Prevalence Of Hypogonadism Research Articles

MP43-06 TESTOSTERONE THERAPY IN MEN WITH KLINEFELTER SYNDROME: ANALYSIS OF A GLOBAL FEDERATED RESEARCH NETWORK

You have accessJournal of UrologyCME1 Apr 2023MP43-06 TESTOSTERONE THERAPY IN MEN WITH KLINEFELTER SYNDROME: ANALYSIS OF A GLOBAL FEDERATED RESEARCH NETWORK Katherine Campbell, Justin Loloi, Chase Carto, and Ranjith Ramasamy Katherine CampbellKatherine Campbell More articles by this author , Justin LoloiJustin Loloi More articles by this author , Chase CartoChase Carto More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Klinefelter Syndrome (KS, 47 XXY) represents the most common genetic form of male hypogonadism. Given the degree and prevalence of hypogonadism in these men, it is recommended that patients with KS and testosterone deficiency should be treated with lifelong testosterone supplementation (TRT) that begins at puberty to secure the development of sexual male characteristics and prevent long-term sequelae. Primary hypogonadism (including KS) is an on-label indication for TRT. The objective of this study was to determine the rates of hypogonadism and prescription of TRT in men with KS. We hypothesized that men with KS are under treated for testosterone deficiency with TRT because of the relationship between KS and neurocognitive impairment. METHODS: We queried TriNetX, a large, multicenter electronic health record database, to identify all men with a diagnosis of Klinefelter syndrome (ICD-10-CM Q98.4). We collected data on comorbidities including cognitive impairment, type 2 diabetes mellitus, obesity, hyperlipidemia, hypertension, osteoporosis in addition to demographic characteristics. Prevalence of testosterone deficiency was determined as defined by testosterone level <300 ng/dl. The primary outcome of the study was prescription of any of the following forms of TRT on the day of diagnosis or later. RESULTS: There were 5,437 total men with diagnosis of KS. A total of 1,581 men with KS received laboratory measurement of testosterone level, 1,113 (70.4%) of whom were hypogonadal. Mean testosterone level in this group was 354 ng/dL [50–658]. Of the 1,113 men found to be hypogonadal, only 657 (59.0%) men were given prescription for TRT. CONCLUSIONS: Despite the recent addition of KS as an indication for treatment to the FDA-approved label for TRT, in this large, retrospective study, TRT was under-prescribed in men with KS. Under treatment of hypogonadism in men with KS can lead to long-term consequences such as metabolic syndrome and cognitive impairment. This is the first study to evaluate TRT prescribing patterns in men with KS. Future research is needed to corroborate these findings and to evaluate barriers, especially as related to to receiving care in this population. Source of Funding: This work was supported by NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to Ranjith Ramasamy © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e603 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Campbell More articles by this author Justin Loloi More articles by this author Chase Carto More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical and epidemiological characteristics of male hypogonadism in type 2 diabetes in Russia: combined analysis of study data for the period 2005–2022

Background: Male hypogonadism is associated with type 2 diabetes mellitus (T2DM), therefore, it is of interest to study its clinical and epidemiological characteristics. These data are published, but their fragmentation and small sample sizes are a problem. A summary assessment of the combined primary data of the conducted studies will provide sufficient representativeness and will allow to extrapolate the results to the general Russian population with T2DM.Aim: Assessment of the clinical and epidemiological characteristics and aggravating factors of male hypogonadism in T2DM in Russia.Materials and methods: A Combining primary data (anamnesis, anthropometric indicators, laboratory tests) of full-design, cross-sectional, screening studies of hypogonadism in men with T2DM conducted on the territory of the Russian Federation in the period from 2005 to 2022. The groups were compared using the Mann-Whitney U-test for quantitative indicators and χ² with Yates’ correction for qualitative ones. Differences were considered statistically significant with p &lt;0,05. The groups were compared using the Mann-Whitney U-test and χ² with Yates correction. Differences were considered statistically significant at p&lt;0.05.Results: Hypogonadism was detected in 893 of 1576 men (56,7%) with T2DM. Patients with hypogonadism were statistically significantly older, had higher body mass index (BMI), worse glycemic control than eugonadal men. There was ­statistically significantly higher prevalence of macroangiopathies and polyneuropathy in hypogonadal patients.Conclusion: The prevalence of male hypogonadism in T2DM 56,7%. Its development is due to age, obesity, worse glycemic control. Hypogonadism syndrome is associated with the development of diabetic macroangiopathy and polyneuropathy. Severe violation of glycemic control (glycated hemoglobin (HbA1c) 10% or more) significantly reduces testosterone production and increases the prevalence of hypogonadism.

Gonadal Function in Male Patients With Metastatic Renal Cell Cancer Treated With Sunitinib.

