I have recently noticed more fatigue, My viral load has been undectectable for 3 years and my CD4 has been dropping slowly(currently 180). I hear some opinions that the health of the immune system is judged more by viral load (lack of it) and another school of thought that indicates cD4 count is a better overall measure.

I have a total testosterone of 161...the normal range on the test indicates 241-827.

Considering my overall fatique should I consider testosterone replacement therapy? Are there significant risks associated with such therapy?

Immune fuction is influenced by CD4 nadir, current CD4 and CD4% and viral load. In general a CD4 more than 200 or 15% should be 'enough' and anything above 450 or 30% is normal. Immune function seems better in persons with suppressed virus and a more normal CD4:CD8 ratio. Low testosterone should be considered for treatment if it is confirmed by a low free testosterone, persistent over, say, 3 months, not the results of other interventions (anabolic steroids, megestrol...recovery my lake longer after these agant have been used) and associated with symptoms (fatigue, loss of libido) or signs (anemia, muscle loss). The preferred agent is androgel as this produces a stable 'physiological' level of testosterone over the day. The aim is to supplement into the upper half of the normal range. The risks are few but, if you don't gain symptmatic benefit after a month or so there is little value in continuing. I hope this helps Regards Graeme Moyle