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Higher BMI may escalate hypoandrogenemia risk
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Men with obesity may be at increased risk for developing hypoandrogenemia or low free testosterone, especially if they have more severe obesity, according to findings published in Obesity.
“Our research is important because the finding of a subnormal level of testosterone in men is not a trivial issue,” José C. Fernández‐García, MD, PhD; María Molina-Vega, MD, PhD, and Francisco J. Tinahones, MD, PhD, of the department of endocrinology and nutrition at Virgen de la Victoria University Hospital in Malaga, Spain, told Endocrine Today. “Hypoandrogenemia is associated with visceral obesity, reduced lean body mass, type 2 diabetes mellitus, the metabolic syndrome, sexual dysfunction, impaired erectile function, decreased quality of life, multi-morbidity and mortality risk.”
The researchers conducted a cross-sectional study with 266 men with obesity who were younger than 50 years and did not have diabetes (mean age, 36.9 years; mean BMI, 39 kg/m2). Participants were recruited from primary care offices in Malaga, Spain, between June 2013 and June 2015. The researchers measured total testosterone, sex hormone-binding globulin and luteinizing hormone in blood samples, as well as weight and height, and calculated free testosterone and visceral fat. In addition, questionnaires established age, medical history and erectile dysfunction.
Free testosterone levels of less than 70 pg/mL were found in 25.6% of the participants, which the researchers used as the threshold for hypoandrogenemia. Participants with a BMI of more than 50 kg/m2 had a particularly high prevalence of hypoandrogenemia (78.3%), whereas those with a BMI of 40 kg/m2 to 49.9 kg/m2 (33.8%), 35 kg/m2 to 39.9 kg/m2 (19.8%) and 30 kg/m2 to 34.9 kg/m2 (11.1%) had a lower prevalence.
The researchers stated that the associations between free testosterone and BMI, waist circumference, fat mass percentage, visceral fat, HbA1c, high-sensitivity C-reactive protein, insulin and insulin resistance were all negative whereas the associations between free testosterone and luteinizing hormone and fat-free mass percentage were positive.
In terms of hypoandrogenemia-identifying free testosterone levels, the researchers stated that there was an association with waist circumference, fat mass percentage, high-sensitivity C-reactive protein, BMI, diastolic blood pressure and HbA1c. They also stated that “protective factors” for the condition included elevated fat-free mass percentage and elevated luteinizing hormone levels.
Lastly, the researchers said a higher BMI, older age and lower amounts of luteinizing hormone were the most effective predictive markers for hypoandrogenemia.
“Our findings might have significant implications given the global epidemic of obesity,” the researchers said. “If a similar prevalence of subnormal testosterone concentrations were found in the population with obesity worldwide, more than 175 million men with obesity could present with hypoandrogenemia.” – by Phil Neuffer
Editor’s note: This article was updated on Sept. 10 to indicate that the researchers calculated free, not fasting, testosterone. The editors regret this error.
For more information:
José C. Fernández‐García, MD, PhD, can be reached at jcfergarcia@gmail.com.
Disclosures: The authors report no relevant financial disclosures.
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