In contrast to testosterone, DHT and other 4,5α-dihydrogenated AAS are already 5α-reduced, and for this reason, cannot be potentiated in androgenic tissues. 19-Nortestosterone derivatives like nandrolone can be metabolized by 5α-reductase similarly to testosterone, but 5α-reduced metabolites of 19-nortestosterone derivatives (e.g., 5α-dihydronandrolone) tend to have reduced activity as AR agonists, resulting in reduced androgenic activity in tissues that express 5α-reductase. In addition, some 19-nortestosterone derivatives, including trestolone (7α-methyl-19-nortestosterone (MENT)), 11β-methyl-19-nortestosterone (11β-MNT), and dimethandrolone (7α,11β-dimethyl-19-nortestosterone), cannot be 5α-reduced. Conversely, certain 17α-alkylated AAS like methyltestosterone are 5α-reduced and potentiated in androgenic tissues similarly to testosterone. 17α-Alkylated DHT derivatives cannot be potentiated via 5α-reductase however, as they are already 4,5α-reduced.The capacity to be metabolized by 5α-reductase and the AR activity of the resultant metabolites appears to be one of the major, if not the most important determinant of the androgenic–myotrophic ratio for a given AAS. AAS that are not potentiated by 5α-reductase or that are weakened by 5α-reductase in androgenic tissues have a reduced risk of androgenic side effects such as acne, androgenic alopecia (male-pattern baldness), hirsutism (excessive male-pattern hair growth), benign prostatic hyperplasia (prostate enlargement), and prostate cancer, while incidence and magnitude of other effects such as muscle hypertrophy, bone changes, voice deepening, and changes in sex drive show no difference. Aromatase and estrogenicity
Testosterone can be metabolized by aromatase into estradiol, and many other AAS can be metabolized into their corresponding estrogenic metabolites as well. As an example, the 17α-alkylated AAS methyltestosterone and metandienone are converted by aromatase into methylestradiol.
Classification
Leiomyosarcomas are now staged using the 2009 FIGO staging system (previously they were staged like endometrial carcinomas)  at the time of surgery. Stage I: tumor is limited to the uterusIA: ≤5 cm in greatest dimension
IB: >5 cmStage II: tumor extends beyond the uterus, but within the pelvisIIA: involves adnexa of uterus
IIB: involves other pelvic tissuesStage III: tumor infiltrates abdominal tissuesIIIA: 1 site
IIIB: >1 site
IIIC: regional lymph node metastasisStage IVA: invades bladder or rectum
Stage IVB: distant metastasis (including intra-abdominal or inguinal lymph nodes; excluding adnexa, pelvic and abdominal tissues)Endometrial stromal sarcomas and uterine adenosarcomas are classified as above, with the exception of different classifications for Stage I tumors. Stage I: the tumor is limited to the uterusIA: limited to endometrium/endocervix
IB: invades <½ myometrium
IC: invades ≥½ myometriumFinally, malignant mixed Müllerian tumors, a type of carcinosarcoma, are staged similarly to endometrial carcinomas. Stage I: the tumor is limited to the uterusIA: invades <½ myometrium
IB: invades ≥½ myometriumStage II: invades cervical stroma, but no extension beyond the uterus
Stage III: local and/or regional spreadIIIA: invades uterine serosa and/or adnexa
IIIB: vaginal and/or parametrial involvement
IIIC: metastases to pelvic and/or paraaortic lymph nodes
IIIC1: positive pelvic nodes
IIIC2: positive para-aortic lymph nodesStage IVA: invades bladder and/or bowel mucosa
Stage IVB: distant metastases (including intra-abdominal metastases and/or inguinal lymph nodes)

Management
Therapy is based on staging and patient condition and utilizes one or more of the following approaches. Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Other approaches include radiation therapy, chemotherapy, and hormonal therapy. Prognosis is relatively poor.