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Many users combat the estrogenic side effects with anastrozole, tamoxifen or clomifene.

This gives the appearance of bad gains in mass and strength, which proves to be temporary once the steroid is discontinued and water weight drops.Because of this, it is often used by bodybuilders at the start of a "steroid cycle", to facilitate rapid strength increases and the appearance of great size, while compounds such as testosterone cypionate or testosterone enanthate with long acting esters build up in the body to an appreciable amount capable of supporting anabolic function on their own.Beginning soon afterwards in 1959, CIBA collaborated with John Bosley Ziegler (a physician specializing in physical rehabilitation and an early pioneer of pharmaceutical performance enhancement) to test the effects of Dianabol on professional weightlifters.Ziegler had a close relationship with Bob Hoffman, owner of York Barbell Company and coach of the US Olympic weightlifting team, The first tentative experiments were disappointing. America winner Jim Park reported that "its only effect was to give him an instant erection upon seeing any female." However, Ziegler believed that Dianabol had significant potential as an anabolic.According to Grimek, "apparently, he doesn’t think it will do that much good, and may even have detrimental effects, ...

He appears doubtful." Instead, Dianabol was given to various lower level lifters to investigate its effectiveness and safety.

He attempted to deflect their curiosity with hints of new isometric and hypnotic techniques.

Over the course of the next 2 years, Ziegler's work with Riecke further explored the new drug's physical and psychological effects.

Riecke's performance and mood consistently improved while taking Dianabol, and dramatically declined when he did not take it.

John Fair also suggests that Riecke was among the first cases of steroid dependency, at one point "mentioning the pills four times in [one] letter, twice being reminders for Ziegler to send more." From 1962 onward, it became increasingly difficult for Ziegler and others to keep their results secret, and word of Dianabol's spectacular performance-enhancing effects gradually spread among competitors in other sports where strength or mass were critical factors in an athlete's success.

Metandienone is subject to extensive hepatic biotransformation by a variety of enzymatic pathways.