ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 GP68 | DOI: 10.1530/endoabs.63.GP68

DHT, rather than free testosterone, influences symptoms of aging in eugonadal men

Andrea Sansone1,2, Sabine Kliesch2, Frank Tüttelmann3, Martin Dugas4, Andrea M. Isidori1, Stefan Schlatt2 & Michael Zitzmann2

1Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy; 2Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Münster, Germany; 3Institute of Human Genetics, University of Münster, Münster, Germany; 4Institute of Medical Informatics, University of Münster, Münster, Germany.

Aim: To assess the relation between questionnaires of androgenic function (AMS and IIEF-EF scores) and sex hormones (DHT, estradiol and total and free testosterone) in men attending an outpatient clinic for endocrine and reproductive disorders.

Methods: We retrospectively reviewed all data entered in the electronic database of the Münster Center of Reproductive Medicine and Andrology (CeRA) Androbase from patients visited between January 2015 and October 2018. Multinomial ordinal logistic regression models were used to test for independent predictors of the questionnaires score in men naïve of possibly interfering treatments (androgens, aromatase inhibitors or PDE5 inhibitors).

Results: Among 4895 (mean age: 37±12.7 years) subjects with a serum measurement of DHT and total and free testosterone during their first visit to the center, the AMS and IIEF (EF domain) questionnaires were completed by 635 and 574 men free of interfering medications and were included in analysis. Total and free testosterone and DHT were all found associated with IIEF and AMS in the whole group. When considering separately hypogonadal (n=219) and eugonadal (n=416) men, only DHT turned to be a significant predictor of AMS score with an increase of 1 ng/ml in serum DHT associated with a 46.7% decrease in the odds of having worse symptoms (P=0.011) in subjects with normal T, but not in hypogonadal men. No significant effects were observed for free testosterone, BMI or age. No significant effects were observed for both free testosterone and DHT in regards to the EF domain of the IIEF questionnaire.

Discussion: Despite being of little value in hypogonadal men, DHT is significantly associated with aging male symptoms in subjects with normal serum testosterone. In the multivariate analysis, neither DHT nor free or total testosterone show significant association with impairment of erectile function as assessed via the IIEF questionnaire.

Conclusions: The present study is the first to demonstrate that, although DHT can be associated with male aging symptoms, it is of little value in hypogonadal men. DHT measurement might become an useful addition to the diagnostic workflow of symptoms of male aging in subjects with normal T, but should not be routinely included in the diagnostic process.

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