Single-agent tyrosine kinase inhibitors are still prescribed as first-line treatment to a relevant subgroup of patients with metastatic renal cell carcinoma (mRCC). These agents are known to cause disfunction of many endocrine glands (e.g., thyroid). In this two-step trial, we aimed to assess gonadal function among male patients with mRCC treated with sunitinib. We enrolled a first cross-sectional cohort of pre-treated (>6 months) patients and a subsequent cohort of treatment-naïve patients who were prospectively followed-up. All patients were screened for hypogonadism and received a Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire at study entry and after 6 months of therapy. Patients who were candidates for testosterone replacement therapy (TRT) also received a FACT-G questionnaire at baseline and 3 months after supplementation. Among the 30 enrolled patients, the prevalence of hypogonadism was found to be higher in those receiving sunitinib for a longer period (27.3% at baseline, 41.7% in the first 6 months, and 68.4% after 9 months of therapy). The testosterone level of patients correlated with quality of life (R=0.32). A total of six patients received TRT, with a significant improvement in their global quality of life after the first 3 months of treatment. An increasing prevalence of hypogonadism was seen among male patients who received long-term treatment with sunitinib. TRT was associated with relevant improvements in quality of life. These findings corroborate similar published observations and encourage the assessment of gonadal function in male patients with mRCC under treatment with sunitinib.

PMON260 Cost-Effectiveness of Testosterone Treatment for Men with Hypogonadism

Abstract Background Testosterone replacement therapy is the standard treatment for male hypogonadism (MH). Prescribing rates of testosterone in the UK have risen between 2001 and 2010 without an observable increase in the prevalence of hypogonadism, which may reflect increasing media awareness among men about hypogonadism. Currently, there is uncertainty about the safety and efficacy of testosterone treatment for MH, especially regarding its impact on cardiovascular risk, which has led to mandatory safety labelling in some countries. Aim We conducted an economic evaluation of testosterone therapy in men with hypogonadism, using individual patient data (IPD) of safety and efficacy outcomes in over 3000 participants as part of an international collaboration of investigators of 17 existing placebo-controlled RCTs assessing the safety and efficacy of testosterone treatment for MH (TestES Consortium). Methods A cost-utility analysis of the use of testosterone treatment for MH was conducted using a cohort Markov model developed following best practice. The model care pathway was informed by existing clinical guidelines, the results of the TestES Consortium individual patient data (IPD) meta-analysis, and discussions with clinical and methodological experts. Five Markov states were included: no complications, post-Cardiac pathology, post-Peripheral Vascular System Pathology, post-Cerebrovascular System Pathology, and Death. All-cause mortality, cardiovascular and cerebrovascular complications, and utility weights were obtained from the TestES IPD analyses. The UK NHS and personal and social services perspective was adopted for costs. Ten-year and lifetime time horizons were considered with costs and effects discounted annually at 3.5% rate. The model was run probabilistically using 10,000 Monte Carlo simulations. Three starting ages were defined (40, 60, and 75 years). Mean total cost, mean QALYs and incremental cost-effectiveness ratios were calculated. Results Cost-effectiveness of testosterone treatment appears to be dependent on the relative risk (RR) of all-cause mortality - favouring TRT - and the methods used to derive health state utility scores (i.e., SF-6D or a mapping between Beck Depression Inventory -BDI- score and EQ-5D score) for testosterone treatment versus standard care. When the RR of mortality and the BDI utilities were used, ICERs remained below the £20,000 ($27,400) UK conventional threshold, irrespective of the cohort starting age. However, ICERs increased above the £20,000 threshold when the difference in all-cause mortality was dropped, and the SF-6D utility scores were used. Conclusions We report the most in-depth economic analysis of male hypogonadism treatment to date. There remains limited data for generating preference-based health-related quality of life (HRQoL) weights for economic evaluation. Further clarity on the long-term cardiovascular safety of testosterone treatment in men with hypogonadism, and more in-depth mapping of clinical outcomes to generic preference-based measures of HRQoL will be crucial to inform robust estimates of the cost-effectiveness of testosterone treatment for MH. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

LBODP054 Hypogonadism in Diabetes Mellitus: Insulin Resistance, The Connecting Link?

