title: Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Abdelouahid
authors.initials: A
authors.lastname: Tajar
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Silman
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.forename: György
authors.initials: G
authors.lastname: Bartfai
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.forename: Thang S
authors.initials: TS
authors.lastname: Han
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.forename: Fernand
authors.initials: F
authors.lastname: Labrie
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Lean
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
mesh_terms: 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
chemical_list: D013739:Testosterone; D004958:Estradiol