Testosterone deficiency

Deficiency of the male hormone testosterone, also known as hypogonadism, can cause physical symptoms that clinically may appear to be very close to depression: chronic fatigue, loss of interest in sex and food, depressed mood and a general sense of not feeling well. Lack of testosterone can also lead to anaemia and osteopenia (lowered bone mineral density).

Wasting (loss of lean body mass) and hypogonadism are also linked, although differentiating between cause and effect is not easy. For example, Berger and colleagues found no significant relationship between low testosterone and wasting, concluding that having low testosterone levels did not necessarily mean wasting occurred.¹ Although a systematic review found that testosterone replacement therapy was more likely to increase lean body mass compared to nothing, that does not necessarily mean all wasting is caused by hypogonadism, or that hypogonadism always leads to wasting.²

Clinical experience suggests that individuals do not become symptomatic until their total testosterone level is about 5nM, which is around half of the normal end of the lower range value. Levels of sex hormone binding globulin (SHBG) levels can become increased during a chronic infection, leading to hypogonadism despite normal testosterone levels.

Low testosterone levels have been identified as a risk factor in the breast enlargement occasionally seen as a side-effect of some antiretroviral drug regimens.³