Serum testosterone levels and excessive erythrocytosis during the process of adaptation to high altitudes

Populations living at high altitudes (HAs), particularly in the Peruvian Andes, are characterized by a mixture of subjects with erythrocytosis (16 g dl⁻¹<haemoglobin (Hb)≤21 g dl⁻¹) and others with excessive erythrocytosis (EE) (Hb>21 g dl⁻¹). Elevated haemoglobin values (EE) are associated with chronic mountain sickness, a condition reflecting the lack of adaptation to HA. According to current data, native men from regions of HA are not adequately adapted to live at such altitudes if they have elevated serum testosterone levels. This seems to be due to an increased conversion of dehydroepiandrosterone sulphate (DHEAS) to testosterone. Men with erythrocytosis at HAs show higher serum androstenedione levels and a lower testosterone/androstenedione ratio than men with EE, suggesting reduced 17beta-hydroxysteroid dehydrogenase (17beta-HSD) activity. Lower 17beta-HSD activity via Δ4-steroid production in men with erythrocytosis at HA may protect against elevated serum testosterone levels, thus preventing EE. The higher conversion of DHEAS to testosterone in subjects with EE indicates increased 17beta-HSD activity via the Δ5-pathway. Currently, there are various situations in which people live (human biodiversity) with low or high haemoglobin levels at HA. Antiquity could be an important adaptation component for life at HA, and testosterone seems to participate in this process.     

Older Men With Low Serum Estradiol and High Serum SHBG Have an Increased Risk of Fractures

Osteoporosis‐related fractures constitute a major health concern not only in women but also in men. To study the predictive role of serum sex steroids for fracture risk in men, serum sex steroids were analyzed by the specific gas chromatography‐mass spectrometry technique at baseline in older men (n = 2639; mean, 75 yr of age) of the prospective population‐based MrOS Sweden cohort. Fractures occurring after baseline were validated (average follow‐up of 3.3 yr). The incidence for having at least one validated fracture after baseline was 20.9/1000 person‐years. Estradiol (E2; hazard ratio [HR] per SD decrease, 1.34; 95% CI, 1.22–1.49), free estradiol (fE2; HR per SD decrease, 1.41; 95% CI, 1.28–1.55), testosterone (T; HR per SD decrease, 1.27; 95% CI, 1.16–1.39), and free testosterone (fT; HR per SD decrease, 1.32; 95% CI, 1.21–1.44) were all inversely, whereas sex hormone–binding globulin (SHBG; HR per SD increase, 1.41; 95% CI, 1.22–1.63) was directly related to fracture risk. Multivariable proportional hazards regression models, adjusted for age, suggested that fE2 and SHBG (p < 0.001), but not fT, were independently associated with fracture risk. Further subanalyses of fracture type showed that fE2 was inversely associated with clinical vertebral fractures (HR per SD decrease, 1.57; 95% CI, 1.36–1.80), nonvertebral osteoporosis fractures (HR per SD decrease, 1.42; 95% CI, 1.23–1.65), and hip fractures (HR per SD decrease, 1.44; 95% CI, 1.18–1.76). The inverse relation between serum E2 and fracture risk was nonlinear with a strong relation <16 pg/ml for E2 and 0.3 pg/ml for fE2. In conclusion, older Swedish men with low serum E2 and high SHBG levels have an increased risk of fractures.     

Serum levels of testosterone and oestrogens in normal and infertile stallions

The serum concentrations of testosterone and oestrogens were determined in stallions classified as geldings, normal (according to age) or infertile (azoospermic). There were significant differences in testosterone and oestrogen levels between the groups. Normal concentrations of testosterone and total oestrogens were attained after 16 months of age. Castrated and immature horses (<15 months of age) had lower levels of testosterone and total oestrogens than did mature and infertile stallions. Azoospermic stallions had lower levels of testosterone and total oestrogens than did normal mature horses except in one case (B₄) in which the level of total oestrogens was increased markedly. Critical ellipses for testosterone and total oestrogens were obtained for both groups (6–15-month-old colts and stallions aged >4 years). The results suggest that serum levels of testosterone and total oestrogens may provide a sensitive index of the endocrine function of the testis in male horses.     

