Using gas chromatography and mass spectrometry we have studied the ratios of steroid metabolites and 24-hour urinary steroid excretion rates in 37 men of whom 14 where positive for the human immunodeficiency virus (HIV; group A), while 9 had acquired immunodeficiency syndrome (AIDS; group B). Controls were sick non-AIDS patients admitted to an intensive care unit (ICU) and healthy volunteers. In groups A and B and the ICU controls, there was a reduction in the excretion of adrenal androgen metabolites and a reduced ratio of 5α to 5β androgen metabolites. These data suggest that adrenal androgens are removed in HIV and AIDS in a similar manner to other systemic illnesses. In group B patients and the sick controls, the ratios of cortisol to cortisone metabolites were raised compared with controls. Daily, total cortisol metabolite excretion rates in AIDS were similar to those in patients in the ICU. The selective loss of adrenal androgens may be mediated by cytokines and influence components of the immune system. The progression of HIV to AIDS may be due in part to an imbalance between androgens and glucocorticoids. © 1995 S. Karger AG, Basel.