HI: I am 45 hiv possitive since 94 my vl is undetectable I am doing pretty well. the problem I am having is a low sex drive I am able to get a semi hard erection to reach orgasm but unable to keep and sustain to have intercourse my cholesterol and triglycerides are on the high side I have brought this to my doctors attention but she seems to think it is of little concern.I do not drink or smoke I started excercising 4 times a week and eating better. What I would like to know is should I start taking testosterone and is there a safe but affective way of doing this without testicular shrinkage and what kind of doctor would be best to see about this problem?

Hello,

Decreased libido and erectile dysfunction are common problems in men who are "virally enhanced." Certainly hypogonadism (low serum testosterone) is a common underlying cause. You can be checked for this condition with a simple blood test: the "free testosterone level." If your value is low, testosterone supplementation would be warranted. This can now be done with a convenient once-per-day self application of a gel (AndroGel or Testim). Testicular atrophy is a potential complication of testosterone replacement therapy, but your low-hanging bull balls aren't going to turn into Tic Tacs overnight. If you need testosterone replacement, the benefits far outweigh the risks.

If your testosterone levels are normal and your problem is limited to erectile dysfunction, a trial of Viagra or Cialis should be considered.

If your HIV specialist isn't comfortable handling these problems, I'd recommend you see an HIV-knowledgeable urologist.

Good luck. Things should be "up and coming" soon.

Dr. Bob