LOW DIHYDROTESTOSTERONE AND WEIGHT-LOSS IN THE AIDS WASTING SYNDROME

24 consecutive AIDS patients with wasting, and who had never received anabolic therapies, were evaluated to determine their profile of sex h ormones and whether transformation of testosterone (T) to the nuclear androgen, dihydrotestosterone (DHT), was impaired. Eleven (46%) patien ts had normal testosterone and DHT (group I), 10 (42%) had normal test osterone but low DHT (group II), and 3 (12%) had low testosterone and low DHT (group III). Age, prior opportunistic complications, symptoms, serum albumin, hemoglobin levels, and CD4 lymphocyte counts were simi lar in the groups. DHT was significantly lower (22.2 +/- 6.8 mu g/dl) in group II compared with group I (50.8 +/- 15.3 mu g/dl). The ratio o f T/DHT, a measure of the conversion of testosterone to DHT, in group I was 15.1 +/- 3.5, which was within the range for eugonadal young men . In group II, the ratio was 22.3 +/- 1.5, indicating a defect in gene ration of DHT. Patients in group II had lost 9.2 +/- 3.5 kg compared w ith 5.6 +/- 2.6 kg in group T (p = .015). Thus, a syndrome of low DHT with normal testosterone was associated with significantly greater wei ght loss than in patients with normal testosterone and DHT. Further st udies are needed to clarify whether low DHT is a result of AIDS wastin g or is causally related to weight loss and whether androgen therapy i n the form of DHT could reverse some of the metabolic changes associat ed with AIDS wasting.