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The Consequences of Androgen Deficiency in Men

Monday, November 23rd, 2009

In a three part series, “The dark side of testosterone deficiency”, Abdulmaged et al, 2009 look at the emerging evidence through a comprehensive Pub Med literature search (1980 through to 2009) for the role of androgen deficiency and risk for metabolic syndrome and vascular disease.(1)(2)(3) Key points to these papers are mentioned briefly below.

In men, metabolic syndrome, the number one health threat of the 21st century, is characterized by a cluster of cardiovascular risk factors including(4)

• Hperinsulinemia and hyperglycemia (fasting blood sugar > 110 mg/dL or type II diabetes mellitus)
• Central obesity (waist circumference >94 cm)
• Triglyceride (>150 mg/dL)
• HDL cholesterol (<40 mg/Dl)
• Blood pressure (systolic >130 mmHg, diastolic >85 mmHg)

A diet rich in carbohydrates, cigarette smoking and physical inactivity also increase the odds of developing metabolic syndrome.

The authors note that low circulating androgen levels are a risk factor for metabolic syndrome; an inverse relationship exists between testosterone levels and odds ratios for having metabolic syndrome. As the endogenous androgen levels decline with age, the prevalence of metabolic syndrome and cardiovascular disease increase. Central to this pathology is endothelial dysfunction. Factors such as, insulin resistance, hyperglycemia, abnormal lipid profiles, hypertension, and elevated pro-inflammatory markers are hallmarks of endothelial dysfunction, the pathology of which includes; vasoconstriction, arterial sclerosis, oxidative stress, thrombosis, inflammatory cell adhesion, smooth muscle proliferation and endothelial permeability. These factors are found to be common in men with androgen deficiency and seem to be intimately linked, whether through ageing, hypogonadism (more prevalent than previously thought) or androgen deprivation therapy in men with prostate cancer.

Central obesity is a classic feature of metabolic syndrome and is associated with reduced testosterone. The authors mention that men with central obesity are in a viscous cycle as obesity may lead to endocrinological imbalances including low testosterone. Elevated serum leptin levels, for example, in men with large fat reserves, may interfere with LH/hCG-stimulated androgen production suppressing androgen production. In addition, increased aromatization of testosterone to estradiol occurring in fat cells may lead to elevated circulating levels of estradiol which in turn may suppress testosterone production via negative feedback. This may consequently reduce testosterone-stimulated lipolysis further leading to abdominal fat deposition. Testosterone suppression may lead to hyperinsulinemia, and insulin resistance.

Testosterone is an anabolic hormone with a crucial role in maintaining metabolic balance. The relationship, as the authors suggest, between androgen deficiency and vascular disease is complex, but may play a central role in its pathology. Testosterone is thought to improve parameters relating to cardiovascular disease through a variety of measures. Testosterone therapy has been shown to improve lipid profiles, reduce body fat percentage, lower blood pressure, decrease fasting glucose, improve insulin sensitivity, reduce production of pro-inflammatory cytokines and regulate vasomotor function all of which contribute positively in reducing the risk for metabolic syndrome.

US BioTek Laboratories’ Comprehensive Urinary Steroid Hormone Profile by GC/MS measures 30 key analytes from a 24-hour urine sample collection:

• Major Androgens, Estrogens, Progesterone & Metabolites
• Adrenal Hormones & Metabolites

To view complete test profile information please click here.

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