The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected me
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ORIGINAL PAPER
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 Pezzaioli1 · Eugenia Quiros‑Roldan2 · Simone Paghera3 · Teresa Porcelli4 · Filippo Maffezzoni5 · Andrea Delbarba5 · Melania Degli Antoni2 · Carlo Cappelli1 · Francesco Castelli2 · Alberto Ferlin1 Received: 18 August 2020 / Accepted: 17 November 2020 © The Author(s) 2020
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. Keywords HIV · Hypogonadism · Calculated free testosterone · SHBG · Gonadotropins
Introduction * Alberto Ferlin [email protected] 1
Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
2
Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali di Brescia, Brescia, Italy
3
Centro Di Ricerca Emato‑Oncologica AIL (CREA), Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
4
Endocrinology, Montichiari Hospital, ASST Spedali Civili Brescia, Montichiari, Italy
5
Unit of Endocrinology and Metabolism, Department of Medicine, ASST Spedali Civili Brescia, Brescia, Italy
Since the early stages of HIV epidemic, hypogonadism has been recognized as a known frequent associated c
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