Faculty Opinions recommendation of Performance of total testosterone measurement to predict free testosterone for the biochemical evaluation of male hypogonadism.

2012 ◽  
Author(s):  
John Amory
Keyword(s):  
Free Testosterone ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Biochemical Evaluation

Performance of Total Testosterone Measurement to Predict Free Testosterone for the Biochemical Evaluation of Male Hypogonadism

2012 ◽  
Vol 187 (4) ◽  
pp. 1369-1373 ◽  
Author(s):  
Bradley D. Anawalt ◽  
James M. Hotaling ◽  
Thomas J. Walsh ◽  
Alvin M. Matsumoto
Keyword(s):  
Free Testosterone ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Biochemical Evaluation

scholarly journals Letrozole once a week normalizes serum testosterone in obesity-related male hypogonadism

2008 ◽  
Vol 158 (5) ◽  
pp. 741-747 ◽  
Author(s):  
Sandra Loves ◽  
Janneke Ruinemans-Koerts ◽  
Hans de Boer
Keyword(s):  
Hypogonadotropic Hypogonadism ◽  
Serum Testosterone ◽  
Free Testosterone ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Serum Lh ◽  
Long Term Effect ◽  
Starting Dose ◽  
Severely Obese ◽  
Lh Secretion

ObjectiveIsolated hypogonadotropic hypogonadism (IHH) is frequently observed in severely obese men, probably as a result of increased estradiol (E2) production and E2-mediated negative feedback on pituitary LH secretion. Aromatase inhibitors can reverse this process. This study evaluates whether letrozole once a week can normalize serum testosterone in severely obese men and maintain its long term effect.DesignOpen, uncontrolled 6-month pilot study in 12 severely obese men (body mass index>35.0 kg/m2) with obesity-related IHH and free testosterone levels <225 pmol/l, treated with 2.5 mg letrozole once a week for 6 months.ResultsSix weeks of treatment reduced total E2 from 123±11 to 58±7 pmol/l (P<0.001, mean±s.e.m.), and increased serum LH from 4.4±0.6 to 11.1±1.5 U/l (P<0.001). Total testosterone rose from 5.9±0.5 to 19.6±1.4 nmol/l (P<0.001), and free testosterone from 163±13 to 604±50 pmol/l (P<0.001). Total testosterone rose to within the normal range in all subjects, whereas free testosterone rose to supraphysiological levels in 7 out of 12 men. The testosterone and E2 levels were stable throughout the week and during the 6-month treatment period.ConclusionLetrozole 2.5 mg once a week produced a sustained normalization of serum total testosterone in obese men with IHH. However, free testosterone frequently rose to supraphysiological levels. Therefore, a starting dose <2.5 mg once a week is recommended.

scholarly journals The clinical and epidemiological characteristics of hypogonadism in men with type 2 diabetes mellitus

2020 ◽  
Vol 22 (6) ◽  
pp. 536-541 ◽  
Author(s):  
Galina A. Mel'nichenko ◽  
Marina V. Shestakova ◽  
Roman V. Rozhivanov
Keyword(s):  
Diabetes Mellitus ◽  
Testosterone Level ◽  
Diabetes Mellitus Type 2 ◽  
Free Testosterone ◽  
Diabetes Mellitus Type ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Rank Correlation Method ◽  
Epidemiological Characteristics

