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Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism : Prospective results from the EMAS

Rastrelli, Giulia, (författare)
University of Florence
O'Neill, Terence W., (författare)
University of Manchester
Ahern, Tomas, (författare)
University of Manchester
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Bártfai, György, (författare)
Albert Szent-György Medical University
Casanueva, Felipe F., (författare)
Carlos III Health Institute, Complejo Hospitalario Universitario de Santiago
Forti, Gianni, (författare)
University of Florence
Keevil, Brian, (författare)
University Hospital of South Manchester NHS Foundation Trust
Giwercman, Aleksander, (författare)
Forskargrupper vid Lunds universitet, Lund University Research Groups, Lunds universitet, Lund University, Reproduktionsmedicin, Malmö, Reproductive medicine, Malmö, Skåne University Hospital
Han, Thang S., (författare)
Royal Holloway University of London
Slowikowska-Hilczer, Jolanta, (författare)
Medical University of Lodz
Lean, Michael E.J., (författare)
University of Glasgow
Pendleton, Neil, (författare)
Manchester Academic Health Science Centre
Punab, Margus, (författare)
Tartu University Hospital
Antonio, Leen, (författare)
Catholic University of Leuven
Tournoy, Jos, (författare)
Catholic University of Leuven
Vanderschueren, Dirk, (författare)
Catholic University of Leuven
Maggi, Mario, (författare)
University of Florence
Huhtaniemi, Ilpo T., (författare)
Imperial College London
Wu, Frederick C.W., (författare)
University of Manchester
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the EMAS study group (aut)
Engelska 11 s.
Ingår i: Clinical Endocrinology. - Wiley-Blackwell. - 0300-0664. ; 89:4, s. 459-469
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
  • Objective: Limited evidence supports the use of free testosterone (FT) for diagnosing hypogonadism when sex hormone–binding globulin (SHBG) is altered. Low total testosterone (TT) is commonly encountered in obesity where SHBG is typically decreased. We aimed to assess the contribution of FT in improving the diagnosis of symptomatic secondary hypogonadism (SH), identified initially by low total testosterone (TT), and then further differentiated by normal FT (LNSH) or low FT (LLSH). Design: Prospective observational study with a median follow-up of 4.3 years. Patients: Three thousand three hundred sixty-nine community-dwelling men aged 40-79 years from eight European centres. Measurements: Subjects were categorized according to baseline and follow-up biochemical status into persistent eugonadal (referent group; n = 1880), incident LNSH (eugonadism to LNSH; n = 101) and incident LLSH (eugonadism to LLSH; n = 38). Predictors and clinical features associated with the transition from eugonadism to LNSH or LLSH were assessed. Results: The cumulative incidence of LNSH and LLSH over 4.3 years was 4.9% and 1.9%, respectively. Baseline obesity predicted both LNSH and LLSH, but the former occurred more frequently in younger men. LLSH, but not LNSH, was associated with new/worsened sexual symptoms, including low desire [OR = 2.67 (1.27-5.60)], erectile dysfunction [OR = 4.53 (2.05-10.01)] and infrequent morning erections [OR = 3.40 (1.48-7.84)]. Conclusions: These longitudinal data demonstrate the importance of FT in the diagnosis of hypogonadism in obese men with low TT and SHBG. The concurrent fall in TT and FT identifies the minority (27.3%) of men with hypogonadal symptoms, which were not present in the majority developing low TT with normal FT.


MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynecology and Reproductive Medicine (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)


androgen deficiency
free testosterone
secondary hypogonadism
sex hormone–binding globulin
sexual symptoms
total testosterone

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