how could you know so little about anabolics - clearly the only known medicine for wasting? you prescribe rhGH as if it builds skeletal muscle. BUT IT DOES NOT. the bodybuilding world knows a great deal about rhGH and knows that it is useless as a skeletal muscle builder unless used in combination with testosterone. see, the medical community knows little about these drugs because clinical trials are few and far in between do to legalities. but when people are using these drugs all the time illegally, they learn a great deal more through trial and error. there are presently hundreds, maybe thousands, of bodybuilders who know MUCH more about rhGH than you do because they have used the drug, and hundreds of thousands of people who learn from these bodybuilders who also put you to shame with their knowledge of the compounds. why don't you show true interest in improving the lives of persons wasting away, and reach out to the bodybuilding community in effort to actually learn something about these drugs you are prescribing. there is just a huge amount of information available to the medical community on these issues that doctors choose to ignore. and it is disgraceful, when this knowledge is in such high demand. smarten up, doc. do some real research, and learn about this stuff the real way. look at who is using these drugs, and study them.

This a fascinating comment and gets to the heart of the way defensibe medicine is practiced. Doctors don't do things by trial and error as errors are costly both to patients and doctors. Defensibe medical practice is about the practice of evidence based medicine, the application of reseach in the clinic. A number of 'levels of evidence' are described...the highest being 2 randomised controlled clinical trials, the lowest form of evidence, something that should not be the basis of practice is 'anecdote' or 'case reort'. Anecdote is the sort of thing you describe in your note. There are some proper controlled studies in HIV of anabolic steroids and more recently with GH (see Moyle et al JAIDS January 2004 for details of a >700 HAART treated patient 2 dose vs. placebo study in wasting). This might help you appreciate that we are doing the research...this study led to a change in the licence for GH in the US.

Both groups of drugs have a role to play althogh the consequences of anabolic steroids on other natural hormones, on lipids and liver function,on risk of certain cancers and mental state make them less attractive (albeit cheaper) alternatives to GH for weight and lean body mass gain. I suggest it may be for you to smarten up and stop relying on drug dealers in the gym for medical information.

kind regards graeme moyle