Testosterone Replacement Among HIV-Infected Men
Testosterone Replacement Among HIV-Infected Men
Global testosterone sales have increased 12-fold over the last decade, and the USA is the second leading consumer worldwide. Androgen use tripled from 2001 to 2011 in the U.S., with 2.9% of men over 40 years of age on testosterone replacement therapy (TRT). Establishing biochemical testosterone deficiency is recommended before TRT initiation, yet up to 83% of men on TRT lack pretreatment testosterone measurements. Direct-to-consumer marketing and the availability of specialty clinics and transdermal preparations may contribute to TRT overuse in the USA. This is concerning in light of recent studies suggesting that TRT may increase the risk of cardiovascular events, including myocardial infarction, stroke, thrombosis and death, though these remain areas of ongoing investigation.
HIV is associated with testosterone deficiency in up to 70% of men, a finding that persists despite successful antiretroviral therapy (ART), and hypogonadism is expected to increase, as this population continues to age. Yet, little is known about TRT among HIV-infected men. In a report from the early ART-era, TRT prevalence was 19%, though pre-TRT testosterone deficiency and post-TRT monitoring were not assessed. In this report, we describe TRT initiation rates and predictors and associated monitoring among HIV-infected men in a large, multicentre U.S. cohort.
Background
Global testosterone sales have increased 12-fold over the last decade, and the USA is the second leading consumer worldwide. Androgen use tripled from 2001 to 2011 in the U.S., with 2.9% of men over 40 years of age on testosterone replacement therapy (TRT). Establishing biochemical testosterone deficiency is recommended before TRT initiation, yet up to 83% of men on TRT lack pretreatment testosterone measurements. Direct-to-consumer marketing and the availability of specialty clinics and transdermal preparations may contribute to TRT overuse in the USA. This is concerning in light of recent studies suggesting that TRT may increase the risk of cardiovascular events, including myocardial infarction, stroke, thrombosis and death, though these remain areas of ongoing investigation.
HIV is associated with testosterone deficiency in up to 70% of men, a finding that persists despite successful antiretroviral therapy (ART), and hypogonadism is expected to increase, as this population continues to age. Yet, little is known about TRT among HIV-infected men. In a report from the early ART-era, TRT prevalence was 19%, though pre-TRT testosterone deficiency and post-TRT monitoring were not assessed. In this report, we describe TRT initiation rates and predictors and associated monitoring among HIV-infected men in a large, multicentre U.S. cohort.