention compared with the clinical evidence for SARM. The efficacy and safety of Mirena are not well established, although the most recent analysis showed a small (P = .02) increase in the incidence of adverse effects, however no statistically significant increase in the incidence of gynecomastia was seen. In Related Article:

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