Hi Dr. Henry I've been HIV poz for 4 years now and healthy on Truvada and Intelence. I have hypogonadism and have been taking testosterone injection 1ml every 10 days. I started a work out program with a personal trainer 4 months ago to help build up lean muscle, but at 40 years old with a natrually small frame, this is not easy to accomplish. I want to build up as much lean muscle as possible so I don't get wasting or if I do, I won't turn into skin and bones. I have poz friends whose doctors have them on testosterone, oxandrin, arimidex, and serostim and they have more muscles than I do. Recently a local HIV doc gave a presentation to an HIV support group about steroid supplementation in his patients, and he stated that he places most of his patients on testosterone, arimidex, oxandrin, and other meds even if they are not wasting. When I mentioned this to my doctor, he said that insurance won't cover oxandrin unless I'm wasting, and that they don't know how arimidex interacts with HIV meds. Basically he refused to consider any other meds for me besides what I am currently on even though I expressed my concerns about losing lean muscle mass. Is my doctor behind the times on using steroids? Should I find a doc who is more progressive in prescribing them? Why the difference in care here?

There is little data on long term safety of use of anabolic steroids and concerns about effects on lipids, liver, cardiac and other organ systems including increased risk for cancer and other conditions. For patients with stable weight doing well on HIV treatment there is no clear evidence supporting use of anabolic steroids in the absence of significant loss of lean body mass which is not often seen these days. Many of the products you mention are expensive and can have significant side effects with minimal/little evidence of actual health benefit. Unquestionably patients taking some of those products may experience increase short term muscle mass but that doesn't equate clearly to improved long term health. See http://www.quackwatch.org/01QuackeryRelatedTopics/hgh.html for discussion of growth hormone or http://www.drugfree.org/playhealthy/Facts/FactLoader.aspx?ID=13

KH