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HIV and Hypogonadism

Hypogonadism is a condition in which the gonads, or sex glands, cannot produce optimal amounts of hormones such as testosterone. This disorder is common in HIV patients, especially those with AIDS. Hypogonadism can be classified as primary, which means the problem stems directly from the gonads, or secondary, which means the problem is an effect of an abnormality elsewhere in the body. Although both forms have been documented in people living with HIV, secondary hypogonadism seems to more common.

Prevalence of Hypogonadism in People Living With HIV

Several studies comparing HIV positive males with age-matched, non-infected control groups have found significantly lower levels of unbound testosterone in men living with HIV. Half of male patients with AIDS or AIDS-related complex have abnormally low testosterone levels, and levels tend to decrease as AIDS progresses. Antiretroviral therapy seems to play a significant role in preventing reduced gonad functions, but about one-in-five HIV positive men who are on antiretroviral therapy and otherwise healthy still experience hypogonadism.

Symptoms and Diagnosis of Hypogonadism in People Living With HIV

Common symptoms of hypogonadism in HIV patients include:

- Loss of muscle mass
- Depression
- Fatigue
- Difficulty concentrating
- Decreased libido

Both men and women can be affected by hypogonadism, but symptoms are generally more prominent in male patients. As HIV progresses to its advanced stages, dramatic weight loss seems to precede a drop in testosterone levels; therefore, HIV patients who experience unexpected weight loss should have a blood analysis to test for hormonal deficiencies. While such deficiencies are common in female AIDS patients, the Endocrine Society discourages doctors from diagnosing women with a testosterone deficiency because data establishing normative levels of testosterone in women is currently lacking.

Treatment for Hypogonadism in People Living With HIV

For newly diagnosed HIV patients in the advanced stage of AIDS, antiretroviral therapy can sometimes reverse hormonal deficiencies. If hypogonadism persists while the patient is taking antiretrovirals, testosterone replacement may ease symptoms in male patients; the effectiveness of testosterone replacement for HIV positive women is still being studied. Testosterone replacement can involve taking pills, wearing patches coated with a special gel or receiving injections. Testosterone replacement therapies do not seem to interact with anti-HIV medications, but patients with a history of breast or prostate cancer should not undergo testosterone treatment.

References

http://myhivclinic.org/hypogonadism
http://www.ncbi.nlm.nih.gov/pubmed/11512091
http://www.ncbi.nlm.nih.gov/pubmed/11073758
http://www.hiv.va.gov/provider/manual-primary-care/androgen-deficiency.asp