Anabolic Therapy Differences

Anabolic Steroids For AIDS Therapy: Differences Between Analogs
by Michael Mooney
from Issue No. 1 (Updated August, 1999)

The table on the following page is designed to clear up some of the misconceptions regarding anabolic steroids as therapeutic agents for AIDS-related wasting therapy. Specifically, some anabolic steroids are rather benign compared to other more problematic steroids. This table is a guide to weighing the relative risks to benefits for some of the common steroid analogs that are available in the United States and other countries. It merges anecdotal information from my survey of doctors and athletes over many years and the published data. Please note, studies show that anabolic steroids may be immuno-potentiating.(1 2 5 6) All anabolic steroids can inhibit the body's production of its own testosterone, and all can produce side effects when the dose is high enough. Note: Anabolic means muscle building power. Androgenic means masculinizing potential.




Effects/Side Effects/Reported Dosages

Nandrolone Decanoate
Trade name is Deca Durabolin
(injections) * * * * * low cost

Best steroid for men. Available in the U.S./foreign


medium to low

Some water retention, rather benign, 100-200 mg/week for men. One HIV study used 600 mg per week.Very good lean muscle growth, can be used by women @25 mg/ week (to 50 mg for severe wasting only), some chance of virilization for women, studies show improvements in immune metabolism.1, 6 Used without testosterone may decrease libido. Most effective for muscle growth when used with testosterone.

Trade name is Primobolan Depot
(injections) * *
A good steroid for women. Available according to FDA guidelines from Europe, Mexico.

low to medium

the lowest

The "cleanest", gentlest anabolic steroid, presents the least chance of virilizing, no water retention, 100-400 mg/week for men, 25-50 mg/week for women or more for severe wasting.

Especially safe for women.

Methenolone/ Primobolan
(Oral = tablets) *

Availability same as injectable version


the lowest

Same as above, 50-100 mg/day for men, up to 50 mg/day for women. This oral steroid is not 17-alkylated and is very safe for the liver, but very weak.

Oxandrolone (Anavar or Oxandrin)
(Oral - tablets) * * expensive

A best steroid for women. Oxandrin is now available in U.S. pharmacies.

low to medium with higher doses

very low

Some lean tissue growth over about 15 mg/day. Men need 20-50 mg/day, women 5-20 mg/day. New data presented in 1998 at the Geneva AIDS Conference by Grunfeld showed evidence of potential liver toxicity with doses of 40 or 80 mg per day with HIV(+) subjects, perhaps because it may interact with 3A4 p450 liver enzymes that metabolize protease inhibitors. Watch liver enzymes/GGT. Very gentle at low doses, though, but only weakly anabolic. Very small chance of virilization for women. Used without testosterone may decrease libido. Most effective for muscle growth when used with testosterone.

Trade name is Winstrol
or Stromba (injections) * * *

This product is not available in the US. I include it here because some PWA's obtain it from foreign sources and self-administer.

low to medium

nb: some people respond well, some don't


Good muscle growth, no water retention, very slight chance of virilizing for women, one drawback is injections need to be every 2-3 days. Pyrogenic (fever-causing). Watch liver enzymes/GGT readings as this water-based injectable is 17-alpha alkylated. Men - 50+ mg 3 times/week. Women/15 mg. 3 times/ week. Used without testosterone may decrease libido. Most effective for muscle growth when used with testosterone.

Trade name is Winstrol
(Oral = tablets) * * * low cost

Available in the U.S./foreign



Men need 6-20 mg/day, women 4- 10 mg/day, some chance of virilizing for women, no water retention, watch liver enzymes/GGT. Used without testosterone may decrease libido. Most effective for muscle growth when used with testosterone.

Trade name is Anadrol 50
(Oral = tablets) * * *
medium cost for dose needed to be effective

very high


10 - 100 mg/day. Most powerful muscle-building oral anabolic steroid. Potential for hair loss, high blood pressure, water retention, gynecomastia, body hair growth. Watch liver enzymes/GGT. Works very well for some with no problem, others experience side effects, mostly water retention/hair loss, etc. Like testosterone, Anadrol supports healthy libido. We recommend using it alone, as combining it with testosterone may promote androgenic side effects.

Testosterone Cypionate
(Injections) * * * * * low cost

Available in the U.S./foreign



Good lean muscle growth at higher doses - Study by Bhasin used 600 mg per week. Water retention, potential for hair loss, acne, gynecomastia. HIV(+) men need 100-200 mg/week for testosterone replacement. Strong effect on libido and energy. May virilize women, see note #3. Rare allergic effect seems to come from cottonseed oil carrier.

Testosterone Enanthate
(Injections) * * * * * low cost

Available in the U.S./foreign



Same as testosterone cypionate, but does not seem to cause the same rare allergic effect. Enanthate is a more "natural" ester.

Note: Five stars = highest rating; one star = lowest rating. Some good muscle-building steroids are given lower ratings because they may be more problematic. That is, there may be more potential for side effects.

1. Nandrolone decanoate, a generic drug, costs about $14.00 (California price) for a 200 mg bottle, whereas Deca Durabolin (trade name by Organon) costs about $35.00 for the exact same compound. If possible buy the generic version. (Update: May, 1999 - generic nandrolone is currently unavailable, and the manufacturer may not ever make it again.)

2. Some studies show that specific anabolic steroids have beneficial effects on specific immune functions.(1 2 5 6) Differences in how specific anabolic steroids affect the immune system in HIV should be studied. Many AIDS doctors prescribe testosterone and the other anabolic steroids and see improvements in immune markers, such as CD8 T cells. Studies show that testosterone can delay the progression of immune diseases, like the autoimmune disease lupus.(7) Data suggests that they may improve useful immune function in AIDS.

