I've recently read that growth hormone will turn fat into muscle. How does this work physiologically and metabolically? What type of exercise should be used...aerobic or anaerobic? Is this the answer those of us suffering from lipodystrophy have been searching for?

Several small studies done in patients with LD have shown that GH can help reduce fat accumulations. This seems to be fairly consistent and predictable. However it also seems that once GH is stopped, fat accumulation may (usually) return. Thus so far we do not have evidence that really supports the use of GH except as a short-term fix. The original studies of GH were done in patients with AIDS-wasting, not in patients with LD (and indeed LD is something different from AIDS wasting). These studies showed that GH taken daily for 12 weeks can reverse wasting by increasing weight and muscle mass ("turns fat into muscle"). The pivotal study on GH did not include regimented or indeed any exercise as part of the treatment. Subsequent study with oxandrolone (an anabolic steroid) in men with AIDS-wasting (not LD) showed that exercise greatly potentiates the anabolic effects of oxandrolone. This exercise was resistance exercise, i.e. muscle building or anaerobic. Now back to LD. We still are miles away from knowing what to do. Some recent evidence incriminates d4t as promoting fat depletion, but not necessarily fat accumulation. Studies are ongoing to look at various strategies such as substitution of one antiretroviral for another...keep tuned in, more to come. Alvan Fisher, M.D.