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Hypogonadism in HIV-infected males

Authors
Morris Schambelan, MD
Melissa Weinberg, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Howard Libman, MD, FACP

INTRODUCTION

Hypogonadism was recognized early in the HIV epidemic as being relatively common. Low serum testosterone levels in HIV-infected men may be associated with a variety of manifestations including fatigue, decreased libido and erectile dysfunction, weight loss, muscle wasting, and bone loss [1].

Hypogonadism in a male refers to a decrease in one or both of the two major functions of the testes: sperm production and testosterone production. These abnormalities can result from disease of the testes (primary hypogonadism) or malfunction of the hypothalamus or pituitary gland (secondary hypogonadism). (See 'Determining the etiology' below.)

This topic addresses hypogonadism in HIV-infected men. General information about male hypogonadism is discussed elsewhere. (See "Clinical features and diagnosis of male hypogonadism" and "Testosterone treatment of male hypogonadism".)

EPIDEMIOLOGY

The prevalence of hypogonadism in HIV-infected men has been observed to be lower since the advent of potent antiretroviral therapy (ART) and its earlier initiation in care.

Earlier studies of endocrine dysfunction among HIV-infected patients showed that 30 to 50 percent of symptomatic men had low total testosterone levels, often in association with weight loss and CD4 lymphocyte depletion, and that this finding was much more common than abnormalities in thyroid or adrenal function [2-5].