BACKGROUND: Male hypogonadism is a frequent complication of diabetes mellitus (DM) type 2; therefore, a study of its clinical and epidemiological characteristics is of interest. AIMS: Assessment of clinical and epidemiological characteristics of hypogonadism in men with diabetes mellitus type 2. METHODS: A full-design, cross-sectional, screening, multicenter, non-interventional study included men with diabetes mellitus type 2. The study was conducted from November 2017 to January 2019.Medical history assessment, sexological testing, estimation of luteinizing hormone (LH), sex hormone-binding globulin; total testosterone and glycated hemoglobin were performed. Free testosterone was calculated by the Vermeullen method. Comparison of groups was carried out using Yatess corrected version of chi-squared test, Mann-Whitney U-test, and Spearmans rank correlation method was also used. Differences were considered statistically significant with p 0,05. RESULTS: The age of 554 men included in the study was 55 [50; 58] years, total testosterone level was 12,5 [9,1; 16,4] nmol/L; free testosterone was 0,266 [0,205; 0,333] nmol/L; HbA1c 7,2 [6,2; 8,9] %. Hypogonadism syndrome was detected in 181 men (32,7%). Total testosterone level in these patients was 7,8 [6,5; 9,4] nmol/L, and free testosterone level was 0,182 [0,152; 0,217] nmol/L. In patients without hypogonadism, these parameters were 14,7 [12,4; 18,0] nmol/L and 0,308 [0,265; 0,362] nmol/L, respectively. In most cases, patients with hypogonadism had normal, but lower LH levels of 3,3 [2,2; 4,9] U/L compared with patients without hypogonadism 3,8 [2,7; 4,9], p = 0,022. Most often, normogonadotropic hypogonadism was detected (89,5%). Statistically significant negative correlations were found between total testosterone levels and body mass index (r = -0,24; p 0,001), and waist circumference (r = -0,21; p0,001). The prevalence of decreased libido in patients with hypogonadism (66,8%) is statistically significantly higher than that in men without hypogonadism (56,3%, p = 0,022). CONCLUSIONS: The prevalence of hypogonadism syndrome in men with diabetes mellitus type 2 is 32,7%. This type of hypogonadism is characterized by normal LH values.

Health status is related to testosterone, estrone and body fat: moving to functional hypogonadism in adult men with HIV

2021 ◽  
Vol 184 (1) ◽  
pp. 107-122
Author(s):  
Sara De Vincentis ◽  
Maria Chiara Decaroli ◽  
Flaminia Fanelli ◽  
Chiara Diazzi ◽  
Marco Mezzullo ◽  
...  
Keyword(s):  
Body Composition ◽  
Health Status ◽  
Body Fat ◽  
Sex Steroids ◽  
Highly Active Antiretroviral Therapy ◽  
Free Testosterone ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Cross Sectional ◽  
Highly Active

Objective Hypogonadism is common in HIV-infected men. The relationship between health status, sex steroids and body composition is poorly known in HIV. The aim was to investigate the association between health status (comorbidities/frailty), body composition, and gonadal function in young-to-middle-aged HIV-infected men. Design Prospective, cross-sectional, observational study. Methods HIV-infected men aged <50 years and ongoing Highly Active Antiretroviral Therapy were enrolled. Serum total testosterone (TT), estradiol (E2), estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, LH and FSH by immunoassay. Free testosterone (cFT) was calculated by Vermeulen equation. Body composition was assessed by dual-energy X-ray absorptiometry and abdominal CT scan. Multimorbidity (MM) and frailty were defined as ≥3 comorbidities and by a 37-item index, respectively. Results A total of 316 HIV-infected men aged 45.3 ± 5.3 years were enrolled. Body fat parameters were inversely related to cFT and TT, and directly related to E1 and E2/testosterone (TS) ratio. Patients with MM had lower cFT (P < 0.0001) and TT (P = 0.036), and higher E1 (P < 0.0001) and E2/TS ratio (P = 0.002). Frailty was inversely related to cFT (R2 = 0.057, P < 0.0001) and TT (R2 = 0.013, P = 0.043), and directly related to E1 (R2 = 0.171, P < 0.0001), E2 (R2 = 0.041, P = 0.004) and E2/TS ratio (R2 = 0.104, P < 0.0001). Conclusions Lower TT and cFT, higher E1, E2/TS ratio and visceral fat were independently associated to poor health status and frailty, being possible hallmarks of unhealthy conditions in adult HIV-infected men. Overall, MM, frailty and body fat mass are strictly associated to each other and to sex steroids, concurring together to functional male hypogonadism in HIV.

