Prevalence of late-onset hypogonadism among middle-aged and elderly males in China: results from a national survey / 亚洲男科学杂志(英文版)

This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l

Establishing the cut off values of androgen markers in the assessment of polycystic ovarian syndrome

Introduction: Hyperandrogenism remains as one of the key features in Polycystic Ovarian Syndrome (PCOS) and can be assessed clinically or determined by biochemical assays. Hirsutism is the most common clinical manifestation of hyperandrogenism. The clinical assessment is subjected to wide variability due to poor interobserver agreement and multiple population factors such as ethnic variation, cosmetic procedures and genetic trait. The difficulty in resolving the androgen excess biochemically is due to a lack of consensus as to which serum androgen should be measured for the diagnosis of PCOS. The aim of the study was to compare and establish the diagnostic cut off value for different androgen biomarker for the diagnosis of PCOS. Materials and Methods: A total of 312 patients classified to PCOS (n = 164) and non PCOS (n = 148) cohorts were selected from the Laboratory Information System (LIS) based on serum total testosterone (TT) and sex hormone binding globulin (SHBG) from the period of 1st April 2015 to 31st March 2016. PCOS was diagnosed based on Rotterdam criteria. Clinical hyperandrogenism and ultrasound polycystic ovarian morphology were obtained from the clinical records. The other relevant biochemical results such as serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and albumin were also obtained from LIS. Free androgen index (FAI), calculated free testosterone (cFT) and calculated bioavailable testosterone (cBT) were calculated for these patients. Receiver Operating Characteristic (ROC) curve analysis were performed for serum TT, SHBG, FAI, cFT, cBT and LH: FSH ratio to determine the best marker to diagnose PCOS. Results: All the androgen parameters (except SHBG) were significantly higher in PCOS patients than in control (p<0.0001). The highest area under curve (AUC) curve was found for cBT followed by cFT and FAI. TT and LH: FSH ratio recorded a lower AUC and the lowest AUC was seen for SHBG. cBT at a cut off value of 0.86 nmol/L had the highest specificity, 83% and positive likelihood ratio (LR) at 3.79. This is followed by FAI at a cut off value of 7.1% with specificity at 82% and cFT at a cut off value of 0.8 pmol/L with specificity at 80%. All three calculated androgen indices (FAI, cFT and cBT) showed good correlation with each other. Furthermore, cFT, FAI and calculated BT were shown to be more specific with higher positive likelihood ratio than measured androgen markers. Conclusions: Based on our study, the calculated testosterone indices such as FAI, cBT and cFT are useful markers to distinguish PCOS from non-PCOS. Owing to ease of calculation, FAI can be incorporated in LIS and can be reported with TT and SHBG. This will be helpful for clinician to diagnose hyperandrogenism in PCOS.

Diagnostic criteria for late-onset hypogonadism: A preliminary study / 中华男科学杂志

<p><b>Objective</b>To determine the stability of androgen indexes by analyzing the relationship of androgen indexes with the results of late-onset hypogonadism (LOH) questionnaire investigations, and offer some reference for the application of the diagnostic criteria for LOH released by The Chinese Society of Andrology in 2009.</p><p><b>METHODS</b>This study included 1 003 males aged 40 years or older who had accomplished the questionnaires of Androgen Deficiency in Aging Males (ADAM), Aging Males' Symptoms Scale (AMS), and International Index of Erectile Function-5 (IIEF-5). We evaluated the correlation of androgen indexes with the results of the questionnaire investigation, repeated the examination of androgen indexes for the subjects with total testosterone (TT) ≤11.5 nmol/L after an average of 1.5 years, and analyzed the factors inducing changes of androgen indexes.</p><p><b>RESULTS</b>Free testosterone index (FTI) ≤ 0.42 (OR, 1.369) and calculated free testosterone (cFT) ≤ 0.3 nmol/L (OR, 1.302) were considered as the risk factors of LOH in AMS, and so were testosterone secretion index (TSI) ≤ 2.8 nmol/IU (OR, 1.679) and cFT ≤ 0.3 nmol/L (OR, 1.371) in IIEF-5. Paired t-test on the results of the examination performed twice showed significant differences in the levels of TT, TSI, cFT, and FT (P<0.05).</p><p><b>CONCLUSIONS</b>Decreased testosterone may cause the diversity of LOH symptoms and hence the fluctuation of androgens. Therefore, the diagnosis of LOH depends on androgen indexes, varied symptoms in the questionnaires, and relief of the symptoms after testosterone therapy.</p>

Laboratory diagnosis of late-onset male hypogonadism andropause / Diagnóstico laboratorial do hipogonadismo masculino tardio (andropausa)

OBJECTIVES: To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). METHODS: Total testosterone (TT), SHBG and albumin were measured in 216 men aged 52-84 years. The laboratorial definition of LOH was two values of calculated free testosterone (cFT) <6.5 ng/dl, according to Vermeulen's formula. RESULTS: At the first blood test, cFT was <6.5 ng/dl in 27 percent of the men. Laboratorial LOH (confirmed by two tests) was present in 19 percent, but TT levels were low in only 4.1 percent. Age influenced TT (p=0.0051) as well as BMI; 23.5 percent of patients > 70 years and 38.9 percent of the obese men who had TT within the reference range were, in fact, hypogonadal. CONCLUSION: Especially in obese men and in those > 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.