                         
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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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References
Top
  1. Wanke CA, Silva M, Knox TA, et al. Weight loss and wasting remain common complications in individuals infected with human immunodeficiency virus in the era of highly active antiretroviral therapy. Clin Infect Dis 2000; 31:803.
  2. Dobs AS, Dempsey MA, Ladenson PW, Polk BF. Endocrine disorders in men infected with human immunodeficiency virus. Am J Med 1988; 84:611.
  3. Raffi F, Brisseau JM, Planchon B, et al. Endocrine function in 98 HIV-infected patients: a prospective study. AIDS 1991; 5:729.
  4. Christeff N, Gharakhanian S, Thobie N, et al. Evidence for changes in adrenal and testicular steroids during HIV infection. J Acquir Immune Defic Syndr 1992; 5:841.
  5. Dobs AS, Few WL 3rd, Blackman MR, et al. Serum hormones in men with human immunodeficiency virus-associated wasting. J Clin Endocrinol Metab 1996; 81:4108.
  6. Dubé MP, Parker RA, Mulligan K, et al. Effects of potent antiretroviral therapy on free testosterone levels and fat-free mass in men in a prospective, randomized trial: A5005s, a substudy of AIDS Clinical Trials Group Study 384. Clin Infect Dis 2007; 45:120.
  7. Collazos J, Martinez E, Mayo J, Ibarra S. Sexual hormones in HIV-infected patients: the influence of antiretroviral therapy. AIDS 2002; 16:934.
  8. Bhatia R, Murphy AB, Raper JL, et al. Testosterone replacement therapy among HIV-infected men in the CFAR Network of Integrated Clinical Systems. AIDS 2015; 29:77.
  9. Slama L, Jacobson LP, Li X, et al. Longitudinal Changes Over 10 Years in Free Testosterone Among HIV-Infected and HIV-Uninfected Men. J Acquir Immune Defic Syndr 2016; 71:57.
  10. Rochira V, Diazzi C, Santi D, et al. Low testosterone is associated with poor health status in men with human immunodeficiency virus infection: a retrospective study. Andrology 2015; 3:298.
  11. Klein RS, Lo Y, Santoro N, Dobs AS. Androgen levels in older men who have or who are at risk of acquiring HIV infection. Clin Infect Dis 2005; 41:1794.
  12. Grossmann M, Gianatti EJ, Zajac JD. Testosterone and type 2 diabetes. Curr Opin Endocrinol Diabetes Obes 2010; 17:247.
  13. Zitzmann M. Testosterone deficiency, insulin resistance and the metabolic syndrome. Nat Rev Endocrinol 2009; 5:673.
  14. Rochira V, Zirilli L, Orlando G, et al. Premature decline of serum total testosterone in HIV-infected men in the HAART-era. PLoS One 2011; 6:e28512.
  15. Wunder DM, Bersinger NA, Fux CA, et al. Hypogonadism in HIV-1-infected men is common and does not resolve during antiretroviral therapy. Antivir Ther 2007; 12:261.
  16. Collazos J. Sexual dysfunction in the highly active antiretroviral therapy era. AIDS Rev 2007; 9:237.
  17. Misra M, Papakostas GI, Klibanski A. Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism. J Clin Psychiatry 2004; 65:1607.
  18. Bliesener N, Albrecht S, Schwager A, et al. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab 2005; 90:203.
  19. Cooper OB, Brown TT, Dobs AS. Opiate drug use: a potential contributor to the endocrine and metabolic complications in human immunodeficiency virus disease. Clin Infect Dis 2003; 37 Suppl 2:S132.
  20. Bannister P, Handley T, Chapman C, Losowsky MS. Hypogonadism in chronic liver disease: impaired release of luteinising hormone. Br Med J (Clin Res Ed) 1986; 293:1191.
  21. Dobs A. Role of testosterone in maintaining lean body mass and bone density in HIV-infected patients. Int J Impot Res 2003; 15 Suppl 4:S21.
  22. Tindall B, Forde S, Goldstein D, et al. Sexual dysfunction in advanced HIV disease. AIDS Care 1994; 6:105.
  23. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95:2536.
  24. Rietschel P, Corcoran C, Stanley T, et al. Prevalence of hypogonadism among men with weight loss related to human immunodeficiency virus infection who were receiving highly active antiretroviral therapy. Clin Infect Dis 2000; 31:1240.
  25. Martin ME, Benassayag C, Amiel C, et al. Alterations in the concentrations and binding properties of sex steroid binding protein and corticosteroid-binding globulin in HIV+patients. J Endocrinol Invest 1992; 15:597.
  26. de Ronde W, van der Schouw YT, Pols HA, et al. Calculation of bioavailable and free testosterone in men: a comparison of 5 published algorithms. Clin Chem 2006; 52:1777.
  27. Rosner W, Auchus RJ, Azziz R, et al. Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab 2007; 92:405.
  28. Arver S, Sinha-Hikim I, Beall G, et al. Serum dihydrotestosterone and testosterone concentrations in human immunodeficiency virus-infected men with and without weight loss. J Androl 1999; 20:611.
  29. Etzel JV, Brocavich JM, Torre M. Endocrine complications associated with human immunodeficiency virus infection. Clin Pharm 1992; 11:705.
  30. Cooley TP. Non-AIDS-defining cancer in HIV-infected people. Hematol Oncol Clin North Am 2003; 17:889.
  31. Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2014; 58:1.
  32. Rabkin JG, Wagner GJ, Rabkin R. A double-blind, placebo-controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Arch Gen Psychiatry 2000; 57:141.
  33. Kong A, Edmonds P. Testosterone therapy in HIV wasting syndrome: systematic review and meta-analysis. Lancet Infect Dis 2002; 2:692.
  34. Fairfield WP, Finkelstein JS, Klibanski A, Grinspoon SK. Osteopenia in eugonadal men with acquired immune deficiency syndrome wasting syndrome. J Clin Endocrinol Metab 2001; 86:2020.
  35. Abrams D. Use of androgens in patients who have HIV/AIDS: what we know about the effect of androgens on wasting and lipodystrophy. AIDS Read 2001; 11:149.
  36. https://www.endocrine.org/news-room/press-release-archives/2014/endocrine-society-calls-for-large-scale-studies-to-evaluate-testosterone-therapy-risks (Accessed on January 23, 2015).
  37. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm436280.htm (Accessed on April 14, 2015).
  38. US Food and Drug Administration. FDA adding general warning to testosterone products about potential for venous blood clots. https://www.fda.gov/Drugs/DrugSafety/ucm401746.htm (Accessed on October 09, 2017).