Basics on hormone replacement therapy

As we grow older our testosterone levels start to slowly decline while estrogen levels increase, In some bodybuilders this process happens a lot sooner than others because of the continuation of attacking your HPTA, Continually shutting your system down for weeks on end then trying to recover it isnt an ideal approach, over time this will effect your own natural production of test, In many cases the damage occurs to your HPTA and there is only one option which comes a lot sooner in life than it should - HRT.

With hormone replacement therapy we try to balance our sex hormones; testosterone, estrogen and progesterone to the same levels that they were at in our mid- twenties, symptoms of lower than normal test are; muscle loss,fat gain, gyno,depression,anger, low libido, erection problems,testicle shrinkage,energy level,low self esteem, irritability, unusual sleeping pattern and relationship problems, in fact every part of your life is effected and the day to day living becomes a toil.

First, blood tests need to be done to establish how your T- levels and some medical and lifestyle background will determine why your sex hormones are out of balance. A blood test needs to find the levels of your free and total testosterone, estradiol, total estrogens , LH, IGF-1, prolaction, DHEA, and several other hormones,

The blood test will determine what type of treatment is needed for balancing the hormones best, not all people should go straight on testosterone replacement therapy, with Andropause (male menopause) our body's go through a slow process where free testosterone levels slowly start to decline, if you were to go straight onto testosterone replacement it could potentially shut down your HPTA fully when it was still producing a certain amount, careful planning will help find which treatment is best for your individual problem. Bodybuilders who go straight onto test replacement may find that they need to stay on it for the rest of their life so sometimes other methods might suit the person better.

When the testes fail to produce Test and men have primary hypogonadism or hypogonadotropic hypognadism Test replacement is the answer, there are a few methods what could solve the problem but knowing the risks what come with each treatment will help to understand the benefits to risk ratio. We produce around 4-7mg of Test per day in a circular pattern with Max levels attained in the early morning and min levels in the evening. Mimicking and stabilizing these levels would be the best approach for treatment.

The best course of treatment would be a therapy what maintains serum concentrations of the hormone without giving significant side effects. many different treatments are available including injectables, tablets and transdermal systems. Within bodybuilding world many go with injection. Estered forms of Test are commonly used with injection of 200-300mg every 14 days (long esters) or shorter ester's can be used but frequent injection normally put a lot of BB's off.

Normally these injection will be good enough to produce enough serum Test levels, many need to adjust the dose or frequency to suit but with more mg comes more possible sides so be careful. Constant monitoring of Test levels to make sure they are in the normal ranges is needed, also men over 40yrs old should have their prostate check on a regular basis. Other sides of such treatment may be lipid abnormalities (reduce HDL,LDL & elevation in blood viscosityl), polycythemia,sleep apnoea, and prostate changes.

In many cases when treatment is implemented sides of andropause will stopped. many will feel a new person and a feeling of well being beholds them. There are positive changes in body composition to more lean mass and decrease BF.

Bodybuilders who are constantly shutting down the HPTA and using steroids over many years have a great potential of damaging their own systems. I've seen so many young guys who are on HRT due to steroids, please think very carefully because what you may do now at this stage could effect your in later life or even sooner. Because we use such higher than normal dosages of Test we get accustomed to the great feeling it produces and when we come off many suffer. I've not known one long term bodybuilder not suffer some of the sides mentioned in this thread. If steroids is the direction your going to achieve your goals makes sure you do it as healthy as possible, spend as little as possible on cycle to achieve your goals and try and keep shutdown to a minimum time. Remember it easier to recover from a short shutdown than it is longer ones.

Does T3 Helps To Lose Weight?

T3 is also known as triiodothyronine, a thyroid hormone. It is related to and even more important than the other but more popular thyroid hormone, T4 or thyroxine.

Thyroxine is the precursor of T4 and the production of both hormones is signaled in the thyroid gland by TSH or thyroid stimulating hormone.

Thyroid stimulating hormone is released from the pituitary gland and forms a feedback loop with both T3 and T4. Therefore, when the plasma levels of the thyroid hormone falls, TSH production is increased and when the thyroid hormones rise above their normal plasma levels, TSH production is reduced.

