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Anabolic Steroids
It is noteworthy that the two completed growth hormone trials
took two years to get into print after they were completed.
This was true despite the fact that rHGH and IGF are both hi-
tech, high-visibility products with very active corporate
sponsors.
As growth hormone research grinds on, alternatives exist at
the grassroots level that cost one-tenth of what rHGH does.
These are anabolic steroids, which body builders and other
athletes use to increase their muscle mass and stamina. The
anabolic steroid family includes testosterone and synthetic
derivatives with fewer androgenic (masculinizing) effects.
A number of knowledgeable AIDS specialists have been
prescribing testosterone to patients complaining of weight
reductions plus loss of libido [see the interview with Lisa
Capaldini, M.D., in AIDS TREATMENT NEWS #184]. But just
correcting the frequent mild testosterone deficiencies is
often not enough, and boosting testosterone levels above
normal can have adverse consequences, including liver
toxicities. This is where the synthetic anabolic steroids
come in.
Despite anabolic steroids' "schedule III" legal status (they
are controlled substances on the same level as aspirin-
codeine combinations), a considerable anabolic steroid lore
has accumulated in the sports world,(7) and HIV-positive body
builders have brought that information to the AIDS community.
One such bridge is Brian Chadsey, M.D., a Los Angeles
physician who is a former football player and body builder.
Chadsey has been looking at anabolic steroids' effect on HIV
wasting for eight years. He currently has almost 100 patients
using the substances. "I've had phenomenal results," said Dr.
Chadsey, "with patients commonly gaining 20 or 30 pounds.
Anabolic steroids are useful when people have unintentional
weight losses of ten percent, low testosterone levels and
decreases in daily functioning. Most doctors tell their
patients to just live with weight loss, that it's part of the
disease process. But wasting syndrome is probably an
escalating event that leads to early death." [See AIDS
TREATMENT NEWS #150 and #166 for two other physicians'
experience with anabolic steroids.]
Dr. Chadsey also reports significant improvements in his
patients' immune cell populations while on anabolic steroids.
Three-quarters of his patients witnessed rises in their CD8
(cytotoxic lymphocyte) counts and 40 percent have had
increases in CD4, or T-helper cell levels.
In Sacramento, California, Michael Dullnig, M.D., a
psychiatrist, also drew on his weightlifting past when trying
to control his own HIV-associated weight loss. Dr. Dullnig
started personally taking anabolic steroids last spring, when
a bout of mycobacterium avium left him 50 pounds below normal
weight, extremely weak, and disabled in one leg. After
following an individual regimen since May that includes
anabolic steroids, extensive use of nutritional supplements,
and a rigorous weight-training schedule, Dullnig said, "I'm
back to the way I looked before, and my energy has returned.
I feel like my life was given back to me."
Dullnig thinks that "exercise is the key. Steroids make cells
receptive to building tissue, but you need exercise to
stimulate the anabolic process. The right nutrients are also
very important. This is like another period of adolescence."
He does warn against overtraining, though. People need to pay
attention to their physical limitations. Dr. Chadsey says
that not all his patients are on exercise programs, although
those who are get better results.
The murky social and legal atmosphere surrounding anabolic
steroids makes it difficult for people with HIV to obtain the
substances or even reliable information about their proper
use. Expert supervision when using anabolic steroids is
especially important for women, who should take lower doses
than men and need to follow a regimen with little potential
for androgenic side effects.
And following an extensive exercise and food supplementation
program is an obstacle for many people who are sick and lack
stamina or digestive capacity. These are just the people who
need the most protection from wasting.
Researchers justify focusing their attention on growth
hormone because of such objections, but more clinical trials
of anabolic steroids could also provide important
information. Dr. Kotler, at St. Luke's/Roosevelt Hospital in
New York, is in a unique position in that he is conducting
separate clinical trials on both anabolic steroids and human
growth hormone. Dr. Kotler says that, although the data has
not been analyzed yet, the results of the two trials seem
similar, with about half the people showing considerable
improvement in body composition. Those who do not are people
who come down with severe opportunistic infections.
Meanwhile, no major side effects with either the anabolic
steroid (in this case oral oxandrolone) or rHGH have been
observed.
So which therapy is more appropriate? Dr. Kotler said, "We
can't tell yet whether anabolic steroids, human growth
hormone, or just testosterone replacement, is best. I don't
even know whether any of these are good long term or have
hidden side effects."
Dr. Chadsey is also looking into using growth hormone to
combat wasting. He thinks a combination of anabolic steroids
and growth hormone may be desirable. "You need some
androgenic effect to increase the reaction to growth
hormone," he said.
Future therapies may well be tailored to the individual,
based on an analysis of each person's hormonal and immune
activity as well as overall disease state. Personal tolerance
to the different therapies would be a factor, too.
Dr. Hellerstein speculated, "We may use a mixture of
approaches depending on what people need: anabolic steroids
for those with low testosterone, human growth hormone to
correct metabolic imbalances, immune modulators to balance
the immune system's effects, nutritional supplementation for
malabsorbers, plus exercise for those who are able to do it."
