Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight
Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight
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DOI：
10.1111/andr.12135
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发表时间：
2016-01-01
期刊：
影响因子：
4.5
通讯作者：
Botella-Carretero, Jose I.
中科院分区：
文献类型：
--
作者：
Calderon, Berniza;Gomez-Martin, Jesus M.;Botella-Carretero, Jose I.
为了研究男性肥胖-继发性性腺功能减退（MOSH）在中重度肥胖患者中的患病率，我们在一所大学三级医院进行了一项前瞻性患病率研究，包括100名中重度肥胖男性患者。检测所有患者的总睾酮（TT）和性激素结合球蛋白（SHBG）浓度。根据TT和SHBG水平计算血清游离睾酮（FT）浓度。对31例患者进行精液分析。当考虑TT和/或FT浓度降低时，我们发现患病率为45% （95% CI: 35-55%）。血清TT浓度与血糖（r = -0.328, p < 0.001）和胰岛素抵抗（r = -0.261, p = 0.011）呈负相关。FT和葡萄糖（r = -0.340, p < 0.001）和胰岛素抵抗（r = -0.246, p = 0.016）也有同样的情况。62% （95% CI: 39-85%）的患者在精液分析中也出现异常结果。精液分析异常与正常患者的低TT、低FT出现频率相似（p = 0.646、p = 0.346）。射精量与BMI呈负相关（q = -0.400, p = 0.029），与超重呈负相关（q = -0.464, p = 0.010）。我们的数据显示，中度至重度肥胖患者的MOSH患病率很高。低循环睾酮与胰岛素抵抗、射精量低、高BMI和超重有关。在考虑生育能力时，无论是否表现出低循环睾酮，必须对这些患者进行精液分析。
To study the prevalence of male obesity-secondary hypogonadism (MOSH) in patients with moderate to severe obesity, we performed a prospective prevalence study including 100 male patients with moderate to severe obesity at a university tertiary hospital. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations among others were assayed in all patients. Serum-free testosterone (FT) concentration was calculated from TT and SHBG levels. Semen analysis was conducted in 31 patients. We found a prevalence of 45% (95% CI: 35-55%) when considering decreased TT and/or FT concentrations. Serum concentrations of TT were correlated negatively with glucose (r = -0.328, p < 0.001) and insulin resistance (r = -0.261, p = 0.011). The same occurred with FT and glucose (r = -0.340, p < 0.001) and insulin resistance (r = -0.246, p = 0.016). Sixty-two percent (95% CI: 39-85%) of the patients with seminogram also presented abnormal results in semen analysis. The frequencies of low TT or low FT values were similar in patients with abnormal or normal semen analysis (p = 0.646 and p = 0.346, respectively). Ejaculate volume inversely correlated with BMI (q = -0.400, p = 0.029) and with excess body weight (q = -0.464, p = 0.010). Our data show the prevalence of MOSH in patients with moderate to severe obesity is high. Low circulating testosterone is associated with insulin resistance and low ejaculate volume with higher BMI and excess body weight. Semen analysis must be performed in these patients when considering fertility whether or not presenting low circulating testosterone.