Hormonal Expression of Androgen Decline in Aging Men (ADAM)

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 554-583-Male Reproductive Endocrinology & Case Reports
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-563
Florence Comite1 and Janet Baek*2
1North Shore-Long Island Jewish Health System, Manhasset, NY, 2ComiteMD, New York, NY
Testosterone decrease is common in aging men and has been linked with several health risks, including osteopenia, cardiovascular events, diabetes, decreased lean muscle, increased morbidity and mortality. Low testosterone in men is most often treated singularly through testosterone replacement. Research to explore the etiologic mechanism of androgen decrease is important given the aging population and growth of testosterone therapy prescriptions. This presentation provides a discussion of an observational study of Androgen Decline in Aging Men (ADAM). Previous studies have suggested secondary (hypogonadotropic) hypogonadism (low or borderline Luteinizing Hormone and low testosterone) as a possible source of testosterone decrease. Currently, LH is not widely measured in clinical practice in the U.S. to diagnose ADAM, and observational studies of hormonal levels have not been reported to date in practice settings. To determine the importance of identifying low LH in relation to decreased testosterone, we reviewed charts of patients at a private practice in New York City. The subjects were a cohort of men aged 30 to 80 years old, assessed between 2006 and 2012. Measurements included baseline LH, free and total testosterone, and various biomarkers, such as Hemoglobin A1c and lipid panel measurements. Our primary aim was to examine the progression in which men’s testosterone levels decline with age in relation to LH. Low LH was hypothesized to be associated with reduced testosterone, thereby indicating secondary hypogonadism. If secondary hypogonadism reflects a natural progression of androgen decline in aging men, it would have implications for an alternative treatment targeting the Leydig cells of the testes, such as human Chorionic Gonadotropin (hCG), rather testosterone replacement. Findings showed that 71.9% of the subjects (n=242) had low total and free testosterone. Of those, 86.2% did indeed show low or borderline LH, providing evidence for a compromised negative feedback loop where the pituitary is desensitized to lower levels of testosterone. Of the seven biomarkers evaluated, only HDL was found to be significantly less in the low testosterone subjects when compared to those with testosterone within the reference range, (p ≤ 0.05). Finally, our research suggests that human Chorionic Gonadotropin is a viable option for men with hypogonadotropic hypogonadism, allowing for Leydig cell stimulation to increase testosterone physiologically.

Nothing to Disclose: FC, JB

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