Screening For Hypogonadism Research Articles

Prevalence of Hypogonadism in Male Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Background: Type 2 Diabetes Mellitus (T2DM) is a widespread metabolic disorder linked with various complications, including hypogonadism—a condition marked by reduced testosterone levels and symptoms such as erectile dysfunction, decreased libido, and increased fatigue. Hypogonadism remains underdiagnosed in diabetic populations, posing significant challenges to healthcare systems, especially in regions with high diabetic populations such as India. Methods: This cross-sectional study comprised 173 male T2DM patients aged 35 to 65. The study employed the Androgen Deficiency in Aging Males (ADAM) questionnaire to screen for hypogonadism, alongside physical examinations and biochemical tests to assess testosterone levels and other metabolic parameters. Results: The incidence of hypogonadism was found to be 27.2% among the study participants. Higher prevalence rates were related with older age, higher body mass index, greater waist circumference, and longer period of diabetes. Elevated fasting blood sugar and poor glycemic control (HbA1c ? 7%) were also significantly correlated with low testosterone levels. Conclusion: The significant association between T2DM and hypogonadism underscores the need for routine screening for testosterone deficiency in diabetic care, particularly given the condition’s impact on quality of life and metabolic health. Recommendations: Based on the findings, it is recommended that screening for hypogonadism be integrated into the regular management protocols for T2DM, particularly for patients presenting with metabolic syndrome features or those with poor glycemic control. Keywords: Type 2 Diabetes Mellitus, Hypogonadism, Testosterone, Metabolic Health, Indian Population

Testosterone therapy reduces insulin resistance in men with adult-onset testosterone deficiency and metabolic syndrome. Results from the Moscow Study, a randomized controlled trial with an open-label phase.

To describe changes in homeostasis model assessment of insulin resistance index (HOMA-IR) following testosterone therapy in men with hypogonadism and metabolic syndrome (MetS). A randomized, placebo-controlled, double-blind randomized controlled trial (RCT) comprising 184 men with MetS and hypogonadism (testosterone undecanoate [TU]: 113 men, placebo: 71 men) was conducted. This was followed by an open-label phase in which all men were given TU. We focused on men who were not receiving antiglycaemic agents (TU: 81 men; placebo: 54 men) as these could affect HOMA-IR. Inter-group comparison of HOMA-IR was restricted to the RCT (30 weeks), whilst intra-group comparison was carried out on men provided TU during the RCT and open-label phases (study cohort) and men given placebo during the RCT and then switched to TU during the open-label phase (confirmatory cohort). Regression analysis was performed to identify factors associated with change in HOMA-IR (∆HOMA-IR). The median HOMA-IR was significantly reduced at almost every time point (after 18 weeks) compared to baseline in men receiving TU in both the study and confirmatory cohorts. There was a significant decrease in median values of fasting glucose (30 weeks: -2.1%; 138 weeks: -4.9%) and insulin (30 weeks: -10.5%; 138 weeks: -35.5%) after TU treatment. Placebo was not associated with significant ∆HOMA-IR. The only consistent predictor of HOMA-IR decrease following TU treatment was baseline HOMA-IR (r2 ≥ 0.64). Baseline HOMA-IR predicted ΔHOMA-IR, with a greater percentage change in insulin than in fasting glucose. In men with MetS/type 2 diabetes (T2DM) not on antiglycaemic therapy, improvements in HOMA-IR may be greater than suggested by change in fasting glucose. Our results suggest that hypogonadism screening be included in the management of men with MetS/T2DM.

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone.

Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. ClinicalTrials.gov, identifier NCT05435222.

A0399 - Clinician’s impression of erectile dysfunction's aetiology can help decide how extensive should male hypogonadism screening be

A0399 - Clinician’s impression of erectile dysfunction's aetiology can help decide how extensive should male hypogonadism screening be

P0526 - Current stepwise EAU recommendations for male hypogonadism screening in erectile dysfunction are not cost-effective in almost any subgroup!

P0526 - Current stepwise EAU recommendations for male hypogonadism screening in erectile dysfunction are not cost-effective in almost any subgroup!

