HIV-associated
hypogonadism is known to be a prevalent endocrine disorder, with a multifactorial etiology. Low
testosterone levels are associated with decreased muscle mass, exercise capacity loss,
erectile dysfunction,
cognitive impairment, depression and decreased quality of life. In the same way,
hypogonadism in HIV-infected men is associated with decreased muscle mass quantity and function, changes in corporal fat mass distribution and quantity, secretion of
adipocytokines and endothelial dysfunction. This combined effect renders the entire body less sensitive to
insulin, promoting development of
atherosclerosis and
glucose metabolism disorders. The clinical presentation is non-specific and
hypogonadism screening scales are not useful in this population. Diagnostic procedures must include determination of free
testosterone (
FTc) in any HIV-infected men at the time of first HIV diagnosis and periodically, because of the clinical implications and the absence of specific predictive disease factors. Substitutive hormonal treatment must be offered only for HIV-infected men with
FTc under reference levels and when reversible causes have been ruled out. Metabolic impact of
hypogonadism suggests the incorporation of low
testosterone levels to the list of cardiovascular risk factor in HIV-infected men.