for Health Care Providers
Testosterone Therapy in HIV-Infected Men: Suboptimal Testing for Diagnosis and Monitoring
Very few data are available to gauge the possible benefits and adverse effects of long-term testosterone supplementation in HIV-infected men. Despite this, and despite concerns about possible risks of testosterone supplementation (eg, cardiovascular events, prostate cancer), testosterone continues to be widely prescribed for both HIV-infected and HIV-uninfected men in the United States.
A recent study examined testosterone use in the large combined cohort of the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) and identified several problems with current testosterone prescribing patterns. It found that, among 14,454 HIV-infected men without prior testosterone use, 10% were prescribed testosterone during the study period (1996-2011). Of the individuals who started testosterone, only two thirds of them had documentation of a testosterone level, and only 24% had laboratory-confirmed deficiency (defined as total testosterone <300 ng/dL). Thus, 76% were treated without laboratory evidence of testosterone deficiency. Additionally, after starting testosterone, only 25% of the group had a repeat testosterone level checked within 6 months as is recommended for monitoring.
Clinical Bottom Line
While its findings may not be generalizable to other populations, this study highlights very basic issues in the way testosterone is used in a large cohort of HIV-infected men. Given the uncertain benefits and risks of testosterone therapy, particularly when given for extended periods of time, it would seem particularly important to diagnose testosterone deficiency accurately and do appropriate monitoring of treatment. The Endocrine Society has published a useful set of guidelines on testosterone therapy that includes recommendations for diagnosis, treatment, and monitoring. About diagnosis they state, "We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels."
Bhatia R, Murphy AB, Raper JL, et al. Testosterone replacement therapy among HIV-infected men in the CFAR Network of Integrated Clinical Systems. AIDS. 2015 Jan 2;29(1):77-81.
Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59.