The control over the release of TSH itself is found in thyrotropin-releasing hormone (TRH) which is released from the hypothalamus.

T3 is only 20% of the amount of thyroid hormones synthesized. The other 80% is thyroxine.

However, in the plasma T3 is only 2.5% of the circulating thyroid hormones. It does not last as long as thyroxine (the time taken for T3 concentration to reduce to half is 2.5 days while for T4, that time is 6.5 days).

Furthermore, most of the T3 found in circulation are produced from T4.

By simply removing an iodine atom in a specific position on the T4 molecule, T3 is produced. The enzymes responsible for converting T4 to T3 are found in different parts of the body including the thyroid, kidney, liver, adipose tissue, placenta, heart, central nervous system and even the pituitary gland.

Even though T3 can be made from T4, the body still makes triiodothyronine directly. This is done in the lumen of the thyroid gland.

The synthesis proceeds with the addition of iodine atoms to tyrosine for form monoiodotyrosine (MIT) and diiodotyrosine (DIT). These reactions require hydrogen peroxide to proceed.

MIT and DIT then combine together in a reaction catalyzed by an enzyme called thyroid peroxidase. The product of this combination is T3.
What T3 Does and How It Works

The biological effects of T3 are extensive and the hormone contributes to almost all the physiological processes in the human body. For example, T3 affects heart rate, the rate of metabolism, body temperature and growth rate.

In the blood, T3 binds to specific types of carrier proteins: serum albumin (with low affinity) and thyroid-binding globulin (with high affinity).

These molecules increase the stability and longevity of T3 but impede the uptake of the hormone by tissues. For T3 to pass through tissues, it must shed its carrier protein.

To produce its biological effects, T3 binds to thyroid receptors in tissues. In addition, because it is fat-soluble, it can cross into cells through their phospholipid layers.

T3 can be found in most tissues although it is notably absent in the tissues of the testes and spleen.

Its overall effect depends on the part of the body where it acts. However, T3 generally increases the basal metabolic rate.

When T3 increases the rate of metabolism, it does the following:

    Increase the amount of oxygen and energy used up by the body
    Increase the amount of calories required for normal body processes even when the muscles are rested
    Increase the population of sodium/potassium/ATPase, the primary energy-generating complex in the body
    Increase the use and breakdown of many nutrient macromolecules produced in the body

On proteins, T3 increases the rate of their production and degradation by increasing the amount of the enzymes, RNA polymerase I and II.

For carbohydrates, T3 increases gluconeogenesis. Gluconeogenesis is the production of glucose from stored glycogen. This effect is mediated by beta adrenergic receptors. By acting on beta adrenergic receptors, T3 can increase heart rate and pulse rate. Specifically, T3 increases systolic blood pressure but decreases diastolic blood pressure.

On lipids, T3 increases the rate of lipolysis. Specifically, it drives the breakdown of cholesterol and increases the number of LDL receptors.

In the brain, T3 increases the production of certain neurotransmitters especially serotonin.

The positive effect of T3 on serotonin is the reason it is now recommended (along with SSRIs or selective serotonin receptor inhibitors) in the treatment of drug-resistance and recurring depression and bipolar disorders. Different studies have established that long-term supplementation with T3 significantly improves the symptoms of (and may even “cure”) these psychological disorders.

T3 (or any of its prodrugs) is also used as a fat loss supplement. It has been proven to increase the metabolism of fatty acid and the breakdown of fat stored in adipose tissue
How T3 Can Promote Weight Loss

The only mechanism by which T3 promotes weight loss is by increasing metabolic rate.

Although it is a one-trick weight loss solution, that one trick is pretty remarkable. T3 increases basal metabolic rate by increasing the rate at which the body breaks down all food groups. It unlocks significant energy for the body to use, and it can produce very dramatic results especially in overweight people with diagnosed or silent hypothyroidism.

When the amount of thyroid hormones produced in the body falls, the rate of metabolism falls with it. In this regard, the amount of circulating T3 is more important than that of T4.

Because of the reduced metabolic rate, low thyroid functioning results in difficulty in reducing body weight. When overweight individuals adopt healthy, low caloric diets and take up regular exercise but still cannot shed weight, the most likely reason is low metabolic rate caused by low T3 levels.

