Prevalence of modifiable risk factors among a clinic-based cohort of secondary hypogonadal men
Joanna Mclorinan, Louise Overend, Ajmal Mohamed Yunus, Ryan Mason, Steven McNulty, Niall Furlong & Upendram Srinivas-Shankar
Background: Male hypogonadism is commonly caused by hypothalamo-pituitary testicular disease. The effect of modifiable risk factors (obesity, alcohol, smoking, prescribed medications and recreational drugs) on secondary hypogonadism in a clinic-based cohort is unclear. The aim of this study was to ascertain the prevalence and effects of modifiable risk factors on secondary hypogonadism.
Method: This was a retrospective, cross-sectional observational study in which 152 men (≥18 years with a testosterone (T) ≤11 nmol/l), who were consequently reviewed in an endocrine clinic were included. Data was extracted from electronic patient records and included baseline characteristics, aetiology and potential risk factors for hypogonadism, biochemical parameters and details of management.
Results: The mean age of the cohort was n (SD), 49 (15.6) years. The mean T level was 6.2 (2.5) nmol/l. Thirty three (22%) patients had primary and 107 (71.3%) had secondary hypogonadism. Thirty seven (34.6%) patients with secondary hypogonadism had a specific diagnosis (pituitary adenomas, empty-sella syndrome, Kallmans syndrome etc) and 70 (65.4%) did not have a specific aetiology. T levels were lower (5.5 vs 6.5 nmol/l; P=0.05) among men with a specific aetiology for secondary hypogonadism. Eleven (7.3%) patients without a specific aetiology for secondary hypogonadism were on steroids, opiates and drugs causing hyperprolactinaemia. They also had a higher prevalence of diabetes (25.6 vs13.7%), ischaemic heart disease (10.3 vs 6.9%), alcohol excess (15.4 vs 3.4%) and recreational drug use (20% vs 0) than those with a specific aetiology for secondary hypogonadism. There was no difference in age, BMI, smoking status, number of co-morbidities and prescribed medication use among patients with and without a specific aetiology.
Conclusion: Lifestyle factors, comorbidities, use of steroids and opiates seem to contribute to secondary hypogonadism in a significant proportion of patients. Modification of these factors should be considered, even if testosterone treatment is initiated.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.