Serum
testosterone concentrations are frequently in the low-normal range (lowest quartile, <500 ng/dl) in men with
AIDS-wasting syndrome (AWS) and in other chronic wasting disorders. The response of patients in this group to
androgen treatment has not been determined, however. Eighteen men with AWS (mean +/- standard error [SE]: 87% +/- 1% usual
body weight; CD4 count 90 +/- 24) and borderline low serum
testosterone concentrations (382 +/- 33 ng/dl) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular (i.m.) placebo (n = 7) with low-dose (65 mg/week; n = 4) and high-dose (200 mg/week; n = 7)
nandrolone decanoate, a
testosterone analogue.
Nitrogen balance, stable
isotope-mass spectrometric measurement of de novo lipogenesis (DNL), resting energy expenditure, and
gonadal hormone levels were measured. Both low-dose and high-dose
nandrolone resulted in significant
nitrogen retention (33-52 g
nitrogen/14 days, representing gains of 0.5 to 0.9 kg lean tissue/week) compared with placebo (loss of 11 g
nitrogen/week). This was reflected biochemically in a borderline significant reduction of high DNL (p < .06). Serum
testosterone and
gonadotropins were suppressed whereas resting energy expenditure was unchanged by
nandrolone treatment. In 10 study subjects completing a 12-week open-label follow-up phase,
body weight increased by 4.9 +/- 1.2 kg, including 3.1 +/- 0.5 kg lean body mass, and treadmill exercise performance also improved. In summary,
nandrolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial
nitrogen retention compared with placebo, similar in extent to the
nitrogen retention previously achieved with
recombinant growth hormone. It is reasonable to expand the criteria for
androgen treatment in AWS to include at least patients in the lowest quartile of serum
testosterone.