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Low testosterone and trouble gaining weight - Androgel/Oxandrin?

Aug 4, 2011


I have been HIV+ since 2004 and am in good health. My T-Cells have never increased above 400 since becoming HIV+ and have been at 350-375 on my current treatment of Isentress+Truvada.

I have been on Androgel for HRT due to low testosterone (<200ng/dl) since 2007. With treatment I reach levels of ~ 550-600ng/dl.

For the last three years I have been training very hard and taking my nutrition seriously. But I am struggling to put on weight! I am not wasting - I merely want to grow. I have flatlined at 170lbs and while my body composition has changed a little, I can't seem to cross this line.

My Doctor has recommended a round of Oxandrin get over this hump.

I have been studying the medication and effects on the endocrine system, and because I am already on HRT there seem to be few risks to giving this a try.

Can you offer any guidance on this?

Thanks - J

Response from Mr. Vergel

I am including an excerpt from my first book " Built to Survive: A Comprehensive Guide to the Medical Use of Anabolic Therapies, Nutrition and Exercise for HIV+ Men and Women" (available on :

Oxandrolone is the only anabolic steroid that has been approved by the FDA for the treatment of unintentional weight loss caused by illness, so cautious doctors are more likely to prescribe it. It is a relatively safe oral steroid with a low potential for creating androgenic side effects. In fact, oxandrolone is so safe that it was prescribed for many years for male and female children with stunted growth (Turner's syndrome). It was removed voluntarily from the U.S. market in 1992 when the political climate and the laws regarding steroids changed, but returned in 1995 to be sold to the HIV marketplace.

While some HIV studies show a good anabolic response to doses as low as 15 mg per day, and anecdotal reports tell us that oxandrolone is an effective anabolic agent for some people at 20 mg per day, doctors' anecdotes and one case review study tell us that some males have only a weak response at 20 mg per day. However, one controlled study showed that 20 mg of oxandrolone per day combined with 100 mg of testosterone enanthate per week and weight-training produced considerable lean body mass gains. We have seen oxandrolone produce much better results when it is combined with testosterone.

While promotional materials for Oxandrin state that it is "13 times as anabolic as testosterone," this is scientifically incorrect, and a misquote from the original literature. The original text that this phrase was taken from stated that oxandrolone is 13 times as anabolic as it is androgenic and this number has only a very indirect relationship to testosterone's anabolic potential. Actually, these kinds of measurements, called disassociation ratios, are not considered to be scientifically credible by scientists like Dr. Charles Kochakian, the man known as the "father of anabolic steroids.47 (This method employs the levator ani, a muscle that is not like other muscles in the body, in that it is dependent on androgens for normal function.) The truth is, while oxandrolone is the safest steroid for women and children that is available in the U.S., and can be quite effective for some males, it is probably the mildest of the anabolic steroids that are currently available. Because it is a dihydrotestosterone-based molecule it does not convert to estrogen or cause estrogen-related side effects.

While oxandrolone is promoted as being safe for the liver, all commonly available oral steroids have the potential to burden the liver. At the 1998 Geneva AIDS Conference Dr. Carl Grunfeld noted that preliminary data on a recent large multi-site dose-ranging HIV study that looked at 20, 40 and 80 mg of oxandrolone per day showed that at the 40 and 80 mg doses oxandrolone produced elevated SGOT and SGPT, which can indicate livertoxicity. We have been surprised that a number of HIV(+) men have reported significant elevations of liver function tests with oxandrolone use. It is suspected that this happens because oxandrolone is metabolized in the same p450 3A4 liver enzyme pathway as protease inhibitors. This needs to be studied.

Although oxandrolone has been said to have no effect on testosterone production, it does attenuate the body's natural testosterone production, the same as all other effective anabolic steroids. At only 10 mg per day oxandrolone has been shown to reduce endogenous (the body's own) testosterone production by 62 percent. All anabolic steroids that are effective have an effect on the body's natural testosterone production when given at "anabolic" doses.

While studies on oxandrolone alone at 20 mg per day have generally shown good gains in lean body mass (LBM), a well controlled study done by Strawford et al showed that this dose of oxandrolone combined with testosterone at 100 mg per week and weight training is perhaps an optimal way to employ oxandrolone. Subjects using this combination gained an average of 15.18 pounds of LBM in 26 weeks, which is much more than growth hormone (Serostim) has been reported to produce.

Keep in mind that it is important that your doctor follows your hematocrit since it can be increased by anabolics and testosterone. High hematocrit can make your blood thicker and increase cardiovascular risks. Oxandrin also lowers good cholesterol (HDL), so I would only use it for no more than 12 weeks. Luckily, all of these effects are reversible.

A small study looked at the use of Oxandrin to treat lipodystrophy belly. The drug was effective at reducing visceral fat but it decreased HDL cholesterol (no liver enzymes were reported), so the investigators concluded it was not a good option for this use.

Oxandrin is expensive even now that is a generic, at $1200 a month for 20 mg per day. Most insurance companies pay for it but many have restrictions on how many refills you can get. Some patients get cheaper Oxandrolone compounded by specialty compounding pharmacies.

You may want to read this guide that I wrote 13 years ago when wasting was more of a problem:

Anabolic Steroids: A Practical Guide by Nelson Vergel

I hope this helps!

Nelson Vergel

Over the counter purchase
is it ok to lower Egrifta dosage frequency?

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