I am an Italian and have been positive for 20 years. After having tried unsuccesfully almost all the available drugs (multi resistant) I am now on a Prezista+Norvir, Fuzeon, Videx, Emtriva and for the very first time my viral load is undetectable. My testosterone (free and total) level have been chronically UNDER the lowe partb of the normal range. My doctors here are not familiar with testosterone replacement. Which could be an appopriate therapy for restoring my normal level? Thanks a lot Giorgio, Roma

Buon giorno Giorgio from Roma!

Comme sta?

Hypogonadism (low testosterone level) is a remarkably common condition for those of us who are "virally enhanced." Replacement therapy is certainly warranted if your free testosterone has been chronically below the normal range and you don't have any contraindicating conditions, such as prostate cancer. Testosterone replacement can be accomplished via intramuscular injections every one to two weeks or by the self-applied daily gels (AndroGel or Testim, for instance). I prefer the daily preparations, as they are more physiologic, i.e. more similar to what the body usually experiences. Besides, shots are inconvenient and they hurt! You can read much more about hypogonadism and testosterone replacement therapy in the archives.

Buona fortuna, Giorgio!

Dr. Bob