Objective: To analyze the relative risk of late-onset hypogonadism in men with osteoporosis and the usefulness of screening questionnaires. Methods: We correlated the Aging Male's Symptoms (AMS), Androgen Defi ciency in Aging Male (ADAM) and International Index of Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone density, paired by age and ethnicity). Results: Hypogonadism presented in 25% of the osteoporotic and in 12.2 % of normal bone density men (OR 2.08; IC95%: 1.14-3.79) and was associated with ADAM fi rst question (low libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels. Conclusion: Hypogonadism was 2.08 times more prevalent in osteoporotic men. The symptom that best correlated with late-onset hypogonadism was low libido (ADAM 1 positive).

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.

Objective: To study and establish sex hormone cutoff levels for osteoporosis risk in men over 50 years old. Methods: Case-control study of 216 men > 50 years, 110 with osteoporosis (O) and 106 with normal bone density (C). We measured estradiol (E2), sex hormone binding globulin (SHBG), total testosterone (TT) and albumin. Free testosterone (FT) and bioavailable testosterone (BT) were calculated through Vermeulen's formula. Results: There was no difference in TT between groups. Relative risks of osteoporosis were 1.89 for E2 < 37 pg/mL (p = 0.02); 1.91 for SHBG > 55 nmol/L (p = 0.019); 2.5 for FT < 7 ng/dL (p = 0.015); 2.7 for BT < 180 ng/dL (p = 0.0003). Conclusions:In men over 50 years old, TT was not indicative of osteoporosis risk while E2 < 37 ng/mL was. SHBG > 55 nmol/L, FT < 7 ng/dL and BT < 180 ng/dL can represent additional indications for osteoporosis screening in men over 50 years old. Arq Bras Endocrinol Metab. 2009;53(8):1020-5 Keywords Male osteoporosis; estradiol; testosterone; free estradiol; free testosterone; SHBG resumo Objetivo: Estudar e estabelecer pontos de corte dos hormônios sexuais para risco de osteoporose em homens após os 50 anos de idade. Métodos: Estudo caso-controle de 216 homens > 50 anos, 110 com osteoporose e 106 com densidade óssea normal. Foram dosados: estradiol (E2), globulina ligadora de hormônios sexuais (SHBG), testosterona total (TT) e albumina. Foram calculadas: testosterona livre (TLC) e testosterona biodisponível (TB) pela fórmula de Vermeulen. Resultados: Não houve diferença na TT entre os grupos. Os riscos relativos de osteoporose foram de 1,89 para E2 < 37 pg/mL (p = 0,02); 1,91 para SHBG > 55 nmol/L (p = 0,019); 2,5 para TLC < 7 ng/dL (p = 0,015) e 2,7 para TB < 180 ng/dL (p = 0,0003). Conclusões: Em homens acima de 50 anos, TT não indicou risco de osteoporose, mas E2 < 37 pg/mL sim. SHBG > 55 nmol/L, TLC < 7 ng/dL e TB < 180 ng/dL podem representar indicações adicionais para pesquisa de osteoporose em homens acima de 50 anos. Arq Bras Endocrinol Metab. 2009;53(8):1020-5 Descritores

Objective: To assess the efficacy and safety of testosterone replacement in males with late-onset hypogonadism compared to hypogonadal men without replacement, and controls, during six months. Methods: We assessed, through ADAM, AMS, IIEF-5 and SF-36 questionnaires, and through clinical and laboratorial examinations, 62 patients divided into three groups: 17 hypogonadal males (HR) used intramuscular testosterone every three weeks; 14 hypogonadal males (HV) and 31 non-hypogonadal males (CV) used oral vitamins daily. Results: When compared to others, HR group obtained libido improvement assessed by ADAM 1 (p = 0.004), and borderline sexual potency improvement assessed by IIEF-5 (p = 0.053), besides a decrease in waist circumference after eight weeks (p = 0.018). The remaining parameters did not differ between the groups. PSA and hematocrit remained stable in those using testosterone. Conclusion: Six months of testosterone replacement improved sexuality and body composition, with prostatic and hematological safety. KeywordsTestosterone replacement therapy; late onset hypogonadism; andropause; libido; body composition; waist circumference resumo Objetivo: Avaliar a eficácia e a segurança da reposição de testosterona em homens com hipogonadismo tardio comparados a hipogonádicos sem reposição e controles, durante seis meses. Métodos: Mediante os questionários ADAM, AMS, IIEF-5 e SF-36, foram feitos exame clínico e laboratorial em 62 pacientes divididos em três grupos: 17 hipogonádicos (HR) usaram testosterona intramuscular a cada três semanas; 14 hipogonádicos (HV) e 31 não hipogonádi-cos (CV) usaram vitaminas via oral diariamente. Resultados: Comparado aos demais, o grupo HR obteve melhora da libido avaliada pelo ADAM 1 (p = 0,004) e melhora limítrofe da potência sexual avaliada pelo IIEF-5 (p = 0.053), além de diminuição da cintura a partir da oitava semana (p = 0,018). Os demais parâmetros não foram diferentes entre os grupos. PSA e hematócrito se mantiveram estáveis nos que usaram testosterona. Conclusão: A reposição de testosterona durante seis meses melhorou a sexualidade e a composição corporal, com segurança prostática e hematológica. Arq Bras Endocrinol Metab. 2009;53(8):996-1004 Descritores