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May 13, 2008

My question is in regards to testosterone levels, sex drive and production of semen. I test HIV positive in November of 2005. I think I converted to positive status in the summer of 05 as I got very ill, ran a high fever 102-103 for almost two weeks, extensive weight loss, 40 pounds (I typically weigh 175), no appetite. I did not have insurance at the time and had little contact with a physician until that November. Since that summer I have had no sex drive, and no production of semen. When my labs came back-in which I tested positive, my testosterone level was 10-or basically undetectable. Since then Ive been on testosterone replacement-Testim 1% daily. This has increased my testosterone level, at 800, and I do have morning erections-but no sex drive or semen production. Im currently on Atripla-began in November of 2007. My doctor sent me to a Endocrinogist, I had a MRI on my brain for any growths, and a colonoscopy. All tests came back ok. As a result my physician said it is just a result of my HIV status. My labs in the past year have been, April 07, T-cells, 140, Viral load 98,000. Since going on meds, my labs as of February 08 are T-cells 360, Viral Load 140. My question is this truly a result of HIV and cope with a future with no sex life? My physician does not seem invested in discussing this further or answering questions in this regard.

Response from Dr. Frascino


The evaluation of hypogonadism (low testosterone) in HIV-positive men can be complex. The first step is to check your hormone levels (luteinizing hormone and follicle-stimulating hormone) to determine if your hypogonadism is hypergonadotropic or hypogonadotropic. (See, I told you this was complicated.) Once that is determined, there are a number of potential causes for each type of hypogonadism. For instance, underlying causes for hypergonadotropic hypogonadism include: hormone resistance, gonadal defects, alcoholism, radiation side effects and mumps orchitis. Underlying causes of hypogonadotropic hypogonadism include: pituitary lesions (neoplasms, granulomas, infarction, hemochromatosis, vasculitis), hyperprolactenemia, genetic disorders, chronic diseases, nutritional deficiency, etc. An endocrinologist is the best subspecialist to help sort all this out. An HIV-knowledgeable endocrinologist would be your very best option. Your normal brain MRI was a good first step in excluding some of the potential underlying conditions. Perhaps the other conditions have also been appropriately evaluated. ("All tests came back OK.") Your testosterone level is now normal on supplementation and since you are experiencing morning erections, we can assume all your "equipment" is functioning normally. That leaves us with lack of libido ("no sex drive") and "no production of semen." I'm not exactly sure what you mean by "no production of semen." I'm assuming you are not able to ejaculate. Once again there is a medical evaluation for lack of production of ejaculation fluid and/or inability to ejaculate. You should discuss this problem with your HIV specialist and/or endocrinologist. The lack of sex drive in the setting of normal serum testosterone levels (and ability to have morning erections) may be due to psychological problems, particularly depression. A referral for counseling may help significantly. If your current HIV specialist is not willing to work with you to resolve these issues, you should consider getting a second opinion or switching to an HIV specialist with whom you have a better working relationship. Coping with HIV/AIDS is challenging enough. With the appropriate evaluation and management, I doubt you'll have to cope with "no sex life" in addition.

Good luck.

Dr. Bob

Murphy's Law
Anxiety panic attacks and ARV's

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