- Sep 17, 2003
- 8,626
- 18
- 38
Steroid Legality and the Physician
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-by Michael Mooney
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The Anabolic Steroid Act of 1990 created grave misunderstandings about the legal status of steroids as medicines to the public and to the physicians trying to help their patients. This law states only that androgenic-anabolic steroids can not be prescribed for cosmetic or athletic purposes, but the impression it created was that steroids were off limits to everyone, and that they are basically illegal for any use. This is not the case. To compound this climate of fear, it seems that when this law was passed in 1990 several of the more conservative regional governing medical organizations made an effort to make doctors uneasy, giving them the impression that they would become the object of scrutiny if they prescribed steroids at all. However, times appear to be changing and it seems as if this attitude has been changing in recent years.
Testosterone and the androgenic-anabolic steroids have clear documentation that supports their medical use for numerous specific pathologies. These include various anemias, hypo-testosteronemia (inadequate testosterone production), muscle wasting diseases, angioedema, phenylketonuria (inability to metabolize the amino acid phenylalanine), weight loss, leukemia, breast cancer, and some other cancers. The scientific literature also shows that anabolic steroids may be useful for treatment of autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis, and lupus.
The physician who cares for HIV(+) patients has the legal right to prescribe anabolic steroids for medical use to any critically ill patient within the same specific guidelines that apply to numerous other medications used by critically ill patients.
For instance, if a patient measures at the low end of normal total testosterone (or below) or suffers from the symptoms of hypogonadism (low testosterone production), such as impotence, testosterone replacement is indicated. One study showed that the standard testosterone replacement dose of 100 mg per week (or 200 mg every two weeks) for HIV-negative men was inadequate for weight-gain in HIV(+) progressed men.(1) In HIV disease there is hormonal insensitivity, as was suggested by data provided in a study by Judith Rabkin, Ph.D., of New York, where she showed that HIV(+) hypogonadal men generally needed a higher testosterone replacement dose than the standard dose for HIV-negative hypogonadal men to experience the normal quality-of-life benefits. As described in the Anabolic Hormone Guidelines section, Dr. Rabkin found that her subjects needed to be given 400 mg every two weeks to respond favorably.(2)
In 1988, noted and frequently published endocrinologist Dr. Adrian Dobs of Johns Hopkins noted that about 50 percent of HIV(+) men are hypogonadal.(3) Dr. Steven Grinspoon found a similar situation with women.(5) When we consider this and Dr. Rabkin's data, perhaps as much as half of HIV(+) men and women need replacement testosterone, and men may need doses of testosterone that will bring them into the high range of blood testosterone measurement or slightly above. The physician should measure free testosterone, but also consider whether the patient is exhibiting the classic symptoms of hypo-testosteronemia (fatigue, lack of libido, sexual dysfunction, depression, muscle loss, and lack of appetite) to determine whether it is appropriate to administer testosterone replacement therapy. Monitoring both the patient's subjective feelings about their symptoms and their free testosterone blood levels two or three days after the fourth weekly injection will confirm whether the therapy is appropriate.
We also know knowledgeable doctors who do not measure testosterone because the measurements do not always mirror the patient's condition. Impotence, for instance, is a valid reason to prescribe testosterone, and we know doctors who prescribe testosterone for this indication when no weight loss is present. We have been told by these doctors that they do not measure testosterone because sometimes the measurements do not give an accurate representation of the person's condition. Often the person's response shows them that testosterone therapy is correct, regardless of the measurements.