scholarly journals Laboratory diagnosis of late-onset male hypogonadism andropause

2008 ◽  
Vol 52 (9) ◽  
pp. 1430-1438 ◽  
Author(s):  
Ruth Clapauch ◽  
Aline Machado Carmo ◽  
Lizanka Marinheiro ◽  
Salo Buksman ◽  
Isabel Pessoa
Keyword(s):  
Blood Test ◽  
Reference Range ◽  
Late Onset ◽  
Free Testosterone ◽  
Laboratory Diagnosis ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Definition Of

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% of the men. Laboratorial LOH (confirmed by two tests) was present in 19%, but TT levels were low in only 4.1%. Age influenced TT (p=0.0051) as well as BMI; 23.5% of patients > 70 years and 38.9% 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.

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

2018 ◽  
Vol 126 (03) ◽  
pp. 176-181
Author(s):  
Mark Livingston ◽  
Richard Jones ◽  
Geoff Hackett ◽  
Gemma Donnahey ◽  
Gabriela Moreno ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Testosterone Level ◽  
Serum Testosterone ◽  
Free Testosterone ◽  
Sex Hormone Binding Globulin ◽  
Serum Prolactin ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
The Uk ◽  
Secondary Hypogonadism

Abstract Background 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. Aim To investigate what tests are performed to screen for hypogonadism and to exclude secondary hypogonadism. Design and Setting All participants attended general practices in the UK. Methods 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. Results 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. Conclusions 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.

Why Do We Need New Markers for Male Hypogonadism and How Seminal Proteomics Might Solve the Problem?

2020 ◽  
Vol 27 (12) ◽  
pp. 1186-1191
Author(s):  
Giuseppe Grande ◽  
Domenico Milardi ◽  
Silvia Baroni ◽  
Andrea Urbani ◽  
Alfredo Pontecorvi
Keyword(s):  
Serum Testosterone ◽  
Clinical Syndrome ◽  
Testosterone Replacement ◽  
Total Testosterone ◽  
Male Hypogonadism ◽  
Grey Zone ◽  
Testosterone Levels ◽  
Normal Number ◽  
Replacement Treatment

Male hypogonadism is “a clinical syndrome that results from failure of the testis to produce physiological concentrations of testosterone and/or a normal number of spermatozoa due to pathology at one or more levels of the hypothalamic– pituitary–testicular axis”. The diagnostic protocol of male hypogonadism includes accurate medical history, physical exam, as well as hormone assays and instrumental evaluation. Basal hormonal evaluation of serum testosterone, LH, and FSH is important in the evaluation of diseases of the hypothalamus-pituitary-testis axis. Total testosterone levels < 8 nmol/l profoundly suggest the diagnosis of hypogonadism. An inadequate androgen status is moreover possible if the total testosterone levels are 8-12 nmol/L. In this “grey zone” the diagnosis of hypogonadism is debated and the appropriateness for treating these patients with testosterone should be fostered by symptoms, although often non-specific. Up to now, no markers of androgen tissue action can be used in clinical practice. The identification of markers of androgens action might be useful in supporting diagnosis, Testosterone Replacement Treatment (TRT) and clinical follow-up. The aim of this review is to analyze the main findings of recent studies in the field of discovering putative diagnostic markers of male hypogonadism in seminal plasma by proteomic techniques. The identified proteins might represent a “molecular androtest” useful as a seminal fingerprint of male hypogonadism, for the diagnosis of patients with moderate grades of testosterone reduction and in the follow-up of testosterone replacement treatment.

