Endocrine Abstracts

Introduction: Male hypogonadism (HG), characterized by a decrease in testosterone levels, becomes more prevalent with age, significantly impacting the quality of life. A noteworthy association with type 2 diabetes (T2D) has increasingly captured medical interest. The critical question persists: is the HG observed in T2D patients of central or peripheral origin? This study delves into this inquiry to enhance our understanding and inform better management.

Methods: We recruited 68 adult male patients with type with T2D and HG from outpatient clinics at the National Institute of Nutrition and Food Technology. Testosteronemia, Sex Hormone-Binding Globulin and albumin, for calculating Free Testosterone (FT) and Bioavailable Testosterone (BT) using the Vermeulen formula¹. The diagnostic criterion for HG included specific thresholds: Total Testosterone (TT) below 231 ng/dl, FT below 6.5 ng/dl or BT below 150 ng/dl. Hypogonadism was Hypergonadotropic (HGHyper) if LH > 8.6 mIU/ml, and hypogonadotrophic (HGHypo) if LH values ≤ 8.6 mIU/ml. For HGHypo cases, magnetic resonance imaging (MRI) was performed in case of clinical and/or biological signs, indicating pituitary hypersecretion or insufficiency, or if TT was below 150 ng/dl.

Results: The median age of the studied population was 59 years with an interquartile range of [56–64]. The highest prevalence of HG was observed in patients aged 60 to 65, reaching 49%. The prevalence of HG did not show statistical significance (P=0.270) in the age groups. The central origin of HG was identified in 75% of cases (n=51). There was no significant correlation between patients’ age and the nature of HG (58.4 ± 5.6 vs 59.9 ± 6.4; P=0.366). Four patients required an MRI-HH justified by TT <150 ng/dl. The etiological investigation didn’t reveal anomalies in all cases.

Conclusion: The study demonstrates a predominance of the central origin of hypogonadism in patients with type 2 diabetes, irrespective of their age. Emphasis is placed on the importance of thorough hormonal exploration for this population. Further investigations are necessary to elucidate underlying mechanisms and guide the development of more personalized therapeutic strategies.

Reference: 1. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84(10):3666-3672. doi:10.1210/jcem.84.10.6079