The Prevalence of and Risk Factors for Androgen Deficiency in Aging Taiwanese Men

Abstract

Introduction Androgen deficiency in aging men has attracted much medical interest. Most studies on androgen deficiency have been conducted in Caucasian populations, and data from other ethnicities are lacking. Aim To evaluate the prevalence of and risk factors for androgen deficiency and symptomatic androgen deficiency in Taiwanese men over 40 years old. Methods From August 2007 to April 2008, a free health screening was conducted by a medical center in Kaohsiung, Taiwan, and 819 men participated in this health screening. All participants completed a health questionnaire, received a detailed physical examination, and blood samples were drawn between 8:00 and 12:00 am. Main Outcome Measures Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms of androgen deficiency were assessed using the Androgen Deficiency in the Aging Male (ADAM) questionnaire. Results Seven hundred thirty-four men who met the inclusion criteria (mean age 57.4 ± 6.7 years; range: 43–87 years) were included in this study. The prevalence of androgen deficiency was 24.1% based on the criterion of TT level < 300 ng/dL, and 16.6% based on the criterion of both TT < 300 ng/dL and FT < 5 ng/dL. The prevalence of symptomatic androgen deficiency was 12.0%. Both prevalence of androgen deficiency and symptomatic androgen deficiency increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency. Conclusions In a sample of aging Taiwanese men, a substantial proportion had androgen deficiency and symptomatic androgen deficiency, and the prevalence increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency. Those potentially modifiable risk factors like obesity and diabetes mellitus should be prevented to maintain normal testosterone levels during aging in men.

Systematic literature review of the risk factors, comorbidities, and consequences of hypogonadism in men

“…Reported effect measures were primarily ORs or correlation coefficients and low T was defined using various thresholds of TT or free testosterone (FT), and quartile or tertile comparisons. Increasing age (Smith et al, 2000;Blouin et al, 2005;Hall et al, 2008a,b;Dhindsa et al, 2010;Tajar et al, 2012) (Liu et al, 2009) (Blouin et al, 2005;Svartberg et al, 2006;Hall et al, 2008a,b), and poor health status (Mulligan et al, 2006;Hall et al, 2008a,b;Liu et al, 2009;Schneider et al, 2009;Tajar et al, 2012) were consistently found to be significantly associated with hypogonadism in all of the population and primary care-based cross-sectional studies in which they were assessed. Metabolic syndrome was significantly associated to hypogonadism in three population-based studies (Blouin et al, 2005;Svartberg et al, 2006;Tajar et al, 2012) and in one primary care study (Schneider et al, 2009), although it did not remain an independent comorbidity on multivariate analysis in one of the population-based studies (Tajar et al, 2012).…”

“…Diabetes mellitus was significantly associated with hypogonadism in three (Smith et al, 2000;Selvin et al, 2007;Tajar et al, 2012) of the five (Smith et al, 2000;Wong et al, 2006;Selvin et al, 2007;Hall et al, 2008a,b;Tajar et al, 2012) populationbased studies and in all three of the primary care studies, in which it was assessed (Mulligan et al, 2006;Liu et al, 2009;Dhindsa et al, 2010). Among the three population-based studies, DM was related to severe (TT < 8 nmol/L) but not moderate hypogonadism (TT of 8-11 nmol/L) in one study (Tajar et al, 2012), and to FT but not TT in another study (Selvin et al, 2007).…”

“…The association between comorbidities and hypogonadism was assessed in 10 cross-sectional population-based studies (Smith et al, 2000;Svartberg et al, 2004Svartberg et al, , 2006Blouin et al, 2005;Wong et al, 2006;Selvin et al, 2007;Tivesten et al, 2007;Hall et al, 2008a,b;Tajar et al, 2012) and in four primary carebased studies (Mulligan et al, 2006;Liu et al, 2009;Schneider et al, 2009;Dhindsa et al, 2010) and are presented in Table 4. Studies were conducted in Canada, China, Europe, Germany, Norway, Sweden, and USA.…”

Testosterone Replacement Therapy in Reversing “Andropause”: What Is the Proof-of-Principle?

“…40 Indeed, despite the lack of precise criteria for andropause, 26 both crosssectional and longitudinal studies have estimated that a substantial number of older men (i.e., especially aged ‡ 70 years) may have low sex steroid hormone levels. 8,10,[41][42][43][44][45][46][47][48][49] This condition places them at higher risk for adverse health outcomes and premature death. 8,28,[50][51][52][53][54][55] This review will aim to examine the uncertainty regarding the nature and the clinical importance of the age-related reduction in the T levels.…”

“…While a medical history of orchitis, testicular trauma, or other pathology may be contributory, 57 interestingly, increased adiposity and obesity were strongly associated with lower TT, FT, and SHBG levels in middle-aged and older men. 57,79,87,[151][152][153][154] Similarly diabetes mellitus and insulin concentrations have been found to be indirectly correlated with SHBG and TT concentrations. 155,156 With respect to lifestyle, excess intake of alcohol and physical and psychological stress were also associated with lower TT concentrations.…”