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undecanoate vs. cypionate/enanthate
May 1, 2000

It seems I have a few options if I decide to start taking testosterone therapeutically for HIV: either orally (as undecanoate) or by injection (cypionate or enanthate). Can you tell me if the hepatoxicity and efficacy of both these methods is the same? Aren't oral steroids 17-alpha-alkalated and therefore more harmful? At what dose would the testosterone start exerting an anabolic effect?

Response from Dr. Fisher

Would not use oral testosterone because of cdoncerns about hepatotoxicity. Either injectable cypionate or enanthate are appropriate. A new preparation that looks promising was recently approved by FDA, a topical gel called androgel. It should be available very soon. Testosterone does not have a dramatic anabolic effect in HIV+ men with testosterone deficiency at the usual doses of 100-200 mg every 1-2 weeks. It replaces what is missing. Much higher doses are probably needed for an anabolic effect...and these doses may cause adverse effects including rises in red blood cell counts, liver toxicity, etc. If you are looking for and need an anabolic effect you should consider one of the approved anabolic steroids...oxandrolone or oxymetholone (the latter is not specifically approved for this use however). Studies that I participating in have shown that oxandrolone does indeed exert an anabolic effect in HIV+ men with weight loss...and with minimal toxicity. Alvan Fisher, M.D.

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