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Late-onset hypogonadism and mortality in aging men
S R Pye1, I T Huhtaniemi, J D Finn
1Andrology Research Unit (S.R.P., J.D.F., F.C.W.W.) and Manchester Diabetes Centre (M.K.R.), The University of Manchester, and Arthritis Research UK Epidemiology Unit (S.R.P., D.M.L., T.W.O., A.T.), Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Surgery and Cancer (I.T.H.), Imperial College London, Hammersmith Campus, London W12 ONN, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H-6721 Szeged, Hungary; Departments of Geriatric Medicine (S.B.) and Andrology and Endocrinology (D.V.), Catholic University of Leuven, Leuven B-3000, Belgium; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, and Centro de Investigación Biomédica en Red de Fisiopatologia 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.), Skåne 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 Łódź, 90-419 Łódź, Poland; Department of Human Nutrition (M.E.L.), University of Glasgow, Glasgow G12 8TA, United Kingdom; School of Community-Based Medicine (N.P.), University of Manchester, Salford Royal National Health Service Trust, Salford M6 8HD, United Kingdom; and Andrology Unit (M.P.), United Laboratories of Tartu University Clinics, 51014 Tartu, Estonia.
Context:
Late-onset hypogonadism (LOH) has recently been defined as a syndrome in middle-aged and elderly men reporting sexual symptoms in the presence of low T. The natural history of LOH, especially its relationship to mortality, is currently unknown.
Objective:
The aim of this study was to clarify the associations between LOH, low T, and sexual symptoms with mortality in men.
Design, Setting, And Participants:
Prospective data from the European Male Aging Study (EMAS) on 2599 community-dwelling men aged 40-79 years in eight European countries was used for this study.
Main Outcome Measure(S):
All-cause, cardiovascular, and cancer-related mortality was measured.
Results:
One hundred forty-seven men died during a median follow-up of 4.3 years. Fifty-five men (2.1%) were identified as having LOH (31 moderate and 24 severe). After adjusting for age, center, body mass index (BMI), current smoking, and poor general health, compared with men without LOH, those with severe LOH had a 5-fold [hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.7, 11.4] higher risk of all-cause mortality. Compared with eugonadal men, the multivariable-adjusted risk of mortality was 2-fold higher in those with T less than 8 nmol/L (irrespective of symptoms; HR 2.3; 95% CI 1.2, 4.2) and 3-fold higher in those with three sexual symptoms (irrespective of serum T; compared with asymptomatic men; HR 3.2; 95% CI 1.8, 5.8). Similar risks were observed for cardiovascular mortality.
Conclusions:
Severe LOH is associated with substantially higher risks of all-cause and cardiovascular mortality, to which both the level of T and the presence of sexual symptoms contribute independently. Detecting low T in men presenting with sexual symptoms offers an opportunity to identify a small subgroup of aging men at particularly high risk of dying.
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