Dear Doctor,

Thanks for your kindness. My question: Can stress cause low testosterone levels? What about viral infections causes the testosterone levels to fall? Thanks for helping us...

Hi,

Hypogonadism - decreased testosterone production - is quite common in HIV-infected men. Some studies indicate 45% of men with AIDS and 25% of asymptomatic HIV-positive guys have suboptimal testosterone levels. There are several potential causes, including 1) testicular dysfunction, i.e. damaged testicles from any of a variety of causes, including opportunistic infections; 2) drug side effects - especially megestrol acetate (megace), ketoconazole, and ganciclovir; 3) elevated cortisol levels - cortisol is an adrenal hormone produced in abundance during chronic infections as a normal body defense against physical stress. So what about psychological stresses? Well, stress/anxiety can definitely decrease libido, but not necessarily by decreasing testosterone output. Certainly if your testosterone level is low, you should try to determine the cause. Luckily, we now have effective replacement therapy that's convenient and effective in the form of patches or topical gel. If you happen to enjoy a bit of pain, intramuscular injections are also still available.

Hope that helps. And you are most welcome.

Dr. Bob