Treatment Review #18; April 1995

Anabolic steroids are recognized by their function of building up tissues and muscles. Synthetically made anabolic steroids, available by prescription or in research studies, may be useful as part of a diet and exercise regimen to increase and maintain the type of weight that comes from muscles - lean body mass. People who are HIV+ may have decreased levels of different steroids in their body due to interference or alterations caused by HIV. Because of the potential for steroid abuse, and their potentially harmful side effects, anabolic steroids are strictly controlled drugs in the United States. But anabolic steroids are powerful drugs that, when used safely , might effectively treat the wasting process in people with AIDS and HIV disease.

Testosterone is the main anabolic steroid in humans. It is produced in the testicles and adrenal glands. Its function is to build muscles and masculinize. Synthetic versions of the hormone have been used to stimulate the bone marrow to produce red and white cells in certain autoimmune diseases in men and women. It is being studied as a treatment for depression and loss of sexual drive in people with AIDS. It is also sometimes used as a male contraceptive because the drug often leads to the inability to produce orgasm. Most cautions against the use of testosterone by women are based on the belief that administration of the drug will confer the secondary sexual characteristics usually attributed to men, such as hair growth, sexual aggressiveness or increased libido, and muscle growth. Use of testosterone is not recommended for women, but thorough study of testosterone treatment for women has not been done.

Naturally occurring testosterone is rapidly cleared by the liver and doesn't circulate in the body long enough to be useful as a treatment. Oral synthetic forms of testosterone are cleared more slowly by the liver, but tend to be liver toxic. A significant side effect of anabolic steroids is a tendency to produce an inflammation of the liver called hepatitis when taken orally. For older men, side effects include rapid enlargement of the prostate, causing difficulty with urination and the possibility of activating a previously undetected and inactive prostate cancer. Injectable testosterone formulations have longer half-lives than naturally occurring testosterone and are less liver toxic than the oral formulations.

The doses of steroids being suggested to maintain or increase weight in people who are HIV+ are usually lower than the doses used for other conditions, so the potential for side effects is theoretically less. Continuous use of very high doses of any anabolic steroid can cause a serious syndrome called peliosis hepatitis which can result in liver failure or stomach bleeding.

To maintain weight through the use of anabolic steroids, it's important to eat foods rich in amino acids and protein sources, and to exercise, preferably weight resistance training (bodybuilding). A recommended amount of protein is one gram for every pound of ideal body weight. Consult with a nutritionist about getting adequate amounts of protein from food and nutrition supplements. Four meals a day may be better for you than three. If you are unable to eat, due to side effects of medications and infections, a consultation with a nutritionist can help you figure out ways to get enough protein through nutrition supplements.

If you are taking an anabolic steroid to increase and maintain your weight, your doctor should consider cycling you off the drug every 6-8 weeks as a safeguard against side effects. If you have any history of diabetes or other liver problems, you should not attempt to use anabolic steroids. For information about anabolic steroids for the treatment of HIV-related weight loss, contact Anabolics for AIDS at (213) 851-6734. This non-profit organization is informational only, but can provide sample treatment protocols.

Another anabolic steroid being studied for the treatment of wasting is called oxandrolone. This anabolic steroid is not believed to have the same masculinizing effects as testosterone. Results of studies of oxandrolone for this purpose are expected soon.

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