Hypogonadism in opioid using males in an inner-city cohort: A cross-sectional study.

The link between male hypogonadism and opioids is well-established, but whether there is a difference in the frequency of hypogonadism between heroin and methadone for treatment of opioid use disorder (OUD) has not been -determined. Cross-sectional. Setting, patients, and participants: Male drug users and nonusers matched for socioeconomic status between 18 and 65 years, recruited in Baltimore as part of the study of HIV, injection drug use, nutrition, and endocrinology (SHINE). Hypogonadism was defined as low free testosterone <50 pg/mL. Participants were categorized into three groups based on opioid use: (1) NONE, (2) methadone use as treatment of OUD (METHADONE), and (3) Heroin use (HEROIN). This third group was further divided to mild (MH), and heavy (HH) heroin use. We used multiple logistic regression to examine the association between hypogonadism and different groups. The cohort consisted of 189 men, 94 percent black, average age 43 years, with high HIV (56 percent) and HCV (38 percent) prevalence. 24 percent had hypogonadism. Compared to NONE, there were higher odds of hypogonadism in METHADONE (aOR 3.46; 95 percent CI [1.34,8.93]; p = 0.01) but not in HEROIN. After dividing HEROIN into MH and HH, there were higher odds of hypogonadism in HH compared to NONE (aOR 3.27; 95 percent CI [1.12,9.53]; p = 0.03) but not in MH. Methadone used for treatment of OUD was associated with male hypogonadism similar to heavy heroin use. Targeted hypogonadism screening and treatment may be warranted in this population to reduce its health consequences such as sexual dysfunction, osteoporosis, and abdominal adiposity.

Advanced Chronic Kidney Disease is a Strong Predictor of Hypogonadism and is Associated with Decreased Lean Tissue Mass.

PurposeIn patients with chronic kidney disease (CKD), hypogonadism is more frequent than in the general population and its prevalence ranges between 40% and 60%. The aim of the study was to investigate the prevalence of hypogonadism and its association with kidney function, body composition, inflammatory markers and lipid disorders in patients with CKD.Materials and MethodsThe study population consisted of 112 men aged ≥40 years in different stages of CKD: 33 participants with eGFR ≥60 mL/min/1.73 m2, 27 men with eGFR 30–59 mL/min/1.73 m2, 17 predialysis patients with eGFR <30 mL/min/1.73 m2, and 35 men on hemodialysis therapy three times a week for more than 3 months (G5D stage). Total testosterone (TT) levels were measured and free testosterone (FT) levels were calculated. Body composition was assessed using bioimpedance spectroscopy (Body Composition Monitor, FMC). Statistical analysis was performed using Statistica version 13.1.ResultsCKD stage was a strong predictor of hypogonadism (providing an information value of 0.83). The weight of evidence technique allowed us to differentiate the high-risk group, which was a group of patients with advanced CKD, defined as eGFR <30 mL/min/1.73 m2. In this group, the likelihood of hypogonadism was 69.23%. Another significant predictor of hypogonadism was lean tissue index (LTI). TT and FT levels were significantly lower in the advanced CKD group in comparison to the control group, whereas prolactin, luteinizing hormone and C-reactive protein levels were significantly higher in the advanced CKD group. The LTI was significantly lower in advanced CKD and was positively correlated with TT and FT.ConclusionDecreased eGFR and decreased LTI are predictors of hypogonadism associated with CKD. The study results suggest that hypogonadism screening should be carried out when eGFR deceases below 30 mL/min/1.73 m2.

How to manage low testosterone level in men: a guide for primary care.