Abstract Background Hypogonadism is commonly found in men with type 2 diabetes mellitus (T2DM) and insulin resistance may play a role in its pathogenesis. There is an inverse relationship between testosterone and insulin resistance. This relationship is often confounded by effects of obesity, metabolic syndrome, sex hormone binding globulin (SHBG), treatment protocols and complication status of diabetes. Objective To determine the prevalence of hypogonadism in T2DM men and to evaluate the association between hypogonadism and clinical, biochemical parameters of diabetes. To look for an independent association between hypogonadism and insulin resistance. Methods This was a cross sectional study of 353 consecutive men aged 20 to 70 years with T2DM. Hypogonadism was defined on the symptoms as defined in the androgen deficiency in aging male questionnaire (ADAM) along with low calculated testosterone levels (calculated by Vermeulen's equation taking total testosterone, albumin and SHBG). Insulin resistance was measured by homeostasis model assessment for insulin resistance [HOMA-IR] and Quantitative insulin sensitivity check index [QUICKI]. Results The prevalence of hypogonadism in our cohort was 17%. We found a significant correlation between calculated free testosterone and BMI (r=-0.149, p value =0. 005), HbA1c (r = -0.145, p value = 0. 006), Triglycerides (r= -0.217, p value =&amp;lt;0. 001), HOMA IR (r=-0.207, p value =&amp;lt;0. 001), QUIKI (r=0.148, p value=0. 005). On applying multiple linear regression, HOMA IR was significantly inversely correlated with calculated free testosterone levels independent of age, duration of diabetes, BMI and glycaemic status of diabetes. Similarly, total testosterone was significantly associated with insulin resistance independent of age, BMI, SHBG, complication status and other potential confounding variables. There was no statistically significant association between hypogonadism and diabetes complications. Conclusions Hypogonadism is a common finding in T2DM men. Hypogonadism is significantly associated with insulin resistance even after adjusting for age, BMI, duration of diabetes, diabetic complications, treatment regimens and other potentially confounding variables. Presentation: No date and time listed

ODP346 Prevalence and Predictors of Endocrinopathies Amongst Patients on Chronic Opioid Use for Non-Cancer Pain

Abstract Introduction Opioids are increasingly used for non-cancer pain control. Studies in cancer patients have shown that chronic opioid use could lead to secondary hypocortisolism and hypogonadism of varying degree. We seek to determine this association in an Asian cohort of patients with non-cancer pain and also examine the effect of opioids on other pituitary hormones comparing them to patients who are on non-opioid analgesia. Methods This is a cross-sectional study of patients recruited from pain clinic. Inclusion criteria were patients aged between 18-75 with non-cancer pain on opioids (morphine/oxycodone/fentanyl/tramadol) for more than 3 months. Patients with active cancer or intracranial pathology, who were already on hormone replacement and on long term glucocorticoids or had intra-muscular or intra-articular steroids in the preceding 3 months were excluded. Controls were age and sex matched. All recruited patients had a renal profile, albumin, cortisol, ACTH, fT4, TSH, FSH, LH, IGF-1, prolactin, testosterone (male) and oestrogen (female) drawn at 8am in a fasting state. Demographic data, menstrual history, pain type and pain score, opioid type and duration of use, were collected. Results Forty eight patients (28 opioid group and 20 controls), 52% men, 31%postmenopausal women, mean age: 55 ±13 years and mean BMI: 27±5 kg/m 2, were recruited. Opioid group had significantly higher pain score (6±2 vs 5±2, p=0. 09) and duration of pain (6.16 ± 5.87 vs 3.56 ± 3.35 years, p=0. 07) compared to controls. 75% of patents were on short acting opioids with a morphine equivalent daily dose (MEDD) of 31 ± 16 mg. There was a higher prevalence of hypocortisolism in the opioid group (50%) compared to control (30%). Of note, 14% of the opioid group had AM cortisol of &amp;lt;100nmol/L, which required replacement. The MEDD of more than 25mg was the only independent predictor of hypocortisolism with OR: 20.4 (95% CI: 1.1-39. 0, p=0. 04). 11% of patients (3 men, 2 post-menopausal women) had secondary hypogonadism. Pain score was significantly higher (7.8±1.5 vs 5.6±2.1, p=0. 03) and the duration of opioid was significantly longer (7.6±3 vs 3.2±4, p=0. 02) in the hypogonadism group. However, there was no independent predictive factor for hypogonadism. The was no sodium abnormality or other pituitary axes involvement in both groups. Conclusion With the increasing use of opioids for non-cancer pain, the prevalence of opioid endocrinopathies are expected to rise. Development of hypocortisolism is independently associated with a higher MEDD. Gonadal axis involvement was more common amongst men and postmenopausal women. Higher use of short acting opioids in our cohort may explain the lower prevalence of hypogonadism compared to previous studies. Further long term studies are needed to examine the need for and effects of hormone replacement in this group of patients. Presentation: No date and time listed

