Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes

Caretta N; Facondo P; Mereu S; Delbarba A; Crepaldi MC; Vedovato M; Avogaro A; Ferlin A

doi:10.1007/s40618-022-01941-0

Diagnostics · Hormone Testing

Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes

Caretta N, Facondo P, Mereu S, Delbarba A, Crepaldi MC, Vedovato M, Avogaro A, Ferlin A

Published March 2023 Journal of endocrinological investigation

DOI 10.1007/s40618-022-01941-0 PMID 36282472 PMC PMC9938038

RRM Academy Synopsis

Cardiometabolic indices predict low testosterone in type 2 diabetes

Three common metabolic indices predicted low testosterone in men with type 2 diabetes. The prospective study enrolled 265 men aged 40 to 70 at one Italian hospital, none with overt diabetic complications. About 70 to 75 out of 100 men with top-quarter scores had low testosterone. In the bottom quarter, about 10 to 17 out of 100 did.

Key Findings

In the highest quartile of each index, about 70.0-75.0% of men had hypogonadism (low testosterone), compared with about 10.0-17.0% in the lowest quartile (p < 0.001).
At the authors' cutoffs, sensitivity for low testosterone was 74.3%, 74.7% and 78.4%. Specificity was 71.4%, 73.5% and 73.2%. The order is visceral adiposity index, triglyceride glucose index and lipid accumulation product.
The three indices predicted low testosterone significantly better than body mass index, waist circumference, lipid profile, glycemia, HbA1c and symptom score, except triglycerides (and waist circumference for the visceral adiposity index).
Of 190 men with testosterone results, 77 (40.5%) had low testosterone. Among the 77, luteinizing hormone was low or inappropriately normal in 89.8% (hypogonadotropic hypogonadism) and elevated in 10.2%.
The indices were negatively correlated with total testosterone (p < 0.001). Erectile dysfunction affected 68.1% of men and did not differ significantly between those with and without low testosterone.

Interpretation

The study enrolled 265 consecutive men with type 2 diabetes at one university hospital. Men with overt diabetic complications or known organic causes of low testosterone were excluded. Testosterone results were available for 190 men. The analysis links index scores to testosterone in the same men. The analysis describes an association at one point in time. The study does not show whether metabolic changes lower testosterone or low testosterone worsens metabolic health. The authors set the cutoffs in this same group. They note that insulin resistance, leptin and sex hormone binding globulin were not measured. Semen and fertility outcomes were outside the study.

RRM Context

Restorative reproductive medicine evaluates both partners and seeks causes that can be addressed. The authors call the most frequent form of low testosterone in men over 40 to 50 potentially reversible. They associate it mainly with other conditions, including obesity and type 2 diabetes. For restorative care, a man's metabolic health belongs in the couple's evaluation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

To evaluate in men with type 2 diabetes the association of cardiometabolic indices [Visceral Adiposity Index (VAI), Triglyceride Glucose Index (TyG), and lipid accumulation product (LAP)] with total testosterone (TT) levels, and their predictive cut-off values in identifying hypogonadism.

Methods

265 consecutive men aged 40-70 years with type 2 diabetes performed an andrological evaluation; metabolic parameters and TT were determined. Receiver operating characteristic (ROC) curves were used to identify cut-off values of cardiometabolic indices in predicting low testosterone (TT < 12 nmol/l).

Results

VAI, TyG, and LAP were negatively associated with TT levels. The prevalence of hypogonadism in men in the fourth quartiles of VAI, TyG, and LAP was ~ 70.0-75.0% compared to ~ 10.0-17.0% in men in the first quartiles (p < 0.001). The sensitivity and specificity of the three cardiometabolic indices in predicting TT < 12 nmol/l were significantly higher concerning BMI, waist circumference, lipid profile and HbA1c. Cut off values of VAI ≥ 3.985, TyG ≥ 4.925, and LAP ≥ 51.645 predict hypogonadism with good sensitivity and specificity.

Conclusion

This is the first study evaluating the association of VAI, TyG, and LAP with hypogonadism in men with type 2 diabetes. Alterations in these indices should direct the patients to andrological evaluation.

Topics

Diagnostics Hormone Testing Serum Panels

Diagnostics › Hormone Testing › Serum Panels

PMID 36282472 36282472 DOI 10.1007/s40618-022-01941-0 10.1007/s40618-022-01941-0 Caretta et al. 2023, Caretta 2023

Cardiometabolic indices predict hypogonadism in male patients with type 2 diabetes

Cardiometabolic indices predict low testosterone in type 2 diabetes

Key Findings

Interpretation

RRM Context

Abstract

Topics

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