Investigation, treatment and monitoring of late-onset hypogonadism in males

Wang, Cong-Yi; Nieschlag, Eberhard; Swerdloff, Ronald S.; Behre, Hermann M.; Hellstrom, Wayne J.G.; Gooren, Louis; Kaufman, Jean‐Marc; Legros, Jean-Jacques; Lunenfeld, Bruno; Morales, Álvaro; Morley, John E.; Schulman, Claude; Thompson, Ian M.; Weidner, W.; Wu, Frederick C. W.

doi:10.1530/eje-08-0601

Cited by 490 publications

(132 citation statements)

References 89 publications

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“…Baseline leptin was already below 2 ng · ml −1 , which has been suggested as a threshold for leptin to exert suppressive effects on other endocrine axes (Holtkamp et al, 2003). However, baseline testosterone and IGF-1 concentrations were near the median of age-matched reference ranges (Rosario, 2010;Wang et al, 2008), which suggests that our participants did not show evidence of metabolic and endocrine suppression prior to the study start. It is further possible that the endocrine suppression during low energy availability was blunted by increased circulating concentrations of binding proteins, which were not assessed in this study.…”

Section: Discussionmentioning

confidence: 78%

Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones

Koehler

Hoerner

Gibbs

et al. 2016

Journal of Sports Sciences

123

161

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Section: Discussionmentioning

confidence: 78%

Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones

Koehler

Hoerner

Gibbs

et al. 2016

Journal of Sports Sciences

123

161

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“…Males with at least two determinations of serum total testosterone levels below the lower limit of the normal range for age (!10.4 and !6.9 nmol/l, before and after the age of 70 respectively) were classified as hypogonadic and underwent additional evaluations (35).…”

Section: Abnormal Laboratory Testsmentioning

confidence: 99%

Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture

Eller-Vainicher

Cairoli

Zhukouskaya

et al. 2013

European Journal of Endocrinology

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Objective: The prevalence of subclinical contributors to low bone mineral density (BMD) and/or fragility fracture is debated. We evaluated the prevalence of subclinical contributors to low BMD and/or fragility fracture in the presence of normal 25-hydroxyvitamin D (25OHVitD) levels. Design: Prospective observational study. Methods: Among 1095 consecutive outpatients evaluated for low BMD and/or fragility fractures, 602 (563 females, age 65.4G10.0 years) with apparent primary osteoporosis were enrolled. A general chemistry profile, phosphate, 25OHVitD, cortisol after 1-mg overnight dexamethasone suppression test, antitissue transglutaminase and endomysial antibodies and testosterone (in males) were performed. Serum and urinary calcium and parathyroid hormone levels were also evaluated after 25OHVitD levels normalization. Vertebral deformities were assessed by radiograph. Results: In total, 70.8% of patients had low 25OHVitD levels. Additional subclinical contributors to low BMD and/or fragility fracture were diagnosed in 45% of patients, with idiopathic hypercalciuria (IH, 34.1%) and primary hyperparathyroidism (PHPT, 4.5%) being the most frequent contributors, apart from hypovitaminosis D. Furthermore, 33.2% of IH and 18.5% of PHPT patients were diagnosed only after 25OHVitD levels normalization. The subclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D were associated inversely with age (odds ratio (OR) 1.02, 95% CI 1-1.04, PZ0.04) and BMI (OR 1.1, 95% CI 1.05-1.17, PZ0.0001) and directly with fragility fractures (OR 1.89, 95% CI 1.31-2.73, PZ0.001), regardless of BMD. Conclusions: Subclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D are present in more than 40% of the subjects with apparent primary osteoporosis. Hypovitaminosis D masks a substantial proportion of IH and PHPT patients.

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“…38 Nevertheless, testosterone deficiency is most often defined as a serum testosterone <300 ng/dL (10.4 nmol/L) 39 and there is a general agreement that total testosterone levels above 346 ng/dL (12 nmol/L) do not require substitution. [40][41] In this review, the average testosterone level for all studies was just below 300 ng/dL (296 ± 85 ng/dL) despite the fact that most studies included low-normal levels of testosterone, up to 400 ng/ dL (13.8 nmol/L). Furthermore, the fact that some hypogonadal men respond fully to PDE-5 inhibitors 28 suggests that their efficacy may depend on minimal levels of circulating testosterone.…”

Section: Discussionmentioning

confidence: 87%

Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: A systematic review

Alhathal¹,

Elshal²,

Carrier³

2012

CUAJ

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Testosterone deficiency seems to impair the clinical response to phophodiesterase-5 (PDE-5) inhibitors in patients with erectile dysfunction (ED). In hypogonadal men, testosterone repletion was associated with enhanced sexual function in patients who failed initial treatment with sildenafil or tadalafil. We conducted a systematic review of studies that evaluated combination therapy of testosterone and PDE-5 inhibitors in patients with ED and low, low-normal testosterone levels who failed monotherapy. The studies we examine are heterogeneous with several methodological drawbacks and that, overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone <300 ng/dL (10.4 nmol/L) who failed monotherapy. Further studies, with a randomized placebo-controlled and double blind design, are needed to describe the appropriate target patient group, testosterone cut-off and to define the optimal dose and duration of combination therapy.

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Investigation, treatment and monitoring of late-onset hypogonadism in males

Cited by 490 publications

References 89 publications

Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones

Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones

Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture

Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: A systematic review

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