CONTEXT: Secondary hypogonadism is common in ageing men; its natural history and predisposing factors are unclear.
OBJECTIVES: 1) To identify factors which predispose eugonadal men (T ≥10.5nmol/L) to develop biochemical secondary hypogonadism (T< 10.5nmol/L, LH≤ 9.4U/L) and secondary hypogonadal men to recover to eugonadism. 2) To characterize clinical features associated with these transitions.
DESIGN: Prospective observational general population cohort survey.
SETTING: Clinical research centres.
PARTICIPANTS: 3369 community-dwelling men aged 40-79 yr in eight European centres.
INTERVENTION: Observational follow-up of 4.3 years.
MAIN OUTCOME MEASURE: Subjects were categorised according to change/no change in biochemical gonadal status during follow-up into persistent eugonadal (n=1909), incident secondary hypogonadal (n=140), persistent secondary hypogonadal (n=123) and recovered from secondary hypogonadism to eugonadism (n=96). Baseline predictors and changes in clinical features associated with incident secondary hypogonadism and recovery from secondary hypogonadism were analysed by regression models.
RESULTS: The incidence of secondary hypogonadism was 155.9/10,000/year, while 42.9% of men with secondary hypogonadism recovered to eugonadism. Incident secondary hypogonadism was predicted by obesity [BMI ≥30kg/m2: odds ratio (OR)=2.86 (95% confidence interval 1.67;4.90); p< 0.0001], weight gain [OR=1.79 (1.15;2.80);p=0.011] and increased waist circumference [OR=1.73 (1.07;2.81); p=0.026 and 2.64 (1.66;4.21);p< 0.0001, for waist circumference 94-102 and ≥102 cm, respectively]. Incident secondary hypogonadal men experienced new/worsening sexual symptoms [low libido, erectile dysfunction and infrequent spontaneous erections]. Recovery from secondary hypogonadism was predicted by non-obesity [OR=2.28 (1.21;4.31); p=0.011], weight loss [OR=2.24 (1.04;4.85); p=0.042], normal waist circumference [OR=1.93 (1.01;3.70); p=0.048], younger age [< 60yr OR=2.32 (1.12;4.82); p=0.024] and higher education [OR=2.11 (1.05;4.26); p=0.037], but symptoms did not show significant concurrent improvement.
CONCLUSION: Obesity-related metabolic and lifestyle factors predispose older men to the development of secondary hypogonadism, which is frequently reversible with weight loss.
Written by:
Rastrelli G, Carter EL, Ahern T, Finn JD, Antonio L, O'Neill TW, Bartfai G, Casanueva FF, Forti G, Keevil B, Maggi M, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Vanderschueren D, Wu FC. Are you the author?
Sexual Medicine and Andrology Unit, Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
Reference: J Clin Endocrinol Metab. 2015 May 22:jc20151571.
doi: 10.1210/jc.2015-1571
PubMed Abstract
PMID: 26000545