Endocrine Abstracts

Introduction: Male hypogonadism secondary to AIDS is common and may present with non specific symptoms. Patients may self-diagnose hypogonadism and seek unauthorised androgen therapy. We report a male patient who developed polycythemia after receiving unauthorised sources of androgen therapy.

Case report: A 42 years old man with AIDS diagnosed 10 years ago has repeatedly refused antiretroviral therapy. His most recent CD4 count was 314 cells/μl. His hemoglobin and hematocrit were elevated at 18.3 g/dl (RI: 13–17) and 52% (RI: 41–51) respectively at a recent review. He complained of lethargy and decrease in libido of 6 months duration. There was no headache or other symptoms of hyperviscosity. He is a non-smoker and there was no known pre-existing cardiopulmonary disease. He was well hydrated and there was no hepatosplenomegaly on examination. Total testosterone was noted to be elevated at 34 nmol/l (RI: 5–30 nmol/l) and FSH and LH suppressed at <1 IU/l. He admitted to taking complementary health products to boost his virility as he had presumed that he has hypogonadism. Advice was given to stop the health products which are likely to contain testosterone. Repeated blood tests done 2 months later showed normalisation of the hemoglobin, hematocrit as well as the FSH, LH and testosterone levels without the need for testosterone therapy.

Discussion: Male hypogonadism secondary to AIDS can result from testicular infiltration by opportunistic infections, medications suppressing the hypothalamic–pituitary–gonadal axis or be associated with advanced immunosuppression. It is important to routinely screen for symptoms of hypogonadism and if the diagnosis confirmed biochemically, to start testosterone replacement therapy with close monitoring of the hematocrit. Clinicians must be cognisant of possible androgen abuse. Self initiation of androgen therapy with no monitoring can result in polycythemia and dire consequences.