Hypogonadism in Cisgender Men Living With HIV: Prevalence, Clinical and Metabolic Features

BACKGROUND: Hypogonadism is frequently observed in men living with human immunodeficiency virus (HIV), although its prevalence, etiology, and predictors remain incompletely understood. OBJECTIVE: To evaluate the prevalence of hypogonadism and its association with metabolic factors in men living with HIV (MLWH), on stable antiretroviral therapy. MATERIALS AND METHODS: Total testosterone (TT), sex hormone-binding globulin (SHBG), calculated free testosterone (cFT), metabolic parameters, and ADAM questionnaire responses were assessed in 136 MLWH (19-73 years), classified as hypogonadal or eugonadal. RESULTS: Subnormal cFT or TT levels were detected in 35.3% of the participants; 52.1% had isolated low cFT and 78.4% were hypogonadotropic. ADAM showed 75.6% sensitivity and 44.7% specificity. DISCUSSION: Hypertension, dysglycemia, higher triglycerides levels, higher BMI, increased waist circumference, older age, longer time of infection, and insulin resistance indexes were positively associated with hypogonadism in univariate analysis. Serum estradiol levels were similar between groups. After multivariate analysis, age and dysglycemia remained independently associated with testosterone deficiency. CONCLUSION: One-third of MLWH had hypogonadism, mostly of central origin. cFT assessment was essential to avoid underdiagnosis. Hypogonadism in MLWH seems to be associated with metabolic impairment, however only age and dysglycemia remained independently associated after adjustment.