Hormones are chemicals that are formed in your glands. They move through your bloodstream and interact with your body’s organs. Some hormones help specific organs. Others act on cells, proteins, and tissue. Hormones have an affect on your growth, metabolism (your body’s chemical processes), sex drive, and ability to have children.

Studies have shown that HIV can affect the body’s ability to produce and maintain hormone levels. There are many types of hormones. The hormones that seem to be particularly affected by HIV are the following:

• Estrogen and Progesterone: Female sex hormones that are made in the ovaries
• Testosterone: Male sex hormone found in small amounts in women’s bodies. Testosterone is made in the adrenal glands (just above the kidneys) and in the ovaries
• DHEA: Steroid hormone that may be connected with immune function and energy

Estrogen, progesterone, testosterone, and DHEA levels naturally get lower as you age. Changes in one of these hormones can affect the levels of the others.

Some drugs that are used to treat HIV-related conditions can also affect hormone levels. These include:

• Cytovene (ganciclovir)
• Megace (megestrol acetate)
• Nizoral (ketoconazole)

Experts believe that hormones are also connected to lipodystrophy, a group of fat-related body changes that can appear in some HIV+ people. However more research is needed in this area.

Changes in your hormone levels can affect many of your body functions. Some of the symptoms that are caused by hormone level changes include:

• Abnormal menstrual cycles, possibly including early menopause for HIV+ women
• Weight loss
• Headaches
• Mood swings
• Depression
• Sleep disturbances
• Fatigue
• Decreased bone density
• Vaginal dryness
• Lack of sexual desire
• Difficulty getting pregnant
• If you are experiencing any of these symptoms, you should speak to your doctor, who can check your hormone levels.

HIV+ women who experience hot flashes at night may be misdiagnosed as having night sweats, common to  HIV  and related conditions such as  "wasting". Vaginal dryness  can be mistaken for a yeast infection. It's important to keep track of your cycles and report your suspicions to your doctor to avoid misdiagnosis or hormonal treatments that may not be necessary.

Women who have low estrogen levels may choose to replace the estrogen in order to regulate menstrual periods and help relieve pre-menstrual syndrome (PMS). However, the most common reason to replace estrogen is to relieve the symptoms of menopause.

Care must be taken in replacing lost estrogen. Taking estrogen alone increases the risk of uterine cancer. If a woman has had her uterus removed, she can take estrogen by itself. This is called estrogen replacement therapy or ERT.

Women who still have a uterus usually take a combination of estrogen and progesterone. This is called hormone replacement therapy (HRT).

HRT may relieve menopausal symptoms, reduce bone loss, and decrease the risk of colon cancer. However, HRT has risks. It should not be used for long-term prevention of heart disease. Taking HRT increases, rather than reduces, the risk for heart disease and stroke. It also increases the risk of breast cancer and blood clots.

Some HIV+ women will benefit from HRT to relieve the symptoms of menopause. However, the risks may outweigh the benefits if you smoke, are overweight, or have had blood clots, breast cancer, diabetes, high cholesterol levels, liver problems, or a family history of heart disease.

HIV+ women who choose to go on HRT should speak to their doctors about drug interactions. Research on birth control pills containing estrogen and or progesterone has shown that they interact with many HIV drugs. Some HIV drugs can cause decreased levels of hormones. Estrogen can also cause decreased levels of HIV drugs and put you at risk for viral rebound and drug resistance.

There are other therapies available to treat menopausal symptoms. However, these may also have undesirable side effects or interact with HIV drugs. If you choose alternative therapies it is best to consult a skilled practitioner and let your doctor know exactly what you are doing.

Other treatments include:

• Herbs such as black cohosh
• Soy foods
• Vitamins
• Chinese Medicine
• Antidepressant drugs and/or counseling
• Fosomax (prescription drug) for bone loss

Treatments are also available to regulate deficiencies of other hormones.

Shortages of testosterone can result in fatigue, sexual problems, depression, and weight loss. Many women using testosterone or anabolic steroids report improved energy, sex drive, mood, and better quality of life. They have also been shown to increase lean muscle mass and add weight. Testosterone is available in many forms including injections, tablets, patches, gels, and creams.

Speak to your doctor about possible side effects from testosterone use. Men may experience shrinkage of the testicles, acne, and increased hair growth on the face and body. Women may experience emasculation (facial hair growth, deeper voice, and clitoral enlargement).

Women suffering from weight loss (wasting) or lipodystrophy may consider treatment with human growth hormone (HGH, Serostim). HGH has been shown to increase lean muscle mass and may reduce fat accumulations associated with lipodystrophy. Unfortunately, HGH does not seem to correct facial wasting. HGH is very expensive and not available to everyone.

Discuss any symptoms you are experiencing with your doctor. If a hormone imbalance is found to be the cause, you can explore therapy options. Make sure to also discuss drug interactions and long-term side effects of hormone use.

1		Abularach, S. & Anderson, J. (2001). Gynecological problems. A Guide to the Clinical Care of Women with HIV. Ch. 6: Retrieved July 2003 from ftp://ftp.hrsa.gov/hab/Guide_01_ChptVI.pdf.
2		Mooney, M. (2001). Anabolic steroids and women. AIDS Treatment Update: Retrieved July 2003 from http://www.medibolics.com/WomenSteroids.htm.