Analysis of 20 randomized controlled trials reveals nandrolone decanoate increases lean soft tissue by 1.59 kilograms compared to placebo, yet produces no measurable improvements in handgrip strength or knee extension power. The steroid also failed to consistently enhance bone mineral density across skeletal sites. This disconnect between tissue growth and functional capacity challenges fundamental assumptions about anabolic interventions for age-related muscle loss. The finding suggests that pharmacologically-induced muscle tissue may lack the contractile quality or neural adaptations that resistance training provides. For aging adults facing sarcopenia, this meta-analysis reinforces that muscle quantity alone doesn't translate to strength or functional independence. The authors' conclusion favoring non-pharmacological approaches aligns with mounting evidence that lifestyle interventions produce more meaningful health outcomes. Given nandrolone's known cardiovascular and hepatic risks, combined with these limited functional benefits, the risk-reward profile appears unfavorable for routine clinical use. This systematic review effectively closes the door on nandrolone as a viable sarcopenia therapy, redirecting focus toward evidence-based resistance training and nutritional strategies.