Middle-aged men living with HIV may have low testosterone levels more commonly seen in older men, according to a study published in the journal AIDS. Men with a longer duration of HIV treatment and viral suppression had lower testosterone than their less treatment-experienced peers, but those with low T still had the same robust sex lives as those with higher levels.


Marie Lachârche, MD, of the Cochin-Pasteur Center for Clinical Investigation in Paris, and colleagues asked 240 mostly gay and bisexual men living with HIV to donate blood samples and undergo bone density testing. Among these participants, 9% had clinically defined low free testosterone levels. That’s double the rate of HIV-negative middle-aged men and more in line with levels typically seen in older men.


Men with lower testosterone were a bit older than the study population as a whole (median 46 versus 43 years). What’s more, they had a longer duration of HIV treatment (median seven versus four years) and undetectable viral load (median five versus three years). They also had more experience using nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors and integrase inhibitors. In particular, men who had used the NRTI efavirenz were nearly four times more likely to have low testosterone.


Men with lower testosterone also had a higher body fat percentage and a lower nadir (lowest-ever) CD4 count. That makes sense, given that low CD4 counts have previously been linked to low testosterone. But the reason for the differences related to the type of HIV treatment is unclear.


What was clear is that having lower clinical measurements of testosterone was not associated with poorer sexual health. Men with low T had rates of erectile dysfunction and depression comparable to those with higher levels, and they reported similar quality of life.