Link Shown Between Men with HIV and Low Testosterone

A new study finds that low testosterone levels are associated with frailty and other health problems in men with Human Immunodeficiency Virus (HIV).

Researchers took blood samples from 1,359 men and measured morning serum total testosterone, luteinizing hormone (LH), estradiol, and HIV parameters.

Results from 212 of those subjects (15.6%) indicated low levels of total testosterone and 183 of them (13.4%) also suffered secondary hypogonadism.

The study team then turned to medical records to compare blood test results with Frailty Index and comorbidity data for each patient. They found a significant negative correlation between total testosterone levels and Frailty Index scores among all patients (r=0.302, r²=0.091) and an even stronger negative correlation among the men with secondary hypogonadism (r=0.403, r²=0.162).

What’s more, the percentage of men with total testosterone levels below 300 ng/dl increased significantly along with total comorbidities. Just 0.5% of men with no comorbidities had low levels of total testosterone, compared to 2.8% of men with one comorbidity, 8.5% of men with 2 comorbidities, 22.7% of men with 3 comorbidities, 25.5% of men with 4 comorbidities and 40% of men with 5 or more comorbidities.

Many previous studies have noted that men with HIV are more likely than healthy men to have low levels of total testosterone — often in conjunction with low levels of LH — but the authors of the new study, who presented their findings at the annual meeting of Società Italiana di Andrologia e Medicina della Sessualità, believe they are the first to show the negative correlation between testosterone and frailty among infected men.

Their work complements earlier research that has connected low testosterone levels with poor health in HIV patients.

A paper from the International Journal of STD & AIDS, for example, studied 587 men with HIV and found that low testosterone levels were associated with CD4+ cell counts below 200 cells/mm³ and opportunistic infections such as HIV wasting syndrome, oesophageal candidiasis, and dementia.

Unfortunately, the nature of the association remains unclear.

The virus itself might impair gonadal function and the resulting loss of testosterone production could make patients frailer and sicklier. In such a case, testosterone supplementation could theoretically keep patients hardier and healthier.

Other possible explanations for the association, however, suggest that supplementation would be counterproductive.

“Poor health status in HIV-infected men might be involved in the pathogenesis of hypogonadism,” the authors of the new study wrote. “This mechanism could reflect an adaptive response to illness in unhealthy patients similarly to what happens in other clinical conditions such as anorexia nervosa. Thus, low TT could be considered a biomarker of frailty and might confer an advantage for both the sick patients (in terms of sparing energy) and the species (preventing fatherhood).”

Another possible explanation for the association lies in the well-established tendency toward premature aging among patients with HIV. Declining testosterone levels and increasing frailty are both a normal part of the aging process for many men.

To date, very few studies have sought any biological explanation for the connection between HIV and low testosterone, so, according to the authors of the new study, “the underlying causes remain poorly understood.

“Moreover,” they write, “the role of HIV and/or HIV infection treatments, as well as the role of the general health status on the gonadal axis have been rarely investigated.”