Title: Updates on Testosterone Deficiency in Men Living With HIV and the Cardiovascular Implications

Abstract Purpose of Review This review evaluates recent literature (2020–2025) on testosterone deficiency (TD) and its cardiovascular implications in men living with HIV (MLH), focusing on prevalence, underlying mechanisms, diagnostic challenges, and management strategies, including cardiovascular risks linked to testosterone replacement therapy (TRT). Recent Findings TD remains highly prevalent in MLH, often manifesting earlier than in the general population due to chronic inflammation and immune dysregulation. While TRT's cardiovascular risks have been debated, recent studies indicate no significant increase in major cardiovascular events among TRT users compared to placebo, though some adverse effects remain a concern. Summary With HIV now a chronic condition due to antiretroviral therapy (ART), the focus has shifted to managing non-infectious comorbidities like TD. MLH experience TD at younger ages and require personalized care to address this condition and its associated risks effectively.