Male hypogonadism is a clinical syndrome characterised by testosterone deficiency and impaired spermatogenesis; due either to diseases of the hypothalamus or pituitary gland, or of the testes themselves.1 The diagnosis requires the presence of clinical features consistent with lack of testosterone plus the finding of persistent and unequivocally low serum testosterone levels. Failure to recognise and treat men with hypogonadism may predispose them to long-term health problems, such as anaemia, osteoporosis, depression, or sexual dysfunction. Over recent years, there has been a surge in testosterone prescriptions for men with sexual dysfunction or putative age-related decline in testosterone,2 possibly reflecting pharmaceutical promotion, or sharing of misleading information on the internet. With growing demands and expectations of men worried about their wellbeing, there is a real risk of overdiagnosis and unnecessary treatment with testosterone. Suboptimal sampling conditions can lead to misinterpretation of serum biochemistry, and the long-term risks of testosterone therapy for men not having verified hypogonadism may be underestimated by ‘enthusiasts’. ### Diagnosis of hypogonadism Routine screening for hypogonadism in asymptomatic men is not recommended, except in certain conditions (Supplementary Figure S1). Clinical features of hypogonadism are not limited to sexual symptoms — reduced libido, erectile dysfunction (ED), and loss of waking erections. Anaemia, osteoporosis, and vasomotor sweating or flushing are frequently present; indeed, older men may not volunteer sexual symptoms, having ascribed them to ageing. ### Sampling conditions Testosterone secretion has diurnal variation and is suppressed post-prandially, so serum testosterone and sex-hormone binding …

PIH8 UNDERSTANDING THE ECONOMIC BURDEN OF COMORBIDITIES ASSOCIATED WITH MALE HYPOGONADISM: A COST MODEL IN ENGLAND

Male hypogonadism is closely associated with a number of comorbidities such as type 2 diabetes (T2DM) and cardiovascular disease (CVD), increasing the complexity and burden of disease. Evidence demonstrates testosterone therapy improves patient outcomes, both in terms of improvements in parameters relating to hypogonadism and the rate of comorbidities. However, there is little evidence on the economic impact of reducing comorbidity rates. A cost model was developed to estimate the economic benefits of testosterone therapy for male patients with hypogonadism with four major comorbidities; T2DM, osteoporosis, obesity and CVD in England, compared to no treatment. The model utilized a ten-year time horizon. Only direct costs were considered. Comorbidity rates were from published literature, and costs for each comorbidity were an average of the related NHS national tariff. No potential drug costs associated with the comorbidities were included. In total, treatment resulted in cost savings of £3,045 per treated individual per year, versus no treatment. For patients treated with testosterone therapy, individual yearly costs of £324, £134, and £229 for treatment, administration, and monitoring are outweighed by a £3,732 reduction in the cost of treating comorbidities. Of this, £823 is attributed to treating obesity (22%), £967 on osteoporosis (26%), £216 on T2DM (6%) and £1,727 on CVD (46%). The cost model demonstrates that reduction of comorbidity rates in patients treated with testosterone therapy versus no treatment translates into an economic benefit through cost savings. This analysis is likely to underestimate savings as drug costs for treatment of comorbidities are not included. Therefore, treatment of hypogonadism has additional advantages related to reducing comorbidities beyond improving testosterone levels and it is important to take this wider benefit into account when making clinical decisions regarding screening for hypogonadism and testosterone therapy.

Estimation of serum testosterone concentration in type 2 diabetic males

Background: A high incidence of hypogonadism in men with Type 2 Diabetes Mellitus has been globally reported. The present study was aimed at determining the frequency of hypogonadism in T2DM males. Screening and management of hypogonadism in Diabetic males should be done.Methods: In this case control study conducted from January 2018 to August 2019 at SGRDIMSR Sri Amritsar 100 Type 2 Diabetic males were taken as cases. 50 age matched nondiabetic males were taken as controls. Apart from BMI and waist hip ratio routine investigations, HbA1C, serum total and free testosterone levels were done. All the subjects were subjected to ADAM questionnaire to evaluate for hypogonadism.Results: Majority of subjects were in the age of 40-50 years. Mean Serum Total Testosterone levels in Study and Control Groups were 4.94±5.32 nmol/L and 6.63±4.54 nmol/L respectively (p=0.045). Mean Serum Free Testosterone levels in Study and Control Groups were 4.12±3.43 pg/ml and 6.05±3.24 pg/ml respectively (p=0.001). A statistically highly significant negative correlation was found between BMI and Serum Testosterone levels in both groups. Prevalence of hypogonadism (Total Testosterone &lt;4.56 nmol/L) in Study and Control Groups was 73% and 58% respectively. Sensitivity and specificity of ADAM questionnaire was found to be 78.46% and 94.29 % respectively.Conclusions: Prevalence of hypogonadism among T2DM males is high. So, screening for hypogonadism should be done. ADAM questionnaire can be used as a screening tool, results must be confirmed with Serum Total Testosterone levels.

