Abrupt decrease in serum testosterone levels after an oral glucose load in men: implications for screening for hypogonadism.
OBJECTIVE
This study examines the physiological impact of a glucose load on serum testosterone (T) levels in men with varying glucose tolerance (GT).


METHODS
Cross-sectional study.


METHODS
74 men (19-74 years, mean 51·4 ± 1·4 years) underwent a standard 75-g oral glucose tolerance test with blood sampling at 0, 30, 60, 90 and 120 min. Fasting serum glucose, insulin, total T (and calculated free T), LH, SHBG, leptin and cortisol were measured.


RESULTS
57% of the men had normal GT, 30% had impaired GT and 13% had newly diagnosed type 2 diabetes. Glucose ingestion was associated with a 25% decrease in mean T levels (delta = -4·2 ± 0·3 nm, P < 0·0001). T levels remained suppressed at 120 min compared with baseline (13·7 ± 0·6 vs 16·5 ± 0·7 nm, P < 0·0001) and did not differ across GT or BMI. Of the 66 men with normal T levels at baseline, 10 (15%) had levels that decreased to the hypogonadal range (<9·7 nm) at one or more time points. SHBG, LH and cortisol levels were unchanged. Leptin levels decreased from baseline at all time points (P < 0·0001).


CONCLUSIONS
Glucose ingestion induces a significant reduction in total and free T levels in men, which is similar across the spectrum of glucose tolerance. This decrease in T appears to be because of a direct testicular defect, but the absence of compensatory changes in LH suggests an additional central component. Men found to have low nonfasting T levels should be re-evaluated in the fasting state.
Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Lisa M
LM
Caronia
Andrew A
AA
Dwyer
Douglas
D
Hayden
Francesca
F
Amati
Nelly
N
Pitteloud
Frances J
FJ
Hayes
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D013739:Testosterone / Q000097:blood*; D055815:Young Adult
D013739:Testosterone; D005947:Glucose