Anabolic-androgenic steroid therapy in the treatment of chronic diseases

The purpose of this study was to review the preclinical and clinical litera ture relevant to the efficacy and safety of anabolic androgen steroid thera py for palliative treatment of severe weight loss associated with chronic d iseases. Data sources were published literature identified from the Medline database from January 1966 to December 2000, bibliographic references, and textbooks. Reports from preclinical and clinical trials were selected. Stu dy designs and results were extracted from trial reports. Statistical evalu ation or meta-analysis of combined results was not attempted. Androgenic anabolic steroids (AAS) are widely prescribed for the treatment of male hypogonadism; however, they may play a significant role in the trea tment of other conditions as well, such as cachexia associated with human i mmunodeficiency virus, cancer, burns, renal and hepatic failure, and anemia associated with leukemia or kidney failure. A review of the anabolic effec ts of androgens and their efficacy in the treatment of these conditions is provided. In addition, the numerous and sometimes serious side effects that have been known to occur with androgen use are reviewed. Although the threat of various side effects is present, AAS therapy appears to have a favorable anabolic effect on patients with chronic diseases and muscle catabolism. We recommend that AAS can be used for the treatment of p atients with acquired immunodeficiency syndrome wasting and in severely cat abolic patients with severe burns. Preliminary data in renal failure-associ ated wasting are also positive. Advantages and disadvantages should be weig hed carefully when comparing AAS therapy to other weight-gaining measures. Although a conservative approach to the use of AAS in patients with chronic diseases is still recommended, the utility of AAS therapy in the attenuati on of severe weight loss associated with disease states such as cancer, pos toperative recovery, and wasting due to pulmonary and hepatic disease shoul d be more thoroughly investigated.