Antigen size influences the type of glomerular pathology in chronic serum sickness

Chronic serum sickness was induced in four groups of Wistarrats by immunization with BSA, cationized BSA (cBSA), humanIgG (HuIgG), or human 1gM (HuIgM), followed by repeated intraperitoneal (i.p.) injection of the antigen used, to study the effectof the characteristics of an antigen on renal immunopathology.Renal tissue sampled 2, 4, 7, and 9 weeks after the start ofthe i.p. injections was examined by light-, immunofluorescence-,and electron microscopy. Proteinuna was measured in urine collected over 24 h. All animals given BSA, cBSA, or HuIgG developedprogressive renal disease character ized by initial depositionof antigen and rat Ig in the mesangium of rats given BSA orHuIgG, and minimal amounts in those given cBSA, followed bythe appear ance in the first instance of subendothelial depositsin the animals receiving BSA or HuIgG, and later subepi thelialdeposits in those given BSA, cBSA, or HuIgG. The appearanceof immunoglobulin deposits along the glomerular capillary wallwas associated with the onset of massive proteinuria reachingaverage levels of 450 mg/24 h for rats given BSA or cBSA, and500 mg/24 h for those given HuIgG. Animals injected with HuIgMshowed only mesangial deposits of human 1gM and rat Ig withoutthe development of proteinuria. Under light-microscopy, ratsgiven BSA, cBSA, or HuIgM showed minimal abnormalities, whereasthose receiving HuIgG showed transient but severe influx ofgranulocytes in glomeruli with the development of diffuse proliferativeglomerulonephritis in association with a long-lasting phasecharacterized by subendothel ially localized immune aggregates.No differences in the degree or type of the immune responsewere found either as measured by ELISA or double radial immunodiffusion. We conclude that the type of glomerular immunopathologyduring chronic serum sickness is partially dependent on thesize of the antigen used for induction of the disease.     

Serum total and free testosterone level of Japanese men: a population-based study

BACKGROUND: There has never been a large scale population-based study of serum levels of total testosterone (TT) and free testosterone (FT) in Japanese men. METHODS: We determined serum levels of TT and FT of 1120 Japanese men aged 40-79 years using radioimmunoassay (RIA), as a part of a population-based longitudinal study of aging. Of these, sex hormone binding protein (SHBG) was also measured by RIA in 471 men. For the latter group, the calculated free testosterone (cFT) was determined by a formula using serum level of albumin, TT and SHBG. RESULTS: The mean +/- 2 SD of TT, FT and cFT were 513 +/- 326 ng/dL (187-839 ng/dL), 13.2 +/- 7.8) pg/mL (5.4-21.0 pg/mL) and 77.0 +/- 43.4 pg/mL (33.6-120.4 pg/mL), respectively. While TT did not relate to age, FT and cFT decreased with age. FT in the 40-49 years age group was 15.1 +/- 8.4 pg/mL (6.7-23.5 pg/mL), in the 50-59 years age group was 13.9 +/- 6.8 pg/mL (7.1-20.7 pg/mL), in the 60-69 years age group was 12.0 +/- 6.6 pg/mL (5.4-18.6 pg/mL) and in the 70-79 years age group was 11.5 +/- 7.0 pg/mL (4.5-18.5 pg/mL). FT significantly correlated with cFT (Spearman's r = 0.803). The correspondence rates were 92.3% at the mean -1 SD and 98.7% at the mean -2 SD level. CONCLUSIONS: We determined the mean and standard deviation of TT, FT and cFT in Japanese men aged 40 years or older. It is supposed that FT determined by RIA would be useful for diagnosing partial androgen deficiency of aging males.     

Low testosterone level of middle-aged Japanese men - the association between low testosterone levels and quality-of-life

Background

Late-onset hypogonadism (LOH) is due to age-related steep declines in free testosterone levels in middle age. LOH can induce a variety of signs and symptoms that deteriorate the quality-of-life (QOL) of middle-aged men. This study examined the circadian rhythm of salivary testosterone levels in three age cohorts: 20s-30s, 40s-50s, and 60s+ to investigate the association between QOL and testosterone levels in adult Japanese men.

