Endocrine Abstracts

Introduction: In the last few years the view that subclinical endocrine disorders represent milder forms of the clinically overt disease has emerged. Accordingly, it has been proposed that compensated hypogonadism represents a genuine clinical subgroup of individuals with late onset hypogonadism (LOH). The aim of the present study is to investigate the association of compensated hypogonadism with clinical and psychological characteristics of male subjects complaining for sexual dysfunction.

Methods: After excluding documented genetic causes of hypogonadism, an unselected consecutive series of 4173 patients consulting our Unit for SD was studied. Compensated hypogonadism was identified according to the European Male Aging Study criteria: total testosterone=10.5 nmol/liter and LH >9.4 U/L. Several hormonal, biochemical, and instrumental (penile Doppler ultrasound) parameters were studied, along with a structured interview on erectile dysfunction (SIEDY), and ANDROTEST.

Results: 170 (4.1%) subjects had compensated hypogonadism, whereas 827 (19.8%) had an overt hypogonadism. After the adjustment for confounding factors, non-specific sexual symptom was related to compensated hypogonadism. However, compensated hypogonadism individuals more often reported psychiatric symptoms, as detected by ΣMHQ score, when compared to both eugonadal and overt hypogonadal subjects (adjusted OR=1.018[1.005;1.031]; 1.014[1.001;1.028]; both p<0.005). In addition, subjects with compensated or overt hypogonadism had an increased predicted CV risk (as assessed by Progetto Cuore risk engine) when compared to eugonadal individuals. Accordingly, major adverse cardiovascular events (MACE)-related mortality, but not MACE incidence, was significantly higher in subjects with both compensated and overt hypogonadism, when compared to eugonadal subjects.

Conclusions: Present data do not support the concept that compensated (subclinical) hypogonadism represents a new clinical entity. In fact, subclinical low T may be considered as a resilient response to adverse conditions, such as CV diseases, that naturally restrain reproductive and sexual activity. Further studies are urgently needed to clarify this latter point.