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Reproductive Endocrinology

ORF09-07 - Hypogonadism, Metabolic Markers, and MASLD Risk in Men Living with HIV

Saturday, June 13, 2026
2:45 PM - 3:00 PM CT
Location: Room W185ABC
Disclosure(s):
Mayara Ribeiro Resende: No financial relationships to disclose

Hypogonadism is common in men living with HIV (MLWH) and frequently associated with metabolic syndrome (MetS). Insulin resistance (IR), visceral adiposity, and metabolic dysfunction–associated steatotic liver disease (MASLD) are increasingly recognized in MLWH and may contribute to gonadal dysfunction through shared metabolic and inflammatory pathways.

Objective: To assess the prevalence of hypogonadism and its association with MetS, IR, and MASLD in MLWH.

Methods: This prospective cross-sectional study included 136 MLWH (19–73 yrs), on stable antiretroviral therapy (ART), recruited from a tertiary outpatient clinic. Participants completed the Androgen Deficiency in the Aging Male (ADAM) questionnaire and were submitted to clinical and laboratorial evaluation. Hypogonadism was defined by confirmed morning total testosterone (TT) ≤ 300 ng/dL and/or calculated free testosterone (cFT) ≤ 6.5 ng/dL (Vermeulen formula), and classified according to LH levels. HOMA-IR, TyG, VAI, and LAP were calculated as surrogate IR markers. MASLD-related risk was estimated using the FIB-4 index, abdominal ultrasound (US) and elastography (FibroScan®). Patients were divided in hypogonadal and eugonadal.

Results: Hypogonadism was identified in 35.3% of participants; among these, 52.1% had isolated low cFT levels and 78% of the cases were hypogonadotropic, with normal or low LH levels. The ADAM questionnaire showed 71% sensitivity and 48% specificity for biochemical hypogonadism. In univariate analysis, hypogonadism was associated with hypertension (p < 0.001), dysglycemia (p < 0.001), higher triglyceride levels (p = 0.001), higher body mass index (p = 0.02), increased waist circumference (p = 0.001), older age (p < 0.001), and longer HIV duration (p < 0.001) and higher FIB-4 categories (p = 0.014). IR markers were higher in the hypogonadal group: HOMA-IR (2.6 vs 1.4), TyG (8.9 vs 8.4), LAP (38.7 vs 26.0), and VAI (2.0 vs 1.3) (all p ≤ 0.009). In the subgroup with liver assessment (n = 120). After multivariable adjustment, age and dysglycemia emerged as the strongest independent predictors of hypogonadism. Hepatic steatosis and/or increased liver stiffness were identified in 44.4% of patients who underwent liver imaging (n = 72); however, neither was independently associated with hypogonadism. Prolactin, estradiol and iron parameters were normal in all patients.

Conclusions:
Hypogonadism affected 31.2% of MLWH and was predominantly hypogonadotropic. Testosterone deficiency was associated with an adverse metabolic profile, including IR markers, as well as higher FIB-4 categories, indicating increased MASLD-related risk. Assessment of sex hormone–binding globulin and calculated free testosterone were essential to avoid underdiagnosis, as SHBG is frequently elevated in individuals living with HIV. Age and dysglycemia were the main independent predictors of testosterone deficiency.