Frequency and Correlation of Hypogonadism in Men with Type 2 Diabetes

Aim: The present study aimed to determine the frequency and association of hypogonadism in men with type 2 diabetes mellitus. Material and Methods: This cross-sectional study was conducted on 242 type 2 DM male patients in the Department of General Medicine, Bahria International Hospital, Lahore from 16th January 2022 to 15th July 2022. The Androgen deficiency in aging male (ADAM) questionnaire was used for screening hypogonadal symptoms in the study group. The presence of low serum testosterone below 3 ng/mL and positive ADAM score was referred to as hypogonadism. T2DM patients with and without hypogonadism had their clinical and biochemical variables compared. Total testosterone, BMI, free testosterone, waist circumference, and sex hormone–binding globulin were measured. SPSS version 26 was used for data analysis. Results: Of the total 242 T2DM male patients, the prevalence of hypogonadism was 24.8% (n=60). The most prevalent symptoms in T2DM patients were hypogonadal symptoms. The overall mean age was 45.8± 9.63 years with range (25-70 years). Mean BMI value was 24.8 ± 3.64 kg/m2. The incidence of overweight and obese patients were 17.8% and 49.3% respectively. The prevalence of erectile dysfunction, reduced libido, and work performance deterioration in hypogonadism were 94.8%, 68.2%, and 56.3% respectively. T2DM patients without hypogonadism had lower a) incidence of diabetic neuropathy (18.6% vs. 43.8%; p=0.021), b) T2DM duration (5.3± 3.82 vs. 9.2± 4.9 years; P=0.002), c) occurrence of diabetic retinopathy (26.9% vs. 57.8%; P=0.006), and d) HbA1c (8.9± 1.53% vs. 9.9 ± 2.54%: P=0.005), and insulin therapy (21.5% vs. 45.8%: P=0.031) compared to those with hypogonadism. Conclusion: The present study found that prevalence of hypogonadism was 24.8% in type 2 diabetes mellitus. Patients with hypogonadism had higher HbA1c, higher prevalence of neuropathy and retinopathy, longer diabetic duration, and predominantly used insulin therapy than those T2DM patients without hypogonadism. Keywords: Hypogonadism, Type 2 diabetes mellitus, Androgen deficiency in aging male (ADAM).

Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes

PurposeTo evaluate in men with type 2 diabetes the association of cardiometabolic indices [Visceral Adiposity Index (VAI), Triglyceride Glucose Index (TyG), and lipid accumulation product (LAP)] with total testosterone (TT) levels, and their predictive cut-off values in identifying hypogonadism.Methods265 consecutive men aged 40–70 years with type 2 diabetes performed an andrological evaluation; metabolic parameters and TT were determined. Receiver operating characteristic (ROC) curves were used to identify cut-off values of cardiometabolic indices in predicting low testosterone (TT < 12 nmol/l).ResultsVAI, TyG, and LAP were negatively associated with TT levels. The prevalence of hypogonadism in men in the fourth quartiles of VAI, TyG, and LAP was ~ 70.0–75.0% compared to ~ 10.0–17.0% in men in the first quartiles (p < 0.001). The sensitivity and specificity of the three cardiometabolic indices in predicting TT < 12 nmol/l were significantly higher concerning BMI, waist circumference, lipid profile and HbA1c. Cut off values of VAI ≥ 3.985, TyG ≥ 4.925, and LAP ≥ 51.645 predict hypogonadism with good sensitivity and specificity.ConclusionThis is the first study evaluating the association of VAI, TyG, and LAP with hypogonadism in men with type 2 diabetes. Alterations in these indices should direct the patients to andrological evaluation.

Ketogenic state improves testosterone serum levels-results from a systematic review and meta-analysis.

It is widely demonstrated that obesity and hypogonadism are bi-directionally correlated, since the hypogonadism prevalence is higher in obese population, while weight loss increases testosterone serum levels. Several approaches are available to contrast weight excess, from simple dietary regimens to more complex surgical procedures. Ketogenic diets (KD) fit in this context and their application is growing year after year, aiming to improve the metabolic and weight patterns in obese patients. However, KD influence on testosterone levels is still poorly investigated. To systematically evaluate the potential effect of KD on testosterone levels. A systematic literature search was performed until April 2022 including studies investigating testosterone levels before and after KD. Secondary endpoints were body weight, estradiol and sex-hormone binding globulin serum levels. Any kind of KD was considered eligible, and no specific criteria for study populations were provided. Seven studies (including eight trials) were included in the analysis for a total of 230 patients, five using normocaloric KD and three very low calories KD (VLCKD). Only three studies enrolled overweight/obese men. A significant total testosterone increase was recorded after any kind of KD considering 111 patients (2.86 [0.95, 4.77], p = 0.003). This increase was more evident considering VLCKD compared to normocaloric KD (6.75 [3.31, 10.20], p < 0.001, versus 0.98 [0.08, 1.88], p = 0.030). Meta-regression analyses highlighted significant correlations between the post-KD testosterone raise with patients' age (R-squared 36.4, p < 0.001) and weight loss (R-squared 73.6, p < 0.001). Comprehensively, KD improved testosterone levels depending on both patients' age and KD-induced weight loss. However, the lack of information in included studies on hormones of the hypothalamic-pituitary-gonadal axis prevents an exhaustive comprehension about mechanisms connecting ketosis and testosterone homeostasis.