Progressive Uses
The anabolic steroid analogs of testosterone, like nandrolone, oxandrolone, stanozolol, and oxymetholone are not appropriate for androgen replacement therapy by themselves, as they do not provide all of the characteristics that are necessary for normal androgen function. Their best use is as adjuncts to the use of testosterone as the fundamental androgen. They are generally used for improving lean body mass for people who have measurable loss of lean body mass; however, the most progressive physicians in several of the major metropolitan areas have been using anabolic steroids proactively before wasting occurs to improve lean body mass so that there is a sufficient reserve of lean body mass in case the patient suffers an opportunistic infection and experiences a rapid loss of lean body mass. This steroid-induced extra lean body mass can act as a buffer so that the patient doesn't ever fall into the danger zone as outlined by Dr. Donald Kotler, where he showed that loss of lean body mass to 54 percent of normal equals death.(4)
Progressive physicians are also administering anabolic steroids to people who typically are underweight normally, again, so that there is reserve lean body mass to burn in case an opportunistic infection occurs. An example of this would be a male who has always weighed 140 pounds at a height of 6 feet. This person is below the bottom of normal on the Metropolitan Life Insurance table. This person would have much better chances of surviving a catabolic infection, where he loses a significant amount of weight if he weighed 170 pounds. The primary consideration here is the person's overall health and ability to withstand infection-induced weight loss.
Cautious physicians are unlikely to employ the more controversial and aggressive uses of anabolic steroids if they feel that they might be challenged legally. However, in the major metropolitan areas, where numerous physicians are known to prescribe testosterone and anabolic steroids to hundreds or thousands of HIV(+) people, there is little likelihood of any legal problem, even though for steroids other than oxandrolone, weight gain is an off-label use. We know of doctors in each of the major cities who employ anabolic steroids very progressively, sometimes using very high doses and unusual combinations of different steroids that they have learned to tailor for specific patient needs. We are not aware of any physician in the United States who has ever been reprimanded for prescribing anabolic steroids for legitimate use in HIV therapy.
The use of anabolic steroids is currently being investigated in over a dozen studies funded by government and medical agencies, so we are fast approaching the day when we will see the kind of broad range acceptance that will yield an understanding that testosterone and anabolic steroids are a major part of the standard of care for HIV and HIV-related wasting. We believe that any physician in this country can prescribe anabolic steroids within the context of the guidelines we feature in this book without repercussion from any government agency or medical board. After all, it is a critical illness.
-
-by Michael Mooney
--------------------------------------------------------------------------------
The Anabolic Steroid Act of 1990 created grave misunderstandings about the legal status of steroids as medicines to the public and to the physicians trying to help their patients. This law states only that androgenic-anabolic steroids can not be prescribed for cosmetic or athletic purposes, but the impression it created was that steroids were off limits to everyone, and that they are basically illegal for any use. This is not the case. To compound this climate of fear, it seems that when this law was passed in 1990 several of the more conservative regional governing medical organizations made an effort to make doctors uneasy, giving them the impression that they would become the object of scrutiny if they prescribed steroids at all. However, times appear to be changing and it seems as if this attitude has been changing in recent years.
Testosterone and the androgenic-anabolic steroids have clear documentation that supports their medical use for numerous specific pathologies. These include various anemias, hypo-testosteronemia (inadequate testosterone production), muscle wasting diseases, angioedema, phenylketonuria (inability to metabolize the amino acid phenylalanine), weight loss, leukemia, breast cancer, and some other cancers. The scientific literature also shows that anabolic steroids may be useful for treatment of autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis, and lupus.
The physician who cares for HIV(+) patients has the legal right to prescribe anabolic steroids for medical use to any critically ill patient within the same specific guidelines that apply to numerous other medications used by critically ill patients.
