Endocrine Abstracts

Late-onset hypogonadism (LOH) remains a debatable entity in terms of diagnosis and management. However, the finding of primary hypogonadism (PHG) in ageing men, in the absence of organic cause, provides an unequivocal biochemical diagnosis. Indeed, it has been established in European Male Ageing Study (EMAS) that PHG, and not secondary hypogonadism, is strongly associated with advanced age and multi-comorbidities. That would be consistent with the underlying pathophysiology of Leydig cell dysfunction occurring with ageing process. PHG in ageing men (LOH-PHG) is a relatively rare disorder, affecting only 2.7% (54/1991) of the EMAS baseline cohort (after exclusions). Some of the associated clinical features described were decreased sexual function, lower haemoglobin level and increased insulin resistance. In the current report, baseline clinical characteristics of ten middle-aged to older men diagnosed with LOH-PHG are described. This is a single centre study based on the experience of a specialised Men’s Health clinic under the Endocrinology service in Singapore General Hospital. Men with a T <10.5 nmol/l and a LH >9.4 U/l were considered to have PHG. Patients were self-referred, or referred from either primary care or other specialities for suspicion of low testosterone. Mean age of diagnosis of hypogonadism was 66 years (range 55-77). All men had 3 or more co-morbidities. Baseline prevalence of common chronic conditions is as follow – Overweight (BMI >25 kg/m2): 80%, Diabetes mellitus: 50%, Hypertension: 80%, Hyperlipidaemia: 100%, Coronary artery disease: 50%, Cerebrovascular disease: 20%, Chronic kidney disease: 40%, Osteoarthritis of knee: 20%, Parkinson disease: 10%. At diagnosis, the mean Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) levels were 44.3 ± 15.0 IU/l and 22.8 ± 8.5 IU/l respectively, while the mean total Testosterone (T) level was 5.9 ±1.9 nmol/l. Eight men had a haematocrit of <43%; the other two had 46.1% and 48.7%. The mean PSA level was 2.0 ± 1.8; one individual with an elevated PSA had a normal prostate biopsy subsequently. All men were symptomatic at presentation. Besides erectile dysfunction (70%), the chief presenting complaints were mostly related to loss of muscle strength and energy (60%), reflecting the concern of loss of physical function. Three patients had distressing vasomotor symptoms including hot flushes and sweating accompanied by mood swings, poor concentration and impaired sleep quality, with one of them being treated for mood disorder prior to diagnosis of LOH. Interestingly, spironolactone-induced gynaecomastia was the primary indication for hormonal evaluation in two men.