Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

U-shaped association between prevalence of secondary hypogonadism and body mass index: a retrospective analysis of men with testosterone deficiency

Abstract

The prevalence of both obesity and hypogonadism in the United States has increased over the past two decades. While prior studies have shown an association between obesity and secondary hypogonadism—low testosterone and luteinizing hormone—few have used a large enough sample size to determine prevalence at each body mass index class. We aimed to compare rates of secondary hypogonadism among body mass index classes by constructing a retrospective database with men who had their body mass index, morning testosterone and luteinizing hormone levels measured during a visit to a urology clinic at a tertiary academic medical center between 2011–2020. Men previously on testosterone replacement therapy, Clomiphene, or Anastrozole were excluded. Chi-squared analysis was conducted in “R”. We found that among the 7211 men studied, 45.7%, 22.6%, and 4.4% were classified as having diagnosis of secondary, primary, and compensated hypogonadism, respectively. We found that obese men and underweight men had increased prevalence of secondary hypogonadism as compared to men with normal body mass index. These findings support the need for routine screening criteria and personalized advice to patients dealing with secondary hypogonadism.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Wang Y, Beydoun MA, Min J, Xue H, Kaminsky LA, Cheskin LJ. Has the prevalence of overweight, obesity and central obesity levelled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic. Int J Epidemiol. 2020;49:810–23.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N. Engl J Med. 2019;381:2440–50.

    Article  PubMed  Google Scholar 

  3. Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008;207:928–34.

    Article  PubMed  Google Scholar 

  4. Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2018;103:1715–44.

    Article  PubMed  Google Scholar 

  5. Tajar A, Forti G, O’Neill TW, Lee DM, Silman AJ, Finn JD, et al. Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab. 2010;95:1810–8.

    Article  CAS  PubMed  Google Scholar 

  6. Masterson JM, Soodana-Prakash N, Patel AS, Kargi AY, Ramasamy R. Elevated body mass index is associated with secondary hypogonadism among men presenting to a tertiary academic medical center. World J Mens Health. 2019;37:93–8.

    Article  PubMed  Google Scholar 

  7. Porte D Jr, Baskin DG, Schwartz MW. Insulin signaling in the central nervous system: a critical role in metabolic homeostasis and disease from C. elegans to humans. Diabetes 2005;54:1264–76.

    Article  CAS  PubMed  Google Scholar 

  8. Mammi C, Calanchini M, Antelmi A, Cinti F, Rosano GM, Lenzi A, et al. Androgens and adipose tissue in males: a complex and reciprocal interplay. Int J Endocrinol. 2012;2012:789653.

    Article  PubMed  Google Scholar 

  9. Gautier A, Bonnet F, Dubois S, Massart C, Grosheny C, Bachelot A, et al. Associations between visceral adipose tissue, inflammation and sex steroid concentrations in men. Clin Endocrinol. 2013;78:373–8.

    Article  CAS  Google Scholar 

  10. Isidori AM, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol. 2005;63:280–93.

    Article  CAS  Google Scholar 

  11. Whitten SJ, Nangia AK, Kolettis PN. Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. Fertil Steril. 2006;86:1664–8.

    Article  CAS  PubMed  Google Scholar 

  12. Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pr. 2006;60:762–9.

    Article  CAS  Google Scholar 

  13. Calderon B, Gomez-Martin JM, Vega-Pinero B, Martin-Hidalgo A, Galindo J, Luque-Ramirez M, et al. Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight. Andrology. 2016;4:62–7.

    Article  CAS  PubMed  Google Scholar 

  14. Defining Adult Overweight & Obesity: Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/obesity/adult/defining.html.

  15. Mulhall JP, Trost LW, Brannigan RE, Kurtz EG, Redmon JB, Chiles KA, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200:423–32.

    Article  PubMed  Google Scholar 

  16. Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363:123–35.

    Article  CAS  PubMed  Google Scholar 

  17. R: A language and environment for statistical computing Vienna, Austria: R Foundation for Statistical Computing; 2021. https://www.R-project.org/.

  18. Kelly DM, Jones TH. Testosterone: a metabolic hormone in health and disease. J Endocrinol. 2013;217:R25–45.

    Article  CAS  PubMed  Google Scholar 

  19. Grossmann M. Testosterone and glucose metabolism in men: current concepts and controversies. J Endocrinol. 2014;220:R37–55.

    Article  CAS  PubMed  Google Scholar 

  20. Fernandez CJ, Chacko EC, Pappachan JM. Male obesity-related secondary hypogonadism - pathophysiology, clinical implications and management. Eur Endocrinol. 2019;15:83–90.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Glass AR, Swerdloff RS, Bray GA, Dahms WT, Atkinson RL. Low serum testosterone and sex-hormone-binding-globulin in massively obese men. J Clin Endocrinol Metab. 1977;45:1211–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank members from the University of Miami Miller School of Medicine Urology and Endocrinology departments for their contribution to this work. This work was supported by National Institutes of Health Grant R01 DK130991 and Clinician Scientist Development Grant from the American Cancer Society to Ranjith Ramasamy.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: AG, MM, JM and RR. Data curation: AG, JM and RR Formal analysis: AG. Investigation: AG, MM, JM, AK and RR. Methodology: AG, MM, JM, AK and RR. Project administration: RR. Resources: AG, MM, JM, AK and RR. Software: AG. Supervision: JM and RR. Validation: AG, MM, JM, AK and RR. Visualization: AG and MM. Writing – original draft: AG, MM, JM, AK and RR. Writing – review & editing: AG, MM, JM, AK and RR.

Corresponding author

Correspondence to Ranjith Ramasamy.

Ethics declarations

Ethical approval

The study protocol was approved by the IRB of The University of Miami (IRB No. 20170849). Informed consent was confirmed by the IRB.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gurayah, A.A., Mason, M.M., Masterson, J.M. et al. U-shaped association between prevalence of secondary hypogonadism and body mass index: a retrospective analysis of men with testosterone deficiency. Int J Impot Res 35, 374–377 (2023). https://doi.org/10.1038/s41443-022-00533-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-022-00533-z

This article is cited by

Search

Quick links