Characteristics of Androgen Deficiency in Late-Onset Hypogonadism: Results from the European Male Aging Study (EMAS)
Tajar A, Huhtaniemi IT, O'Neill TW, Finn JD, Pye SR, Lee DM, Bartfai G, Boonen S, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Labrie F, Lean ME, Pendleton N, Punab M, Vanderschueren D, Wu FC; the EMAS Group. J Clin Endocrinol Metab. 2012 Mar 14. [Epub ahead of print]


Arthritis Research U.K. Epidemiology Unit (A.T., T.W.O., S.R.P., D.M.L.), Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PT, United Kingdom; Department of Surgery and Cancer (I.T.H.), Imperial College London, Hammersmith Campus, London W12 ONN, United Kingdom; Andrology Research Unit (J.D.F., F.C.W.W.), Developmental and Regenerative Biomedicine Research Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, Szeged, Hungary; Department of Geriatric Medicine (S.B.), Katholieke Universiteit Leuven, B-3001 Leuven, Belgium; Department of Medicine (F.F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, and Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15705 Santiago de Compostela, Spain; Endocrinology Unit (G.F.), Department of Clinical Physiopathology, University of Florence, 50121 Florence, Italy; Reproductive Medicine Centre (A.G.), Sk\ane University Hospital, University of Lund, SE-22 184 Lund, Sweden; Department of Endocrinology (T.S.H.), University College London, London W1T 3AA, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Lódz, 90-131 Lódz, Poland; Laboratory of Molecular Endocrinology and Oncology (F.L.), Laval University, Québec City, Canada G1K 7P4; Department of Human Nutrition (M.E.J.L.), University of Glasgow, G12 8TA Glasgow, Scotland, United Kingdom; School of Community-Based Medicine (N.P.), The University of Manchester, Salford Royal National Health Service Trust, Salford M6 8HD, United Kingdom; Andrology Unit (M.P.), United Laboratories of Tartu University Clinics, 50090 Tartu, Estonia; and Department of Andrology and Endocrinology (D.V.), Katholieke Universiteit Leuven, B-3001 Leuven, Belgium.


Context:Late-onset hypogonadism (LOH) has been defined as a syndrome in middle-aged and elderly men reporting symptoms in the presence of low testosterone (T).Objective:The objective of the study was to seek objective biochemical and end-organ evidence of androgen deficiency in men classified as having LOH according to our previously published criteria.Design, Setting, and Participants:The design of the study included cross-sectional data from the European Male Aging Study on 2966 community-dwelling men aged 40-79 years in eight European countries.Main Outcome Measure(s):Waist circumference, body mass index, muscle mass, estimated heel bone mineral density (eBMD), hemoglobin, insulin sensitivity, physical activity, metabolic syndrome, insulin resistance index, and cardiovascular disease were measured.Results:Sixty-three men (2.1%) were classified as having LOH: 36 moderate and 27 severe. They were older and more obese than eugonadal men and had, in proportion to the graded T deficiency, lower muscle mass, eBMD, and hemoglobin, with poorer general health. Both moderate and severe LOH was associated with lower hemoglobin, mid-upper arm circumference, eBMD, physical function (measured by the Short Form-36 questionnaire), slower gait speed and poorer general health. Only men with severe LOH showed significant associations with larger waist circumference (β= 1.93cm; 0.04-3.81), insulin resistance (β= 2.81; 1.39-4.23), and the metabolic syndrome (odds ratio 9.94; 2.73-36.22) after adjustments for confounders. Men with low testosterone only (irrespective of symptoms) showed lesser magnitudes of association with the same end points.Conclusions:LOH is associated with multiple end-organ deficits compatible with androgen deficiency. These data support the existence of a syndrome of LOH in only a minority of aging men, especially those with T below 8 nmol/liter.