The Association between Testosterone Related Markers and Aging Males' Symptoms Scale
Date Issued
2011
Date
2011
Author(s)
Lee, I-Ching
Abstract
Introduction
Serum testosterone can be classified as sex hormone binding globulin (SHBG)-bound, albumin-bound and free forms. The latter two combined are termed bioavailable testosterone. Testosterone decreases with age and thus causes related symptoms. Hypogonadism indicates the condition of decreased serum testosterone. Late-onset hypogonadism (LOH) has been used to describe hypogonadism in combination with its related symptoms. The crude prevalence is about 12% in Taiwan. Aging males’ symptoms scale (AMS) has been used widely to evaluate symptoms related to hypogonadism. Its association with serum testosterone has been studied with inconsistent conclusions. Our aim is to explore the association between serum testosterone related markers and the symptoms of hypogonadism. In addition, this study also explored other factors which may interfere with the association.
Materials and Methods
This was a cross-sectional study. A total of 774 men aged 40 years or older were recruited from the self-paid health checkup service at National Taiwan University Hospital (NTUH) from November 2008 to October 2009. All of them completed the AMS and blood sample was collected to determine serum testosterone level along with other biomarkers. Absolute value of testosterone was tertiled and two testosterone-related markers were created, bioavailable and free testosterone ratio (BTR, FTR). The outcome of this study was AMS, and it was dichotomized by severity. Other covariates were also adjusted in the study. Logistic regression and multinomial logistic regression analyses were used for data analysis.
Results
Testosterone decreased with age (p for trend <0.0001). The association between tertiled testosterone and AMS was inconsistent and unstable. In contrast, higher BTR and FTR showed a decreased risk of developing psychological symptoms (AOR for BTR=0.98, 95% CI=0.97-0.99; AOR for FTR=0.62, 95% CI=0.40-0.95). Higher BTR and FTR were also associated with decreased risks of developing severe overall symptoms (AOR for BTR=0.94, 95% CI=0.90-0.98; AOR for FTR=0.25, 95% CI=0.08-0.72). Similar results were also found by multinomial logistic regression. However, effect modification by some covariates, e.g., hypertension, hyperuricemia, hyperlipidemia, CRP, marital status and age, were not significant.
Discussions
Lifespan has expanded nowadays so aging has become an important issue. LOH may deteriorate health-related quality of life so testosterone replacement therapy can be considered if correct diagnosis is made, and no contraindication exists. Previous studies used absolute value of testosterone to analyze its association with symptoms, but the conclusions were inconsistent. In our study, BTR and FTR were two stable biomarkers which were consistently associated with psychological AMS. Testosterone can cross the blood-brain-barrier and act on the androgen receptors in the brain. Therefore, decreased testosterone is associated with the development of psychological symptoms. Other covariates were also adjusted in this study. However, none of them significantly modified the association between testosterone related markers and AMS.
Conclusions
Bioavailable and free testosterone ratios (BTR and FTR) were significantly associated with psychological and total AMS with a protective effect. In contrast, the association between absolute value of testosterone and AMS was inconsistent and unstable. Therefore, BTR and FTR can help urologists in making correct diagnosis of LOH.
Subjects
Testosterone
Hypogonadism
Andropause
Aging
Risk factor
Type
thesis
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