Subjects and Methods

Eighty-one healthy male Japanese volunteers and 20 LOH patients in their 40s-50s were recruited. Their salivary testosterone levels were measured as were independent variables including Body Mass Index (BMI) and smoking rates. The SF-36 v2 was used as the health-related questionnaire to evaluate QOL. Saliva samples were collected at 2-hour intervals between 9:00 am and 9:00 pm. Salivary testosterone levels were determined using an enzyme-linked immunosorbent assay (ELISA: Demeditec Diagnostics, Germany).

Results

There were no significant differences in BMI and smoking rates among the three healthy groups. However, scores from the SF-36 related to body pain were significantly lower in the 40s-50s cohort than in the 20s-30s group. The mean salivary testosterone levels in the 40s-50s group were the lowest at any point of time, except for 9:00 am among all healthy cohorts, and were similar to those of LOH patients. A circadian rhythm was seen in salivary testosterone levels in the 20s-30s and 40s-50s groups, whereas it was lost in the 60s+ group and in LOH patients.

Conclusion

Middle-aged Japanese men had the lowest levels of salivary testosterone and the worst QOL scores in relation to body pain, which may affect their overall QOL.     

Serum testosterone levels in diabetic men with and without erectile dysfunction

Diabetes mellitus is a common chronic disease, affecting 0.5–2% worldwide. The Massachusetts Male Aging Study reported that up to 75% of men with diabetes have a lifetime risk of developing ED. Type 2 diabetes is associated with low total serum testosterone (TT) identified in several cross‐sectional studies and systemic analyses. There is a lack of consensus regarding what constitutes the lowest level of testosterone within the boundaries of normality. In this retrospective study, we sought to evaluate the effect of associated co‐morbidities on serum total testosterone (TT) level in men with type 2 diabetes DM, either with or without erectile dysfunction (ED). Three hundred and ninety‐one patients were evaluated for erectile function using an abridged, five‐item version of the International Index of Erectile Function‐5. Measurements of TT, fasting lipid profile, blood sugar and glycated haemoglobin (HbA1c) were conducted. Penile hemodynamics was assessed using intracavernosal injection and penile duplex study. Hypogonadism was found in 126 cases (33.2%), and normal TT was observed in 254 (66.8%). ED was detected in 119 cases in the hypogonadal group (94.4%) as compared to 155/254 (61.0%) in eugonadal group, P = 0.0001. TT was lower in diabetic men with ED as compared to those with normal erectile function (EF), 392.4 ± 314.9 versus 524.3 ± 140.2 ng dl^?1, respectively, P < 0.0001. After exclusion of patients with hypertension and dyslipidaemia, 185 men were evaluated, and there was no difference in the mean TT level among men with ED 490.6 ± 498.2 ng dl^?1 versus normal EF 540.6 ± 133.4 ng dl^?1 although, HbA1c remained lower in men with normal erectile function. Receiver operating characteristic (ROC) curve of TT in men without associated co‐morbidities showed that EF was compromised at TT = 403.5 ng dl^?1 or less. Sensitivity of 63.3% and a specificity of 94.0% were detected. At this level, ED was found in 33/38 (86.8%) men with TT 403.5 ng dl^?1, whereas ED was observed in 57/147 (38.8%) men with TT ≥ 403.5 ng dl^?1 (P < 0.0001). We propose a cut‐off value of 403.5 ng dl^?1 of TT blood levels as an indicator for initiation of testosterone replacement therapy in diabetic men with ED. Further prospective controlled trials are recommended.     

The cost‐effectiveness of HIV pre‐exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil

Introduction

Men who have sex with men (MSM) and transgender women (TGW) in Brazil experience high rates of HIV infection. We examined the clinical and economic outcomes of implementing a pre‐exposure prophylaxis (PrEP) programme in these populations.

Methods

We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model of HIV prevention and treatment to evaluate two strategies: the current standard of care (SOC) in Brazil, including universal ART access (No PrEP strategy); and the current SOC plus daily tenofovir/emtracitabine PrEP (PrEP strategy) until age 50. Mean age (31 years, SD 8.4 years), age‐stratified annual HIV incidence (age ≤ 40 years: 4.3/100 PY; age > 40 years: 1.0/100 PY), PrEP effectiveness (43% HIV incidence reduction) and PrEP drug costs ($23/month) were from Brazil‐based sources. The analysis focused on direct medical costs of HIV care. We measured the comparative value of PrEP in 2015 United States dollars (USD) per year of life saved (YLS). Willingness‐to‐pay threshold was based on Brazil's annual per capita gross domestic product (GDP; 2015: $8540 USD).

