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MP21-13 OBESITY IMPAIRS HYPOGONADISM COMPENSATION LEADING TO AGE-RELATED TESTOSTERONE DECLINE

INTRODUCTION AND OBJECTIVE: In normal physiologic conditions, the hypothalamic-pituitary-gonadal (HPG) axis is expected to increase luteinizing hormone (LH) levels, as testosterone (T) levels tend to decline. This phenomenon could theoretically prevent the establishment of testosterone deficiency (TD), which contradicts the understanding that T levels have a steady decline during the normal aging process. The present study aimed to investigate the prevalence of compensated hypogonadism (CH) in a cohort of middle-aged men and to search for predictors of an adequate compensatory response. METHODS: We analyzed a prospectively maintained database of patients seeking treatment at a general urology clinic. We included patients seen from August 2020 to October 2021in the present analysis. Sociodemographics, comorbidity profile, and metabolic syndrome parameters were routinely assessed. Obesity was defined as waist circumference >102 cm. Early morning blood samples were collected, and a complete hormonal blood panel was measured. TD was defined as TT levels <300 ng/dL. CH was defined as TT< 300 ng/dL and LH > 9.4 mUI/mL. We used a multivariable model to identify independent predictors of CH, which included age, metabolic syndrome components, and lab results. RESULTS: 577 consecutive patients were included in the analysis. The median age was 59 years [IQR 49-68 years]. The median baseline TT was 478 ng/dl [IQR 348-617]. In our sample, 41% had diabetes, 44% had hypertension, and 33% had metabolic syndrome. The prevalence of TD in our sample was 15.5%. Out of 84.5% of men with normal T levels, 6.8% had CH. Compared to eugonadal men, those with CH were more than 20 years older (median age 56.0 vs. 76.0). Median waist circumference was 97.0 cm, 94.0 cm, and 107 cm for men with normal T, CH, and TD, respectively (p<0.001). On multivariable analysis, obesity was the only TD predictor (OR[4.23[1.85-9.77]). On the prediction model of CH among men with normal T levels, age (OR [1.11 95%CI 1.06 1.16 per year) and obesity (OR[0.14, 95% CI 0.03 to 0.62) remained significant. CONCLUSIONS: In our patient population, increasing age and absence of obesity were predictors of CH. For individuals with WC<102, age appears not to impact T levels significantly as LH levels tend to maintain androgen production. Such findings might partially explain the absence of increased TD prevalence in normal-weight populations found in previous published epidemiological studies.