Endocrine Abstracts

Introduction: The association between male hypogonadism (HG) and type 2 diabetes (T2D) has become a growing focus in medical research. However, a major challenge stems from the lack of consensus in defining HG, leading to variations in diagnostic thresholds among different medical societies. This study addresses this challenge by proposing a new perspective on the classification and thresholds of HG.

Methods: The research focused on a group of 250 adult male individuals with T2D. A comprehensive assessment of gonadal hormones was conducted to calculate Free Testosterone (FT) and Bioavailable Testosterone (BT) using the Vermeulen formula, available at https://www.issam.ch/freetesto.htm¹, and adhering to the suggested cut-off values². Diagnostic criteria for male HG included specific thresholds, such as Total Testosterone (TT) below 231 ng/dl or TT≥ 231 ng/dl with FT below 6.5 ng/dl, and/or BT below 150 ng/dl. Additionally, participants responded to an Arabic-validated ADAM questionnaire [3]

Results: The median age of our population was 58 years, with an interquartile range (IQR) of [52.7–62]. The prevalence of HG was 27.2% (n=68). In our study, a significant correlation was observed between responses to the ADAM questionnaire and the diagnosis of HG (P<10^-3). The most notable differences in clinical signs between the HG and non-HG groups were the decrease in muscle strength and endurance, present in 86.6% vs 46.1% (P<10^-3), followed by erectile dysfunction, present in 82.1% vs 52.2% (P<10^-3), and a decrease in libido, present in 65.7% vs 37.8% (P<10^-3). Biologically, the differences between the HG and non-HG groups for mean levels of TT, FT, and BT were 301 vs 491.5 ng/dl (P<10^-3), 5.6 vs 9.8 ng/dl (P<10^-3), and 124.6 vs 213.9 ng/dl (P<10^-3), respectively. A TT level > 350 ng/dl was noted in 173 (69.2%), among whom 17 were diagnosed as having HG (6.8%).

Conclusion: In conclusion, this study offers a new perspective on addressing the definition of male hypogonadism within a T2D population and emphasizes the importance of standardizing diagnostic criteria for HG to enhance sensitivity and clinical management within this population.

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