-Thirty human immunodeficiency virus (HIV)-infected men were randomized to a high dose of nandrolone decanoate weekly (group 1) or nandrolone plus resistance training (group 2) for 12 wk. For the two groups, nandrolone had no significant effects on total cholesterol, LDL cholesterol, LDL phenotype, or fasting triglycerides, although triglycerides decreased by 66 Ϯ 124 mg/dl for the entire population (P ϭ 0.01). Group 2 subjects had a favorable increase of 5.2 Ϯ 7.7Å in LDL particle size (P ϭ 0.03), whereas there was no change in group 1. Lipoprotein(a) decreased by 7.3 Ϯ 6.8 mg/dl for group 1 (P ϭ 0.002) and by 6.9 Ϯ 8.1 for group 2 (P ϭ 0.013). However, HDL cholesterol decreased by 8.7 Ϯ 7.4 mg/dl for group 1 (P Ͻ 0.001) and by 10.6 Ϯ 5.9 for group 2 (P Ͻ 0.001). Percentages of HDL 2b (9.7-12 nm) and HDL2a (8.8-9.7 nm) subfractions decreased similarly for the two groups, whereas HDL 3a (8.2-8.8 nm) and HDL3b (7.8-8.2 nm) increased in the groups during study therapy (P Յ 0.02 for all comparisons). There was no evidence of a decreased insulin sensitivity in either group, whereas fasting glucose, fasting insulin, and homeostasis model assessment improved in group 2 (P Ͻ 0.05). These metabolic effects were favorable (other than for HDL), but changes were generally transient (except for HDL in group 2), with measurements returning to baseline 2 mo after the interventions were completed. anabolic steroids; lipoprotein(a); androgen therapy; insulin resistance; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; serum triglycerides THE PRINCIPAL USE of supplemental testosterone therapy is to restore eugonadal hormone levels in men with primary or secondary hypogonadism. However, treatment with androgens, including semisynthetic derivatives of testosterone, also has positive anabolic effects in subjects with cachexia due to severe burns (16), renal failure (32), chronic lung disease (51), cancer (13), and alcoholic hepatitis (44). Androgens also promote synthesis of myofibrillar proteins (53, 59) and are attractive therapies for sarcopenia in older individuals with frailty (19, 56). Thus it is likely that androgens will be further tested for a broad range of medical conditions.Androgens can also influence lipid and carbohydrate metabolism in both men and women. These effects include reductions in plasma triglycerides (30), HDL cholesterol (7,21,55), and lipoprotein(a) [Lp(a)] (41