Letrozole versus testosterone: a single-center pilot study of HIV-infected men who have sex with men on highly active anti-retroviral therapy (HAART) with hypoactive sexual desire disorder and raised estradiol levels.
Author(s):Jurgen Rockstroh. 
Source:Journal of HIV Therapy 12.2 (June 2007): p.60(1).
Full Text :COPYRIGHT 2007 Mediscript Ltd.

Letrozole versus testosterone: a single-center pilot study of HIV-infected men who have sex with men on highly active anti-retroviral therapy (HAART) with hypoactive sexual desire disorder and raised estradiol levels

Richardson D, Goldmeier D, Frize G et al. J Sex Med 2007, 4, 502-508 Review by Jurgen Rockstroh Dept. of Medicine, University of Bonn, Germany

Since the advent of highly active antiretroviral therapy (HAART), men with HIV experience good quality of life and expect to have normal sexual function. However, it appears that men infected with HIV commonly complain of sexual problems. There is evidence that men on HAART develop low sexual desire that is associated with raised oestradiol levels. It has been postulated that abnormal metabolism seen in this group of men increases the aromatisation of testosterone to oestradiol. The authors of the current article hypothesise that letrozole, an aromatase inhibitor that inhibits the conversion of testosterone to oestradiol, might be beneficial in these men. Therefore they conducted a study in which they compared the effects of testosterone versus an aromatase inhibitor, letrazole, in HIV-infected men with raised oestradiol and low sexual desire. Overall 13 men who have sex with men on HAART with low sexual desire as well as raised oestradiol levels (>120 pmol/1) were randomly allocated to receive either parenteral testosterone (Sustanon 250 intramuscular injection) (n = 6) or letrozole 2.5 mg orally daily (n = 7) for 6 weeks. Sex steroid hormone assays, sex hormone-binding globulin, virological, haematological, and biochemical parameters were measured before and after treatment. Each subject was given the Spector Sexual Desire Inventory and the Depression/Anxiety Stress Scale before and immediately after treatment. Subjects were also asked to estimate the number of actual sexual acts before and after treatment. Inventory data showed a rise in dyadic desire in both treatment arms. Mean actual sexual acts rose from 0.33 to 1.5 in the testosterone group and from 0.43 to 1.29 for the letrozole group. Luteinizing hormone increased in seven of seven men on letrozole. Serum testosterone increased in seven of seven men on letrozole. There were no adverse events from either medication. The authors conclude that letrozole may be useful in the management of men on HAART who have low sexual desire. These results at least warrant further investigation taking into account the high number of patients affected and the low number of therapeutic approaches available at present.