Would you like steroids with that cocktail?

Tom O'Berg, who has AIDS, had forgotten what it was like to wake up with an erection. Although the protease inhibitor regimen he started a year ago gave him hope that he might still live a long life, O'Berg felt weak, skinny, and depressed. "Sex just wasn't important anymore," he said. That's when, under his doctor's guidance, O'Berg started supplementing his protease cocktails with anabolic steroids. Soon after, both his libido and his general health bounced back.

He's not alone. Spurred by positive reports at 1996's International Conference on AIDS and success stories such as O'Berg's, a growing number of doctors are prescribing anabolic steroids as a way to counteract the effects of decreased testosterone levels often caused by HIV. Used in combination with protease inhibitors, the same steroids publicized for their abuse in the sports world are now successfully fighting wasting syndrome (loss of lean body mass), skin problems, depression, diarrhea, thrush, and flagging libido.

"Anabolic hormones are relatively inexpensive and benign drugs that are needed not only to put meat on people's bones but to fight wasting syndrome and give people the motivation to live," said Michael Mooney, a nutrition industry insider and activist. As spokesman for the AIDS treatment and research advocacy group Program for Wellness Restoration, he has gained national recognition for educating HIV-positive people about lean tissue loss.

"Someone who couldn't get out of bed was put on a steroid regimen and is now shopping and decorating," Mooney said at a May 13 meeting on the subject attended by 200 people in West Holkwood, Calif.

But despite the drugs' apparent success and low cost, some are finding them difficult to obtain, he said: "Because steroids [which were banned for nonmedical purposes in 1990] are still perceived as illegal drugs by many doctors, many people with AIDS are dying due to the misconception that [steroids] can't be used medically--or because some doctors think it's unethical to boost the sex drive of a person with HIV."

Mooney said steroids work best when incorporated with increased protein consumption and micronutrient supplementation. Still, questions remain about proper dosage and whether it's important to supplement steroid treatments with human growth hormone and testosterone.

Almost no one at the West Hollywood meeting voiced dissent from Mooney's recommendations, but some AIDS activists take a more conservative approach. "I'm supportive of testosterone replacement only if people need it," said Ruben Gamundi, treatment education program manager at AIDS Project Los Angeles. He also stressed that people should work with physicians and not get steroids off the street. Used unwisely, "steroids can contribute to severe abnormalities in fat metabolism," he said.