For instance, if a patient measures at the low end of normal total testosterone (or below) or suffers from the symptoms of hypogonadism (low testosterone production), such as impotence, testosterone replacement is indicated. One study showed that the standard testosterone replacement dose of 100 mg per week (or 200 mg every two weeks) for HIV-negative men was inadequate for weight-gain in HIV(+) progressed men.(1) In HIV disease there is hormonal insensitivity, as was suggested by data provided in a study by Judith Rabkin, Ph.D., of New York, where she showed that HIV(+) hypogonadal men generally needed a higher testosterone replacement dose than the standard dose for HIV-negative hypogonadal men to experience the normal quality-of-life benefits. As described in the Anabolic Hormone Guidelines section, Dr. Rabkin found that her subjects needed to be given 400 mg every two weeks to respond favorably.(2)
In 1988, noted and frequently published endocrinologist Dr. Adrian Dobs of Johns Hopkins noted that about 50 percent of HIV(+) men are hypogonadal.(3) Dr. Steven Grinspoon found a similar situation with women.(5) When we consider this and Dr. Rabkin's data, perhaps as much as half of HIV(+) men and women need replacement testosterone, and men may need doses of testosterone that will bring them into the high range of blood testosterone measurement or slightly above. The physician should measure free testosterone, but also consider whether the patient is exhibiting the classic symptoms of hypo-testosteronemia (fatigue, lack of libido, sexual dysfunction, depression, muscle loss, and lack of appetite) to determine whether it is appropriate to administer testosterone replacement therapy. Monitoring both the patient's subjective feelings about their symptoms and their free testosterone blood levels two or three days after the fourth weekly injection will confirm whether the therapy is appropriate.
We also know knowledgeable doctors who do not measure testosterone because the measurements do not always mirror the patient's condition. Impotence, for instance, is a valid reason to prescribe testosterone, and we know doctors who prescribe testosterone for this indication when no weight loss is present. We have been told by these doctors that they do not measure testosterone because sometimes the measurements do not give an accurate representation of the person's condition. Often the person's response shows them that testosterone therapy is correct, regardless of the measurements.
Progressive Uses
The anabolic steroid analogs of testosterone, like nandrolone, oxandrolone, stanozolol, and oxymetholone are not appropriate for androgen replacement therapy by themselves, as they do not provide all of the characteristics that are necessary for normal androgen function. Their best use is as adjuncts to the use of testosterone as the fundamental androgen. They are generally used for improving lean body mass for people who have measurable loss of lean body mass; however, the most progressive physicians in several of the major metropolitan areas have been using anabolic steroids proactively before wasting occurs to improve lean body mass so that there is a sufficient reserve of lean body mass in case the patient suffers an opportunistic infection and experiences a rapid loss of lean body mass. This steroid-induced extra lean body mass can act as a buffer so that the patient doesn't ever fall into the danger zone as outlined by Dr. Donald Kotler, where he showed that loss of lean body mass to 54 percent of normal equals death.(4)
Progressive physicians are also administering anabolic steroids to people who typically are underweight normally, again, so that there is reserve lean body mass to burn in case an opportunistic infection occurs. An example of this would be a male who has always weighed 140 pounds at a height of 6 feet. This person is below the bottom of normal on the Metropolitan Life Insurance table. This person would have much better chances of surviving a catabolic infection, where he loses a significant amount of weight if he weighed 170 pounds. The primary consideration here is the person's overall health and ability to withstand infection-induced weight loss.
Cautious physicians are unlikely to employ the more controversial and aggressive uses of anabolic steroids if they feel that they might be challenged legally. However, in the major metropolitan areas, where numerous physicians are known to prescribe testosterone and anabolic steroids to hundreds or thousands of HIV(+) people, there is little likelihood of any legal problem, even though for steroids other than oxandrolone, weight gain is an off-label use. We know of doctors in each of the major cities who employ anabolic steroids very progressively, sometimes using very high doses and unusual combinations of different steroids that they have learned to tailor for specific patient needs. We are not aware of any physician in the United States who has ever been reprimanded for prescribing anabolic steroids for legitimate use in HIV therapy.
The use of anabolic steroids is currently being investigated in over a dozen studies funded by government and medical agencies, so we are fast approaching the day when we will see the kind of broad range acceptance that will yield an understanding that testosterone and anabolic steroids are a major part of the standard of care for HIV and HIV-related wasting. We believe that any physician in this country can prescribe anabolic steroids within the context of the guidelines we feature in this book without repercussion from any government agency or medical board. After all, it is a critical illness.