title: Sex hormone levels are not associated with progression of renal disease in male patients with T2DM.
abstract: BACKGROUND
  Greater renal function decline (RFD) in type 2 diabetes (T2DM) has been suggested in men compared with women, and imbalances in estrogen/androgen levels have been associated with cardiovascular disease mortality in elderly men, but it remains unclear whether sex hormone disequilibrium is related to diabetic nephropathy (DN) in men with T2DM.
  
  
  OBJECTIVE
  This study examined the relationship between sex steroid concentrations and renal outcomes in male T2DM patients.
  
  
  METHODS
  Total testosterone (T), total estradiol (E2), sex hormone-binding globulin (SHBG), and total and calculated free (cf) E2/T ratios were compared in 735 male T2DM patients with (n=513) and without (n=222) DN, using a cross-sectional approach. Also, in a pilot complementary prospective nested case-control cohort, total E2/total T and cfE2/cfT were evaluated according to a hard renal outcome (HRO): end-stage renal disease/doubling of baseline serum creatinine (36 HRO cases, 72 HRO controls) and rate of eGFR decline (68 rapid vs 68 slow RFD).
  
  
  RESULTS
  With the cross-sectional approach, E2 and cfE2 were higher in DN cases vs DN controls (95.5 vs 86.8pmol/L [P=0.0246] and 2.59 vs 2.36pmol/L [P=0.005], respectively). The difference in E2 persisted on multivariate analysis. In the prospective approach, E2 and T concentrations, and total E2/total T and cfE2/cfT2 ratios did not differ in HRO cases vs controls or in patients with rapid vs slow RFD.
  
  
  CONCLUSIONS
  Although positively related to DN in the cross-sectional analysis, progression of renal disease in male patients with T2DM was not related to either sex hormone levels or aromatase index as reflected by E2/T ratio.
authors.affiliation: CHU de Poitiers, Service d'Endocrinologie, Pole DUNE, 86021 Poitiers, France; Université de Poitiers, UFR Médecine Pharmacie, 86021 Poitiers, France; Inserm, CIC 1402 & U1082, 86021 Poitiers, France. Electronic address: eva.feigerlova@fulbrightmail.org.
authors.forename: E
authors.initials: E
authors.lastname: Feigerlová
authors.affiliation: Inserm, CIC 1402 & U1082, 86021 Poitiers, France.
authors.forename: P-J
authors.initials: PJ
authors.lastname: Saulnier
authors.affiliation: CHU de Toulouse, Service de Diabétologie, Maladies Métaboliques et Nutrition, 31059 Toulouse, France; Inserm, UMR1048/I2MC, 31059 Toulouse, France; Université Paul-Sabatier, UMR1048/I2MC, 31059 Toulouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Gourdy
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Inserm, UMRS1138, Centre de Recherche des Cordeliers, 75006 Paris, France; AP-HP, Hôpital Bichat, Diabétologie, Endocrinologie Nutrition, DHU FIRE, 75018 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Roussel
authors.affiliation: CHU de Tours, Service Néphrologie, Dialyse et Transplantation, 37000 Tours, France; Inserm, Centre d'Investigation Clinique 0202, 37000 Tours, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Halimi
authors.affiliation: CHU de Poitiers, Service d'Endocrinologie, Pole DUNE, 86021 Poitiers, France.
authors.forename: E
authors.initials: E
authors.lastname: Gand
authors.affiliation: Hospital of Sud Francilien, Endocrinology Department, 91100 Corbeil-Essonnes, France.
authors.forename: D
authors.initials: D
authors.lastname: Dardari
authors.affiliation: CHU de Nancy, Service d'Endocrinologie, 54511 Vandoeuvre-lès-Nancy, France.
authors.forename: B
authors.initials: B
authors.lastname: Guerci
authors.affiliation: Complexe médico-sportif Mon-Stade, 75013 Paris, France; Université de Poitiers, Laboratoire MOVE (EA 6314), 86021 Poitiers, France.
authors.forename: P
authors.initials: P
authors.lastname: Sosner
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Inserm, UMRS1138, Centre de Recherche des Cordeliers, 75006 Paris, France; AP-HP, Hôpital Bichat, Diabétologie, Endocrinologie Nutrition, DHU FIRE, 75018 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Marre
authors.affiliation: CHU de Grenoble, Service Néphrologie, Dialyse et Transplantation, 38700 Grenoble, France; Université Joseph-Fournier, Faculté de Médecine, 38700 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Zaoui
authors.affiliation: Inserm, CIC 1402 & U1082, 86021 Poitiers, France.
authors.forename: S
authors.initials: S
authors.lastname: Ragot
authors.affiliation: CHU de Poitiers, Service d'Endocrinologie, Pole DUNE, 86021 Poitiers, France; Université de Poitiers, UFR Médecine Pharmacie, 86021 Poitiers, France; Inserm, CIC 1402 & U1082, 86021 Poitiers, France.
authors.forename: S
authors.initials: S
authors.lastname: Hadjadj
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003928:Diabetic Nephropathies / Q000097:blood*; D018450:Disease Progression; D004958:Estradiol / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D013739:Testosterone / Q000097:blood*
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol
keywords: Aromatase index; Diabetic nephropathy; Estradiol; Testosterone; Type 2 diabetes