Even a 10% reduction in metabolic rate can make weight loss very difficult. However, available clinical data suggest that most people who find it difficult to lose weight have 15 – 40% reduction in metabolic rate.

For this group of people, T3 is the magic remedy for losing weight.

The ability of T3 to prompting weight loss does not really depend on adopting a low caloric diet. In fact, the usual response to a low-carbohydrate diet is a reduction in the body’s metabolic rate. By supplementing with T3, the body keeps up a high rate of metabolism even with the amount of calories in the diet is reduced.

Exercise, on the other hand, has a more significant effect on the result of T3 supplementation in weight loss. In fact, T3 increases the amount of available energy, and practically encourages the user to exercise.

Unlike stimulants like caffeine and synephrine, T3 increases the rate of metabolism without such side effects as jitters. It does not make the user “hyper”. Instead, it simply energizes the user without the crash that comes from overstimulation with stimulants.

When taking T3 for weight loss, the aim is to increase the levels of T3 to the edge of the upper limit while not stepping over and setting off hyperthyroidism.

To do that, it is important to closely monitor the plasma levels of T3 while taking the supplement.

Where this is not possible, clear signs of hyperthyroidism such as irregular, rapid heartbeats should be the indication to stop T3 supplementation.

In most cases of abnormal weight gain even in the face of dieting and exercise, there is an impairment in the enzymes responsible for converting T4 to T3. Since most of the circulating T3 in the body comes from T4, such impairment makes it important to find another source of T3. This can be done through drugs and supplements that increase T3 levels.

The Use of Human Growth Hormone in the treatment of HIV / AIDS

HIV (human immunodeficiency virus) is the virus that causes AIDS. The HIV retrovirus may be passed from one person to another when infected blood, semen, vaginal secretions or other bodily fluids come in contact with an uninfected person's broken skin or mucous membranes. People with HIV have what is called HIV infection and are fit and well. Some of these people will develop AIDS as a result of their HIV infection.

Growth hormone is a popular bodybuilding and performance enhancing aid, and the use of recombinant human growth hormone (HGH, or simply GH) to treat various conditions in HIV infection has been debated with excitement for years. Indeed it is licensed for the treatment of wasting syndrome in advanced stages of AIDS. GH is also a commonly used bodybuilding and performance enhancing drug, which can be purchased on the black market; used to help both muscle anabolism / strength and reduction in body fat levels. Both of these applications have possible significance in the treatment of HIV.

Other than in the treatment of wasting disease, results from the studies using HGH to treat body changes associated with HIV and/or drugs used to treat HIV have been very favourable. One which has been studied extensively is the use of HGH in reducing HIV-associated adipose redistribution syndrome (HARS). However, the positive effects of HGH treatment in HIV may be more direct. Several studies have proposed that HGH may bolster the immune system in ways that might improve clinical outcomes in HIV.

Let's look at each of the possible treatment benefits of HGH in HIV in turn:

Wasting
Like cancer cachexia, advanced stages of AIDS are characterised by severe muscle wasting and weakness. The reasons for this are because the patient often has a very poor appetite and food intake, as well as there being direct wasting effects from the HIV and some associated diseases which the patient may have, e.g. pneumonia. The patient then enters a downward cycle with diminished strength, poor food intake and further wasting, and it's often this which leads to eventual death.

Both anabolic steroids (AS) and HGH therapy are used clinically to both slow the effects of wasting and to help improve appetite. Both have been shown to prolong life significantly and improve quality of life in advanced stages of AIDS .

HIV-associated adipose redistribution syndrome (HARS)
HARS is a type of lipodystrophy (abnormal distribution of body fat), where there is accumulation of excess truncal fat and visceral adipose tissue, as opposed to regular gynoid (glutes and hips) or android (abdomen) deposition. This is observed in HIV infected people, moreso as virus load increases. Although not a debilitating condition in itself (indeed extra body fat can prolong life if followed by wasting), HARS is unpleasant for the individual, giving reduced confidence in body image; another negative aspect of the disease.
HGH therapy has been shown to significantly reduce HARS, leading to an improved body image, and significant improvement in psychological well-being. Numerous studies have demonstrated the benefits of this, leading to HGH being licesenced for the treatment of HARS in some countries. It should also be noted that improvement in psychological well-being could also contribute to a positive clinical outcome, in that it reduces the effects of wasting.

