Functional Hypogonadism and Testosterone Deficiency in Aging Males With and Without HIV-infection

Abstract

Introduction HIV infection has become a chronic, well-treatable disease and the focus of caretakers has shifted to diagnosis and treatment of comorbidities. Hypogonadism in elderly men with HIV might be of particular relevance, however, little is known about its epidemiology in contrast to non-infected peers and men with other chronic medical conditions, such as type 2 diabetes. This study aimed at comparing the prevalence of testosterone deficiency and functional hypogonadism in men ≥ 50 years in these three groups. Patients and Methods Multi-center, cross-sectional substudy of the German-wide 50/2010 study, including men aged 50 years or older with HIV-infection, type 2 diabetes, and controls. Results Altogether, 322 men were included (mean age: 62 years (SD±7.9)). The prevalence of testosterone deficiency in men living with HIV, type 2 diabetes, and controls was 34.5, 44.9, and 35.0%, respectively; the prevalence of functional hypogonadism was 7.7, 14.3 and 3.5%, respectively. Single-factor ANOVA demonstrated significant differences between the groups for total testosterone (p<0.001), SHBG (p<0.001), as well as for free testosterone concentrations (p=0.006). Comorbidities were, however, most important single factor in multi-factor analysis. Discussion Despite a comparable prevalence of testosterone deficiency, functional hypogonadism was more frequent in men living with HIV when compared to non-infected controls. This was the result of a higher burden of symptoms that might, however, also be secondary to other conditions. Number of comorbidities was a more important factor than belonging to one of the groups.

Correlation between different equations to calculate free testosterone for improved detection of hypogonadism in people living with HIV

“…21 In these types of hypogonadism – often classified as functional hypogonadism – pituitary gland LH and FSH levels are inappropriately normal or low. 22,23 The clinical relevance of such abnormalities in androgen levels depends on the presence of signs and symptoms of testosterone deficiency including fatigue, weight loss, loss of libido or erectile dysfunction or depressive symptoms. 23 However, some of these symptoms may be subtle and overlapping with those arising from co-existing co-morbidities and therefore a low threshold for suspicion of testosterone deficiency should be kept in PLWH.…”

“…12,25 This is particularly relevant in ageing men, in whom clinical diagnosis of hypogonadism is even more challenging as symptoms are often nonspecific and mimicked by other prevalent disorders. 21,22…”

New perspectives in functional hypogonadotropic hypogonadism: beyond late onset hypogonadism

“…Furthermore, drugs (especially opiates and HAART per se ) or opportunistic infections involving the hypothalamic-pituitary area, may have direct effects on the HPG-A, leading to its suppression. HIV- and AIDS-related lipodystrophy and wasting, characterized by changes in body fat distribution (including fat loss - lipoatrophy -, skeletal muscle loss and visceral fat accumulation) can also inhibit gonadotropin secretion through an increased aromatization of androgens to estradiol, in turn inhibiting the HPG-A ( 96 , 97 ).…”

Allopregnanolone and neuroHIV: Potential benefits of neuroendocrine modulation in the era of antiretroviral therapy

“…127,130,[148][149][150] The incidence of hypogonadism increases with age, HIV duration and lower CD4 + T-cell counts. [150][151][152][153] Men living with HIV experience a premature transition to andropause associated with a lower level of circulating testosterone, 127,131,[154][155][156][157][158] normal or low levels of luteinizing hormone, 127,131,159 a greater level of sex hormone binding globulin 150,155,160 and a greater estradiol-to-testosterone ratio. 159 Androgen deficiency increases the risk for central fat accumulation, cardiovascular diseases and frailty among HIV-infected men.…”