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Testosterone Treatment
Feb 10, 2010

Dr. Henry,

I have been infected for going on 9 years, but haven't started meds yet. I'm in this big debate on this issue, because my numbers have remained good--CD4 around 800 and vl always below 27,000.

I recently had a lot of fatigue after the holidays. I had some labs done. I was told the only thing out of whack was the total testosterone. Mine was 288..Normal Range is 250-1100. Testosterone Free was 55.6...Normal Range is 35-155. Testosterone Free % was 1.93.

My question: I've heard a lot of HIVers talk about taking testosterone treatment. I'm wondering if this is safe--such as like taking a vitamin. Or, should starting testosterone treatment be carefully weighed due to any possible side-effects that I don't know about?

If treatment is no big deal, then I suppose I would do it without hesitation to see if it helps. I realize the fatigue could be due to untreated HIV or possibly even depression. As I said, I debate everyday about whether to start HIV meds now at my numbers.

Thank you very much!

Response from Dr. Henry

Many males in general population and perhaps a higher percent of HIV+ males have low testosterone levels. The long term safety and benefit of testosterone supplementation has not been properly assessed despite the wide spread advertising and word of mouth testimonials. Hormone replacement in women has been extensively studied in large numbers of women for decades with complicated results but clear concern raised about safety of hormone replacement (increased risk for death) though often a benefit on quality of life. Once hormone replacement is started no end in sight in fact supplementation can suppress natural hormone production further worsening underlying problems. That being said many HIV+ men have taken testosterone at replacement levels and have reported less fatigue (though not guaranteed), increased libido, and less depression. There may be positive effects on bone health though data still limited. For now use of testosterone supplementation is a quality of life issue for most without strong moderate to long term data regarding benefits and risks ( is there an increased risk for heart disease or prostate cancer). Clearly more studies on this important topic need to be done and it will be a long time before good data is available on a par with data for hormone replacement in women. KH

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