The American journal of medicine
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Gonadal, adrenal, and thyroid functions were evaluated in 70 men seropositive for human immunodeficiency virus (HIV) infection, clinically categorized as asymptomatic (n = 19), AIDS-related complex (ARC) (n = 9), or acquired immunodeficiency syndrome (AIDS) (n = 42). Twenty of 40 men (50 percent) with AIDS were hypogonadal. Mean serum testosterone concentrations in both ARC (292 +/- 70 ng/dl) and AIDS (401 +/- 30 ng/dl) men were significantly less than in asymptomatic (567 +/- 49 ng/dl) or normal men (608 +/- 121 ng/dl). ⋯ Adrenal cortisol reserve, evaluated by adrenocorticotropin stimulation, was normal in 36 of 39 patients (92 percent) with AIDS. Indices of thyroid function were normal with the exception of one ARC man with a low free thyroxine index. In conclusion, hypogonadism is common in men with HIV infection and may be the first or most sensitive endocrine abnormality.
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Contrary to the common assertion that there is too much science in medicine, it is precisely the application of the natural sciences in the clinic that has enhanced the diagnostic and therapeutic powers of the physician. Much of the criticism of science in medicine mistakes the technology made possible by science, and the way that technology is employed, for science itself. ⋯ The concepts and methods of the social sciences must be integrated into medical education if physicians are to be enabled to respond effectively to illness as a human experience. Nonetheless, without major changes in the social context of medical practice, efforts to improve performance through curriculum reform will be futile.