World J Mens Health.  2019 Jan;37(1):93-98. 10.5534/wjmh.180047.

Elevated Body Mass Index Is Associated with Secondary Hypogonadism among Men Presenting to a Tertiary Academic Medical Center

• Masterson
• Soodana-Prakash N
• Patel AS
• Kargi AY
• Ramasamy R

• KMID: 2429726
• DOI: http://doi.org/10.5534/wjmh.180047

Abstract

PURPOSE
To characterize the population of hypogonadal men who presented to a tertiary academic urology clinic and evaluate risk factors for primary vs. secondary hypogonadism.
MATERIALS AND METHODS
We evaluated all men with International Classification of Diseases-9 diagnosis codes R68.82 and 799.81 for low libido, 257.2 for testicular hypofunction, and E29.1 for other testicular hypofunction at a tertiary academic medical center from 2013 to 2017. We included men who had testosterone (T) and luteinizing hormone (LH) drawn on the same day. We classified men based on T and LH levels into eugonadal, primary, secondary, and compensated hypogonadism. Risk factors including age, body mass index (BMI) over 30 kg/m2, current smoking status, alcohol use greater than 5 days per week, and Charlson comorbidity index greater than or equal to 1 were investigated and measured in each group using the eugonadal group for reference.
RESULTS
Among the 231 men who had both T and LH levels, 7.4%, 42.4%, and 7.4% were classified as primary, secondary, and compensated hypogonadism, respectively. Only elevated BMI was associated with secondary hypogonadism compared to eugonadal men (median BMI, 30.93 kg/m2 vs. 27.69 kg/m2, p=0.003). BMI, age, comorbidities, smoking, or alcohol use did not appear to predict diagnosis of secondary hypogonadism.
CONCLUSIONS
Secondary hypogonadism appears to be the most common cause of hypogonadism among men complaining of low T and decreased libido at a tertiary academic medical center. Secondary hypogonadism is associated with elevated BMI and therefore obesity should be used as a marker to evaluate men for both T and LH levels.

Keyword

Clomiphene; Luteinizing hormone; Tertiary care centers; Testosterone; Testosterone replacement therapy

MeSH Terms

Academic Medical Centers*
Body Mass Index*
Classification
Clomiphene
Comorbidity
Diagnosis
Humans
Hypogonadism*
Libido
Luteinizing Hormone
Male
Obesity
Risk Factors
Smoke
Smoking
Tertiary Care Centers
Testosterone
Urology
Clomiphene
Luteinizing Hormone
Smoke
Testosterone

Figure

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  Fig. 1 Of the 231 men included in our study population, 99 (42.9%) were eugonadal, 98 (42.4%) had secondary hypogonadism, 17 (7.4%) had primary hypogonadism, and 17 (7.4%) had compensated hypogonadism.

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