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Cited by 27Hormonal and reproductive studiesHIV-related health complications and treatmentsHypothalamic control of reproductive hormones

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The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience

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Pezzaioli, Letizia Chiara, Quiros-Roldan, Eugenia, Paghera, Simone, Porcelli, Teresa, Maffezzoni, Filippo, Delbarba, Andrea, Degli Antoni, Melania, Cappelli, Carlo, Castelli, Francesco, Ferlin, Alberto·2021·Infection
DOI 10.1007/s15010-020-01558-6PMC PMC7990869
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Abstract

Purpose: The 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. Methods: We 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. Results: Overt 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. Conclusion: Only 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.

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  • In HIV-positive men, underdiagnosis of male hypogonadism would have occurred in one third to half of the study subjects if only total T was measured as opposed to combining it with free T.

    “Moreover, in HIV-positive men, underdiagnosis of male hypogonadism would have occurred in one third to half of the study subjects if only total T was measured as opposed to combining it with free T [183, 184].”

    From Role of sex hormone-binding globulin in the free hormone hypothesis and the relevance of free testosterone in androgen physiology (2022) · cites this paper as [184]

    The Results report that measuring total testosterone alone would have missed 12 of 22 diagnoses in the 118-person group. The Discussion describes this as nearly half of diagnoses, and reports a one-third figure from another study. Neither figure refers to one third to half of all study subjects; the 12 missed cases were about 10% of that group. (LLM, conf=0.88)

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Research works printed but not linked: 24

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Metadata

Authors
Pezzaioli, L. C., Quiros-Roldan, E., Paghera, S., Porcelli, T., Maffezzoni, F., Delbarba, A., Degli Antoni, M., Cappelli, C., Castelli, F., & Ferlin, A.
Affiliations
  • University of Brescia (IT)
  • Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
Corresponding author
Ferlin, Alberto
ORCID
Venue
Infection
Publisher
Springer Science and Business Media LLC
Published
2020-12-08
Volume
49
Issue
2
Pages
295-303
ISSN
  • 0300-8126 (ISSN-L)
  • 1439-0973
DOI
10.1007/s15010-020-01558-6
PMC
PMC7990869
OpenAlex
W3110729192
Cited by
27
References
3
Citations by year
2026: 2 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 6
FWCI
3.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Infection (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by)
Funders
Università degli Studi di Brescia
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Infectious Diseases › HIV-related health complications and treatments
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
hypogonadism, HIV infection, sex hormone-binding globulin, free testosterone, total testosterone, luteinizing hormone, sexual symptoms, androgen deficiency, HIV duration
MeSH terms
Humans, Hypogonadism, Male, Retrospective Studies, Sex Hormone-Binding Globulin, Testosterone, HIV Infections

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