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Research Paper|Volume 12, Issue 24|pp 26012—26028

Decreased testosterone secretion index and free testosterone level with multiple symptoms for late-onset hypogonadism identification: a nationwide multicenter study with 5980 aging males in China

Honggang Li1,2, Yiqun Gu3, Xuejun Shang4, Yuanzhong Zhou5, Huiping Zhang1,2, Liandong Zuo6, Guangan Mei7, Wei Xia1,2, Huangtao Guan1,2, Wenpei Xiang1,2, Shanjie Zhou8, Changchun Wan9, Baojin Hao9, Xubo Shen5, Linguo Tang6, Weixiong Wu6, Ying Qi7, Na Yu10, Xiangbin Kong1, Yaoping Chen1, Yihong Yang11, Xingrong Qing1, Chengliang Xiong1,2
  • 1Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  • 2Wuhan Tongji Reproductive Medicine Hospital, Wuhan 430013, China
  • 3National Health and Family Planning Key Laboratory of Male Reproductive Health, National Research Institute for Family Planning, Beijing 10081, China
  • 4Department of Andrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
  • 5School of Public Health, Zunyi Medical University, Zunyi 563006, China
  • 6Guangzhou Women and Children’s Medical Center, Guangzhou 510180, China
  • 7Technical Guidance Institute of Shanxi Province Family Planning Commission, Xi’an 710000, China
  • 8Reproductive Medicine Centre, Peking University International Hospital, Beijing 102206, China
  • 9People’s Hospital of Jinhu, Jinhu 211600, China
  • 10School of Public Health, Guangdong Medical University, Guangzhou 524023, China
  • 11Reproductive Medical Centre, Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
Received: July 29, 2020Accepted: September 29, 2020Published: November 21, 2020
https://doi.org/10.18632/aging.202227

Copyright: © 2020 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Late-onset hypogonadism (LOH) is a syndrome in middle-aged and elderly men caused by age-related testosterone deficiency. Age-related change of total testosterone (TT) of Asian males is different from Caucasian population, suggesting difference for LOH identification in Asians. A nationwide cross-sectional study involving six centers in China was conducted. Totally 6296 men aged 40-79 were recruited. After exclusions 5980 men were left for analyses. The serum TT level, was neither decreased with aging nor correlated with most hypogonadal symptoms. Instead, ten hypogonadal symptoms were found to be significantly correlated with free testosterone and testosterone secretion index, thus were chosen to form a concise scale. Further analysis identified a level of free testosterone <210 pmol/L, testosterone secretion index <1.8, and the concise scale score ≧17 could be diagnosed as having significantly aggravated LOH. This study developed an evidence-based criteria for LOH identification in Chinese population and may be adopted in other Asians. It includes the impaired testosterone secretion ability and deficiency of bioavailable testosterone, which should be the main cause in LOH pathogenesis despite normal TT levels, as well as correlated multiple hypogonadal symptoms. Our results may guide the LOH treatment to increase testicular function of testosterone secretion and bioavailable testosterone.