HIV-associated hypogonadism

Hypogonadism in men with HIV disease is an ongoing concern, even among patients whose viral replication is under control and who have normalized CD4+ cell counts. Men with HIV disease may be more prone to a syndrome of "early andropause," marked by dysregulation of the hypothalamic-pituitary axis and the associated signs and symptoms. Testosterone is primarily bound to plasma proteins, mainly albumin and sex hormone-binding globulin; testing for levels of free testosterone may be necessary when total testosterone levels are equivocal. In managing patients with hypogonadism, forms of testosterone replacement that provide stable physiologic levels of testosterone may be preferable to those that result in supraphysiologic levels.