Immune system
Of most interest in HIV therapy are the possible benefits of HGH use on the immune system, since HIV's primary adverse effect is reduction in the immune system. It has been clearly demonstrated that HGH does benefit the immune system, but the method by which it helps is still under debate. One theory is that HGH may stimulate renewal of the thymus gland, an important organ in the immune system. This may, in turn, lead to improved immune health in people with HIV. Studies are now examining whether or not renewing thymus tissue leads to better health and longer survival.

The thymus is necessary for developing new T-lymphocytes, which are key immune cells in the defence against disease, and numbers of which steadily reduce in HIV as infection progresses. In particular the thymus gland is involved in the development of CD4+ and CD8+ cells, and it is the CD4+ level which is a very critical marker in HIV outcome. Without some thymus activity, immune reconstitution that produces a wide range of functional CD4+ cells is not believed to be possible. Thus, the state of the thymus in HIV disease and how therapies affect it are of great interest to those researching ways to restore the immune system.

Acute Infections
HIV patients are often more prone to acute infections which may take longer to clear up than in non-HIV individuals. Sometimes these can be associated with poor appetite and weight loss. HGH therapy may curb rapid weight loss often associated with acute infections in HIV positive people and may also reduce length of infection. Far more research is needed here though.

Fasting lipid profile
HIV patients have been shown to have elevated serum lipids, and dyslipidaemia, i.e. high LDL (bad) cholesterol and low HDL (good) cholesterol with raised total cholesterol and triglycerides. This is associated with anti-HIV drug treatment especially later on in infection. This does increase risk of cardiovascular diseases, and HGH treatment may improve lipid profiles.

Bone Building
HIV patients may have loss of bone density associated with wasting. Both treatment with HGH and growth hormone releasing factor (GHRF) have indicated improved bone mass in HIV patients (Koutkia et al 2005).

Side effects of HIV (human immunodeficiency virus) is the virus that causes AIDS. The HIV retrovirus may be passed from one person to another when infected blood, semen, vaginal secretions or other bodily fluids come in contact with an uninfected person's broken skin or mucous membranes. People with HIV have what is called HIV infection and are fit and well. Some of these people will develop AIDS as a result of their HIV infection.

Growth hormone is a popular bodybuilding and performance enhancing aid, and the use of recombinant human growth hormone (HGH, or simply GH) to treat various conditions in HIV infection has been debated with excitement for years. Indeed it is licensed for the treatment of wasting syndrome in advanced stages of AIDS. GH is also a commonly used bodybuilding and performance enhancing drug, which can be purchased on the black market; used to help both muscle anabolism / strength and reduction in body fat levels. Both of these applications have possible significance in the treatment of HIV.

Other than in the treatment of wasting disease, results from the studies using HGH to treat body changes associated with HIV and/or drugs used to treat HIV have been very favourable. One which has been studied extensively is the use of HGH in reducing HIV-associated adipose redistribution syndrome (HARS). However, the positive effects of HGH treatment in HIV may be more direct. Several studies have proposed that HGH may bolster the immune system in ways that might improve clinical outcomes in HIV.

Steroid Abuse and Treatment

Who abuses anabolic steroids? Mainly body builders and athletes abuse steroids to alter their muscle mass and enhance performance however steroids can be abused by anyone. Unfortunately steroids have many negative side effects which may lead to severe psychological and physical changes.

What Is Anabolic Steroid Abuse?
It was not long ago when steroid use and abuse was within the domain of athletes, body builders and physical fitness fanatics. But the increased availability of drugs (including steroids) across the country has affected everyone, even school-age children. Media images promote the concept of the big powerful athlete, bulging with well-formed muscles. Insecurity develops within and steroid abuse offers a new way to achieve that look that seems unattainable. But is it worth the risk?

