By Sam Baltrusis

Originally published on Advocate.com November 04 2009 10:00 AM ET

I’ve been HIV-positive for about three years and have started working with a physical trainer. I’ve always had trouble putting on muscle mass. (I was called “scrawny” in high school.) My trainer told me that doctors sometimes prescribe testosterone for people with HIV. Do you think this is something I should consider? Would it help me put size on faster? --Rob, Pasadena, Calif.

Most people know that testosterone -- like growth hormone -- is an androgen that your body produces, so you need to see a doctor to determine if your natural levels are in keeping with a “normal” medical reference range. The first question you should really be asking your doc is, “Are my natural levels of testosterone too low?”

If your natural levels fall below the normal reference range, you should weigh your options. There are many new delivery methods available -- from patches, gels, and creams to injections -- so be sure to have a robust discussion with your provider.

Incidentally, there are other screenings that your doctor can do, including for thyroid hormone, growth hormone, and free and total testosterone. Resulting levels can be taken into account before making a decision.

I’d do everything you can to enhance your natural levels of testosterone before you consider replacement therapy. Make sure that you are eating a balanced diet, taking a multivitamin, getting enough sleep, and avoiding excessive caffeine, alcohol, and nicotine. While it’s true that supraphysiological levels of testosterone and growth hormone will increase lean body mass, reduce fat, and improve well-being, the long-term effects are largely unknown.

Also ask your trainer to customize your workout. For instance, there’s some evidence that “multiple joint” exercises (such as the bench press and squat) may play a role in higher levels of post-workout testosterone in the people who do them.