Relationship Between Serum Testosterone and Severity of Lower Urinary Tract Symptoms Among Malaysian Men

Background Lower urinary tract symptoms (LUTS) are commonly experienced among ageing males. The increasing prevalence of late-onset hypogonadism suggests a possible relationship between serum testosterone and severity of LUTS. This study examines the association between serum testosterone and severity of lower urinary tract symptoms among Malaysian men, as reflected by the International Prostate Symptom Score (IPSS). Method A total of 163 men with LUTS were enrolled in a cross-sectional study in Hospital Canselor Tuanku Mukhriz, Malaysia. Full examination, IPSS, and serum total testosterone (TT) levels were evaluated. Categorical and continuous correlations were analyzed using chi-square test and age-adjusted Pearson’s partial correlation, respectively. Result Mean age was 66.25 (SD = 7.05), with mean serum TT of 16.74 nmol/L (SD = 6.32). Twenty eight percent (n = 46) had low testosterone levels. Severity of LUTS (mild, moderate, severe) was not found to be dependent on TT status (normal, low, severely low), (χ2 [4, N = 163] = 4.24, P = 0.37). Weak negative correlations between total IPSS and IPSS storage sub-score with serum TT levels were exhibited respectively (r = −0.17, P &lt; 0.05; r = −0.17, P &lt; 0.05). Conclusion Among elderly Malaysian men, severity of LUTS and TT status were not found to be associated, despite a weak negative correlation between IPSS and serum testosterone levels. Nonetheless, with a high prevalence of hypogonadal ageing men, further research regarding serum testosterone measurement among this population may be valuable as part of a multimodal approach to treatment.

Prevalence of hypogonadism in transfusion-dependent β-thalassemia patients of Bangladesh: investigating the role of serum ferritin level as a diagnostic tool

IntroductionHypogonadism is one of the most frequent complications in transfusion-dependent thalassemia patients and early recognition and treatment is the core element in restoring impaired gonadal function. Despite the high burden of disease, relevant studies are scarcely addressing the gonadal function of such patients in Bangladesh. The pattern of gonadal function in transfusion-dependent thalassemia patients must be characterized before planning a generalized management plan. Moreover, since iron overload is a key reason behind hypogonadism in thalassemia patients, investigating the role of serum ferritin level as a diagnostic tool for hypongadism was also an aim of this study. MethodsThis cross-sectional study was conducted at the Department of Transfusion Medicine of the Bangabandhu Sheikh Mujib Medical University. According to the inclusion and exclusion criteria, a total of 94 patients were enrolled in this study. A detailed history and thorough clinical examination were carried out in each patient and recorded using a pretested structured questionnaire. In addition, the laboratory assessment of serum ferritin, luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and estradiol in serum were also performed. The data were analyzed using the STATA (v.16). ResultsThe mean age of the patients with transfusion-dependent thalassemia was 18.81 ± 4.65 (SD), with 53.3% of the patients being male. The overall prevalence of hypogonadism was 35.11%, 18.1% being normogonadotropic, 11.7% being hypogonadotropic and 5.3% being hypergonadotropic. The serum ferritin level was significantly higher (p < 0.001) in patients with hypogonadism (Eugonadal: 2,174.79 (± 749.12) ng/ml; Hypogonadal: 3,572.59 (± 1,199.49) ng/ml). The area under the receiver operating characteristic (ROC) curve of serum ferritin was high (0.83) and the p-value was highly significant (< 0.001). ConclusionTherefore, the serum ferritin level and gonadal hormone analysis of transfusion-dependent thalassemia patients can be considered a screening tool for assessing gonadal function and early detection and prevention of hypogonadism.

