Tomás Ahern1, Agnieszka Swiecicka1, Robert J A H Eendebak1, Emma L Carter1, Joseph D Finn1, Stephen R Pye2, Terence W O'Neill2, Leen Antonio3, Brian Keevil4, György Bartfai5, Felipe F Casanueva6, Gianni Forti7, Aleksander Giwercman8, Thang S Han9, Krzysztof Kula10, Michael E J Lean11, Neil Pendleton12, Margus Punab13, Giulia Rastrelli7, Martin K Rutter1,14, Dirk Vanderschueren3, Ilpo T Huhtaniemi15,16, Frederick C W Wu1. 1. Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK. 2. Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. 3. Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium. 4. Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester, UK. 5. Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary. 6. Department of Medicine, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatología Obesidad y Nutricion (CB06/03), Santiago de Compostela University, Instituto Salud Carlos III, Santiago de Compostela, Spain. 7. Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy. 8. Reproductive Medicine Centre, Malmö University Hospital, University of Lund, Lund, Sweden. 9. Institute of Cardiovascular Research, "Royal Holloway University of London (ICR2UL), Egham & Agham and St Peter's NHS Foundation Trust, Egham, Surrey, UK. 10. Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland. 11. Department of Human Nutrition, University of Glasgow, Glasgow, UK. 12. School of Community Based Medicine, Hope Hospital, The University of Manchester, Salford, UK. 13. United Laboratories of Tartu University Clinics, Andrology Unit, Tartu, Estonia. 14. Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science, Manchester, UK. 15. Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, UK. 16. Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland.
Abstract
OBJECTIVE: In ageing men, the incidence and clinical significance of testosterone (T) decline accompanied by elevated luteinizing hormone (LH) are unclear. We describe the natural history, risk factors and clinical features associated with the development of biochemical primary hypogonadism (PHG, T < 10·5 nmol/l and LH>9·4U/l) in ageing men. DESIGN, PATIENTS AND MEASUREMENTS: A prospective observational cohort survey of 3,369 community-dwelling men aged 40-79 years, followed up for 4·3 years. Men were classified as incident (i) PHG (eugonadal [EUG, T ≥ 10·5 nmol/l] at baseline, PHG at follow-up), persistent (p) PHG (PHG at baseline and follow-up), pEUG (EUG at baseline and follow-up) and reversed (r) PHG (PHG at baseline, EUG at follow-up). Predictors and changes in clinical features associated with the development of PHG were analysed by regression models. RESULTS: Of 1,991 men comprising the analytical sample, 97·5% had pEUG, 1·1% iPHG, 1·1% pPHG and 0·3% rPHG. The incidence of PHG was 0·2%/year. Higher age (>70 years) [OR 12·48 (1·27-122·13), P = 0·030] and chronic illnesses [OR 4·24 (1·08-16·56); P = 0·038] predicted iPHG. Upon transition from EUG to PHG, erectile function, physical vigour and haemoglobin worsened significantly. Men with pPHG had decreased morning erections, sexual thoughts and haemoglobin with increased insulin resistance. CONCLUSIONS: Primary testicular failure in men is uncommon and predicted by old age and chronic illness. Some clinical features attributable to androgen deficiency, but not others, accompanied the T decline in men who developed biochemical PHG. Whether androgen replacement can improve sexual and/or physical function in elderly men with PHG merits further study.
OBJECTIVE: In ageing men, the incidence and clinical significance of testosterone (T) decline accompanied by elevated luteinizing hormone (LH) are unclear. We describe the natural history, risk factors and clinical features associated with the development of biochemical primary hypogonadism (PHG, T < 10·5 nmol/l and LH>9·4U/l) in ageing men. DESIGN, PATIENTS AND MEASUREMENTS: A prospective observational cohort survey of 3,369 community-dwelling men aged 40-79 years, followed up for 4·3 years. Men were classified as incident (i) PHG (eugonadal [EUG, T ≥ 10·5 nmol/l] at baseline, PHG at follow-up), persistent (p) PHG (PHG at baseline and follow-up), pEUG (EUG at baseline and follow-up) and reversed (r) PHG (PHG at baseline, EUG at follow-up). Predictors and changes in clinical features associated with the development of PHG were analysed by regression models. RESULTS: Of 1,991 men comprising the analytical sample, 97·5% had pEUG, 1·1% iPHG, 1·1% pPHG and 0·3% rPHG. The incidence of PHG was 0·2%/year. Higher age (>70 years) [OR 12·48 (1·27-122·13), P = 0·030] and chronic illnesses [OR 4·24 (1·08-16·56); P = 0·038] predicted iPHG. Upon transition from EUG to PHG, erectile function, physical vigour and haemoglobin worsened significantly. Men with pPHG had decreased morning erections, sexual thoughts and haemoglobin with increased insulin resistance. CONCLUSIONS:Primary testicular failure in men is uncommon and predicted by old age and chronic illness. Some clinical features attributable to androgen deficiency, but not others, accompanied the T decline in men who developed biochemical PHG. Whether androgen replacement can improve sexual and/or physical function in elderly men with PHG merits further study.
Authors: Thomas G Travison; Hubert W Vesper; Eric Orwoll; Frederick Wu; Jean Marc Kaufman; Ying Wang; Bruno Lapauw; Tom Fiers; Alvin M Matsumoto; Shalender Bhasin Journal: J Clin Endocrinol Metab Date: 2017-04-01 Impact factor: 5.958