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Query about testosterone values in HIV positive male.

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Hi,

I am a 30 year old HIV positive male and have been on a combination of medication to manage my illness for 18 months. I have also suffered from symptoms of depression for approximately 5 years and have so far been on 5 different medications to various degrees of success. The symptoms of fatigue, lack of motivation, no sex drive, mood swings, insomnia. When I was first diagnosed with "depression" the diagnosing doctor never tested my blood for any hormonal imbalances or anything else that could potentially have presented these symptoms, which in hindsight makes me quite annoyed due to the terrible side effects of most antidepressants.

Approximately two weeks ago, I asked my GP to check my testosterone levels for two reasons

1. I understand that HIV positive men can present lower than normal testosterone levels
2. After reading several endocrinology texts, I was curious to know my testosterone levels and whether they could be the reason for my symptoms.

My results returned a total testosterone of 325 with a ref range of 250 -825.

Whilst I understand that the levels may have a reference range surely there is some acknowledgement that this range is quite broad and it would seem for 30 year old male to share the same level of a 60 or 70 year old male. My Doctor said that she would not consider replacing it because I was in the reference range, which I'm sure was being read from some text book.

I would really like to understand what the optimal level is for ultimate, cognitive function, sexual function over well being? I would also like to understand if I am within a healthy range for my age, because there very little information that I could find to tell me this.

What should I do next? I don't want to deal with someone that has very little knowledge of endocrinology or mens health, just wondering if I should perhaps find a mens health doctor to address my concerns?

regards
Jamie

Category: Endocrinologist

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Category: Diabetologist
 27 Doctors Online

Hello and thankyou for approaching DoctorSpring with your query.

I have gone through you case and I understand your concern. What your doctor is saying is right. Your testosterone levels are within normal range and hence you do not need any supplementation.

The testosterone hormone acts by a threshold level, which means that any level above a set minimum level (of 250ng/dl) of threshold works well, and no further amount of the increasing will help. But an excess of testosterone can cause side effects.
Now this is question I often get when the Testosterone values is in the low normal range. One very important thing is that the testosterone values are not a steady , single value. It varies throughout the day. There is a feedback mechanism for T secretion. So if T goes up, a negative feedback occurs on other hormones like FSH and LH which will inturn bring the T levels down. So it is kind of a cycle. YOUR Testosterone values are well within normal range ( It is called a normal range for a reason) and so you need not worry. If you are really worried you can do the FSH and LH levels. They should be also in normal levels.

HIV may cause decreased testosterone levels, but you have nothing to worry as your levels are well above the threshold level. No amount of increasing it will cause any difference.
Your testosterone is normal for your age, and does not seem to be the reason of your symptoms.

Your symptoms are probably due to the depression and stress your body is undergoing both physically and mentally.
Of the tablets you have taken, citalopram and sertraline are both selective serotonin reuptake inhibitors. They are known to decrease sex drive in 1 of 100 patients. If you are still on those tablets you can discuss it with your doctor and change to another group of drugs if required.

You can test your Haemoglobin levels and do Thyroid function tests to rule out any other pathology.

As for your doctor, I think she is doing a good job and you have nothing to worry.

I hope this has helped. Feel free to follow up.

Thankyou


Dr. J Muthukrishnan
Category: Diabetologist
Experience: 
Fellowships/Training: 
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
Dr. J Muthukrishnan and 4 other Medical Specialists are ready to help you

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