The effects of testosterone supplementation on health-related outcomes in HIV-infected men have not been rigorously examined in adequately powered, prospective studies. However, in several placebo-controlled trials, testosterone administration has been associated with improvements in several subdomains of health-related quality of life. For example, testosterone administration has been reported to improve depression indices in HIV-infected men (72). In a recent study, Pope et al. (73) administered a replacement dose of a testosterone gel or placebo to men with refractory depression and low testosterone levels. Testosterone administration was associated with greater improvements in scores on the Hamilton depression scale than was placebo. These preliminary data suggest that testosterone administration might have a clinically important antidepressant effect. In open-label, studies of healthy, hypogonadal men, testosterone replacement also improved positive aspects of mood and reduced irritability and negative aspects of mood (74). Wilson et al. (75) reported that lean body mass is an important determinant of health-related quality of life. Therefore, testosterone administration by increasing lean body mass might be expected to improve health-related quality of life; this hypothesis has not been rigorously tested. We do not know, however, whether physiological androgen replacement can produce meaningful changes in the quality of life, use of health care resources, and physical function in HIV-infected men. Emerging data suggest that testosterone does not affect HIV replication, but its effects on virus shedding into the genital tract are not known.
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