820-P: Testosterone Treatment Improves Glycemic Control and Leads to Remission in 56.8% of Patients with Hypogonadism and Type 2 Diabetes (T2DM) : Update of Real-World Data from a Registry Study

Background: Prevalence of hypogonadism is as high as 50% in men with T2DM. ADA Guidelines recommend measuring testosterone in men with T2DM. Methods: In a registry of 883 men with hypogonadism, 370 men (41.9%) have T2DM. 190 received TU 1000 mg/12 weeks (T-group) , 180 opted against treatment (CTRL) . All patients received standard diabetes care including lifestyle courses at a diabetes center. Remission was defined as discontinuation of diabetes drugs and HbA1c &amp;lt;6.5% for the remaining observation time. Means and standard deviations of absolute measures over 13 years of treatment are reported. Results: Mean follow-up 9.3±3.2, baseline age: 61.0±5.3 (T-group) and 63.0±4.9 (CTRL) years. HbA1c decreased from 9.5±1.4% to 5.5±1.2% (79.8±15.5 to 36.6±1.9 mmol/mol) in the T-group and increased from 7.8±0.7% to 10.5±1.2% (61.8±7.7 to 91.7±13.3 mmol/mol) in CTRL (p&amp;lt;0.00for both) . Fasting glucose (mmol/L) decreased from 7.9±1.3 to 5.4±0.1 in the T-group and increased from 6.4±0.8 to 8.2±1.3 in CTRL (p&amp;lt;0.00for both) . HOMA-IR decreased from 10.2±2.1 to 1.5±0.3 in the T-group and increased from 7.3±1.3 to 14.8±2.5 in CTRL (p&amp;lt;0.00for both) . In the T-group, 89 men (46.8%) received insulin at baseline at a mean dose of 38.0±13.3 U/d. Dose requirement declined from 38.0±13.3 to 4.1±5.7 during the observation period. In CTRL, 71 men (39.4%) received insulin at baseline at a mean dose of 31.2±6.1 U/d. Dose requirement increased from 31.2±6.1 to 44.5±5.6 (p&amp;lt;0.00for both) . In the T-group, 1patients (56.8%) went into remission. The median time to remission was 87 months. Conclusions: Long-term testosterone therapy with TU in men with hypogonadism and T2DM progressively improved glycemic control. More than half of men achieved remission. Glycemic control deteriorated in untreated men. Disclosure A.Haider: Other Relationship; Bayer AG. K.S.Haider: Other Relationship; Bayer AG. F.Saad: Consultant; Bayer AG, Stock/Shareholder; AbbVie Inc., Bayer AG, GlaxoSmithKline plc. Funding Bayer AG

1427-P: Long-Term Treatment with Testosterone Leads to Profound Weight Loss in Men with Hypogonadism and Type 2 Diabetes: Update of Real-World Data from a Registry Study

Background: Prevalence of hypogonadism in men with T2DM has been reported as high as 50%. ADA Guidelines recommend measuring testosterone in men with T2DM. Methods: Of 370 men with hypogonadism and T2DM, 302 (81.6%) were obese, 62 (16.8%) overweight and 6 (1.6%) had normal weight. 190 received injections of testosterone undecanoate 1000 mg/12 weeks (T-group) following an initial 6-week interval, 180 opted against treatment (CTRL) . Means and standard deviations of absolute measures over 13 years of treatment are reported. Results: Mean baseline age: 62.0±5.2 years, mean (median) follow-up: 9.3±3.1 (10) years. Waist circumference (cm) decreased from 117.9±14.8 to 98.2±4.3 in the T-group (p&amp;lt;0.0001) and increased in CTRL from 116.9±13.5 to 119.0±8.4 (p&amp;lt;0.0001) . Difference between groups at 13 years: 21.8 (p&amp;lt;0.0001) . Weight (kg) decreased from 114.4±13.8 to 88.3±7.6 in the T-group (p&amp;lt;0.0001) and increased in CTRL from 102.7±14.1 to 104.5±10.2 (p&amp;lt;0.0001) . Difference between groups: 21.4 (p&amp;lt;0.0001) . BMI (kg/m²) decreased from 36.5±4.4 to 28.5±2.4 in the T-group (p&amp;lt;0.0001) and increased in CTRL from 32.8±4.7 to 33.3±3.6 (p&amp;lt;0.0001) . Difference between groups: 6.9 (p&amp;lt;0.0001) . Weight change from baseline was -21.5±5.2% in the T-group and 9.3±3.0% in CTRL (p&amp;lt;0.00for both) . Difference between groups: 30.4% (p&amp;lt;0.0001) . Waist:height ratio decreased from 0.67±0.to 0.56±0.03 in the T-group and increased from 0.66±0.to 0.67±0.05) in CTRL (p&amp;lt;0.00for both) . Difference between groups: 0.12 (p&amp;lt;0.0001) . Visceral adiposity index (VAI) decreased from 5.9±3.1 to 1.8±0.4 in the T-group and increased from 5.2±2.6 to 9.1±4.4 in CTRL (p&amp;lt;0.00for both) . Difference between groups: 7.6 (p&amp;lt;0.0001) . Adherence to testosterone therapy was 100%. Conclusions: Long-term treatment with testosterone undecanoate injections results in profound weight loss maintained over up to 13 years. Untreated hypogonadal patients gain weight. Disclosure A.Haider: Other Relationship; Bayer AG. K.S.Haider: Other Relationship; Bayer AG. F.Saad: Consultant; Bayer AG, Stock/Shareholder; AbbVie Inc., Bayer AG, GlaxoSmithKline plc. Funding Bayer AG

The hypothalamic-pituitary-gonad axis in male Cushing's disease before and after curative surgery.