Results

Lifetime HIV infection risk among high‐risk MSM and TGW was 50.5% with No PrEP and decreased to 40.1% with PrEP. PrEP increased per‐person undiscounted (discounted) life expectancy from 36.8 (20.7) years to 41.0 (22.4) years and lifetime discounted HIV‐related medical costs from $4100 to $8420, which led to an incremental cost‐effectiveness ratio (ICER) of $2530/YLS. PrEP remained cost‐effective (<1x GDP) under plausible variation in key parameters, including PrEP effectiveness and cost, initial cohort age and HIV testing frequency on/off PrEP.

Conclusion

Daily tenofovir/emtracitabine PrEP among MSM and TGW at high risk of HIV infection in Brazil would increase life expectancy and be highly cost‐effective.

     

长沙市男男性行为者异性性行为特征及影响因素分析

目的了解长沙市男男性行为者(MSM)异性性行为的特征、影响因素及其HIV/梅毒感染状况,为制定阻断HIV/性传播疾病向妇女传播的干预措施提供参考。方法采取滚雪球和同伴推动抽样方法,对参加自愿咨询检测服务的MSM进行匿名问卷调查,同时抽取静脉血进行HIV和梅毒血清学检测。结果共调查MSM 604例,15.2%在最近6个月内与女性发生过性行为,其中28.0%发生异性性行为从未使用安全套,坚持每次使用安全套仅31.7%。84.8%MSM最近6个月也发生了同性性行为,6.4%从不使用安全套,56.4%有时使用安全套。最近6个月发生过异性性行为的MSM在异性性行为中安全套使用率低于同性性行为中的使用率(P0.05)。MSM的HIV和梅毒感染率分别为12.9%和7.3%。多因素Logistic回归分析显示,婚姻状况、月收入、性取向、首次性交对象是MSM异性性行为的影响因素(P0.05,P0.01)。结论 MSM有异性性行为者比例较高,且发生异性性行为时安全套使用率较低。应重点加强对已婚、月收入高、性取向为双性恋或异性恋或不确定、首次性交对象为女性的MSM安全性行为干预,以降低HIV/性传播疾病向妇女传播的风险。     

Production, clearance, and metabolism of testosterone in men with prostatic cancer

It was previously unknown whether the production and metabolism of testosterone was altered in men with prostatic cancer. We recently observed a familial influence on the plasma concentration of sex steroids in men with the cancer. We have now determined, by isotope dilution techniques, the blood testosterone production and clearance rates and testosterone metabolism to potent androgen metabolites in men with prostatic cancer, their brothers, and unrelated controls. Nineteen men had a diagnosis of prostatic cancer before age 63 (probands), 23 were brothers of these index cases, and nine controls matched for age were selected randomly from the general population. None had received endocrine therapy. The plasma content of testosterone, dihydrotestosterone, sex hormone binding globulin, apparent free testosterone concentration, follicle-stimulating hormone, and luteinizing hormone were not significantly different between the groups. The metabolic clearance rate of testosterone was significantly (P = .04) higher in probands (458 liters/day/body surface area, median) than in controls (306 liters/day/body surface area). The conversion ratios of both testosterone (1.8%) and dihydrotestosterone (16.9%) to 3 alpha-androstanediol were significantly greater (P = .04 and P = .004, respectively) in probands than in controls (0.95%, 7.8%). These results indicate that men with prostatic cancer have elevated clearance rates of testosterone and an increased conversion ratio of testosterone to its potent 5 alpha-reduced metabolites.     

