Testosterone supplementation of megestrol therapy
produces "robust" weight gain and preserves sexual function when given
with testosterone, but does not enhance lean tissue accrual in men with HIV-associated weight loss, according to researchers.
In the February issue of The Journal of Clinical Endocrinology &
Metabolism, Dr. Kathleen Mulligan of the University of California, San
Francisco and colleagues note that although HAART has helped reduce
HIV-associated wasting, weight and lean body mass are not fully or
consistently restored after its initiation.
Megestrol acetate, they add, can help by stimulating appetite and
promoting weight gain. However, much of the weight gained is fat.
To investigate whether testosterone might help increase lean body
mass, the researchers studied 79 HIV-positive men who had a body mass
index of less than 20 or who had lost 5% of their body mass. They were
randomized to receive megestrol 800 mg daily along with testosterone
enanthate 200 mg or placebo.
At 12 weeks, the combination group had gained a median of 5.3 kg and
the placebo group had gained 7.3 kg. However, lean body mass accounted
for 3.3 kg in both groups. There were no significant differences
between groups in the magnitude or composition of weight gain.
There were also no differences between groups in sexual functioning
at baseline. However, at the end of the study, sexual functioning was
unchanged or improved in the combination group, but worsened
significantly in the placebo group.
Dr. Mulligan told Reuters Health that "these results provide another
demonstration of the potent appetite-stimulating effects of megestrol
acetate. However, clinicians should be aware of the potent suppressive
effects of megestrol acetate on adrenal and gonadal hormones and
carefully monitor its use."
Commenting on the findings, author of an accompanying editorial Dr.
William J. Evans, added that "megestrol acetate suppresses testosterone
production, resulting in either loss of muscle -- or only fat as the
tissue added with weight gain -- as well as reduced libido and
impotence."
"Even replacing testosterone," concluded Dr. Evans of the University
of Arkansas for Medical Sciences, Little Rock, "appears to be
ineffective in adding muscle to the weight gain."
J Clin Endocrinol Metab 2007;92:420-421,563-570.
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