Normal Testosterone Levels May Not Be Enough

The following study by well-known researchers Wagner and Rabkin showed that HIV(+) men who had normal levels of testosterone (they were "eugonadal"), but had the symptoms of testosterone deficiency, responded to testosterone replacement therapy with a significant reduction in symptoms. The men in the study had blood levels of testosterone that were higher than 500 mg/dL, which is mid-normal.

HIV(+) men can exhibit hormonal resistance with several different hormones. This can mean that they do not respond with normal sensitivity to their body's own testosterone at blood levels that are in the normal range. Drs. Wagner and Rabkin have published several studies that have documented a syndrome of hormonal resistance to testosterone in HIV(+) men.

Testosterone therapy for clinical symptoms of hypogonadism in eugonadal men with AIDS. Wagner GJ; Rabkin JG Address Department of Psychiatry, New York State Psychiatric Institute, New York 10032, USA. Source Int J STD AIDS, 9(1):41-4 1998 Jan.

Abstract: We conducted a small exploratory study to assess whether testosterone therapy is an effective treatment for clinical symptoms characteristic of hypogonadism in eugonadal men with AIDS. Treatment consisted of 12 weeks of bi-weekly intramuscular injections of testosterone cypionate. Twenty-three men enrolled in the study; mean age was 37 and 44% were ethnic minorities. All had an AIDS diagnosis and the mean CD4 cell count was 150 cells/mm3. All baseline serum testosterone levels were within the laboratory reference range and above 500 ng/dl.

Diminished libido was an inclusion criterion, plus each patient had at least one additional symptom (low mood, low energy, loss of appetite and/or weight). Nineteen men completed the trial and a majority of patients responded with regard to libido (89%), mood (67%), energy (71%), and appetite (67%) as rated by the Clinical Global Impressions Scale. With the exception of appetite, self and clinician rated measures showed significant improvement in all symptom domains. Among the 14 study completers with significant weight loss, the average weight gain was 2.3 kg, with a 1.8 kg increase in body cell mass and no change in body fat. These results suggest that testosterone is as effective in treating these symptoms in eugonadal men with AIDS as we have found in our research with hypogonadal HIV+men.

Note the last sentence. This indicates that the "normal' scale for testosterone does not apply well to HIV(+) men, and that doctors should consider symptoms as much as they do blood tests to determine if testosterone replacement may be beneficial.

Michael Mooney