中老年男性血清睾酮与动脉粥样硬化的相关性研究

目的 :探讨中老年男性睾酮水平与动脉粥样硬化之间的相关性。方法:选取2012年10月至2013年3月40~75岁的广州男性居民413例作为研究对象,收集人口学资料、临床资料及身体测量指标,实验室检测性激素、血糖、血脂等指标,彩色多普勒超声诊断仪测定颈动脉内膜中层厚度(CIMT)。结果:以CIMT=0.9 mm作为切点将人群分为颈动脉硬化组与非硬化组,游离睾酮(FT)在两组间的中位数分别为57.41 pmol/L及59.72 pmol/L(P=0.005),总睾酮(TT)两组间未见差异。Spearman相关分析提示TT、FT与CIMT呈负相关,r分别为-0.126(P=0.011)和-0.188(P<0.01)。以四分位数点作为切点由低到高将FT分为Q1、Q2、Q3、Q4组,各组颈动脉硬化患病率分别为23.30%、13.46%、17.48%、7.77%(P for trend=0.008)。TT各组颈动脉硬化的患病率分别为17.48%、18.27%、16.50%、9.71%(P for trend=0.116)。多因素Logistic回归分析评估FT各组颈动脉硬化患病优势比(OR)提示,以Q4组作为对照,在校正了年龄、腰围、收缩压、糖基化血红蛋白的影响后,Q1组的患病风险明显增高(OR1=2.491,95%CI:1.01~6.149)。同样在TT的分组中采取Logistic回归分析,以Q4组作为对照,各组患病风险未见明显差异。结论:中国40岁以上男性,血清FT低下可能是动脉粥样硬化的危险因素。     

Effect of Lepidium meyenii (MACA) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men

This study was a 12-week double blind placebo-controlled, randomized, parallel trial in which active treatment with different doses of Maca Gelatinizada was compared with placebo. The study aimed to demonstrate if effect of Maca on subjective report of sexual desire was because of effect on mood or serum testosterone levels. Men aged 21-56 years received Maca in one of two doses: 1,500 mg or 3,000 mg or placebo. Self-perception on sexual desire, score for Hamilton test for depression, and Hamilton test for anxiety were measured at 4, 8 and 12 weeks of treatment. An improvement in sexual desire was observed with Maca since 8 weeks of treatment. Serum testosterone and oestradiol levels were not different in men treated with Maca and in those treated with placebo (P:NS). Logistic regression analysis showed that Maca has an independent effect on sexual desire at 8 and 12 weeks of treatment, and this effect is not because of changes in either Hamilton scores for depression or anxiety or serum testosterone and oestradiol levels. In conclusion, treatment with Maca improved sexual desire.     

Exposing the gaps in awareness,knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia

Introduction

The incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group.

Methods

A cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices) completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population.

Results

Of 72% (95% confidence interval (CI): 67–77) who had heard of anal cancer, 47% (95% CI: 41–53) could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57) underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01–1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93). They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96), to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59) or speak English at home (OR 0.28, 95% CI: 0.09–0.90).

Conclusions

This survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.     

Serum 25-hydroxyvitamin D levels and testosterone deficiency in middle-aged Korean men: a cross-sectional study

Previous studies have demonstrated that male hypogonadism is associated with a low level of vitamin D. However, no reports have investigated the effects of vitamin D on testosterone levels in Korean men. Our aim was to investigate whether testosterone levels are associated with serum vitamin D levels and whether seasonal variation exists. This cross-sectional study analyzed serum 25-hydroxyvitamin D [25(OH)D], total testosterone (TT), and free testosterone (FT) in 652 Korean men over 40 years of age who had undergone a comprehensive medical examination. The average age of the subjects was 56.7 ± 7.9 years, and the mean serum 25(OH)D, TT and FT levels were 21.23 ± 7.9 ng ml⁻¹, 4.70 ± 1.6 ng ml⁻¹, and 8.12 ± 3.3 pg ml⁻¹, respectively. In the multiple linear regression model, 25(OH)D showed positive association with TT (β =0.137, P < 0.001) and FT (β =0.103, P = 0.008). 25(OH)D and FT showed similar seasonal or monthly variation after adjustment for age. A vitamin D deficiency [25(OH)D < 20 ng ml⁻¹] was associated with an increased risk of deficiencies of TT (<2.30 ng ml⁻¹) (odds ratio [OR]: 2.65; 95% confidence interval [CI]: 1.21–5.78, P = 0.014) and FT (<6.50 pg ml⁻¹) (OR: 1.44; 95% CI: 1.01–2.06 P = 0.048) after adjusting for age, season, body mass index, body composition, chronic disease, smoking, and alcohol use. In conclusion, we demonstrated a positive correlation between 25(OH)D and testosterone, which showed similar seasonal variation in Korean men.     

