Do You Need More Testosterone?

We’ve all seen the commercials: attractive middle-aged men who’ve slowed down a bit due to low testosterone, using hormone replacement products to get their groove back. What they generally don’t mention is that low testosterone is a concern for people with HIV — not as much as it once was, but definitely for a certain growing subset of the population.

Before the advent of protease inhibitors and other highly effective HIV treatments, beginning in the mid-1990s, some people with the virus experienced severely reduced testosterone levels, says Octavio Vallejo, MD, MPH, who works in the treatment education department at AIDS Project Los Angeles. This is less common now, he says, due to the newer drugs and the fact that people are often beginning treatment immediately after diagnosis, before the virus has had a chance to do much damage to the immune system and other components of the body.

But by prolonging lives, the drugs have resulted in an aging HIV-positive population, and low T is a common problem for those over 50, Vallejo notes. The data on how many people are affected vary from study to study, but, for instance, an Italian study of 1,325 HIV-positive men published in 2012 found that 11 percent of participants in their 30s had testosterone deficiencies, 15 percent of those in their 40s, and 24 percent of those in their 50s. In contrast, only about 6 percent of HIV-negative men in their 40s and 50s have low T, the researchers reported.

Some loss of testosterone is common as men age, and replacement therapy isn’t indicated for everyone, Vallejo says, but he recommends that men experiencing certain complications — low sex drive, depression, fatigue, loss of bone density, or loss of muscle mass — have T levels tested and consider treatment. Testosterone gels and patches are widely available (by prescription), providing an easier means than injection for delivering the hormone.

There are potential complications. Some studies have shown increased risk of stroke or heart attack in men taking testosterone replacement therapy. There is some concern about a link to prostate cancer, but scientists say more research is needed on this. And a new study published in January by Italian scientists sees a link between low T and “frailty” in poz men but notes that this could be the body’s way of making HIV-positive people conserve their energy.

Although most people think of testosterone as a male hormone, women have testosterone too, and they can see similar complications from decreases in the hormone. Some researchers say testosterone replacement can benefit women as well as men, but the general feeling is that more study is needed. In 2013, the HIV Medicine Association of the Infectious Diseases Society of America recommended that even monitoring testosterone levels in HIV-positive women be done only in research settings.

Bottom line: If you have any of the symptoms associated with low T, talk frankly with your doctor to see if testing and replacement are warranted.