By Prof. Alan Cocchetto

The "Just Ask" column is intended to act as a means for patients to inquire about issues related to the NCF's research activities.  This column is NOT intended to act as medical advice in any way, shape or form!  The National CFIDS Foundation assumes no responsibilities for any action or treatment undertaken by readers.  For medical advice, please consult your own personal healthcare providers.
 
I would like to dedicate this column to two friends from the CFIDS of Rochester (NY) support group who died several weeks ago. Lew Shuman and Rudy Zingler were two patients whom I first met well over a decade ago. Lew was a school teacher and Rudy was a machinist. Rudy became one of my best and closest friends. I feel fortunate to have known both of them and will miss Rudy's quick wit and Lew's gentle humor They both were staunch advocates for all CFIDS patients. My sincere condolences go out to their families.
 
Q: From the previous Forum, the NCF mentioned that rubulaviruses, such as Parainfluenza Virus-5, can cause alterations in testosterone production. In fact, the NCF mentioned that men can become hypogonadal due to the reduction in their own natural testosterone production. My doctor has me on testosterone gel because my body doesn't produce enough. Can you explain why this happens? (Internet question)
 
A: As you know, Parainfluenza Virus-5 (PIV-5) has been explicitly identified in CFIDS/ME patients. PIV-5 is a member of the rubulavirus family as is mumps. Rubulaviruses have been found to be responsible for sterility [1] due to direct infection of Leydig cells in the testes. The infection of Leydig cells leads to the inhibition of testosterone production. The mechanism associated with testosterone inhibition is related to the generation of gamma interferon-induced protein-10 production (IP-10) in these infected Leydig cells [2]. Thus, the infection can reduce natural testosterone production. I recommend that patients who are concerned with this contact an endocrinologist for a complete endocrine workup. It is important to note that with any type of testosterone replacement therapy, that periodic tests for prostate-specific antigen (PSA) be monitored since testosterone replacement can have an adverse effect on PSA and may influence the risk of prostate cancer [3]. It is common for physicians to measure serum free/total testosterone as well as free/total PSA as baseline tests. Repeat or periodic tests can then be made for subsequent comparison should patients opt for testosterone replacement therapy.
 
References:
1. Mumps virus decreases testosterone production and gamma interferon-induced protein 10
secretion by human leydig cells; Le Goffic R, Mouchel T, Ruffault A, Patard JJ, Jegou B,
Samson M; J Virol. 2003 Mar;77(5):3297-3300

2. Expression and regulation of interferon-gamma-inducible protein 10 gene in rat Leydig cells; Hu J, You S, Li W, Wang D, Nagpal ML, Mi Y, Liang P, Lin T; Endocrinology. 1998
Aug;139(8):3637-3645

3. Testosterone treatment in hypogonadal men: prostate-specific antigen level and risk of prostate cancer; Guay AT, Perez JB, Fitaihi WA, Vereb M; Endocr Pract. 2000 Mar-Apr;6(2):132-138
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