Abstract
PurposeThe prevalence of low testosterone and symptoms of hypogonadism in HIV-infected men is still debated. We aimed to estimate the prevalence and type of hypogonadism in HIV-infected males complaining about sexual symptoms, and to evaluate the role of calculated free testosterone (cFT) vs total testosterone (TT) for diagnosis. Furthermore, we evaluated relationship between sex hormone-binding globulin (SHBG), gonadal status and clinical and virologic parameters.MethodsWe retrospectively evaluated 169 HIV-infected men with sexual symptoms, with TT available. Among them, we selected 94 patients with TT, SHBG, cFT, and luteinizing hormone (LH) available, and classified hypogonadism into overt (low TT and/or low cFT) and compensated (high LH, normal TT and cFT). Comparison was performed by non-parametric Kruskal–Wallis test and Spearman’s correlation was calculated to verify the possible associations.ResultsOvert and compensated hypogonadism were found in 20.2% and 13.8% of patients, respectively. With reliance on TT alone, only 10.6% of patients would have met diagnosis. SHBG values were elevated in one third of patients, and higher in men with compensated hypogonadism. Significant positive correlation was found between SHBG and HIV infection duration, TT and LH.ConclusionOnly a complete hormonal profile can properly diagnose and classify hypogonadism in HIV-infected men complaining about sexual symptoms. TT alone reliance may lead to half of diagnoses missing, while lack of gonadotropin prevents the identification of compensated hypogonadism. This largely comes from high SHBG, which seems to play a central role in the pathogenesis of hypogonadism in this population.
Highlights
Since the early stages of HIV epidemic, hypogonadism has been recognized as a known frequent associated condition
We aimed to estimate the prevalence of true hypogonadism in HIV-infected males complaining about sexual symptoms, using different and gradually more specific biochemical criteria, to classify hypogonadism according to gonadotropin levels and evaluate the rate of misdiagnosis resulting from the use of TT alone versus a complete hormonal profile, including calculated free testosterone (cFT) and luteinizing hormone (LH) measurement
The addition of cFT in Group B allowed the identification of 12 further patients, who otherwise would have been considered eugonadal, with a neat increase in diagnosis rate of 2.2 times
Summary
Since the early stages of HIV epidemic, hypogonadism has been recognized as a known frequent associated condition. Hypogonadism is a clinical syndrome caused by failure of the testis to produce physiological amounts of testosterone and/or a normal number of spermatozoa, depending on alteration at different levels of the hypothalamic–pituitary–testicular axis [1]. For borderline levels between 2.31 and 3.46 ng/ml and in conditions with altered sex hormone-binding globulin (SHBG) levels (e.g., ageing, hyperthyroidism, liver disease, HIV infection), calculated free testosterone (cFT) determination could be helpful to reach a diagnosis [3], standard cutoff isn’t well defined. Determination of luteinizing hormone (LH) levels allows distinction between primary hypogonadism, with low TT levels and high gonadotropins, due to a direct testicular damage, and secondary forms, with low to normal gonadotropins, due to defects in hypothalamic–pituitary–testis axis [1]. Elevated LH with normal TT levels identifies the so-called compensated hypogonadism
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