Hypogonadism in HIV-infected males
- Morris Schambelan, MD
Morris Schambelan, MD
- Professor Emeritus of Medicine
- University of California San Francisco
- Melissa Weinberg, MD
Melissa Weinberg, MD
- Assistant Clinical Professor of Medicine
- University of California, San Francisco
Hypogonadism was recognized as being relatively common early in the HIV epidemic. Low levels of testosterone in HIV-infected men may be associated with a variety of symptoms and signs including weight loss, muscle wasting, low bone mineral density, and decreased libido .
This topic will address hypogonadism in HIV-infected men. Issues related to sex hormones in HIV-infected women, such as menstrual irregularities, fertility, and pregnancy are found elsewhere. (See "HIV and women" and "Prenatal evaluation of the HIV-infected woman in resource-rich settings" and "Antiretroviral and intrapartum management of pregnant HIV-infected women and their infants in resource-rich settings".)
The general management and treatment of AIDS-associated tissue wasting is discussed in detail elsewhere. General information about hypogonadism in HIV-uninfected patients, testosterone replacement therapy, and patient monitoring are found in other selected topics. (See "Clinical features and diagnosis of male hypogonadism" and "Testosterone treatment of male hypogonadism" and "Treatment of osteoporosis in men".)
Testosterone is produced by the Leydig cells of the testes under stimulation of leuteinizing hormone (LH), which is secreted by the pituitary gland. Both LH and follicle-stimulating hormone (FSH) are required for the maturation of spermatozoa. Testosterone, in turn, inhibits gonadotropin secretion. Failure of the testes to produce physiological levels of testosterone results in the syndrome of hypogonadism.
Primary versus secondary hypogonadism — Hypogonadism can result from disease of the testes (primary hypogonadism) or disease of the pituitary or hypothalamus (secondary hypogonadism). Differentiation of the two types of hypogonadism has implications for patient evaluation and therapeutic interventions. (See 'How to distinguish between primary and secondary hypogonadism?' below.)
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- Primary versus secondary hypogonadism
- RISK FACTORS
- Liver disease
- CLINICAL PRESENTATION
- General approach
- Free testosterone versus total testosterone levels
- Caveats about when to test serum testosterone
- How to distinguish between primary and secondary hypogonadism?
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR TESTOSTERONE TREATMENT
- Patients with low libido and/or hypogonadal symptoms
- - Clinical trial data
- Patients with low bone mineral density
- - Clinical trial data
- Patients with weight loss and low lean body mass
- DRUG FORMULATION AND DOSING
- DURATION OF THERAPY
- ADVERSE EVENTS
- CAUTIONS REGARDING TESTOSTERONE THERAPY
- Caution regarding unintentional drug transfer
- Male infertility
- PATIENT MONITORING
- SUMMARY AND RECOMMENDATIONS