Galactosemia.

Galactosemia.

Leydig cell failure with testicular radiation doses

Testosterone replacement is generally considered likely to be required only at testicular radiation doses in excess of 20Gy. Long-term data are not available for patients receiving 9-14.4Gy as part of Total Body Irradiation in childhood. Retrospective cohort study. notes review, laboratory results, prescription of testosterone. Forty-two of 96 boys who received Total Body Irradiation (9-14.4Gy) and Haematopoietic Stem Cell Transplantation for childhood leukaemia at Great Ormond Street Hospital between 1981-2011 and survived >5years. The serum concentrations of testosterone and gonadotrophins and the prescription of testosterone were recorded. Of the 42 boys included, 37 (88%) entered puberty spontaneously and 5 required induction. Median length of follow-up was 19.4years (range 5-33.1). At last follow-up, 23 of the 37 (62%) with spontaneous puberty were receiving testosterone replacement and 4 of the 5 (80%) with induced puberty. This study with the benefit of long follow-up indicates that Leydig cell failure occurs with radiation doses <20Gy. It may occur many years after irradiation and mandates long-term screening for hypogonadism.

37-Year-Old Man With Fatigue and Erectile Dysfunction

37-Year-Old Man With Fatigue and Erectile Dysfunction

Current stepwise recommendations for hypogonadism screening in erectile dysfunction are not cost-effective.

Hypogonadism is a prevalent comorbidity with erectile disfunction (ED) and current guidelines recommend screening for hypogonadism with total testosterone (TT). If low TT is detected, further assessment with LH and SHBG plus albumin are needed to establish an etiology and treatment. Our primary objective was to determine the cost benefit of current stepwise approach versus ad initium full hormonal assessment. Two hundred consecutive male patients referred for ED were screened after consent and 81 were included and assessed for hypogonadism according to the current stepwise approach with TT, and only if TT was less than 345 ng/mL, a full hormonal assessment with TT, LH, and SHBG plus albumin to calculate free testosterone was performed. Direct costs were calculated using the national public healthcare system reimbursement tables and were compared with a hypothetical initial full hormonal assessment. Screening TT was less than 345 ng/mL in 34.6% patients leading to a full hormonal assessment on these. Using a stepwise approach there was a direct cost increase of 5.82 € per patient. Moreover, one out of every three patients had two extra venipunctures and an additional follow-up appointment. Current stepwise recommendations may prove costly in high prevalence scenarios such as the ED subpopulation as a direct cost increase was observed.

PO-01-056 Current step-wise ESSM recommendations for hypogonadism screening in erectile dysfunction are not cost-effective

PO-01-056 Current step-wise ESSM recommendations for hypogonadism screening in erectile dysfunction are not cost-effective

1066 - Current step-wise EAU recommendations for hypogonadism screening in erectile dysfunction are not cost-effective

1066 - Current step-wise EAU recommendations for hypogonadism screening in erectile dysfunction are not cost-effective

Screening for Hypogonadism in Primary Healthcare: How to do this Effectively.

