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Fatigue and AnemiaFatigue and Anemia
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Mar 20, 2001


Response from Dr. Frascino


First of all, since this site is devoted to HIV-related fatigue and anemia, I'll assume your boyfriend is HIV-positive and that his low testosterone level is causing some fatigue, OK?

Hypogonadism - decreased testosterone production - is a very common problem in HIV-positive men. Testosterone is primarily produced in the testes and helps regulate men's moods, sexual function, nutrient metabolism, and energy levels. Approximately 45% of all people with AIDS have low testosterone levels, as do 25% of all asymptomatic HIV-infected individuals. There are several causes for decreased testosterone production, including testicular dysfunction (damaged testicles, possibly due to opportunistic infections), drug side effects (especially megace, ketoconazole, and ganciclovir), and elevations in the adrenal hormone cortisol, which is often increased during chronic infections as a normal body defense against physical stress.

No matter what the cause, the treatment is quite easy: Replacement therapy to bring the testosterone levels back into the normal range. This can be done with intramuscular injections, although this does tend to sting and is not the most physiologic method. By that I mean that an intramuscular injection gives your system a walloping dose of testosterone, often sending your blood levels very high, which may be fine if you're planning a particularly amorous weekend; however, these high levels can have a negative effect on other organs, particularly your prostate gland. Also, the blood testosterone level then falls gradually over a period of weeks, often falling back below the normal range before the next injection of "love juice." To prevent these highs and lows, other delivery systems, which are more similar to the human body's, have been developed. Transdermal testosterone patches, which were initially restricted to be worn on the shaved scrotum!) can now be worn on non-hairy areas of the body, such as the back, upper buttocks, etc., and have been very effective. Some folks don't like the idea of wearing one or several patches all day long. They can be inconvenient when changing into your gym clothes in the locker room. If you tend to toss and turn at night, they also sometimes come off. I occasionally find mine stuck to the bed sheets. Once, I awoke to find one of my patches on my dog. He loved it by the way. A new formulation of testosterone is now available. It's a gel formulation called Androgel. This can be rubbed in and is probably the most convenient formulation available now. Unfortunately, not all insurance companies (read: managed care) will pay for this preparation.

Now, if by chance your boyfriend is not HIV-positive, and by low testosterone you mean his sex drive isn't all that you would like it to be, well I'd suggest you address your question to "Dr. Ruth" or other "sexperts" who might be able to help you perk things "up" a bit.

Good luck.


Tired in ALABAMA

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