Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism: Prospective results from the EMAS
| Autor: | Giulia, Rastrelli, Terence W, O'Neill, Tomas, Ahern, György, Bártfai, Felipe F, Casanueva, Gianni, Forti, Brian, Keevil, Aleksander, Giwercman, Thang S, Han, Jolanta, Slowikowska-Hilczer, Michael E J, Lean, Neil, Pendleton, Margus, Punab, Leen, Antonio, Jos, Tournoy, Dirk, Vanderschueren, Mario, Maggi, Ilpo T, Huhtaniemi, Frederick C W, Wu, Min, Jiang |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine obesity medicine.medical_specialty Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Free testosterone sexual symptoms 03 medical and health sciences 0302 clinical medicine Endocrinology Sex hormone-binding globulin Hypothyroidism secondary hypogonadism Internal medicine Androgen deficiency Epidemiology medicine Humans Testosterone Cumulative incidence Obesity Prospective Studies Aged Morning androgen deficiency biology business.industry Hypogonadism total testosterone Testosterone (patch) Middle Aged sex hormone binding globulin medicine.disease Observational Studies as Topic Logistic Models 030104 developmental biology Erectile dysfunction biology.protein business |
| Zdroj: | Clinical Endocrinology. 89:459-469 |
| ISSN: | 0300-0664 |
| DOI: | 10.1111/cen.13756 |
| Popis: | OBJECTIVE: Limited evidence supports the use of free testosterone (FT) for diagnosing hypogonadism when sex hormone-binding globulin (SHBG) is altered. Low total testosterone (TT) is commonly encountered in obesity where SHBG is typically decreased. We aimed to assess the contribution of FT in improving the diagnosis of symptomatic secondary hypogonadism (SH), identified initially by low total testosterone (TT), and then further differentiated by normal FT (LNSH) or low FT (LLSH). DESIGN: Prospective observational study with a median follow-up of 4.3 years. PATIENTS: Three thousand three hundred sixty-nine community-dwelling men aged 40-79 years from eight European centres. MEASUREMENTS: Subjects were categorized according to baseline and follow-up biochemical status into persistent eugonadal (referent group; n = 1880), incident LNSH (eugonadism to LNSH; n = 101) and incident LLSH (eugonadism to LLSH; n = 38). Predictors and clinical features associated with the transition from eugonadism to LNSH or LLSH were assessed. RESULTS: The cumulative incidence of LNSH and LLSH over 4.3 years was 4.9% and 1.9%, respectively. Baseline obesity predicted both LNSH and LLSH, but the former occurred more frequently in younger men. LLSH, but not LNSH, was associated with new/worsened sexual symptoms, including low desire [OR = 2.67 (1.27-5.60)], erectile dysfunction [OR = 4.53 (2.05-10.01)] and infrequent morning erections [OR = 3.40 (1.48-7.84)]. CONCLUSIONS: These longitudinal data demonstrate the importance of FT in the diagnosis of hypogonadism in obese men with low TT and SHBG. The concurrent fall in TT and FT identifies the minority (27.3%) of men with hypogonadal symptoms, which were not present in the majority developing low TT with normal FT. ispartof: CLINICAL ENDOCRINOLOGY vol:89 issue:4 pages:459-469 ispartof: location:England status: published |
| Databáze: | OpenAIRE |
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