Living Well With Steroids

For the first years of the HIV epidemic, people with AIDS would literally waste away, their weight shrinking to starvation levels, as doctors looked helplessly on. The advent of the antiretroviral "cocktail" of meds in the mid-1990s greatly reduced wasting, but it still happens, especially in the developing world, where HIV is still often referred to as "the wasting disease."

Here in the U.S., the biggest reasons some people experience wasting include not taking meds, which is yet another reason why combination pills have become so crucial in helping pozzers stay healthy. But there are many other contributing factors to wasting, including poor appetite; side effects of various meds, such as nausea, lack of taste or dry mouth; lack of energy to shop or motivation to cook; and depression.

HIV causes the body to burn calories fast, which was one of the main reasons why so many people suffered wasting in those dark early years. In addition, over the years, as the body fights HIV infection, it develops hormone deficiencies that cause the body to lose nutrients, as well as get-up-and-go and, last but not least, sexual drive.

To stimulate the appetite, many people resort to a product that, since the '60s, has been infamous for bringing on the "munchies"; pot. HIV activists and organizations have been instrumental in changing drug laws. A pill form of the distillate in marijuana that increases appetite has been around for several years, although some people still seem to respond better to the real thing, whether smoked or added to food (like the recipe for brownies that made Gertrude Stein's love, Alice B. Toklas, so famous) than pills.

L.A. Doctors Saw It First

To combat wasting, build up muscle, and for overall health, doctors in the mid-'90s discovered another popular illegal drug: anabolic steroids. The same "juice" that athletes and bodybuilders have been taking for years for better performance or to get big fast was doing the same thing for long-term pozzers; that is, boosting testosterone, the hormone responsible for our sex drive as well as increased muscle mass.

Pozzers routinely suffer from low testosterone, which is responsible for a lot of the fatigue (and, in some cases, depression) often found in HIV-positive men. Nearly half of all HIV-positive men, by some estimates, may suffer from a testosterone level low enough to cause decreased appetite, depression, low libido, poor food metabolism and even HIV-related illnesses.

Not surprisingly, doctors in Los Angeles, the mecca of bodybuilding, first became aware of the beneficial effects of 'roids for people with HIV. A lot of these doctors had been prescribing them to bodybuilders on the down low, so they were more familiar with them. From there, anabolic steroid therapy began to creep into the mainstream.

In 1994, a researcher at Columbia University in New York conducted a pioneering study that found people with low CDR cells and testosterone levels showed improvement in their mood and sex drive. If steroids sound dangerous, compare the side effects of antidepressant medications.

It should be pointed out that HIV steroid therapy always involves a much lower dosage than Alex Rodriguez or Arnold Schwarzenegger would be taking, so liver damage, enlarged organs and other nasty side effects are significantly mitigated. Most doctors don't inject patients anyway; instead, they prescribe testosterone patches, which provide a much milder delivery (unless you cover yourself with them!).

Here, I should note that women also need testosterone, in far lower doses, and can also suffer from a lack of it. But because of the greater risk of side effects, testosterone therapy is much more rarely used for women. Studies, however, are ongoing, and some doctors are cautiously using the therapy in small doses for some women.

Advocates & Doctors

There are many success stories involving this therapy. Back in July, Dave Purdy wrote about his long-term experiences with steroids and HIV, which began in 1988 when he was working with a doctor in West Hollywood with a large gay practice and who was busted for juicing his HIV-positive patients. Purdy looked at the records of 13 AIDS patients, spoke to them and became an advocate of 'roid therapy.

One of the people Purdy has hooked up with in his work is Nelson Vergel, probably the most prominent - certainly the most ardent - HIV activist and promoter of anabolic steroid therapy. The subtitle of his book "Built to Survive" spells out his basic philosophy: "a comprehensive guide to the medical use of anabolic steroids, nutrition and exercise for HIV-positive men and women."

Unlike Vergel, the book's co-author, Michael Mooney, is HIV-negative. Like Purdy, Mooney was living in Los Angeles when he first became aware of steroid therapy.

Their enthusiasm for steroids encompasses lipodistrophy, that weird reaction to certain meds that causes wasting, usually in the face, but also fatty deposits appearing in other unlikely places on the body. They also believe that steroids can counter many of the side effects of long-term use of the meds cocktail.

The two men aren't necessarily pushing steroids, however; rather, they are passionate advocates for doctors to consider their use more than they do now. Not that many doctors don't; my own physician, Dr. Howard Grossman, the former executive director of the American Academy of HIV Medicine.

If you are experiencing any of the symptoms mentioned above, do your homework and talk to your doctor. If he dismisses steroid therapy out of hand, ask him if he ever has dispensed steroids. If he is adamant about it, and you believe that this can help you, don't be afraid to get a second opinion. Your doctor would probably advise you to do the same thing.

On the other hand, if you keep getting the same advice, then you should listen. And above all, don't think that this will become the magic bullet that will transform you into a he-man like those ancient Charles Atlas ads in the back of comic books.

That's not to say that steroid therapy for HIV patients doesn't come with that side effect. One of the most controversial aspects to this regimen is that a lot of HIV-positive guys do, indeed, look amazing.

Steroids can have beneficial effects for health, but if you want the added bonus of looking great, that will only come from hard work at the gym. But exercise provides as many benefits as a fistful of pills, so if getting juiced gets you motivated to work out, more power to you - in every sense of the word.

Steve Weinstein has been a regular correspondent for the International Herald Tribune, the Advocate, the Village Voice and Out. He has been covering the AIDS crisis since the early '80s, when he began his career. He is the author of "The Q Guide to Fire Island" (Alyson, 2007).

This story is part of our special report: "Keeping Fit with HIV". Want to read more? Here's the full list.