Korean J Urol.  2008 Jun;49(6):556-561.

Correlation of the Serum Testosterone Level with Insulin Resistance and Metabolic Syndrome in Patients of Erectile Dysfunction and Benign Prostatic Hyperplasia

• Lee SY
• Kim SC

Abstract

PURPOSE: Testosterone deficiency has recently captured attention as a possible risk factor for metabolic syndrome. This study was conducted to investigate a correlation of the serum testosterone level with insulin resistance(IR) and metabolic syndrome(MS).
MATERIALS AND METHODS
The metabolic risk factors, the blood pressure, the waist circumference and the fasting serum levels of glucose, triglyceride and high density lipoprotein cholesterol were measured for a total of 215 patients(mean age; 61.04+/-0.54 years) with erectile dysfunction(ED) or/and symptomatic benign prostatic hyperplasia(BPH). The serum total testosterone and insulin were measured at the same time, and the free testosterone, bioavailable testosterone and IR were calculated.
RESULTS
The prevalence of MS and the number of associated MS risk factors were significantly higher in the insulin resistance group(IRG) than in the insulin sensitive group(ISG). The serum testosterone level significantly decreased with more risk factors. The IRG showed a significantly lower level of serum testosterone than the patients with ED and the total patients.
CONCLUSIONS
The negative correlation of a decrease in the serum testosterone level with IR and MS suggests that late onset hypogonadism might be a risk factor of MS.

Keyword

Metabolic syndrome; Insulin resistance; Testosterone

MeSH Terms

Blood Pressure
Cholesterol
Cholesterol, HDL
Erectile Dysfunction
Fasting
Glucose
Humans
Hypogonadism
Insulin
Insulin Resistance
Lipoproteins
Male
Prevalence
Prostatic Hyperplasia
Risk Factors
Testosterone
Waist Circumference
Cholesterol
Cholesterol, HDL
Glucose
Insulin
Lipoproteins
Testosterone

Reference

1. Cause of Death in Korea, The Department of Statistics. 2003. 5.

2. Ferrannini E, Haffner SM, Mitchell BD, Stern MP. Hyperinsulinemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia. 1991; 34:416–22.

3. Gray RS, Fabsitz RR, Cowan LD, Lee ET, Howard BV, Savage PJ. Risk factor clustering in the insulin resistance syndrome. The Strong Heart Study. Am J Epidemiol. 1998; 148:869–78.

4. Carantoni M, Zuliani G, Volpato S, Palmieri E, Mezzetti A, Vergnani L, et al. Relationships between fasting plasma insulin, anthropometrics, and metabolic parameters in a very old healthy population. Associazione Medica Sabin. Metabolism. 1998; 47:535–40.

5. Kalyani RR, Dobs AS. Androgen deficiency, diabetes, and the metabolic syndrome in men. Curr Opin Endocrinol Diabetes Obes. 2007; 14:226–34.

6. Stellato RK, Feldman HA, Hamdy O, Horton ES, McKinlay JB. Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male aging study. Diabetes Care. 2000; 23:490–4.

7. Oh J, Barrett-Connor E, Wedick NM, Wingard DL. Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo study. Diabetes Care. 2002; 25:55–60.

8. Zitzmann M, Faber S, Nieschlag E. Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab. 2006; 9:4335–43.

9. Kapoor D, Malkin CJ, Channer KS, Jones TH. Androgens, insulin resistance and vascular disease in men. Clin Endocrinol. 2005; 63:239–50.

10. Tan RS, Pu SJ. Impact of obesity on hypogonadism in the andropause. Int J Androl. 2002; 25:195–201.

11. Barrett-Connor E, Khaw KT, Yen SS. Endogenous sex hormone levels in older adult men with diabetes mellitus. Am J Epidemiol. 1990; 132:895–901.

12. Lunenfeld B. Testosterone deficiency and the metabolic syndrome. Aging Male. 2007; 10:53–6.

13. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001; 285:2486–97.

14. WHO Regional Office for the Western Pacific/International Association for the Study of Obesity/International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney, Health Communications Australia. 2000.

15. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999; 84:3666–72.

16. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28:412–9.

17. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991; 14:173–94.

18. Kim SC. Insulin resistance and erectile dysfunction. Korean J Urol. 2006; 47:917–27.

19. Bojesen A, Kristensen K, Birkebaek NH, Fedder J, Mosekilde L, Bennett P, et al. The metabolic syndrome is frequent in Klinefelter's syndrome and is associated with abdominal obesity and hypogonadism. Diabetes Care. 2006; 29:1591–8.

20. Gustafson DR, Wen MJ, Koppanati BM. Androgen receptor gene repeats and indices of obesity in older adults. Int J Obes Relat Metab Disord. 2003; 27:75–81.

21. Lacko L, Wittke B, Geck P. Interaction of steroids with the transport system of glucose in human erythrocytes. J Cell Physiol. 1975; 86(Suppl 2):673–80.

22. Morimoto S, Mendoza-Rodriguez CA, Hiriat M, Larrieta ME, Vital P, Cerbon MA. Protective effect of testosterone on early apoptotic damange induced by streptozotocin in rat pancreas. J Endocrinol. 2005; 187:217–24.

23. Hellmich M, Evers T, Kubin M, Merchant S, Lehmacher W, Engelmann U, et al. Development and validation of a risk score for somatic erectile dysfunction: combined results from three cross-sectional surveys. Eur Urol. 2005; 48:495–502.

24. Kim JH, Shim BS, Hong YS. The relating factors of metabolic syndrome to benign prostatic hyperplasia. Korean J Urol. 2005; 46:1046–50.

25. Hammarsten J, Hogstedt B, Holthuis N, Mellstrom D. Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 1998; 1:157–62.

26. Hammarsten J, Hogstedt B. Clinical, anthropometric, metabolic and insulin profile of men with fast annual growth rates of benign prostatic hyperplasia. Blood Press. 1999; 8:29–36.

27. Braga-Basaria M, Dobs AS, Muller DC, Carducci MA, John M, Egan J, et al. The metabolic syndrome in men with prostate cancer undergoing longterm androgen-deprivation therapy. J Clin Oncol. 2006; 24:3979–83.

28. Keating NL, O'Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol. 2006; 24:448–56.

29. Nuver J, Smit AJ, Wolffenbuttel BH, Sluiter WJ, Hoekstra HJ, Sleijfer DT, et al. The metabolic syndrome and disturbances in hormone levels in longterm survivors of disseminated testicular cancer. J Clin Oncol. 2005; 23:3718–25.

30. Sampson N, Unterggasser G, Plas E, Berger P. The aging male reproductive tract. J Pathol. 2007; 211:206–18.