3. Oral/tableted steroids are 17-alpha alkylated. This presents a burden to the liver that can cause an increase in liver-specific blood tests because they may be somewhat toxic to the liver, in a dose-dependent manner. Injectable steroids, except injectable stanozolol (not sold in the US), which is 17-alpha alkylated, do not cause any significant liver burden.(3 13) Injectable steroids are generally preferred over oral steroids for this reason. However, injectable steroids may appear to cause elevations in multi purpose liver function tests (SGOT, SGPT, and LDH) during increased muscular stress or other stress in the body. Steroid-free athletes with high metabolic and muscular stress may show some elevation of some of these blood tests, too. Numerous other drugs also elevate these blood tests. Liver test elevations usually reverse with cessation of the steroids. Anecdotal evidence from competitive bodybuilders who use steroids in high doses, and published data in the medical literature suggest that the incidence of liver toxicity from oral steroids is somewhat exaggerated and rarely creates severe problems in healthy humans. I suggest that physicians be particularly sensitive to the discrete liver readings bilirubin, GGT, and the liver isoenzyme of LDH. Data suggests that these are more consistent indicators than the multi-purpose liver tests, like SGOT and SGPT, when looking for potential liver problems related to anabolic steroids.(11 12) Of course, it is prudent to respond to all liver function tests when pharmacology is complicated with compounds like the common AIDS medications.

4. "Virilizing" means masculinizing. This can mean increased body hair growth, a deeper voice, etc. in males and females. Women may find that they start to get oily skin and acne, grow dark peach fuzz or a mustache or other body hair, have itching of the clitoris followed by increasing clitoral size, or develop other "male" characteristics with continued administration of steroids that are somewhat androgenic. These problems sometimes reverse if the steroid dose is not too high and steroid use is stopped immediately when side effects are detected.

5. "Anabolic" means growth of muscle and is desirable for wasting therapy. Optimal lean body mass is highly correlative with survival in AIDS.(4) While increased "androgenic" potential can mean more potential for side effects and virilizing, some androgenic potential is necessary for healthy metabolism as natural androgenic activity is necessary for libido, energy, and healthy brain chemistry. Generally speaking, the less androgenic a steroid is, the less side effects there will be. However, all anabolic steroids have some androgenic potential, and steroids that have very low androgenic potential also usually have very low anabolic activity.

6. The upper dosage listed for women is usually for severe wasting only. Women's bodies do not tolerate anabolic steroids as well as men in general, so doctors agree that it is best to be conservative in the dosages, except in special circumstances where there is severe wasting. The steroids that are more androgenic, like testosterone, may not be problematic if the dosage is appropriately low. It is wise to consider starting at the lowest dosage possible when women use androgens/steroids.

References cited:

  1. Ooshika, N, et al. Effect of an anabolic steroid on cellular immunity and postoperative evaluation of uterine cervical cancer. Jap J of Canc Chemo (1984) 11(10):2177-2184.

  2. Mendenhall, CL, et al. Anabolic steroid effects on immune function: differences between analogues. J Ster Biochem Molec Biol (1990) 37(1):71-76.

  3. Marquardt, GH, et al. Failure of non-17-alkylated steroids to produce abnormal liver function tests. J Clin Endocrinol (1964) 24:1334-1336.

  4. Kotler, DP, et al. Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr (1989) 50:444-447.

  5. Calabrese, LH, et al. The effect of anabolic steroids and strength training on the human immune system. Med Sci Sports Exerc (1989) 21(4):386-392.

  6. Huys, JV, et al. Effect of nandrolone decanoate on T-Cell lymphocytes during radiotherapy. Clin Therap (1979) 2(5):352-357.

  7. Ansar, AS, et al. Sex hormones, immune responses, and autoimmune diseases. Mechanisms of sex hormone action. Am J Pathol (1985) 121(3):531-551.

  8. Ehriches, L. Testosterone may prevent AIDS wasting. Fam Pract (1994) Oct. 10:36.

  9. Jekot, WF, et al. Treating HIV/AIDS patients with anabolic steroids. AIDS Patient Care (1993) April; 7(2):11-17.

  10. Gilden, D. Weight loss: a role for growth hormone and anabolic steroids. AIDS Treatment News (1993) Nov 19; 187:16.

  11. Haupt, HA, et al. Anabolic steroids: a review of the literature. Am J Sports Med (1984) 12(6):469- 484.

  12. Dickerman, R, et al. Gamma glutamyl transpeptidase, aminotransferases, and anabolic steroids. Clin J Sport Med (1999) Jan;9(1):34-39.

  13. Welder, AA, et al. Toxic effects of anabolic-androgenic steroids in primary rat hepatic cell cultures. J Pharmacol Toxicol Meth (1995) 33(4):187-195.

Disclaimer: This article is provided for educational purposes only, and is in no way a substitute for the advice of a qualified medical doctor or a recommendation to do other than your doctor determines is best for you. You should present this information to your doctor for their analysis because appropriate medical therapy and the use of pharmaceutical compounds like anabolic steroids should be tailored by a knowledgeable doctor for the individual as no two individuals are alike. I do not recommend self-medicating with any pharmaceutical drug as you should consult with a qualified medical doctor who can determine your individual situation. If you use the information I present without the approval of your doctor, you do so strictly at your own risk and no responsibility is implied or intended on my part.

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