Of the 556 men studied, 54 (9.7%) reported currently taking androgens. Current androgen use was significantly more common among HIV-seropositive men (OR, 10.3; 95% CI, 3.7−29.0) and men who reported having had sex with men within the previous 5 years (OR, 6.4; 95% CI, 3.5−11.5), with no significant difference by race, age, smoking, or illicit drug use.
Selected characteristics of the 502 men who were not currently taking androgens are shown in . HIV-seropositive men were significantly more likely to be nonwhite, to have had sex with men, and to have used sildenafil recently; they were significantly less likely to have used drugs recently and to be overweight or obese. Among HIV-seropositive men, CD4+ lymphocyte counts were ≥500 cell/mm3 in 26%, 200−499 cells/mm3 in 49%, and <200 cells/mm3 in 25%. Nearly two-thirds of subjects reported that they were currently taking HAART, and 44% were taking protease inhibitors; the viral load was undetectable in 36% of HIV-seropositive men.
Selected characteristics of 502 men not currently taking androgens by HIV status
Total testosterone levels were ≥300 ng/dL in 229 men (45.6%), 200−299 ng/dL in 111 (22.1%), and <200 ng/dL in 162 (32.3%). The majority of specimens (290 [58%] of 502) had been obtained in the morning, with the remainder obtained in the afternoon. Univariate associations of demographic, behavioral, and medical variables with free androgen index and total testosterone level are shown in . Injection drug use within the past 5 years, smoking cigarettes, not having sex with men within 5 years, current use of psychotropic medications, being seropositive for antibody to HCV, and having detectable HCV RNA were significantly associated with lower free androgen indices and lower total testosterone levels. Seropositivity for antibody to HCV was associated with low androgen levels, even when we excluded men with detectable HCV RNA or the 55 men who had ever received IFN treatment (data not shown). Only testosterone levels differed significantly by race and ethnic background and by body mass index; testosterone levels were significantly lower in overweight and obese men. Very low testosterone levels were significantly less prevalent among HIV-seropositive men than among HIV-seronegative men. Among the 275 HIV-seropositive men only, univariate results were similar. Injection drug use, smoking, having sex with men, and body mass index remained significantly associated with androgen levels, but race no longer was, likely as a result of the reduced sample size (data not shown). Low and very low testosterone levels were significantly more common among men with HIV-1 loads of >10,000 copies/mL (). Inclusion of the 54 men (50 HIV-seropositive men and 4 HIV-seronegative men) who reported currently taking androgens, with the assumption that their unmodified androgen levels would have been low in the absence of exogenous androgen therapy, had only minor effects on the factors associated with androgen levels.
Associations of free androgen index (FAI) and total testosterone (TT) level with demographic, behavioral, and medical characteristics in 502 men who were not currently taking androgens.
Mean luteinizing hormone levels (± SD) among men with low testosterone levels, compared with those without low testosterone levels, were 3.6±3.5 U/L and 5.9±4.0 U/L (P < .001), respectively, for HIV-seronegative men, and they were 7.0±7.4 U/L and 7.5±3.9 U/L (P < .001), respectively, for HIV-seropositive men. Mean luteinizing hormone levels (± SD) among men with very low testosterone levels, compared with those without very low testosterone levels, were 3.4±3.8 U/L and 5.4±3.8 U/L (P < .001), respectively, for HIV-seronegative men, and they were 5.3±5.1 U/L and 8.0±6.2 U/L (P < .001), respectively, for HIV-seropositive men. Thirty-nine men (8%) had luteinizing hormone levels of <1.0 U/L, of whom 18 (46%) had testosterone levels of <200 ng/ dL. The 89 men (18%) who had any history of receipt of androgens (median duration, 6 months; range, <1 to 120 months) did not have lower luteinizing hormone levels than those who had never received androgens. Of the 89 men who had a history of androgen use, only 23 (26%) had taken androgens recently (i.e., since the most recent study visit); of these, estimated median lifetime duration of use was 3 months (range, <1 to 72 months), and luteinizing hormone levels were not lower, compared with men who had not taken androgens recently. Among men with low or very low testosterone levels, there was no association between luteinizing hormone levels and history of injection drug use for either HIV-seropositive or HIV-seronegative men.
Factors found by multivariate analysis to be associated with low androgen levels are shown in . Injection drug use, being overweight or obese, seropositivity for HCV, current receipt of psychotropic medications (i.e., barbiturates, sleeping pills, antidepressants, or tranquilizers), and having had blood drawn in the afternoon were associated with ≥1 of the following findings: low free androgen index, low testosterone level, or very low testosterone level. Replacing detectable seropositivity for HCV with detectable HCV RNA levels in the model had little effect on the findings (data not shown). Only among men who reported having had sex with men was HIV infection significantly associated with low testosterone levels. However, among all seropositive men, an HIV load of >10,000 copies/ mL was associated with a testosterone level of <200 ng/dL (adjusted OR [ORadj], 2.1; 95% CI, 1.1−4.3; P = .03). Black race was inversely associated with low testosterone levels.
Factors associated with low androgen levels on multivariate analysis.
The univariate associations with androgen levels of selected symptoms possibly attributable to hypogonadism and of measured bone density are shown in . Reported decreased interest in sex, depressive symptoms, poorer overall health, and osteopenia noted by dual x-ray absorptiometry scan were significantly associated with each of the androgen measurements. Perceived loss of concentration or memory and difficulty sleeping were significantly associated with low testosterone levels, but not with free androgen index. Reported erectile dysfunction was not associated with androgen levels, and current use of sildenafil was significantly associated only with very low testosterone levels; men who currently used sildenafil had a significantly lower prevalence of very low testosterone than men who did not. Men who reported having erectile dysfunction did have a greater number or frequency of depressive symptoms than those without erectile dysfunction (median Center for Epidemiologic Studies Depression Scale for HIV-seronegative men, 21 [range, 14−58] vs. 15 [range, 8−55]; median for HIV-seropositive men, 17 [range, 11−45] vs. 12.5 [range, 7−40]; P < .001 for both).
Associations of symptoms and measured bone loss with free androgen index (FAI) and total testosterone (TT) level in 502 men who were currently not taking androgens.