ECE2017 Eposter Presentations: Diabetes, Obesity and Metabolism Obesity (81 abstracts)
Testosterone deficiency in obese males: is insulin resistance the one to blame?
Pedro Souteiro 1, , Daniela Magalhães 1, , Jorge Pedro 1, , Sofia Castro Oliveira 1, , João Sérgio Neves 1, , Sandra Belo 1, , Maria Manuel Costa 1, , Rita Bettencourt-Silva 1, , Ana Varela 1, , Joana Queirós 1, , Paula Freitas 1, , Davide Carvalho 1, & Group AMTCO 3
1Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal; 2Faculty of Medicine of University of Porto, Porto, Portugal; 3Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal.
Introduction: Obesity is a growing worldwide public health issue and it is associated with multiple comorbidities, namely the so called Male Obesity-associated Secondary Hypogonadism (MOSH). However, the mechanisms that explain this association are not fully understood.
Methods: Cross-sectional study of 163 obese men that were evaluated for several clinical and analytic parameters. Testosterone deficiency was defined as: total testosterone <2.8 ng/ml and/or free testosterone calculated by the Vermeulen formula <50 pg/ml.
Results: The studied population had a mean age and BMI of 40.8±10.5 years-old and 45.8±6.7 kg/m2, respectively. Testosterone deficiency prevalence was 47.2%. The majority (96.1%) of these men had hypogonadotropic dysfunction and 2.9% presented high gonadotrophins. When only calculated free testosterone was considered, the deficiency prevalence was 18.1%. Higher BMIs correlated with lower levels of SHBG (sex hormone binding globulin): r=−0.19; P<0.05. BMI (r=−0.26; P<0.001), age (r=−0.21; P<0.05) and HOMA-IR (r=0.39; P<0.001) had a negative correlation with calculated free testosterone levels, while SHBG levels exhibited a positive correlation (r=0.18; P<0.05). There was no significant correlation between oestradiol levels and free/total testosterone or BMI. When the aforementioned significant variables were included in a linear regression model, HOMA-IR (β=−0.33; P<0.001) and SHBG levels (β=0.20; P<0.01) could predict the free testosterone levels, while age (P=0.07) and BMI (P=0.23) lost their significance after the adjustment. In accordance, males with normal glucose tolerance had higher free testosterone levels than those with pre-diabetes or diabetes even after adjusting for age and BMI (β=0.22; P<0.01).
Conclusions: Testosterone deficiency is frequent in obese males, with most of them presenting hypogonadotropic dysfunction. SHBG levels and mainly insulin resistance, and not obesity per se, seem to be the true mediators of this interplay. We found no correlation between oestradiol and testosterone levels suggesting that androgen aromatization in adipose tissue is not a key determinant as previously thought.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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