Prevalence of and Risk Factors for Low Free Testosterone Levels in Japanese Men with Well-controlled Human Immunodeficiency Virus Infection

2020 ◽  
Vol 18 (5) ◽  
pp. 381-386
Author(s):  
Yusuke Yoshino ◽  
Ichiro Koga ◽  
Yoshitaka Wakabayashi ◽  
Takatoshi Kitazawa ◽  
Yasuo Ota
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Standard Deviation ◽  
Hiv Infection ◽  
Free Testosterone ◽  
Serum Levels ◽  
University Hospital ◽  
Rapid Decline ◽  
Total Testosterone ◽  
Immunodeficiency Virus

Background: The change in the prevalence of hypogonadism with age in men with human immunodeficiency virus (HIV) infection is subject to debate. Objective: To address this issue, we diagnosed hypogonadism based on serum levels of free testosterone (fTST) rather than total testosterone which is thought to be an inaccurate indicator. We also determined the relationship between age and fTST levels and identified risk factors for hypogonadism in men with HIV infection. Method: We retrospectively reviewed fTST levels and associated clinical factors in 71 wellcontrolled HIV-infected men who were treated at Teikyo University Hospital between April 2015 and March 2016 and who had data available on serum fTST levels, measured >6 months after starting antiretroviral therapy. fTST was measured using radioimmunoassay on blood samples collected in the morning. Risk factors for hypogonadism were identified using Welch’s t-test and multiple regression analysis. Results: The men had a mean (± standard deviation) age of 47.4 ± 13.6 years, and mean (± standard deviation) serum fTST level of 13.0 ± 6.1 pg/mL. Fifteen (21.1%) men had hypogonadism based on a fTST <8.5 pg/mL. Serum fTST levels significantly decreased with age (−0.216 pg/mL/year). Older age and low hemoglobin levels were identified as risk factors for hypogonadism. Conclusion: The men in the study experienced a more rapid decline in fTST levels with age than men in the general population (−0.161 pg/mL/year). Serum fTST levels in men with HIV infection should be monitored, especially in older men and those with low hemoglobin levels.

scholarly journals Hypogonadism and liver fibrosis in HIV-infected patients

2021 ◽  
Author(s):  
E. Quiros-Roldan ◽  
T. Porcelli ◽  
L. C. Pezzaioli ◽  
M. Degli Antoni ◽  
S. Paghera ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Univariate Analysis ◽  
Free Testosterone ◽  
Sex Hormone Binding Globulin ◽  
Total Testosterone ◽  
Cross Sectional ◽  
Pituitary Dysfunction ◽  
Consequent Reduction ◽  
Secondary Hypogonadism ◽  
The Relationship

Abstract Purpose Hypogonadism is frequent in HIV-infected men and might impact on metabolic and sexual health. Low testosterone results from either primary testicular damage, secondary hypothalamic-pituitary dysfunction, or from liver-derived sex-hormone-binding-globulin (SHBG) elevation, with consequent reduction of free testosterone. The relationship between liver fibrosis and hypogonadism in HIV-infected men is unknown. Aim of our study was to determine the prevalence and type of hypogonadism in a cohort of HIV-infected men and its relationship with liver fibrosis. Methods We performed a cross-sectional retrospective study including 107 HIV-infected men (median age 54 years) with hypogonadal symptoms. Based on total testosterone (TT), calculated free testosterone, and luteinizing hormone, five categories were identified: eugonadism, primary, secondary, normogonadotropic and compensated hypogonadism. Estimates of liver fibrosis were performed by aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) scores. Results Hypogonadism was found in 32/107 patients (30.8%), with normogonadotropic (10/107, 9.3%) and compensated (17/107, 15.8%) being the most frequent forms. Patients with secondary/normogonadotropic hypogonadism had higher body mass index (BMI) (p < 0001). Patients with compensated hypogonadism had longer HIV infection duration (p = 0.031), higher APRI (p = 0.035) and FIB-4 scores (p = 0.008), and higher HCV co-infection. Univariate analysis showed a direct significant correlation between APRI and TT (p = 0.006) and SHBG (p = 0.002), and between FIB-4 and SHBG (p = 0.045). Multivariate analysis showed that SHBG was independently associated with both liver fibrosis scores. Conclusion Overt and compensated hypogonadism are frequently observed among HIV-infected men. Whereas obesity is related to secondary hypogonadism, high SHBG levels, related to liver fibrosis degree and HCV co-infection, are responsible for compensated forms.

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