Dr. Bob,

1) What causes low testosterone in HIV+'s who are not on meds?

2) If we postulate that only a small amount of HIV is present in blood, and the rest settling in other compartments, what cells in those compartments does HIV infect? (I thought HIV's target was T cells which are in blood, or are Tcells somehow in other tissue also?)

3) Is there a link between serum viremia levels and low testosterone? (ie., HIV+ patient with lowered testosterone will have higher viremia, and as viremia escalates, testosterone will correspondingly decline?)

Thanks to you for your constant and tireless energy and for the sense of humor you display which no doubt gives many happiness and peace.

Hi,

1. Common culprits for causing hypogonadism include: a. Damaged testicles (usually from HIV-related infection, not the swift kick you got from your date last Saturday night). b. An elevation in the adrenal hormone cortisol. (Cortisol can go up to fight chronic infections.) c. Medications. (not only HIV-related medications, like ganciclovir and megace, but also drugs such as ketoconazole, an antifungal agent.) d. General wasting.

2. T-cells are almost everywhere. They are a subset of lymphocytes and can be found in lymph nodes, bone marrow, blood, and many other tissues. 3. Nope, no specific link between serum viremia and low testosterone.

Sense of humor? Yeah, OK, I'll buy that. Tireless energy? I wish!!!

Stay well.

Dr. Bob