title: Development of and Recovery from Secondary Hypogonadism in Aging Men: Prospective Results from the EMAS.
abstract: BACKGROUND
  Secondary hypogonadism is common in aging men; its natural history and predisposing factors are unclear.
  
  
  OBJECTIVE
  The objectives were 1) to identify factors that predispose eugonadal men (T ≥ 10.5 nmol/L) to develop biochemical secondary hypogonadism (T < 10.5 nmol/L; LH ≤ 9.4 U/L) and secondary hypogonadal men to recover to eugonadism; and 2) to characterize clinical features associated with these transitions.
  
  
  METHODS
  The study was designed as a prospective observational general population cohort survey.
  
  
  METHODS
  The setting was clinical research centers.
  
  
  METHODS
  The participants were 3369 community-dwelling men aged 40-79 years in eight European centers.
  
  
  METHODS
  Interventions included observational follow-up of 4.3 years.
  
  
  METHODS
  Subjects were categorized according to change/no change in biochemical gonadal status during follow-up as follows: persistent eugonadal (n = 1909), incident secondary hypogonadal (n = 140), persistent secondary hypogonadal (n = 123), and recovered from secondary hypogonadism to eugonadism (n = 96). Baseline predictors and changes in clinical features associated with incident secondary hypogonadism and recovery from secondary hypogonadism were analyzed by regression models.
  
  
  RESULTS
  The incidence of secondary hypogonadism was 155.9/10 000/year, whereas 42.9% of men with secondary hypogonadism recovered to eugonadism. Incident secondary hypogonadism was predicted by obesity (body mass index ≥ 30 kg/m(2); odds ratio [OR] = 2.86 [95% confidence interval, 1.67; 4.90]; P < .0001), weight gain (OR = 1.79 [1.15; 2.80]; P = .011), and increased waist circumference (OR = 1.73 [1.07; 2.81], P = .026; and OR = 2.64 [1.66; 4.21], P < .0001, for waist circumference 94-102 and ≥102 cm, respectively). Incident secondary hypogonadal men experienced new/worsening sexual symptoms (low libido, erectile dysfunction, and infrequent spontaneous erections). Recovery from secondary hypogonadism was predicted by nonobesity (OR = 2.28 [1.21; 4.31]; P = .011), weight loss (OR = 2.24 [1.04; 4.85]; P = .042), normal waist circumference (OR = 1.93 [1.01; 3.70]; P = .048), younger age (< 60 y; OR = 2.32 [1.12; 4.82]; P = .024), and higher education (OR = 2.11 [1.05; 4.26]; P = .037), but symptoms did not show significant concurrent improvement.
  
  
  CONCLUSIONS
  Obesity-related metabolic and lifestyle factors predispose older men to the development of secondary hypogonadism, which is frequently reversible with weight loss.
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Emma L
authors.initials: EL
authors.lastname: Carter
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Tomas
authors.initials: T
authors.lastname: Ahern
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Leen
authors.initials: L
authors.lastname: Antonio
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Bartfai
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Brian
authors.initials: B
authors.lastname: Keevil
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Thang S
authors.initials: TS
authors.lastname: Han
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Lean
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.affiliation: Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007006:Hypogonadism / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D020127:Recovery of Function / Q000502:physiology; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology; D055105:Waist Circumference / Q000502:physiology; D015431:Weight Loss / Q000502:physiology