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A clinical nomogram for predicting biochemical androgen deficiency in men with chronic spinal cord injury
Daniele Tienforti1,2, Giovanni Terrana1, Adriano Ciriani1
1Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Context/Objective:
Biochemical androgen deficiency is a frequent but often under-recognized complication in men with chronic spinal cord injury (SCI). We aimed to identify routinely available clinical predictors of biochemical androgen deficiency and to develop a simple risk stratification tool suitable for rehabilitation settings.
Design:
Cross-sectional observational study.
Setting:
Single tertiary spinal rehabilitation center in Italy.
Participants:
A total of 136 men with chronic traumatic SCI (duration ≥12 months) not receiving testosterone therapy.
Outcome Measures:
Biochemical androgen deficiency, defined as total testosterone <3 ng/mL (<300 ng/dL).
Results:
Biochemical androgen deficiency was identified in 45 participants (33.1%). In multivariable logistic regression, body mass index (BMI) (OR 1.16 per kg/m², 95% CI 1.01-1.33) and Charlson Comorbidity Index (CCI) (OR 1.39 per point, 95% CI 1.10-1.76) independently predicted biochemical androgen deficiency, whereas age was not significant. A nomogram incorporating BMI and CCI demonstrated clinically meaningful discrimination (AUC 0.77, 95% CI 0.69-0.85) and good agreement between predicted and observed risk. At a predicted probability threshold of 31%, sensitivity was 70% and specificity 76%. Internal bootstrap validation showed minimal optimism.
Conclusion:
Biochemical androgen deficiency is highly prevalent in men with chronic SCI. A clinically oriented nomogram based on BMI and comorbidity burden may help prioritize biochemical testing and early endocrine evaluation in rehabilitation settings.