It is noteworthy that the two completed growth hormone trials
took two years to get into print after they were completed.
This was true despite the fact that rHGH and IGF are both hi-
tech, high-visibility products with very active corporate
sponsors.
As growth hormone research grinds on, alternatives exist at
the grassroots level that cost one-tenth of what rHGH does.
These are anabolic steroids, which body builders and other
athletes use to increase their muscle mass and stamina. The
anabolic steroid family includes testosterone and synthetic
derivatives with fewer androgenic (masculinizing) effects.
A number of knowledgeable AIDS specialists have been
prescribing testosterone to patients complaining of weight
reductions plus loss of libido [see the interview with Lisa
Capaldini, M.D., in AIDS TREATMENT NEWS #184]. But just
correcting the frequent mild testosterone deficiencies is
often not enough, and boosting testosterone levels above
normal can have adverse consequences, including liver
toxicities. This is where the synthetic anabolic steroids
come in.
Despite anabolic steroids' "schedule III" legal status (they
are controlled substances on the same level as aspirin-
codeine combinations), a considerable anabolic steroid lore
has accumulated in the sports world,(7) and HIV-positive body
builders have brought that information to the AIDS community.
One such bridge is Brian Chadsey, M.D., a Los Angeles
physician who is a former football player and body builder.
Chadsey has been looking at anabolic steroids' effect on HIV
wasting for eight years. He currently has almost 100 patients
using the substances. "I've had phenomenal results," said Dr.
Chadsey, "with patients commonly gaining 20 or 30 pounds.
Anabolic steroids are useful when people have unintentional
weight losses of ten percent, low testosterone levels and
decreases in daily functioning. Most doctors tell their
patients to just live with weight loss, that it's part of the
disease process. But wasting syndrome is probably an
escalating event that leads to early death." [See AIDS
TREATMENT NEWS #150 and #166 for two other physicians'
experience with anabolic steroids.]
Dr. Chadsey also reports significant improvements in his
patients' immune cell populations while on anabolic steroids.
Three-quarters of his patients witnessed rises in their CD8
(cytotoxic lymphocyte) counts and 40 percent have had
increases in CD4, or T-helper cell levels.
In Sacramento, California, Michael Dullnig, M.D., a
psychiatrist, also drew on his weightlifting past when trying
to control his own HIV-associated weight loss. Dr. Dullnig
started personally taking anabolic steroids last spring, when
a bout of mycobacterium avium left him 50 pounds below normal
weight, extremely weak, and disabled in one leg. After
following an individual regimen since May that includes
anabolic steroids, extensive use of nutritional supplements,
and a rigorous weight-training schedule, Dullnig said, "I'm
back to the way I looked before, and my energy has returned.
I feel like my life was given back to me."
Dullnig thinks that "exercise is the key. Steroids make cells
receptive to building tissue, but you need exercise to
stimulate the anabolic process. The right nutrients are also
very important. This is like another period of adolescence."
He does warn against overtraining, though. People need to pay
attention to their physical limitations. Dr. Chadsey says
that not all his patients are on exercise programs, although
those who are get better results.
The murky social and legal atmosphere surrounding anabolic
steroids makes it difficult for people with HIV to obtain the
substances or even reliable information about their proper
use. Expert supervision when using anabolic steroids is
especially important for women, who should take lower doses
than men and need to follow a regimen with little potential
for androgenic side effects.
And following an extensive exercise and food supplementation
program is an obstacle for many people who are sick and lack
stamina or digestive capacity. These are just the people who
need the most protection from wasting.
Researchers justify focusing their attention on growth
hormone because of such objections, but more clinical trials
of anabolic steroids could also provide important
information. Dr. Kotler, at St. Luke's/Roosevelt Hospital in
New York, is in a unique position in that he is conducting
separate clinical trials on both anabolic steroids and human
growth hormone. Dr. Kotler says that, although the data has
not been analyzed yet, the results of the two trials seem
similar, with about half the people showing considerable
improvement in body composition. Those who do not are people
who come down with severe opportunistic infections.
Meanwhile, no major side effects with either the anabolic
steroid (in this case oral oxandrolone) or rHGH have been
observed.
So which therapy is more appropriate? Dr. Kotler said, "We
can't tell yet whether anabolic steroids, human growth
hormone, or just testosterone replacement, is best. I don't
even know whether any of these are good long term or have
hidden side effects."
Dr. Chadsey is also looking into using growth hormone to
combat wasting. He thinks a combination of anabolic steroids
and growth hormone may be desirable. "You need some
androgenic effect to increase the reaction to growth
hormone," he said.
Future therapies may well be tailored to the individual,
based on an analysis of each person's hormonal and immune
activity as well as overall disease state. Personal tolerance
to the different therapies would be a factor, too.
Dr. Hellerstein speculated, "We may use a mixture of
approaches depending on what people need: anabolic steroids
for those with low testosterone, human growth hormone to
correct metabolic imbalances, immune modulators to balance
the immune system's effects, nutritional supplementation for
malabsorbers, plus exercise for those who are able to do it."
