Is Your Testosterone Level "Normal?"
Are you depressed or fatigued? Have you lost weight for no discernable cause? Have you experienced a loss in sex drive, or in men, a loss of erectile function? Have you suffered from muscle loss or the inability to grow muscle? Low testosterone levels, or hypogonadism, in both men and women may cause any, or all, of these symptoms.
Testosterone is the primary androgenic/anabolic steroid hormone in the body of men and women. It is produced primarily in the testes of men and in the ovaries in females. A testosterone level check is a routine blood test that your doctor can order. Insurance will almost always cover it, but the biggest difficulty seems to be getting your doctor to order the test. Research over the last few years has shown the importance of monitoring testosterone levels in both men and women. However, many physicians are either hesitant to order these tests (possibly due to the idiotic belief that we shouldn't be allowed to have regular sexual function for fear of the further spread of HIV), or unaware of the importance of testosterone in so many vital bodily functions.
What are considered "normal levels" of testosterone vary from individual to individual, and thus are a source of frustration for many people living with HIV. Different labs have varying ranges of what they consider normal with values ranging from the low 200s to over 1200 ng./dl. considered normal for men and from 15 to 70 ng./dl. considered normal for women. Much of the recent research suggests that people living with HIV should be in the upper range of normal, with men at ranges of at least 500 ng./dl. or higher. Jon Kaiser, M.D., author of Healing HIV, suggests that for peak health we should be in optimal ranges of 500 to 1000 ng./dl. of total testosterone levels for men, and 50 to 100 ng./dl. of total testosterone levels for women.
Recent research has also indicated that at least half of all men living with AIDS suffer from hypogonadism, and that as many as 33 to 66% of women also have lower than normal testosterone values. Additional research has connected hypogonadism with depression, mood disturbances, loss of appetite, inability to grow muscle, loss of libido, fatigue and reduced quality of life. Numerous studies have also shown that many PWAs suffering from wasting are hypogonadyl and that testosterone supplementation has resulted in gains in lean body and muscle mass, as well as improvements in quality of life and overall well-being. These results have been shown in both men and women.
Supplementing with testosterone is relatively inexpensive and becoming easier with the approval of the new gel formulation now available. Testosterone can be administered either by intramuscular injection, by patches, or by gel, which is rubbed into any hairless part of the body. Injections are the least expensive of the options, but also have the possibility of producing highly variable levels in the body. In other words, right after your injection, your testosterone levels are very high, and then they decrease through the time until your next injection. Weekly injections seem to be the most popular with the least negative effects of these varying levels. Patches give more constant levels of the hormone to your body but are sometimes embarrassing or cumbersome to wear. The new gel approved this past summer, Androgel by Unimed Pharmaceuticals Inc., is the easiest way to supplement testosterone as it is a clear gel that is rubbed into the skin once a day. This method produces the most stable testosterone levels; however, it is also more expensive than the other methods.
As with any other drug therapy, there can be side effects from testosterone supplementation. Testicular atrophy, or shrinkage of the testicles, is fairly common, as supplementing the body with testosterone can shut down the body's own production of this hormone. HCG, or human chorionic gonadotropin, can be administered either at the end of a testosterone cycle, or during the cycle, to kick start the testes into producing testosterone again, and will usually return the testes to near normal size. Cycling is the practice of taking breaks between applications of testosterone to give the body a chance to resume its own natural production. This seems to be more of an issue when injections are used, as opposed to the patches or gel. Other side effects can be acne, increased hair growth on the face and body, male pattern baldness, changes in sex drive (usually elevated). In women there may be menstrual irregularities, hoarseness, deepening of the voice, increased facial hair growth, clitoral enlargement, and also acne or thinning of hair. Among males there is also a concern of increased risk of prostate cancer. These side effects seem to be observed in a small percentage of patients, but you should always consult your physician if you notice any of these symptoms.
Testosterone level checks should be standard lab work, just as viral load, CD4 counts, CBC, etc. However, most physicians will not voluntarily check for this. Tell your doctor you want this lab work done. And when the lab work returns, if he/she tells you that your numbers are normal, ask for the actual number. Low range normal levels may not be optimal for us. If you are in the low normal range, you may benefit from testosterone supplementation.
"Testosterone" Binder at the Treatment Resource Center, AIDS Survival Project, Atlanta, GA.
"Blame It On Your Hormones," Lark Lands, POZ, November 1999, www.poz.com/archive/november1999/inside/blameiton.html.
"Testosterone Beats Fatigue," Kevin O'Leary, POZ, November 1998, www.poz.com/archive/november1998/partner/bigscience.html.
"Testosterone Replacement and Resistance Exercise in HIV-infected Men with Weight Loss and Low Testosterone Levels," JAMA, February 9, 2000, http://jama.ama-assn.org/cgi/content/full/283/6/763.
Testosterone Therapy in Women with Wasting, Loss of Periods," WISE Words, Project Inform, December 1999, http://www.thebody.com/pinf/wise_words/dec99/gender.html#testosterone.
"Built To Survive," Michael Mooney and Nelson Vergel, available through AIDS Treatment Initiatives, Atlanta, http://www.aidstreatment.org.
Medibolics website: http://www.medibolics.com.
"The Ball's in Your Court: Testosterone 101," November 1997, http://www.thebody.com/pwa/NFUnov97.html#test.
"The Use of Testosterone in the AIDS Wasting Syndrome," AIDS Clinical Care, April 1999.