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which is safer Procrit or androgen therapy?
Sep 14, 2003

Hi Dr. Bob, OK thr anemia finally kicked in and my ass is a dragon. My doc wants to give me androgen therapy --- not sure which one. Does this stuff have worse side effectrs than Procrit would? What type of side effects or medical conditions would I have to watch out for? tired and anemic

Response from Dr. Frascino

1A)

Hello,

"Your ass is a dragon?" Did you mean "Your ass is a-draggin'?" or is your butt really a ferocious green monster that spits fire?

So is your doctor prescribing androgen therapy for HIV wasting or low testosterone? If so, it may be the correct thing to consider. However, if he's prescribing it for HIV-related anemia, I'd be concerned.

Does androgen therapy have potentially worse side effects than Procrit? Well, as they say in Fargo, "Ya, you betcha'." Androgen therapy (e.g. oxymetholone, testosterone, etc.) has been used as an alternative to Procrit for some types of anemia; however, published clinical trial data supporting its use in HIV-positive folks is lacking.

Erythropoietin is a hormone produced by your kidneys, which stimulates the production of red blood cells. Androgens increase the production and excretion of erythropoietin. It is indicated for the treatment of specific conditions, including acquired aplastic anemia, congenital aplastic anemia, myelofibrosis and hypoplastic anemia due to myelotoxic drugs.

Androgens are associated with various adverse effects, including pain upon intramuscular administration, hirsutism (getting excessively hairy like Cousin "It" from the Addams Family), virilization in female patients, priapism in males (a hard-on that won't go down), acne, premature closure of the bone growth plates in kids, increased blood Triglycerides, and liver problems. Their use is contraindicated in patients with breast or prostate cancer, as well as pregnant and pediatric patients.

Epoetin alfa (Procrit) is biologically indistinguishable from naturally occurring erythropoietin. In stark contrast to androgen therapy, Procrit has been extensively studied and used for over a decade for treating anemia in patients with HIV disease. It is safe, well tolerated, and remarkably effective. In clinical trials, side effects from Procrit were the same as with a placebo.

I'd suggest you talk these issues over with your doctor. Bring a copy of this post to review with him or her. Good luck. Write back if you have additional questions. And before you or someone else asks, yes, priapism, although it may sound good, can indeed be an adverse reaction!

Dr. Bob


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