OBJETIVOS: Avaliar os fatores que influenciam o diagnóstico laboratorial do hipogonadismo masculino tardio. MÉTODOS: Avaliamos 216 homens entre 52 e 84 anos. O diagnóstico laboratorial foi definido como dois valores de testosterona livre calculada (TLC) <6,5 ng/dl, segundo a fórmula de Vermeulen, a partir das dosagens de testosterona total (TT), SHBG e albumina. RESULTADOS: Na primeira dosagem, a TLC foi <6.5 ng/dl em 27 por cento da amostra. Hipogonadismo laboratorial (confirmado por duas dosagens) esteve presente em 19 por cento, no entanto a TT foi baixa em apenas 4.1 por cento dos homens. A idade influenciou a TT (p=0.0051) bem como o IMC; 23,5 por cento dos homens > 70 anos e 38,9 por cento dos obesos com TT dentro dos níveis de referência eram, na verdade, hipogonádicos. CONCLUSÃO: Especialmente em homens obesos e nos > 70 anos a dosagem de SHBG é importante para calcular TL e diagnosticar o hipogonadismo.

The Relationship between Sex Hormones and Bone Turnover Markers in Adult Men

BACKGROUND: Bone mass changes in men is related to age, BMI, sex hormones and other factors. In prior studies, bone markers were negatively correlated with bone mineral density, free testosterone, and estrogen and was positively correlated with SHBG. In a study of sex hormones and bone markers in Korean men estradiol was negatively correlated with deoxypyridinoline. In this study, the relationship of testosterone, estradiol, calculated free testosterone, FEI and SHBG to bone turnover markers in adult men were investigated. METHODS: This was a cross-sectional study of 184 men who had undertaken a health screening program in one general hospital in Bundang from November, 2001 to February, 2003. We surveyed information concerning the past medical history, current medication, alcohol consumption amount per week and smoking amount by means of self questionnaire records. Serum total testosterone, estradiol, SHBG and osteocalcin, alkaline phosphatase were measured at a fasting state. Urine was tested for deoxypyridinoline. Free testosterone was calculated using albumin, SHBG, and total testosterone level. RESULTS: Deoxypyridinoline adjusted by age, BMI was negatively correlated with FEI (r=-0.17, P=0.020) and was positively correlated with smoking amount (r=0.20 P= 0.007). Osteocalcin was negatively correlated with calculated free testosterone and ethanol consumption amount (r=-0.186, P=.0.12, r=-0.186, P=0.012). Multiple regression analysis showed that the most powerful factor influencing deoxypyridinoline was smoking amount (R2= 0.046), followed by FEI, BMI, and the one influencing osteocalcin was BMI (R2=0.050), ethanol amount and calculated free testosterone. After adjusting for age, BMI, drinking amount and smoking amount FEI shown to be a predictor of deoxypyridinoline (beta=-0.08, p<0.01, R2=0.101). After adjusting for age, BMI, and drinking amount calculated free testosterone was shown to be a predictor of osteocalcin (beta=-0.570, P<0.01, R2=0.130) in multiple regression model. CONCLUSIONS: In adult men, FEI shown to be a predictor of deoxypyridinoline and calculated free testosterone to be a predictor of osteocalcin as an independent variable.

The Relationship among Testosterone, IGF- 1 and Fat Mass

BACGROUND: The age-related increase in fat mass seems related to decrease in hormone level. Few studies have been done in Korea concerning the association between testosterone, GH (growth hormone) and fat mass. This study was undertaken to evaluate the relationship among testosterone, IGF-1 and fat mass. METHODS: The study was performed from February to October 2001 in the Health Screening Center of Pundang CHA Hospital with 243 men as subjects. Fat intake was measured through interview with diet therapist and other data were obtained by self-questionnaire. Fat mass was measured using Inbody 3.0 and the level of total testosterone, SHBG and IGF-1 in serum were measured. RESULTS: Smoking was negatively correlated with fat mass and WHR (waist to hip ratio) (P <0.05) and fat intake was positively correlated with fat mass (P <0.05). Fat mass was negatively correlated with total testosterone, calculated free testosterone, and SHBG (gamma = 0.26; P <0.01, gamma = 0.15; P <0.05, gamma = 0.31; P <0.01). WHR was positively correlated with age (gamma =0.26; P <0.01) and negatively correlated with total testosterone, calculated free testosterone, and IGF-1 (gamma = 0.24; P <0.01, gamma = 0.20; P <0.01, gamma = 0.16; P <0.05). After adjustment for age, body mass index, smoking, and fat intake, the calculated free testosterone and IGF-1 were independently negatively correlated with fat mass (beta = 0.072; P <0.01, beta = 0.0035; P <0.05) and WHR (beta = 6.9E-04; P <0.05, beta = 4.0E-05; P <0.05) but, total testosterone and SHBG were not independently correlated with fat mass and WHR. CONCLUSION: The results indicate that the calculated free testosterone and IGF-1 can be independent determinants of fat mass and WHR in middle-aged men.