Why don't any doctors prescribe steroids anymore???

Question

Why are the I.D. doctors not prescribing steroids, such as Oxandrin, or any of the Deca steroids for wasting, and/or lipodistrophy? I have been positive for at least 14 years, been almost to the grave and back, and was on Oxandrin years ago, which kept me in very good shape, physically and mentally. They also helped with erections, which seemed to stop when I started drug cocktails years ago. I now have fat redistribution, since stopping the steroids a few years ago, and have lost about 30 pounds. I am in the normal weight range for my size, but not for my bone structure. I cannot restict my lifstyle anymore, or add more exersice, than I currently do, which is over the top to begin with. The last 4 doctors I have seen do not believe it is wise to start me back on Oxandrin, but do not give any specific reasons, other than not a good idea. I now feel like a rolly poley person with skinny arms and legs, and big tummy, and rely on Viagra for erections. Any reasons any of you may think of for the local doctors not wishing to continue prescribing Oxandrin. The doctor that prescribed it moved to Africa, so I seem SOL! My testesterone is low average.

Answer

I tend to object to broad generalizations about treatment approaches, since experienced HIV physicians look to individualize therapy. I do prescribe oxandrolone for some of my patients, when appropriate.

The issue with anabolic steroids for wasting and lipodystrophy centers not on the issue of whether this class of medications can improve muscle bulk, but rather that they tend to increase the loss of peripheral fat (this is why body builders like the drugs). This actually worsens lipoatrophy- perhaps the most stigmatizing symptom of lipodystrophy. I would propose that this is why many physicians who used to prescribe more anabolic steroids use lesser amounts for their patients now.

It has also become painfully obvious that liver disease and hypogonadism (low testosterone levels) can seriously complicate the lives of persons with HIV-- two other areas where indiscriminate use of anabolic steroids can also cause significant problems.

Paradoxically, I'm not sure why oxandrolone should have helped with your erectile dysfunction, since the use of oxandrolone usually is associated with lower levels of testosterone. If your testosterone level is low-average, I'd definately want to know what your free (not total) testosterone level is. I'd bet that with your symptoms, that your level is low and therefore, that you'd benefit from testosterone (not oxandrolone) replacement.

It would be worth asking about the type and location of your fat "redistribution" (it's not really a redistribution, but "maldistribution)-- also information about the type of HIV medications that you take (or not), CD4 cell count and CD4 cell nadir (lowest count), since all of this influences your risk of lipodystrophy.

Hope this helps- BY