Ewa A Jankowska1,2,3, Michał Tkaczyszyn1, Kinga Węgrzynowska-Teodorczyk2,4, Jacek Majda5, Stephan von Haehling6,7, Wolfram Doehner6,8, Waldemar Banasiak2, Stefan D Anker6,7, Piotr Ponikowski1,2. 1. Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland. 2. Cardiology Department, Centre for Heart Diseases, Military Hospital, Wrocław, Poland. 3. Institute of Anthropology, Polish Academy of Sciences, Wrocław, Poland. 4. Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland. 5. Laboratory Division, Military Hospital, Wrocław, Poland. 6. Division of Applied Cachexia Research, Department of Cardiology, Charité Medical School, Berlin, Germany. 7. Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany. 8. Centre for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
Abstract
BACKGROUND: Male ageing is characterized by diminished circulating androgens with several adverse psychosomatic consequences and can be aggravated by concomitant chronic diseases. According to the European Male Aging Study (EMAS) Group, late-onset hypogonadism (LOH) refers to testosterone deficiency accompanied by sexual complaints. AIM: We investigated the prevalence of LOH in men with systolic heart failure (HF), and its clinical determinants and prognostic consequences. METHODS: Among 201 men with systolic HF (age: 60 ± 11 years), serum total testosterone (TT) was assessed using an immunoassay, and estimated free testosterone (eFT) was calculated using Vermeulen's formula. LOH was diagnosed when TT < 3.2 ng/mL and eFT < 64 pg/mL were accompanied by three sexual symptoms (decrease in the number of morning erections, reduced potency, and low libido) of at least moderate severity assessed using the Aging Males' Symptoms Scale. RESULTS: Decreased frequency of morning erections, reduced potency, and low libido were experienced by 56%, 62%, and 55% of men with HF, respectively; whereas 67%, 61%, and 44% of subjects complained of at least one, two, and three symptoms, respectively. Hypogonadal TT and eFT were observed in 34% and 47% of patients, respectively; and in 33% subjects, both TT and eFT were reduced. Finally, 30 men with HF (15%) were diagnosed with LOH as compared with 2% in a European male population (EMAS). In a multivariable model, older age and higher serum uric acid were independently associated with greater LOH prevalence (both P < 0.05). Among men aged ≤60 years (but not in those aged >60 years), LOH increased 5-year all-cause mortality in the univariable model; however, when adjusted for HF severity, the association lost its statistical significance. CONCLUSIONS: Men with systolic HF commonly report sexual complaints. LOH-the combination of sexual dysfunction and testosterone deficiency-occurs more frequently than in a general male population. LOH does not affect long-term mortality, when adjusted for HF severity.
BACKGROUND: Male ageing is characterized by diminished circulating androgens with several adverse psychosomatic consequences and can be aggravated by concomitant chronic diseases. According to the European Male Aging Study (EMAS) Group, late-onset hypogonadism (LOH) refers to testosteronedeficiency accompanied by sexual complaints. AIM: We investigated the prevalence of LOH in men with systolic heart failure (HF), and its clinical determinants and prognostic consequences. METHODS: Among 201 men with systolic HF (age: 60 ± 11 years), serum total testosterone (TT) was assessed using an immunoassay, and estimated free testosterone (eFT) was calculated using Vermeulen's formula. LOH was diagnosed when TT &#60; 3.2 ng/mL and eFT &#60; 64 pg/mL were accompanied by three sexual symptoms (decrease in the number of morning erections, reduced potency, and low libido) of at least moderate severity assessed using the Aging Males' Symptoms Scale. RESULTS: Decreased frequency of morning erections, reduced potency, and low libido were experienced by 56%, 62%, and 55% of men with HF, respectively; whereas 67%, 61%, and 44% of subjects complained of at least one, two, and three symptoms, respectively. Hypogonadal TT and eFT were observed in 34% and 47% of patients, respectively; and in 33% subjects, both TT and eFT were reduced. Finally, 30 men with HF (15%) were diagnosed with LOH as compared with 2% in a European male population (EMAS). In a multivariable model, older age and higher serum uric acid were independently associated with greater LOH prevalence (both P &#60; 0.05). Among men aged ≤60 years (but not in those aged >60 years), LOH increased 5-year all-cause mortality in the univariable model; however, when adjusted for HF severity, the association lost its statistical significance. CONCLUSIONS:Men with systolic HF commonly report sexual complaints. LOH-the combination of sexual dysfunction and testosteronedeficiency-occurs more frequently than in a general male population. LOH does not affect long-term mortality, when adjusted for HF severity.