Gonadal and sexual disturbances are commonly encountered in patients with Cushing's disease. Nevertheless, the prevalence of hypogonadism in male Cushing's disease, the risk factors as well as the recovery time have been scarcely reported. Therefore, we aimed to explore the prevalence of hypogonadism at baseline and its determinants. In addition, the recovery time of hypogonadism and risk factors for unrecovered gonadal axis in male Cushing's disease with biochemical remission were investigated. We reviewed medical records of males with Cushing's disease managed between 2010 and 2020. Fifty-two male patients were enrolled according to the criteria. Each case attained biochemical remission after transsphenoidal surgery. Demographic details, clinical features, 24-hour UFC, hormonal profile [serum PRL, FSH, LH, TT, ACTH, cortisol, TT4/FT4, TT3/ FT3, TSH and IGF-1] were measured at baseline and during follow-up. The maximal tumor diameter on MRI was recorded at diagnosis. Hypogonadotropic hypogonadism was observed in thirty-nine patients (75%) at diagnosis. Total testosterone was negatively correlated with ACTH and 24-hour UFC. Midnight serum ACTH level at diagnosis was significantly associated with hypogonadism after adjusting for confounding factors. Thirty-two (80%) patients achieved eugonadism within 12 months after the surgery, of which twenty-eight (87.5%) achieved eugonadism within 3 months. Seven patients were persistently hypogonadal during the follow-up (≥1 year), mainly due to the hypopituitarism as a complication of the therapies such as surgery. Hypogonadotropic hypogonadism is frequent in male Cushing's disease, but it is reversible in most cases within one-year follow-up after remission.

Investigating the prevalence of hypogonadism and associated cardiovascular risk of males presenting with infertility: Results from a diverse and multi-ethnic UK patient cohort

Investigating the prevalence of hypogonadism and associated cardiovascular risk of males presenting with infertility: Results from a diverse and multi-ethnic UK patient cohort

Abstract #1183979: Prevalence of hypogonadism and its relation with glycemic control in young adults with chronic type 2 diabetes mellitus

There is an increased prevalence of hypogonadism in type 2 diabetes mellitus our study was aimed at to study the prevalence of hypogonadism in young adults with chronic type 2 diabetes mellitus In this cross sectional study 260 patients from 3 different cities of India were included between age group 30-39 with history of type 2 diabetes mellitus. Patients were divided into 2 groups, group A(130 patients) with history of type 2 diabetes mellitus more than 6 years and group B( 130 patients) with history of type 2 diabetes less than 6 years. Levels of hypogonadism and erectile dysfunction was compared between 2 groups on the basis parameters of Total Testosterone values and ADAMS questionnaire, glycemic parameters were measured on the basis of HbA1c. One-way ANOVA followed by post hoc Tukey's test and Pearson's coefficient of correlation tests were used for analysis. Hypogonadism was measured with levels of total testosterone less than 250 - Mean HbA1c levels of group A was 8.12% and group B was 8.09% 9 patients opted out of the study due to non consent, 5patients from group A and 4 patients from group B. Hypogonadism TT < 250 was observed in 25.6% of males(32/125) in group A as compared to 10% of males(13/126) in group B. Prevalence of erectile dysfunction was observed in 54.4% of males(68/125) in group A as compared to 31.74 % in males(40/126) in group B Higher degree of low testosterone was observed in group A with chronic history of type 2 diabetes as compared to group B, prevalence of erectile dysfunction in group A was non significantly higher as compared to group B An overall positive correlation was found between levels of hypogonadism and chronic history of type 2 diabetes. – We observed hypogonadism as indicated in significant proportion of males with chronic history of type 2 diabetes mellitus

Primary, secondary and compensated male biochemical hypogonadism in people living with HIV (PLWH): relevance of sex hormone-binding globulin (SHBG) measurement and comparison between liquid chromatography-tandem mass spectrometry (LC-MS/MS) and chemiluminescent immunoassay for sex steroids assay

