Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study.
BACKGROUND
The diagnosis of late-onset hypogonadism (LOH) in older men with age-related declines in testosterone (T) is currently not well characterized.


OBJECTIVE
Our objective was to investigate whether different forms of hypogonadism can be distinguished among aging men.


METHODS
The study was a cross-sectional survey on 3369 community-dwelling men aged 40-79 yr in eight European centers.


METHODS
Four groups of subjects were defined: eugonadal (normal T and normal LH), secondary (low T and low/normal LH), primary (low T and elevated LH), and compensated (normal T and elevated LH) hypogonadism. Relationships between the defined gonadal status with potential risk factors and clinical symptoms were investigated by multilevel regression models.


RESULTS
Among the men, 11.8, 2.0, and 9.5% were classified into the secondary, primary, and compensated hypogonadism categories, respectively. Older men were more likely to have primary [relative risk ratio (RRR) = 3.04; P < 0.001] and compensated (RRR = 2.41; P < 0.001) hypogonadism. Body mass index of 30 kg/m(2) or higher was associated with secondary hypogonadism (RRR = 8.74; P < 0.001). Comorbidity was associated with both secondary and primary hypogonadism. Sexual symptoms were more prevalent in secondary and primary hypogonadism, whereas physical symptoms were more likely in compensated hypogonadism.


CONCLUSIONS
Symptomatic elderly men considered to have LOH can be differentiated on the basis of endocrine and clinical features and predisposing risk factors. Secondary hypogonadism is associated with obesity and primary hypogonadism predominately with age. Compensated hypogonadism can be considered a distinct clinical state associated with aging. Classification of LOH into different categories by combining LH with T may improve the diagnosis and management of LOH.
Tajar
Abdelouahid
A
The University of Manchester, Manchester Academic Health Science Centre, Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom. frederick.wu@manchester.ac.uk.
Forti
Gianni
G
O'Neill
Terence W
TW
Lee
David M
DM
Silman
Alan J
AJ
Finn
Joseph D
JD
Bartfai
György
G
Boonen
Steven
S
Casanueva
Felipe F
FF
Giwercman
Aleksander
A
Han
Thang S
TS
Kula
Krzysztof
K
Labrie
Fernand
F
Lean
Michael E J
ME
Pendleton
Neil
N
Punab
Margus
M
Vanderschueren
Dirk
D
Huhtaniemi
Ilpo T
IT
Wu
Frederick C W
FC
D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D000428:Alcohol Drinking / Q000453:epidemiology; D000886:Anthropometry; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000453:epidemiology; D004958:Estradiol / Q000097:blood; D005060:Europe / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007006:Hypogonadism / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood; D044465:White People
D013739:Testosterone; D004958:Estradiol