Morning free and total testosterone in HIV-infected men: implications for the assessment of hypogonadism
Open accessAbstract
BACKGROUND: Hypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART). Our objective in this study was to determine the prevalence of biochemical hypogonadism among HIV-infected men compared with HIV-uninfected controls. We also examined the use of free testosterone (FT) and total testosterone (TT) measurements in the assessment of biochemical hypogonadism in HIV-infected and -uninfected men. METHODS: This was a cross-sectional analysis from the Multicenter AIDS Cohort Study (MACS). TT levels were measured from archived serum using liquid chromatography-tandem mass spectrometry. FT was calculated from TT and sex hormone-binding globulin (SHBG) (measured by radioimmunoassay) using the Vermeulen equation. Biochemical hypogonadism was defined as having low TT, low FT, or both. RESULTS: Of 945 men in the MACS Cardiovascular Substudy, T assays were not performed in 89 because of insufficient/no stored serum (n = 18) or use of T replacement therapy (TRT) (n = 71). 530 men had morning (AM) T measurements; 364 (68.7%) were HIV-infected. The prevalence of biochemical hypogonadism was similar in HIV-infected (34/364 = 9.3%) and HIV-uninfected (12/166 = 7.2%) men. Prevalence of hypogonadism, when men on TRT (n = 71) were included in the group of hypogonadal men, was higher in HIV-infected (104/434 = 24.0%) compared with HIV-uninfected (13/167 = 7.8%) men (p < 0.0001). Of 34 HIV-infected men with biochemical hypogonadism not on TRT, 11 (32.4%) had normal TT, but low FT. Of 12 HIV-uninfected men with biochemical hypogonadism not on TRT, none were in this category (p = 0.04) - all had low TT. CONCLUSIONS: The prevalence of biochemical hypogonadism in our sample of HIV-infected men was approximately 10%, with a substantial proportion of these men having a normal TT, but low FT. The measurement of AM FT, rather than TT, in the assessment of hypogonadism in HIV-infected men will likely increase diagnostic sensitivity and should be recommended.
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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 [183]
The Results report that total testosterone alone would have missed 11 of 34 (32.4%) HIV-infected men with biochemical hypogonadism who were not on testosterone therapy. This is about one-third of that subgroup, not one-third to half of all study subjects; the paper does not report the half figure. (LLM, conf=0.88)
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References 19 · Cited by 56
Research works printed but not linked: 15
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- Authors
- Monroe, A. K., Dobs, A. S., Palella, F. J., Kingsley, L. A., Witt, M. D., & Brown, T. T.
- Affiliations
- Johns Hopkins University (US)
- Northwestern University (US)
- University of Pittsburgh (US)
- The Lundquist Institute (US)
- Corresponding author
- Monroe, Anne K
- Venue
- AIDS Research and Therapy
- Published
- 2014
- Volume
- 11
- Issue
- 1
- Pages
- 6
- ISSN
- 1742-6405 (ISSN-L)
- PMC
- PMC3900935
- OpenAlex
- W2158278031
- Cited by
- 56
- References
- 19
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 9 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 7 · 2017: 5 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 1
- FWCI
- 3.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- AIDS Research and Therapy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
- Funders
- Deutsches Krebsforschungszentrum
- National Institutes of Health (-35043, UL1TR000124, UL1TR001079, RR025005, RR00425, UO1-AI-35043, UO1-AI-35041)
- National Cancer Institute (UO1-AI-35039, UO1 AI35040, UO1-AI-35042, UO1 AI35041, UO1 AI35043)
- National Institute of Allergy and Infectious Diseases (UM1AI035043, UO1-AI 35043, UO1-AI35040, UO1‐AI‐35041, U01AI035040, UO1-AI35039, U01AI035041, U01AI035039, UO1-AI35042, U01AI035042)
- National Center for Research Resources (UL1RR025005)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- HIV infection, free testosterone, total testosterone, sex hormone-binding globulin, testosterone replacement therapy, antiretroviral therapy, Multicenter AIDS Cohort Study
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