Testosterone, the most important androgen produced by the testes, plays an integral role in male health. Testosterone levels are increasingly being checked in primary healthcare as awareness of the risks of male hypogonadism grows. To investigate what tests are performed to screen for hypogonadism and to exclude secondary hypogonadism. All participants attended general practices in the UK. Data search was performed using the EMIS®: clinical database (provider of the majority of GP operating systems in Cheshire). The anonymised records of male patients aged 18-98 years who had undergone a check of serum testosterone during a 10-year period were analysed. Overall screening rate was 4.3%. Of 8 788 men with a testosterone result, 1 924 men (21.9%) had a total testosterone level <10 nmol/L. Just 689 of 8 788 men (7.8%) had a sex hormone-binding globulin (SHBG) result, corresponding to 30.5% of those potentially hypogonadal. Estimated free testosterone was negatively associated with BMI (Spearman's rho -0.2, p<0.001) as was total testosterone in the over 50 s. Of 1 924 potentially hypogonadal men with a serum testosterone <10 nmol/L, 588 of 1 924 (30.6%) had a check of serum prolactin. 46.3% and 41.7% had LH and FSH measured, respectively. Only 19.1% of 1 924 men with a hypogonadal total testosterone level were subsequently put on testosterone replacement. The percentage of men in the relatively socially disadvantaged category was similar for both eugonadal and hypogonadal men with a much higher rate of screening for hypogonadism in more socially advantaged men. Screening in primary healthcare identified a significant minority of men who had potential hypogonadism. Interpretation of a low serum testosterone requires measurement of serum prolactin, LH and FSH in order to rule out secondary hypogonadism. We suggest that this becomes part of routine screening with a balanced screening approach across the socioeconomic spectrum.

Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism.

The symptoms of low testosterone frequently overlap with psychiatric complaints including depression and fatigue. Testosterone repletion has been shown to improve mood symptoms in men with low testosterone, although this finding has not been consistent across all studies. Despite the potential importance of low testosterone for psychiatry, the prevalence of low testosterone in men who present to psychiatric clinics with mental health complaints is unknown. To provide an overview of the current state of knowledge of the psychiatric complications of male hypogonadism, the challenges of screening for hypogonadism in a psychiatric population, and the potential mental health treatment implications of hypogonadism. A literature review was conducted using PubMed. Publications pertaining to the epidemiology, psychiatric symptomatology, and impact of treatment of male hypogonadism on psychiatric outcomes. A review of the literature suggests a lack of information on the prevalence of low testosterone in patients presenting with psychiatric complaints despite an overlap in clinical symptoms. The identification of low testosterone could have a significant impact on treatment through urologic referral for testosterone repletion or the use of treatments that spare the gonadal axis. We hope our results will help those who care for patients in psychiatric settings to better assess for the presence of hypogonadism and its potential contribution to depressive illness. Smith JB, Rosen J, Colbert A. Low Serum Testosterone in Outpatient Psychiatry Clinics: Addressing Challenges to the Screening and Treatment of Hypogonadism. Sex Med Rev 2018;6:69-76.

PS-08-015 Screening for hypogonadism in UK primary healthcare: How to do this effectively

PS-08-015 Screening for hypogonadism in UK primary healthcare: How to do this effectively

Prevalence and Etiology of Hypogonadism in Young Men With Chronic Spinal Cord Injury: A Cross-Sectional Analysis From Two University-Based Rehabilitation Centers

BackgroundSpinal cord injury (SCI) triggers an “accelerated aging” process that may include development of hypogonadism, even among younger men with SCI; however, few studies have investigated the prevalence or etiology of hypogonadism in men with SCI. Young men with SCI also are at increased risk for developing metabolic dysfunction after injury, which may be exacerbated by concomitant testosterone (T) deficiency, thus identifying the prevalence and risk factors for T deficiency in men with SCI is important for their long-term health. ObjectiveTo investigate the prevalence, risk factors, and etiology of T deficiency (hypogonadism) in otherwise-healthy men with chronic, motor complete SCI. DesignSecondary cross-sectional analysis. SettingRehabilitation research centers in Washington, DC, and Miami, Florida. ParticipantsMen (n = 58) aged 18-45 years with chronic (≥1 year), motor complete SCI without comorbidities or use of testosterone therapy. MethodsPlasma concentrations of hormones were measured with standardized assays. Body composition was assessed with dual-energy x-ray absorptiometry scan. Main Outcome MeasurementsSerum total T and calculated free T. ResultsT deficiency was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI versus 6.7%, non-SCI, P < .001). The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat. The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI. ConclusionsHypogonadism is more common in young men with SCI than in similarly aged men without SCI, suggesting that SCI should be identified as a risk factor for T deficiency and that routine screening for hypogonadism should be performed in the SCI population. Level of EvidenceII