Korean J Urol.  2011 Aug;52(8):566-571. 10.4111/kju.2011.52.8.566.

Effect of Testosterone Replacement Treatment in Testosterone Deficiency Syndrome Patients with Metabolic Syndrome

• Jeong SM
• Ham BK
• Park MG
• Oh MM
• Yoon DK
• Kim JJ
• Moon DG

• KMID: 1988963
• DOI: http://doi.org/10.4111/kju.2011.52.8.566

Abstract

PURPOSE
This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome.
MATERIALS AND METHODS
We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured.
RESULTS
In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT.
CONCLUSIONS
Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

Keyword

Hormone replacement therapy; Metabolic syndrome X; Testosterone

MeSH Terms

Aging
Asian Continental Ancestry Group
Cholesterol, LDL
Fasting
Glucose
Hand
Hemoglobins
Hormone Replacement Therapy
Humans
Hypertension
Male
Metabolic Syndrome X
Obesity
Serologic Tests
Sorbitol
Testosterone
Tyramine
Waist Circumference
Cholesterol, LDL
Glucose
Hemoglobins
Sorbitol
Testosterone
Tyramine

Reference

1. 2005 life table of each city, district and cause of death in korea. 2007. The Department of Statistics;24.

2. Reaven GM. Banting Lecture 1988. 2ole of insulin resistance in human disease. Diabetes. 1988. 37:1595–1607.

3. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes and its complications. Part I: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998. 15:539–553.

4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of 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. 285:2486–2497.

5. Balkau B, Charles MA. Comment on the provisional report from the WHO consultation: European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999. 16:442–443.

6. Lee SY, Kim SC. Correlation of the serum testosterone level with insulin resistance and metabolic syndrome in patients of erectile dysfunction and benign prostatic hyperplasia. Korean J Urol. 2008. 49:556–561.

7. Nieschlag E, Swerdloff R, Behre HM, Gooren LJ, Kaufman JM, Legros JJ, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. J Androl. 2006. 27:135–137.

8. Kim MJ, Rhee Y, Seo JT, Yang DY, Moon DG, Park NC, et al. 2006 KOSAR recommendations for investigation, treatment and monitoring of LOH in males. Korean J Androl. 2008. 26:8–10.

9. Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, et al. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Int J Impot Res. 2009. 21:1–8.

10. 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. 148:869–878.

11. 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. 47:535–540.

12. Phillips GB. Relationship between serum sex hormones and glucose, insulin, and lipid abnormalities in men with myocardial infarction. Proc Natl Acad Sci USA. 1977. 74:1729–1733.

13. Simon D, Preziosi P, Barrett-Connor E, Roger M, Saint-Paul M, Nahoul K, et al. Interrelation between plasma testosterone and plasma insulin in healthy adult men: the Telecom Study. Diabetologia. 1992. 35:173–177.

14. Selvin E, Feinleib M, Zhang L, Rohrmann S, Rifai N, Nelson WG, et al. Androgens and diabetes in men: results from the Third National Health and Nutrition Examination Survey (NHANES III). Diabetes Care. 2007. 30:234–238.

15. Barrett-Connor E. Lower endogenous androgen levels and dyslipidemia in men with non-insulin-dependent diabetes mellitus. Ann Intern Med. 1992. 117:807–811.

16. Andersson B, Mårin P, Lissner L, Vermeulen A, Björntorp P. Testosterone concentrations in women and men with NIDDM. Diabetes Care. 1994. 17:405–411.

17. Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab. 2004. 89:5462–5468.

18. Kapoor D, Aldred H, Clark S, Channer KS, Jones TH. Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007. 30:911–917.

19. Zumoff B, Strain GW, Miller LK, Rosner W, Senie R, Seres DS, et al. Plasma free and non-sex-hormone-binding-globulin-bound testosterone are decreased in obese men in proportion to their degree of obesity. J Clin Endocrinol Metab. 1990. 71:929–931.

20. Pasquali R, Casimirri F, Cantobelli S, Melchionda N, Morselli Labate AM, Fabbri R, et al. Effect of obesity and body fat distribution on sex hormones and insulin in men. Metabolism. 1991. 40:101–104.

21. Haffner SM, Valdez RA, Stern MP, Katz MS. Obesity, body fat distribution and sex hormones in men. Int J Obes Relat Metab Disord. 1993. 17:643–649.

22. Seidell JC, Björntorp P, Sjöström L, Kvist H, Sannerstedt R. Visceral fat accumulation in men is positively associated with insulin, glucose and C-peptide levels but negatively with testosterone levels. Metabolism. 1990. 39:897–901.

23. Vermeulen A, Goemaere S, Kaufman JM. Testosterone, body composition and aging. J Endocrinol Invest. 1999. 22:110–116.

24. Rebuffé-Scrive M, Mårin P, Björntorp P. Effect of testosterone on abdominal adipose tissue in men. Int J Obes. 1991. 15:791–795.

25. Hromadová M, Hácik T, Malatinský E, Riecanský I. Alterations of lipid metabolism in men with hypotestosteronemia. Horm Metab Res. 1991. 23:392–394.

26. Simon D, Charles MA, Nahoul K, Orssaud G, Kremski J, Hully V, et al. Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The Telecom Study. J Clin Endocrinol Metab. 1997. 82:682–685.

27. Haffner SM, Mykkänen L, Valdez RA, Katz MS. Relationship of sex hormones to lipids and lipoproteins in nondiabetic men. J Clin Endocrinol Metab. 1993. 77:1610–1615.

28. Zmuda JM, Cauley JA, Kriska A, Glynn NW, Gutai JP, Kuller LH. Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men. A 13-year follow-up of former multiple risk factor intervention trial participants. Am J Epidemiol. 1997. 146:609–617.

29. Whitsel EA, Boyko EJ, Matsumoto AM, Anawalt BD, Siscovick DS. Intramuscular testosterone esters and plasma lipids in hypogonadal men: a meta-analysis. Am J Med. 2001. 111:261–269.

30. Dobs AS, Bachorik PS, Arver S, Meikle AW, Sanders SW, Caramelli KE, et al. Interrelationships among lipoprotein levels, sex hormones, anthropometric parameters, and age in hypogonadal men treated for 1 year with a permeation-enhanced testosterone transdermal system. J Clin Endocrinol Metab. 2001. 86:1026–1033.