Association between HIV PrEP indications and use in a national sexual network study of US men who have sex with men

IntroductionHIV pre‐exposure prophylaxis (PrEP) is effective in preventing HIV transmission. United States Public Health Service (USPHS) clinical practice guidelines define biobehavioral indications for initiation. To assess guideline implementation, it is critical to quantify PrEP nonusers who are indicated and PrEP users who are not indicated. We sought to estimate current PrEP use among US men who have sex with men (MSM), characterize whether their PrEP use aligned with their current indications for PrEP, and assess whether the association between PrEP indications and PrEP use differed by demography or geography.MethodsUsing data from a US web‐based sexual network study of MSM between 2017 and 2019, we measured PrEP usage and assessed whether respondents met indications for PrEP. Log‐binomial regression was used to estimate the relationship between PrEP indications and PrEP use, with adjustment for geography, age and race/ethnicity.ResultsOf 3508 sexually active, HIV‐negative MSM, 34% met indications for PrEP. The proportion with current PrEP use was 32% among MSM meeting indications and 11% among those without indications. Nearly 40% of those currently using PrEP did not meet indications for PrEP, and 68% of MSM with indications for PrEP were not currently using PrEP. After adjusting for geography and demographics, MSM with PrEP indications were about three times as likely to be currently using PrEP. This association varied slightly, but not significantly, by geographic region, age and race/ethnicity.ConclusionsIndications for PrEP strongly predicted current PrEP use among US MSM. However, we identified substantial misalignment between indications and use in both directions (indicated MSM who were not benefitting from PrEP, and MSM taking PrEP while not presently being indicated). PrEP underuse by those at greatest risk for HIV acquisition may limit the projected impact of PrEP implementation, despite reported increases in PrEP provision. This calls for further implementation efforts to improve PrEP delivery to those most in need during periods of elevated sexual risk and to close the gap between indications and uptake.     

New HIV testing technologies in the context of a concentrated epidemic and evolving HIV prevention: qualitative research on HIV self‐testing among men who have sex with men and transgender women in Yangon,Myanmar

Introduction : Global effort to increase early diagnosis and engagement in HIV care emphasize the importance of developing novel approaches to reaching those missed by traditional methods. Such needs are particularly great for men who have sex with men (MSM), transgender women (TW), and other populations who face stigma. Myanmar's HIV epidemic is concentrated among key populations and the revised National Strategy aims to reduce late diagnosis and barriers to care to curb HIV incidence among these groups. HIV self‐testing (HIVST) may be one method to improve testing and diagnosis among key populations, by placing HIV testing and disclosure within the individual's control. Methods : Formative, qualitative research including in‐depth interviews with adult MSM (N = 12) and TW (N = 13) and focus group discussions with MSM, TW, and community key informants (N = 35) were conducted in June‐September 2015 in Yangon, Myanmar. To inform a subsequent HIV care continuum intervention, including HIVST, participants’ opinions and perceptions about HIVST were elicited. Results : The confidentiality and privacy of HIVST, particularly as it related to disclosure of HIV status and sexual behaviour, was widely recognized among participants. These major advantages were further supported by the opportunity to avoid stigma, convenience of self‐testing (reduced need for transportation and time to go to clinics), and the availability of a pain‐free testing option. Participants weighed these benefits against perceived disadvantages of HIVST, the majority of which centred on the perception that HIVST does not include counselling. Participants were concerned that potential lack of counselling would result in poor mental health outcomes, inadequate linkage to HIV care and surveillance, and reductions in disclosure of HIV status. Participants did not view these disadvantages as an impediment, but provided suggestions for future implementation of HIVST in Myanmar. Conclusions : MSM and TW are optimistic about the confidentiality and privacy afforded by HIVST but wanted HIV counselling and linkage to appropriate services. The domestic reprioritization of HIV and opening of the country to international support has substantially increased the availability of HIV treatment and provides new opportunities, like HIVST, to potentially improve the HIV response for key populations who are at risk for HIV acquisition.