Background Data about classification of hypogonadism and estrogen deficiency in male people living with HIV (PLWH) are scanty. Aim To investigate the prevalence and characterization of biochemical hypogonadism and relative estrogen deficiency in male PLWH aged < 50 comparing liquid chromatography-tandem mass spectrometry (LC-MS/MS) with chemiluminescent immunoassay (CI), and combining gonadotropin, sex hormone-binding globulin (SHBG) and serum estradiol (E2) measurements. Methods Prospective, cross-sectional, observational study. Serum total testosterone (TT), E2, gonadotropins, SHBG were measured by CI. TT and E2 were also assessed by LC-MS/MS. Free testosterone (cFT) was calculated by Vermeulen equation. Results A total of 316 PLWH (45.3 ± 5.3 years) were enrolled. TT and cFT by LC-MS/MS were lower compared to CI (p < 0.0001). The prevalence of biochemical hypogonadism was higher with LC-MS/MS than CI, both for TT (5.1% vs 3.2%, p < 0.0001) or cFT (9.5% vs 7%, p < 0.0001). The prevalence of hypogonadism (overt + compensated) was 17.1% for cFT using LC-MS/MS. Secondary form of hypogonadism was more prevalent than primary. The prevalence of relative estrogen deficiency was of 30.0% among hypogonadal patients and 15.5% among eugonadal. Conclusions The prevalence of male hypogonadism results underestimated by CI compared to LC-MS/MS in PLWH, both for TT and cFT. SHBG and gonadotropins are essential for detecting T deficiency.

Association between hypertriglyceridemic waist phenotype and hypogonadism in Taiwanese adult men.

Aging-related hypogonadism in men is related to the deterioration of overall health. Those with this disease rarely receive treatment. The hypertriglyceridemic waist (HTGW) phenotype is a tool for predicting abnormalities of cardiovascular metabolism. However, the relationship between the HTGW phenotype and hypogonadism remains undetermined. This study aimed to determine the association between HTGW phenotype and hypogonadism in different age groups. Data of this cross-sectional study were obtained from MJ Health Screening Center in Taiwan from 2007 to 2016. The HTGW phenotype was divided into four categories based on whether the waist circumference (WC) and triglyceride levels were normal. WC of <90 cm and triglyceride level of <150 mg/dL were defined as normal. Hypogonadism was defined as a testosterone level of <300 ng/dL. Overall, 6442 male participants were divided into three age groups: <50, 50-64, and ≥65 years (n = 4135, 1958, and 349; age groups 1, 2, and 3, respectively). The overall prevalence of hypogonadism was 10.6%. In group 1, participants with HTGW (odds ratio, 1.98; 95% confidence interval (CI), 1.354-2.896) had a higher risk of hypogonadism than those with normal WC and normal triglyceride levels after adjustment for body mass index and fasting blood glucose level. In group 2, participants with HTGW (odds ratio, 1.873; 95% CI, 1.099-3.193) had an increased risk of hypogonadism after adjustment for body mass index, fasting blood glucose level, Cholesterol levels, high-density lipoprotein (HDL) levels, low-density lipoprptein (LDL) levels and smoking status. However, no relationship was observed between HTGW phenotype and hypogonadism in group 3. HTGW phenotype was highly associated with hypogonadism in Taiwanese adult men. More attention should be paid to men aged <50 years with HTGW.

20-Year-Old Man With Elevated Liver Tests

20-Year-Old Man With Elevated Liver Tests

Abstract 120: Prevalence of hypogonadism in men with type 2 diabetes mellitus and its association with insulin resistance, metabolic and clinical parameters

Background: Hypogonadism is commonly found in men with type 2 diabetes mellitus (T2DM). The inverse association between testosterone and insulin resistance is also reported.Aims and Objectives: To investigate the prevalence of hypogonadism in men with T2DM and to evaluate the association between hypogonadism with insulin resistance along with metabolic and clinical parameters.Methods: This is a cross sectional study of 257 consecutive men with T2DM. Hypogonadism is defined on the symptoms as defined in the androgen deficiency in aging male questionnaire (ADAM) along with low calculated testosterone levels (calculated by vermeulen equation taking total testosterone, albumin and sex hormone binding globulin). Insulin resistance is measured by HOMA-IR, QUICKI.Results: The overall prevalence of hypogonadism in our cohort was 11.67%. 86.67% patients had hypogonadotropic hypogonadism while rest were hypergonadotropic hypogonadism. There is a significant inverse correlation of fasting Insulin (r=-0.198, p<0.001), HOMA IR (r=-0.288, p<0.001) and BMI (r=0.139, p<0.001) with testosterone levels. On linear regression analysis, HOMA IR was independently associated with testosterone levels (odds ratio= -5.185; 95% CI= -8.29 -to -2.075) even after adjusting for age, BMI, HBA1c and lipid levels. Among chronic complications, only diabetic retinopathy was significantly associated with presence of hypogonadism.Conclusion: In our recruited population, hypogonadism was found in 11.67% of individuals. Markers of insulin resistance were independently associated with hypogonadism among T2DM men.