The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience

Letizia Chiara Pezzaioli; Eugenia Quiros-Roldan; Simone Paghera; Teresa Porcelli; Filippo Maffezzoni; Andrea Delbarba; Melania Degli Antoni; Carlo Cappelli; Francesco Castelli; Alberto Ferlin

doi:10.1007/s15010-020-01558-6

The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience

Pezzaioli LC, Quiros-Roldan E, Paghera S, Porcelli T, Maffezzoni F, Delbarba A, Degli Antoni M, Cappelli C, Castelli F, Ferlin A

Published April 2021 Infection

DOI 10.1007/s15010-020-01558-6 PMID 33289905 PMC PMC7990869

RRM Academy Synopsis

Testosterone alone misses half of symptomatic hypogonadism in HIV

Among 94 HIV-infected men with sexual symptoms, total testosterone alone detected hypogonadism in about 1 out of 10, while a full hormone profile found it in about 2 out of 10. LH testing found compensated hypogonadism in a further 13.8%.

Key Findings

Among 94 men with a complete hormonal profile, overt hypogonadism appeared in 19 (20.2%). Of these, 5 were primary and 14 were secondary and/or normogonadotropic.
Total testosterone alone would have diagnosed hypogonadism in 10 of 94 men (10.6%). Adding calculated free testosterone raised the count from 10 to 19, an increase of 1.9 times.
In 13 of 94 men (13.8%), testosterone values were normal while LH was clearly raised, fitting compensated hypogonadism. Counting overt and compensated cases, 32 of 94 (34.0%) had a gonadal axis alteration.
SHBG exceeded the laboratory's upper cutoff in 34 of 94 men (36.2%), and 18 of those 34 (52.9%) were eugonadal. SHBG correlated positively with HIV infection duration (P < 0.01).

Interpretation

One clinic in Brescia, Italy, reviewed its records from 2012 to 2019 in a retrospective cross-sectional design. The men had sexual symptoms and were clinically stable on antiretroviral therapy. The authors conclude that a full hormone panel is needed to diagnose and classify hypogonadism in them. They attribute the gap mostly to high SHBG, which seems central to hypogonadism in these men. The results apply to HIV-infected men referred for sexual symptoms.

RRM Context

RRM evaluates both partners, so male hormone health belongs in the workup. Here, a full panel found hypogonadism in symptomatic HIV-infected men that total testosterone alone left unseen.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

The prevalence of low testosterone and symptoms of hypogonadism in HIV-infected men is still debated. We aimed to estimate the prevalence and type of hypogonadism in HIV-infected males complaining about sexual symptoms, and to evaluate the role of calculated free testosterone (cFT) vs total testosterone (TT) for diagnosis. Furthermore, we evaluated relationship between sex hormone-binding globulin (SHBG), gonadal status and clinical and virologic parameters.

Methods

We retrospectively evaluated 169 HIV-infected men with sexual symptoms, with TT available. Among them, we selected 94 patients with TT, SHBG, cFT, and luteinizing hormone (LH) available, and classified hypogonadism into overt (low TT and/or low cFT) and compensated (high LH, normal TT and cFT). Comparison was performed by non-parametric Kruskal-Wallis test and Spearman's correlation was calculated to verify the possible associations.

Results

Overt and compensated hypogonadism were found in 20.2% and 13.8% of patients, respectively. With reliance on TT alone, only 10.6% of patients would have met diagnosis. SHBG values were elevated in one third of patients, and higher in men with compensated hypogonadism. Significant positive correlation was found between SHBG and HIV infection duration, TT and LH.

Conclusion

Only a complete hormonal profile can properly diagnose and classify hypogonadism in HIV-infected men complaining about sexual symptoms. TT alone reliance may lead to half of diagnoses missing, while lack of gonadotropin prevents the identification of compensated hypogonadism. This largely comes from high SHBG, which seems to play a central role in the pathogenesis of hypogonadism in this population.

Topics

Diagnostics

Hormone Testing Serum Panels

Diagnostics › Hormone Testing › Serum Panels

Letizia Chiara Pezzaioli, Eugenia Quiros-Roldan, Simone Paghera, Teresa Porcelli, Filippo Maffezzoni, Andrea Delbarba, Melania Degli Antoni, Carlo Cappelli, Francesco Castelli, Alberto Ferlin

L Pezzaioli, E Quiros-Roldan, S Paghera, T Porcelli, F Maffezzoni, A Delbarba, M Antoni, C Cappelli, F Castelli, A Ferlin

PMID 33289905 33289905 DOI 10.1007/s15010-020-01558-6 10.1007/s15010-020-01558-6 Pezzaioli et al. 2021, Pezzaioli 2021

The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience

Testosterone alone misses half of symptomatic hypogonadism in HIV

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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