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More hypogonadal men seeing endocrinologists than previously assumed
Endocrinologists should look for testosterone deficiency in patients with diabetes and metabolic syndrome.
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SEATTLE — In 2007, the endocrinologist should rethink the possibility of finding testosterone deficiency in men, according to Richard F. Spark, MD.
The endocrinologist’s office may be filled with more hypogonadal men than in the past, said Spark, an associate clinical professor of medicine at Harvard Medical School and director of the Steroid Research Lab at Beth Israel Deaconess Medical Center.
“We have known for a long period of time that [testosterone deficiency] is associated with erectile dysfunction, osteoporosis, osteopenia and aging. Now we also know that it is prevalent in men with diabetes mellitus and metabolic syndrome,” Spark said at the American Association of Clinical Endocrinologists 16th Annual Meeting and Clinical Congress. He recommended assessing patients with diabetes and the metabolic syndrome for testosterone deficiency.
Adverse effects
Testosterone deficiency can cause a number of adverse conditions, including decreased muscle mass, increased fat mass, anemia, osteoporosis, impotence and decreased sex drive.
Diabetes can also now be added to that list. Low testosterone values are prominent in about 30% of men with type 2 diabetes, according to Spark. The prevalence of low testosterone in patients with diabetes increased from 21% in a 1990 study to 43.7% in a 2004 study.
Recent data suggest that low testosterone is an early marker for insulin resistance in patients with metabolic syndrome, according to Spark. These patients have a 2.6-fold increased risk for testosterone deficiency. Spark recommended that endocrinologists check testosterone levels in patients with metabolic syndrome and likewise look for features of metabolic syndrome in patients with low testosterone.
As a man ages, he is more likely to have a low testosterone value, Spark said. However, measuring testosterone can be difficult. When doctors measure total testosterone, they measure testosterone plus sex hormone-binding globulin (SHBG), which starts to increase when men reach age 60. This becomes problematic because the increased SHBG gives the illusion that testosterone levels are normal when, in fact, they are not, he said.
New androgen delivery systems run the gamut from gels and patches to tablets and injections. Gels such as Androgel (Solvay Pharmaceuticals) and Testim (Auxilium Pharmaceuticals) have been effective in raising testosterone values, with mild concerns of scent and partner transfer. Twice-daily tablets that fall into the buccal class of drugs, such as Striant (Columbia Laboratories), have also had beneficial results in raising testosterone. Patches such as Androderm (Watson Pharma) penetrate the skin so testosterone can enter the bloodstream. A new intramuscular injection, Nebido (Bayer HealthCare) will appear on the market soon, as well; it is a 4-cc injection into the buttocks that will last for up to three months.
Careful evaluation can determine which testosterone deficient patients will benefit best from the variety of treatment options. Spark recommended that testosterone therapy should not be used in patients with prostate or breast cancer, polycythemia and malignant hypertension or in sexual predators. – by Katie Kalvaitis
For more information:
- Spark RF. Testosterone 2007 – update on an embattled steroid. Presented at: The American Association of Clinical Endocrinologists 16th Annual Meeting and Clinical Congress. April 11-15, 2007; Seattle.