The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Background: Hypogonadism is a common comorbidity in human immunodeficiency virus (HIV)-infected men, although the real prevalence is difficult to be estimated. Moreover, in HIV settings, the efficacy of exogenous testosterone (Te) administration at improving body composition remains unclear. Aim of the study: This review has a double aim. First, to estimate the prevalence of pituitary–testis axis abnormality in HIV-infected patients compared to uninfected subjects. Second, to evaluate the effect of androgen administration on body composition in HIV-infected men. Materials and Methods: A systematic review of the literature and meta-analysis was carried out. Two separated literature searches were performed, the first to evaluate the prevalence of Te deficiency in HIV-infected men and the second one to evaluate effects of androgen administration on body composition. Results: The overall prevalence of Te deficiency in HIV-infected men was calculated from 41 studies, showing a 26% prevalence, which was even higher when free T (fT) levels, more than total T, were considered. Indeed, TT serum levels were similar between HIV patients and controls, although higher SHBG and lower fT were detected in HIV populations. When HIV-infected men were treated with exogenous Te, a significant increase in body weight, lean body mass and fat free mass was detected. Conclusion: The systematic review confirms the high prevalence of Te deficiency in HIV-infected men, particularly when fT has been considered. Moreover, chronic androgen supplementation improves body composition, affecting the lean mass compartment. However, considering the general frailty of HIV patients, a tailored indication for Te therapy should be advocated.

The Role of Androgen Supplementation in Women With Diminished Ovarian Reserve: Time to Randomize, Not Meta-Analyze

The management of patients with diminished ovarian reserve (DOR) remains one of the most challenging tasks in IVF clinical practice. Despite the promising results obtained from animal studies regarding the importance of androgens on folliculogenesis, the evidence obtained from clinical studies remains inconclusive. This is mainly due to the lack of an evidence-based methodology applied in the available trials and to the heterogeneity in the inclusion criteria and IVF treatment protocols. In this review, we analyze the available evidence obtained from animal studies and highlight the pitfalls from the clinical studies that prevent us from closing the chapter of this line of research.

Eighteen-Year Effect of Androgen Therapy on Bone Mineral Density in Trans(gender) Men

The study explores the influence of long-term androgen supplementation (18 years) on bone metabolism in trans(gender) men. Thirty five trans(gender) men aged (47±4) were treated with adequate dose of testosterone. BMD was measured by DEXA at lumbar spine and neck and T score was determined. Biochemical parameters of bone turnover were measured in all patients. As compared with female and male age matched controls they showed a not significantly different T-score at spine [1.213±0.15 in trans(gender) men vs. 1.192±0.19 in females and 1.203±0.06 g/cm2 in males (p<0.01)]. BMD in the hip skeleton in trans(gender) men (0.950±g/cm2) was statistically higher than females (0.822±0.09) but not statistically different from normal males 0.988±0.06). Circulating biochemical markers of bone formation, and resorption were not different between the trans(gender) men, and matched controls. We conclude that BMD at the hip (site rich in cortical bone) after adequate dose of testosterone therapy is higher while it is not different at the spine (trabecular bone) in trans(gender) men even after 18 years of testosterone administration.