Anabolic Steroids, like any drug, have a profound impact on the brain’s neurotransmitters, which can set up mood and behavioral changes. Scientific research shows that anabolic steroid addiction and steroid abuse can cause aggression and other psychiatric side effects.

Warning Signs of Steroid Abuse
Men who become obsessed with body building and who ingest steroids to help them increase their muscle mass may have a distorted perception of their bodies, called muscle dysmorphia or megarexia. It is usually associated with low self-esteem and is related to feeling small or weak. Generally, these men adhere to a strict diet and constantly analyze their body images in the mirror. Frequent workouts with weights for extended hours in the gym are common. These men often abandon close relationships, careers and other forms relaxation in order to exercise more.

Signs of steroid abuse and addiction:

    Inflated self-esteem
    Extreme mood swings
    Depression
    Paranoid jealousy

    Extreme irritability
    Aggressive/violent behavior
    Delusions
    Impaired judgment

Anabolic steroids are taken orally or injected and when abused are taken in cycles that last weeks or months (referred to as "cycling"). Cycling involves taking multiple doses of steroids over a specific period of time, stopping for a period and then starting again. In addition, steroid users may combine several different types of steroids to maximize the effectiveness and minimize negative effects. This process is known as stacking. Prolonged use of steroids can lead to steroid dependence and a host of major medical problems.

Steroids are abused by both men and women, but the side effects differ by gender. For women many of the side effects are irreversible and can lead to fertility problems and masculinization.

Gender specific side effects:

Male Side Effects 

    Shrinking of the testicles
    Reduced sperm count
    Infertility
    Baldness
    Development of breasts
    Increased risk for prostate cancer

Female Side Effects 

    Growth of facial hair
    Male-pattern baldness
    Changes in or cessation of the menstrual cycle
    Deepened voice
    Diminished breast size

Steroid Addiction Treatment
Steroid withdrawal must be medically managed by an endocrinologist for the safest possible drug detox. The major health problems created by steroid abuse are related to the alterations in the levels of hormones in the body. Steroid withdrawal must be closely monitored and a specific steroid taper needs to be prescribed. Severe depression is the most common psychological side effect of stopping steroid use. Recovery Connection recommends going to a medical detox center because they are best equipped to prescribe medications for depression.

Many times, the withdrawal period will far exceed the actual tapering period. Steroid detox, which removes the steroids from the body, does not help with the severe self-esteem and psychological issues that may be the underlying issue for those struggling with steroid addiction.

Withdrawal symptoms can mimic other health problems and can include:

    Weakness
    Fatigue
    Decreased appetite
    Vomiting
    Abdominal pain

Some steroid abusers turn to other drugs to alleviate the negative effects of anabolic steroid addiction. Therapeutic interventions are recommended to handle steroid addiction, addiction to other substances and the accompanying psychological issues.

How Effective Is Tamoxifen Nolvadex for Gynecomastia?

Gynecomastia, a condition where the breast tissue of adolescent boys or adult men becomes enlarged and sometimes tender or sore, can be an uncomfortable and embarrassing problem, but treatment with the estrogen-blocking drug tamoxifen can help. Though the primary use of this medication is for the treatment of breast cancer, several studies have shown positive results when using Tamoxifen (Nolvadex) for gynecomastia. It can be helpful in a variety of situations that lead to the condition, including hormonal changes during puberty, anti-androgen treatment for prostate cancer, and in men for whom the issue has no known cause. Tamoxifen (Nolvadex) is also known to help men who take anabolic steroid cycles to increase muscle mass avoid gynecomastia from the hormonal changes caused by the steroids. It is most effective for treating the condition before it occurs, or when it has only been present for a few months.

Tamoxifen (Nolvadex) has traditionally been used to treat certain types of breast cancer. The drug does this by blocking the effects of estrogen, which can encourage some tumors to grow. Since gynecomastia typically results from excess estrogen in a man's body, Tamoxifen (Nolvadex) can also help prevent or treat the condition by blocking the hormone's effects.

Adolescent boys who develop the problem during puberty may be given the drug if the condition does not resolve itself quickly or causes severe emotional distress for the patient. Men undergoing prostate cancer treatment involving anti-androgen therapy may take tamoxifen to prevent the breast enlargement it usually causes. Those with idiopathic gynecomastia, where no cause for the condition is apparent, may also choose the drug, particularly if it persists for several months or causes discomfort.

