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Headlines: Today in Health

Macho Men: Testosterone and AIDS

By Deborah Gardiner



"Every time I go off the testosterone ... I slump back into my fatigue. I have come to terms with the fact that right now, I have to take testosterone in order to be well."



Steve Kovacev spent the spring of 1994 in bed, dying from AIDS. His immune system had crashed completely. He lay emaciated, fatigued and horribly depressed.

Kovacev treated himself with holistic remedies — juices, a vegetarian diet, running, meditation and lots of supplements. But nothing worked. Nothing, that is, until he shook himself free of depression and got himself to a doctor who recommended testosterone.

Pumping up with a purpose

Using testosterone — the hormone touted as the essence of manhood — has been controversial for years. Some Americans are outraged by testosterone abuse by athletes and women body builders, while others associate increased testosterone with violence.

All that bad press tends to obscure an important medical use for the hormone: fighting body wasting and fatigue in HIV positive men.

For Kovacev, testosterone wasn't a magic cure, but it helped. Within four months of using the testosterone replacements, he was making great strides. His body stopped wasting and he even began gaining weight.

"There isn't an immediate rebound after the testosterone," said Kovacev, "but every time I go off the testosterone ... I slump back into my fatigue. I have come to terms with the fact that right now, I have to take testosterone in order to be well."

Size matters

Experts have known for some time that a decreased testosterone level is directly related to body wasting in HIV positive men. And in 1995, the World Health Organization reported that body wasting was the number two cause of death in AIDS patients.

Michael Mooney, author of Built to Survive, a comprehensive text on the subject, said that for HIV patients, losing body mass equals death.

"The studies show that if AIDS patients lean body mass decreases to 54 percent of their normal weight, they die. If they are given the medically appropriate dose, testosterone can cause considerable gain in body weight," said Mooney.

Prescribed as a shot, pill, patch and soon as a gel, testosterone works by building muscle tissue.

"In men this causes soft skin, soft shiny hair, increases the libido and causes peripheral circulation in the body," explained Mooney.

"Over time, brain health and bone health is also aided," he said. And in addition, "a small amount of testosterone converts to Dihydrotestosterone — a hormone that we think affects drive, energy and motivation. Having a small amount of DHT is also part of a healthy metabolism."

Testimonies from people with AIDS seem to back these claims. Nelson Vergel, 41, an HIV positive survivor for 17 years, reports that he is able to lead a fairly active life by taking copious vitamins, anabolic steroids and injecting himself with 200 milligrams of testosterone every week or two.

"I started testosterone replacement therapy in 1994 when I was tired, thin, depressed, had lost my sexual drive and suffered from diarrhea. With testosterone as the baseline of my therapy, I was able to go from 140 pounds to 165," said Vergel, who is now executive director of two non-profit AIDS organizations in Boston. Aside from needing a nap everyday at two o'clock, he says he leads a fairly normal life.

More than anecdotal

More and more, a growing body of research substantiates these claims. At last month's Americans for AIDS Research Conference in San Francisco, Dr. Nichalaos Bellos, an HIV physician based in Dallas, TX presented data stating that "with 20 mg of oxandrolone (an anabolic steroid) and 100 mg of testosterone daily, after four months the average weight gain of HIV patients was over six pounds and the average lean body mass gain was nearly five pounds."

While the research seems promising, some physicians remain skeptical. Dr. Lawrence Goldyn, an HIV physician in San Francisco is not dazzled by the findings. In his experience, testosterone has only a marginal benefit to AIDS patients.

"Testosterone is not this panacea that changes your life. It is another piece of the whole structure in helping an AIDS patient's sense of well being. ... In some patients it doesn't work at all."

Goldyn added that the side effects are hardly paltry. "A lot of men develop acne, an increase growth in body hair, balding and men's testes may shrink."

Moody also named other side effects. Testosterone replacement shots, he explained, can cause polychtemia, or overproduction of red blood cells, and hypertension. And the oral testosterone drugs (though not the injections) can also be hard on the liver.

Another concern is that testosterone can produce wacky hormonal patterns in the patient's body. Tim Teetar, treatment support specialist for the San Francisco Aids Foundation says his patients report feeling a little speedy for the first 24 hours from having too much testosterone at one time.

"There is a lot of 'peak and a trough' with patients on testosterone. This means a maximum concentration and a minimum concentration in the body. Kind of like how a roller coaster hits highs and lows," Teetar said.

But all of these drawbacks may come to an end this summer when a pharmaceutical company called Unimed, releases Androgel — a testosterone gel that, according to Mooney, is the most natural way to deliver the testosterone.

"The gel will have much less potential to cause the hypertension and the polychtemia. Which is why it is so exciting coming closer to mimicking the natural release of testosterone in the body," Mooney said.

Kovacev agrees that the continued development of testosterone treatments is good news. "I know that I have buried lot of friends who would not have died had they had access to testosterone treatments."

From New Zealand, a nation of travelers, Deborah Gardiner is a freelance journalist based in San Francisco. If you have questions or comments, she can be reached at kiwichick@earthlink.net.




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