title: Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS).
abstract: BACKGROUND
  Late-onset hypogonadism (LOH) has been defined as a syndrome in middle-aged and elderly men reporting symptoms in the presence of low testosterone (T).
  
  
  OBJECTIVE
  The objective of the study was to seek objective biochemical and end-organ evidence of androgen deficiency in men classified as having LOH according to our previously published criteria.
  
  
  METHODS
  The design of the study included cross-sectional data from the European Male Aging Study on 2966 community-dwelling men aged 40-79 years in eight European countries.
  
  
  METHODS
  Waist circumference, body mass index, muscle mass, estimated heel bone mineral density (eBMD), hemoglobin, insulin sensitivity, physical activity, metabolic syndrome, insulin resistance index, and cardiovascular disease were measured.
  
  
  RESULTS
  Sixty-three men (2.1%) were classified as having LOH: 36 moderate and 27 severe. They were older and more obese than eugonadal men and had, in proportion to the graded T deficiency, lower muscle mass, eBMD, and hemoglobin, with poorer general health. Both moderate and severe LOH was associated with lower hemoglobin, mid-upper arm circumference, eBMD, physical function (measured by the Short Form-36 questionnaire), slower gait speed and poorer general health. Only men with severe LOH showed significant associations with larger waist circumference (β=1.93 cm; 0.04-3.81), insulin resistance (β=2.81; 1.39-4.23), and the metabolic syndrome (odds ratio 9.94; 2.73-36.22) after adjustments for confounders. Men with low testosterone only (irrespective of symptoms) showed lesser magnitudes of association with the same end points.
  
  
  CONCLUSIONS
  LOH is associated with multiple end-organ deficits compatible with androgen deficiency. These data support the existence of a syndrome of LOH in only a minority of aging men, especially those with T below 8 nmol/liter.
authors.affiliation: Arthritis Research U.K. Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PT, United Kingdom.
authors.forename: Abdelouahid
authors.initials: A
authors.lastname: Tajar
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pye
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.forename: György
authors.initials: G
authors.lastname: Bartfai
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Felipe F F
authors.initials: FF
authors.lastname: Casanueva
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
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: Frederick C W
authors.initials: FC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000097:blood*; D000728:Androgens / Q000172:deficiency*; D015519:Bone Density; D003430:Cross-Sectional Studies; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000150:complications; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications; D012735:Sexual Dysfunction, Physiological / Q000097:blood*; D055105:Waist Circumference
chemical_list: D000728:Androgens