Bodybuilders or other athletes who take anabolic steroids sometimes use tamoxifen for gynecomastia. The elevated estrogen levels that occur after a cycle of steroids ends puts the men using them at risk for gynecomastia. Taking Tamoxifen (Nolvadex) has been known to help prevent this issue.

While taking tamoxifen for gynecomastia has typically been found to be quite successful, it is important to note that it typically needs to be taken at the right times to be most effective. It works best as a preventive measure, or before the breast tissue has been enlarged for too long, typically within a few months of development. Once the condition has been present for a year or more, positive results from taking tamoxifen decrease significantly.

What Conditions Are Treated With Steroids and Their Benefits?

Steroids are used to treat a variety of conditions in which the body's defense system malfunctions and causes tissue damage. Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, Sjögren's syndrome, or gout.

What Are the Benefits of Steroids?

When inflammation threatens to damage critical body organs, steroids can be organ saving and, in many instances, life-saving. For example, they may help prevent the progression of kidney inflammation, which can lead to kidney failure in people who have lupus or vasculitis. For these people, steroid therapy may eliminate the need for kidney dialysis or transplant.

Low doses of steroids may provide significant relief from pain and stiffness for people with conditions including rheumatoid arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare-up of arthritis.

What Conditions Are Treated With Steroid Injections?

Steroids often are injected directly into joints to treat conditions such as rheumatoid arthritis, gout, or other inflammatory diseases. They also can be injected into an inflamed bursa or around tendons near most joints in the body.

Some people report relief from osteoarthritis when steroids are injected directly into swollen or painful joints.

What Are the Expected Benefits of Steroid Injections?

Steroid injections into a specific area are generally well tolerated and are less likely than other forms of steroid drugs to produce serious side effects. Also, the injections may help avoid the need for oral steroids or increased doses of oral steroids, which could have greater side effects.

What Role Do Steroid Injections Play in an Overall Treatment Program?

Steroid injections can be added to a treatment program that may already include anti-inflammatory pain medications (NSAIDs), physical therapy, occupational therapy, or supportive devices such as canes and braces. Whether one or more of these treatment methods are used depends on the nature of the problem.

For example, in an otherwise healthy person, tendinitis may be adequately treated with only a steroid injection into the inflamed area. However, in a person with rheumatoid arthritis, injections are generally a small part of a multifaceted treatment approach.

When Should Steroid Injections Not Be Used?

Steroids should not be injected when there is infection in the area to be targeted or even elsewhere in the body because they could inhibit the natural infection-fighting immune response. Also, if a joint is already severely destroyed, injections are not likely to provide any benefit.

If someone has a potential bleeding problem or is taking anticoagulants (often referred to as blood thinners), steroid injections may cause bleeding at the site. For these people, injections are given with caution.

Frequent steroid injections, more often than every three or four months, are not recommended because of an increased risk of weakening tissues in the treated area.

Anabolic steroids help people with HIV put on weight and muscle mass

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass.

The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase in those taking anabolic steroids was nearly three pounds.

The magnitude of weight gain observed may be considered clinically relevant. One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success.

The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, nandrolone decanoate and oxandrolone, have been used to help increase weight and muscle mass in small studies of people with wasting.

Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids.
In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use.

The risks and side effects of taking anabolic steroids long-term are certainly of concern.

HIV/AIDS program director at the Group Health Cooperative in Seattle, suggests that clinicians should obtain blood testosterone levels, if an HIV-infected individual has had significant weight loss, significant fatigue or muscle wasting, and particularly if associated with a significant decrease in libido and erections. If testosterone is in the low or low-normal range then a trial of steroids could be tried. The individual and the clinician should decide what result would constitute a successful trial: weight gain of 15 pounds, a 30 percent improvement in sense of well-being or a successful erection once a week.

The reviews authors conclude that further studies are needed to determine if increase in weight leads to improved physical functioning and quality of life, and ultimately increased survival, as well as the potential for serious side effects, especially with prolonged use.