Early studies (1-4) suggested that as many as 30-50% of HIV-infected men have serum testosterone levels that are below the lower limit of the normal range for healthy, young men. For instance, Dobs et al. (1) reported that 50% of HIV-infected men had low testosterone concentrations. Grinspoon et al. (2) described a reduction in free testosterone levels in 49% of HIV-infected men with AIDS wasting. In a prospective survey (5) conducted in 1998 during the early days of protease inhibitor therapy, we prospectively measured serum total and free-testosterone and dihydrotestosterone (DHT) levels in 148 consecutive HIV-infected men and compared the results to 42 healthy men. Thirty-one percent of HIV-infected men had serum testosterone levels less than 275 ng/dL, the lower limit of the normal male range (5). Overall, serum testosterone, free-testosterone, and DHT levels were lower in HIV-infected men than in healthy men, but serum DHT-to-testosterone ratios were not significantly different between the two groups. Serum total- and free-testosterone levels were lower in HIV-infected men who had lost 5 lb or more of weight in the preceding 12 mo than in those who had not lost any weight (5).
With the advent of highly active antiretroviral therapy, the prevalence of low testosterone levels has decreased. However, more recent studies (6,7) in patients treated with antiretroviral drug therapy suggest that androgen deficiency continues to be a significant clinical problem in HIV-infected men. For example, Rietschel et al. (7) reported that 21% of HIV-infected men with weight loss who were receiving highly active anti-retroviral therapy had low free-testosterone levels.
Almost 80% of HIV-infected men with low testosterone levels have low or inappropriately normal luteinizing hormone (LH) concentrations (5); these patients have hypogonadotropic hypogonadism, whereas the remaining 20% have high LH concentrations, consistent with primary testicular dysfunction. Thus, the pathophysiology of androgen deficiency in HIV-infection is complex and involves dysregulation at all levels of the hypothalamic-pituitary-testicular axis.
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