title: Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study.
abstract: BACKGROUND
  The cause of declining testosterone (T) in aging men and their relationships with risk factors are unclear.
  
  
  OBJECTIVE
  The objective of the study was to investigate the relationships between lifestyle and health with reproductive hormones in aging men.
  
  
  METHODS
  This was a baseline cross-sectional survey on 3200 community-dwelling men aged 40-79 yr from a prospective cohort study in eight European countries.
  
  
  RESULTS
  Four predictors were associated with distinct modes of altered function: 1) age: lower free T (FT; -3.12 pmol/liter.yr, P < 0.001) with raised LH, suggesting impaired testicular function; 2) obesity: lower total T (TT; -2.32 nmol/liter) and FT (-17.60 pmol/liter) for body mass index (BMI; > or = 25 to < 30 kg/m(2)) and lower TT (-5.09 nmol/liter) and FT (-53.72 pmol/liter) for BMI 30 kg/m(2) or greater (P < 0.001-0.01, referent: BMI < 25 kg/m(2)) with unchanged/decreased LH, indicating hypothalamus/pituitary dysfunction; 3) comorbidity: lower TT (-0.80 nmol/liter, P < 0.01) with unchanged LH in younger men but higher LH in older men; and 4) smoking: higher SHBG (5.96 nmol/liter, P < 0.001) and LH (0.77 U/liter, P < 0.01) with increased TT (1.31 nmol/liter, P < 0.001) but not FT, compatible with a resetting of T-LH-negative feedback due to elevated SHBG.
  
  
  CONCLUSIONS
  Complex multiple alterations in the hypothalamic-pituitary-testicular axis function exist in aging men against a background of progressive age-related testicular impairment. These changes are differentially linked to specific risk factors. Some risk factors operate independently of but others interact with age, in contributing to the T decline. These potentially modifiable risk factors suggest possible preventative measures to maintain T during aging in men.
authors.affiliation: Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom. frederick.wu@manchester.ac.uk
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
authors.forename: Abdelouahid
authors.initials: A
authors.lastname: Tajar
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pye
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Silman
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Bartfai
authors.forename: Felipe
authors.initials: F
authors.lastname: Casanueva
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D000428:Alcohol Drinking; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood; D012307:Risk Factors; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013737:Testis / Q000502:physiology*; D013739:Testosterone / Q000097:blood; D049629:Waist-Hip Ratio
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D007986:Luteinizing Hormone