Diagnosis and treatment of androgen deficiency in human immunodeficiency virus-infected men and women

Androgen deficiency is a common endocrine abnormality among men and women w ith human immunodeficiency virus (HIV) infection. Low testosterone concentr ations are associated with lower CD4 cell count, advanced stage of illness, medication use, and weight loss. Signs and symptoms may be nonspecific. Th e most useful laboratory indicator is the serum bioavailable (free) testost erone concentration. A number of different testosterone preparations for tr eatment of androgen deficiency in HIV-infected men now exist. Administratio n of im testosterone significantly increases weight and lean body mass, ene rgy, quality of life, and depression scores in HIV-infected men with low te stosterone levels. Newer transdermal and gel preparations provide more-cons istent steady-state dosing but are not as well tested, and sufficient testo sterone concentrations may not be achieved with their use. Androgen deficie ncy is also common among HIV-infected women. Preliminary studies suggest th at use of physiological testosterone administration, to achieve testosteron e levels within the normal range, is of benefit in HIV-infected women, but further studies are necessary to define the therapeutic role of androgen th erapy in this population.