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hypogonadism and hiv
Aug 19, 2011

hello greetings from Caracas Venezuela Doctor!, my query is, I have understood that suffer hypogonadism is common in HIV patients (30%), but that type of hypogonadism is the most attacks the patient? primary hypogonadism, secondary? On the other hand what kind of drugs can affect testosterone levels, antiretroviral therapy, antidepressants, recreational drugs etc. ..? I am patient with secondary hypogonadism starting HIV treatment with testosterone gel.

Response from Mr. Vergel

When someone is found to have low testosterone blood levels this is known as "hypogonadism" There are several types of hypogonadism:

Primary hypogonadism is a hypergonadotropic condition (higher than normal levels of LH and FSH). This occurs when the testicles fail to produce sufficient levels of testosterone to suppress produc-tion of LH and FSH. As a result, LH and FSH levels are elevated while testosterone levels are decreased. The pituitary gland tries to increase testosterone at no avail even after increasing LH and FSH.

Secondary hypogonadism results from hypothalamic or pituitary dysfunction. It is characterized by disruption of central components of the HPGA resulting in decreased levels of GnRH, LH, or FSH. In this type of hypogonadism, low levels of LH do not allow for the proper stimulation of the production of testosterone by the testes.

Mixed hypogonadism results from a combination of primary and secondary causes. The most common cause of mixed hypogonadism is late-onset hypogonadism, which occurs with aging. This is associated with osteoporosis, decreased lean body mass, reduced cognition, fatigue and impairment of libido and erectile function. Other causes of mixed hypogonadism include alcoholism, diseases (such as uremia, liver failure, AIDS, and sickle cell disease), street drugs/alcohol, and medications like corticosteroid steroids used for inflammatory conditions. It should be noted that high levels of cortisol (hypercortisolism), resulting from either the use of anti-inflammatory steroids or physical causes, could lead to hypogonadism.

Dr.Givanni Guaraldi at the Adverse Reactions Conference in Rome this year presented data that showed that the incidence of hypogonadism in healthy HIV+ males on treatment with a median age of 45 years of age was 16 percent which is similar to reported rates in HIV negative men 15 years older. He also found that the majority of hypogonadism cases were secondary in nature.

Nelson Vergel Author," Testosterone: A Man's Guide"



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