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Untreated HIV and testosterone levels in woman

Jun 22, 2011

Hello Nelson,

I am a medical student based out of Prague and we are debating with a fellow member of the faculty regarding the testosterone levels in untreated long term HIV positive females. Can you please confirm that testosterone levels drop in females with long term untreated HIV and give us some more details (if you happen to have written a blog entry on that or if you have a document)?

On a side note, I would like to express my extreme admiration for you and all the work you do to help people manage their status and get healthy!

Thank you, Sandy

Response from Mr. Vergel

Dear Sandy

Thanks for the excellent question. I usually answer questions on testosterone in men but we have some data on testosterone in HIV positive women as well.

Your question specifies untreated HIV+ women. I am attaching a great paper by Dr Bhasin et al that found that the higher the HIV viral load, the lower the blood levels of testosterone in HIV+ women. In general, HIV+ women had lower testosterone than HIV- women. Low testosterone was not correlated to unintentional weight loss in Bhasin's data.

We know that testosterone supplementation in men and women who have testosterone deficiency tends to increase lean body mass, stamina, bone density, and sex drive. We have good data in HIV+ men but little in HIV+ women when it comes to testosterone supplementation, however.

In healthy women, the ovaries and the adrenal glands contribute equally to the maintenance of circulating testosterone levels. Bhasin tends to hint that there may be some HIV effect on the ovaries. The Use of a Sensitive Equilibrium Dialysis Method for the Measurement of Free Testosterone Levels in Healthy, Cycling Women and in Human Immunodeficiency Virus-Infected Women

A study showed that low dose testosterone supplementation in HIV+ women with unintentional weight loss increased lean body mass and strength. The study does not say how many of these women had low testosterone at baseline, however.

Effects of testosterone administration in human immunodeficiency virus-infected women with low weight: a randomized placebo-controlled study.

I want to clarify that high testosterone has been found in women with lipodystrophy. I have met many HIV+ women that have been on antiretrovirals for years who have some signs of masculinization. So, we have to be careful not to generalize the findings of Dr Bhasin's study (he did not mention if any of the women in his study had increased visceral fat).

Hyperandrogenemia in Human Immunodeficiency Virus-Infected Women with the Lipodystrophy Syndrome

I have not seen good data on the incidence of Polycystic Ovary Syndrome in HIV+ women. We know that PCOS in HIV- women tends to increase testosterone in them. Is there a link between PCOS in HIV+ women and lipodystrophy?

Dr Grispoon found that HIV+ women with severe lipodystrophy had no higher incidence of PCOS, but some other reports contradict this finding.

Absence of Polycystic Ovary Syndrome Features in Human Immunodeficiency Virus-Infected Women Despite Significant Hyperinsulinemia and Truncal Adiposity

So, as you can tell, testosterone blood levels in untreated HIV+ women may be lower than normal. In treated women with lipodystrophy, it is not clear if that is the case. In fact, some reports say that testosterone in those patients may be higher.

Most HIV+ women that I talk to have never had their testosterone blood levels checked. Unfortunately, most doctors in HIV practice do not do that in the United States, even in well insured women with symptoms of low sex drive, fatigue, loss of lean body mass, and menstrual irregularities.

I hope this reply did not confuse you!


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