Endocrine Abstracts

Background: Numerous studies have provided evidence of the link between low testosterone levels and obesity, cardiovascular disease and type 2 diabetes. A recent UK study revealed 20% of type 2 diabetics had testosterone levels <8 nmol/l and 31% between 8 and 12 nmol/l. Hypogonadism in men can present with a variety of clinical symptoms which could include erectile dysfunction (ED). However, diabetic patients infrequently volunteer information regarding ED and is often not considered by the clinician. There are two validated questionnaires (ADAM and AMS) that can be used to aid the detection of hypogonadism.

Aim: The purpose behind this work was to screen for hypogonadism in a hospital diabetic population using the ADAM questionnaire and measure testosterone levels in those men with a positive result to the questionnaire.

Results: Between March and September 2008, 147 male diabetic patients (both type 1 and 2) had appointments. Twenty-six did not attend. Twelve men were excluded as it was considered clinically inappropriate to complete the questionnaire. Of the remaining 109 men 23 asked/completed the questionnaire during their consultation. Of those 23, 16 gave positive and 7 negative results to the questionnaire. Of those 16 men, question 1 was most frequently answered positively followed then by questions 2 and 7. Three of the men with positive results to the questionnaire had low or low or borderline testosterone levels.

Conclusions: Screening for hypogonadism in a hospital setting is for a variety of reasons hard to do and may be something more suited to primary care. Only asking about ED will miss nearly 50% of men who would otherwise respond positively to the ADAM questionnaire. Thirdly, measuring both total testosterone and SHBG levels will identify more men with hypogonadism because of the ability to then calculate free testosterone levels.