The diagnosis of hypogonadism in people living with HIV (PLWH) remains challenging by the lack of a standardised diagnostic algorithm. Since sexual hormone-binding globulin levels are commonly increased in PLWH, guidelines recommend assessing free testosterone (FT) along with total testosterone levels. We compared different online equations available to estimate FT levels and found a good correlation amongst all algorithms. Estimating FT levels increased diagnostic accuracy of hypogonadism and therefore should be encouraged in clinical practice in PLWH with clinical symptoms of hypogonadism, even when total testosterone levels are normal.
GomesARSouteiroPSilvaCG, et al.Prevalence of testosterone deficiency in HIV-infected men under antiretroviral therapy. [Internet]. BMC Infect Dis2016; 16(1): 628, Available from: http://www.ncbi.nlm.nih.gov/pubmed/27809804.
2.
MylonakisEKoutkiaPGrinspoonS. Diagnosis and treatment of androgen deficiency in human immunodeficiency virus-infected men and women. [Internet]. Clin Infect Dis2001; 33(6): 857–864, Available from: http://www.ncbi.nlm.nih.gov/pubmed/11512091.
3.
WongNLevyMStephensonI. Hypogonadism in the HIV-Infected Man. [Internet]. Curr Treat Options Infect Dis2017; 9(1): 104–116, Available from: http://www.ncbi.nlm.nih.gov/pubmed/28344518.
4.
ShifrenJLDavisSR. Androgens in postmenopausal women: a review. Menopause2017; 24(8): 970–979.
5.
Al KindiMKAl EssryFSAl EssryFS, et al.Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism. Oman Med J2012; 27(6): 471–474.
6.
SantiDSpaggiariGVenaW, et al.The prevalence of hypogonadism and the effectiveness of androgen administration on body composition in hiv‐infected men: a meta‐analysis. [Internet]. Cells2021; 10(8): 2076. [cited 2022 Jan 7].
7.
HackettGKirbyMEdwardsD, et al.british society for sexual medicine guidelines on adult testosterone deficiency, with statements for UK practice. J Sex Med2017; 14(12): 1504–1523.
8.
MonroeAKDobsASXuX, et al.Sex hormones, insulin resistance, and diabetes mellitus among men with or at risk for HIV infection. J Acquir Immune Defic Syndr2011; 58(2): 173–180.
9.
Pena DiasJHaberlenSADobsAS, et al.Longitudinal changes in sex hormone-binding globulin in men with HIV. J Acquir Immune Defic Syndr2021; 87(5): 1178–1186.
10.
BhasinSBritoJPCunninghamGR, et al.Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. [Internet]. J Clin Endocrinol Metab2018; 103(5): 1715–1744, Available from:http://www.ncbi.nlm.nih.gov/pubmed/29562364.
11.
KackerRHornsteinAMorgentalerA. Free testosterone by direct and calculated measurement versus equilibrium dialysis in a clinical population. Aging Male2013; 16(4): 164–168.
12.
MonroeAKDobsASPalellaFJ, et al.Morning free and total testosterone in HIV-infected men: implications for the assessment of hypogonadism. [Internet]. AIDS Res Ther2014; 11(1): 6, Available from. DOI: 10.1186/1742-6405-11-6.
13.
VermeulenAVerdonckLKaufmanJM. A critical evaluation of simple methods for the estimation of free testosterone in serum. [Internet]. J Clin Endocrinol Metab1999; 84(10): 3666–3672, [cited 2022 Jan 17] Available from: https://pubmed.ncbi.nlm.nih.gov/10523012/.
14.
SödergardRBäckströmTShanbhagV, et al.Calculation of free and bound fractions of testosterone and estradiol-17β to human plasma proteins at body temperature. J Steroid Biochem1982; 16(6): 801–810.
15.
NanjeeMNWheelerMJ. Plasma free testosterone--is an index sufficient?Ann Clin Biochem1985; 22(Pt 4): 387–390.
16.
Emadi-KonjinPBainJBrombergIL. Evaluation of an algorithm for calculation of serum “bioavailable” testosterone (BAT). [Internet]. Clin Biochem2003; 36(8): 591–596, Available from. DOI: 10.1016/s0009-9120(03)00076-6.
17.
BachmannGBancroftJBraunsteinG, et al.Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment. Fertil Steril2002; 77(4): 660–665.
18.
GuayADavisSR. Testosterone insufficiency in women: fact or fiction?World J Urol2002; 20(2): 106–110.
RochiraVZirilliLOrlandoG, et al.Premature decline of serum total testosterone in HIV-infected men in the HAART-era. PloS One[Internet]. 2011Dec 9 [cited 2022 Jan 18]; 6(12). Available from: https://pubmed.ncbi.nlm.nih.gov/22174826/
21.
de VincentisSDecaroliMCFanelliF, et al.Health status is related to testosterone, estrone and body fat: moving to functional hypogonadism in adult men with HIV. European journal of endocrinology[Internet]. 2021Jan 1 [cited 2022 Jan 7]; 184(1): 107–122. Available from: https://pubmed.ncbi.nlm.nih.gov/33112262/
22.
PostelNWolfEBaloghA, et al.Functional Hypogonadism and Testosterone Deficiency in Aging Males With and Without HIV-infection. Exp Clin Endocrinol Diabetes2021; 129(11): 798–802.
23.
CoronaGGoulisDGHuhtaniemiI, et al.European academy of andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: endorsing organization: European Society of endocrinology. Andrology[Internet]. 2020Sep 1 [cited 2022 Jan 18]; 8(5): 970–987. Available from: https://pubmed.ncbi.nlm.nih.gov/32026626/
24.
RochiraVGuaraldiG. Hypogonadism in the HIV-Infected Man. Endocrinology and metabolism clinics of North America[Internet]. 2014[cited 2022 Jan 7]; 43(3): 709–30. Available from: https://pubmed.ncbi.nlm.nih.gov/25169563/
25.
PezzaioliLCQuiros-RoldanEPagheraS, et al.The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience. Infection2021; 49(2): 295–303, Available from: DOI: 10.1007/s15010-020-01558-6.
26.
BrambillaDJMatsumotoAMAraujoAB, et al.The effect of diurnal variation on clinical measurement of serum testosterone and other sex hormone levels in men. J Clin Endocrinol Metab2009; 94(3): 907–913.
