Use of androgens in patients who have HIV/AIDS: what we know about the effect of androgens on wasting and lipodystrophy.

Decreases in energy, sense of well-being, libido, muscle strength, and muscle mass occur often in patients who have chronic diseases, such as HIV infection. When these symptoms were first recognized in HIV-positive patients, they were thought to be manifestations of HIV infection but may possibly be associated with hypogonadism. Most HIV-infected patients who have hypogonadism have secondary or central hypogonadism, not primary testicular failure. In HIV-infected hypogonadal men, administration of testosterone appears to increase fat-free mass, muscle mass, and quality of life (increased libido, erectile function, and sense of well-being). Similarly, anabolic steroid hormones appear to increase lean body weight and decrease fat content. Although androgens have been used for the treatment of HIV-related wasting and for hypogonadism, many questions remain unanswered, including those regarding the long-term effects, if any, of suppression of luteinizing hormone and follicle-stimulating hormone, as well as the long-term possibilities of malignancy of the prostate and of hepatocellular cancer. Appropriate doses of the various preparations of testosterone and anabolic steroids have not been determined.