Endocrine Abstracts

Background: Hypogonadism is estimated to account for over 10% of male-factor infertility. However, due to conflicting data regarding the relationship between testosterone levels and sperm quality, hormone evaluation is not consistently requested during initial assessment of the infertile male. Hypogonadism is associated with cardiovascular disease (CVD) and has been linked to an increased risk of mortality The aim of this study was to investigate the prevalence of hypogonadism and cardiovascular risk in a cohort of infertile men.

Methods: This was a single-centre retrospective analysis of all patients presenting with male-factor infertility between January 2015 and December 2020. Biochemical hypogonadism was defined as a morning serum testosterone level <10 nmol/l according to local reference range. Semen analyses were compared between hypogonadal and eugonadal males. Lipid-profiles were compared between both cohorts. Patient demographic and clinical data were used to calculate the Charlson Comorbidity Index (CCI) and QRISK^®3 scores.

Results: Of 855 patients, hypogonadism was present in 284 (33.22%) of patients. The median (IQR) testosterone level in eugonadal males was 15.5 (12.7-20.68), compared to 7.3 (5.25-8.60) in hypogonadal males (P<0.0001). A significantly greater proportion of hypogonadal males were found to be azoospermic compared to eugonadal males (57.6% vs. 42.2%, P<0.0001). Moreover, eugonadism was more prevalent amongst patients from a White-Background (30.8%, vs 20.1%, <0.0001). Whereas hypogonadism was more common amongst patients from an Asian-Background (22.5% vs. 12.6%, P<0.0001). Accordingly, median testosterone levels were significantly lower in Asian males compared to white males (10.3 vs. 13.5, P=0.000162). A higher BMI was observed in hypogonadal males compared to eugonadal males (28.9 vs. 26.4, P<0.0001) and had significantly higher serum cholesterol (5.00 vs. 4.7, P=0.031), triglycerides (1.73 vs. 1.09, P<0.0001) and non-HDL cholesterol (3.90 vs. 3.49, P=0.001) compared with eugonadal males., However, HDL-Cholesterol levels were higher in males with normal testosterone (1.06 vs. 1.25, P<0.0001). Median QRISK^®3 scores were significantly higher in hypogonadal males than eugonadal males (1.40% vs. 1.10%, P=0.0004). A significantly greater proportion of hypogonadal males had a CCI score of 1 compared to eugonadal males (15.1% vs. 7.2%, P=0.0002).

Discussion and Conclusions: This study demonstrated a high prevalence of hypogonadism within a cohort of infertile males compared to existing literature. Whilst an association between testosterone and sperm quality was not established, hypogonadism was shown to be associated with raised lipid parameters and an increased risk of CVD. All infertile men should undergo endocrinological evaluation and follow-up to mitigate the risks of dyslipidaemia and CVD.