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


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.

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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.

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Authors and Affiliations



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.

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Correspondence to Ranjith Ramasamy.

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

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The authors declare no competing interests.

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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).

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