Late-onset hypogonadism: beyond testosterone
Open Access
- 1 January 2015
- journal article
- research article
- Published by Medknow in Asian Journal of Andrology
- Vol. 17 (2), 236-8
- https://doi.org/10.4103/1008-682x.135985
Abstract
Late-onset hypogonadism is defined as a combination of low testosterone (T) levels and typical symptoms and signs. A major area of uncertainty is whether T concentrations are always really sufficient to fully reflect Leydig cell (dys)function. Mild testicular alteration could be diagnosed only by additional biochemical markers, such as luteinizing hormone (LH) and 25-hydroxyvitamin D levels. These markers help in identifying the so-called "subclinical" hypogonadism (normal T, high LH levels). Patients with hypogonadism have frequently low levels of 25-hydroxyvitamin D due to impairment of the hydroxylating enzyme CYP2R1 in the testis. However, no data have been published dealing with the best treatment option (cholecalciferol - the Vitamin D precursor, or calcidiol - 25-hydroxylated form of Vitamin D) in these patients. We studied 66 patients with classic hypogonadism (total T [TT] −1 , LH ≥ 8 IU l−1 ) (n = 26) and subclinical hypogonadism (TT ≥ 12 nmol l−1 , LH ≥ 8 IU l−1 ) (n = 40) and low 25-hydroxyvitamin D (−1 ). Subjects received cholecalciferol (5000 IU per week) (n = 20) or calcidiol (4000 IU per week) (n = 46), and 25-hydroxyvitamin D and parathyroid hormone (PTH) were evaluated after 3 months of therapy. Supplementation with calcidiol significantly increased 25-hydroxyvitamin D and significantly decreased PTH levels in both groups of men with hypogonadism (primary, n = 16 and subclinical, n = 30), whereas supplementation with cholecalciferol did not modify their levels. This study shows for the first time that the administration of the 25-hydroxylated form of Vitamin D (calcidiol), and not the administration of the precursor cholecalciferol, restores 25-hydroxyvitamin D levels in subjects with hypogonadism.Keywords
This publication has 18 references indexed in Scilit:
- Calcidiol [25(OH)D3]: from diagnostic marker to therapeutical agentCurrent Medical Research and Opinion, 2013
- Testicular function and bone metabolism—beyond testosteroneNature Reviews Endocrinology, 2013
- Subclinical vitamin D deficiencyBest Practice & Research Clinical Endocrinology & Metabolism, 2012
- Low Free Testosterone Predicts Mortality from Cardiovascular Disease But Not Other Causes: The Health in Men StudyJournal of Clinical Endocrinology & Metabolism, 2012
- Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2011
- Bone Mineral Density and Testicular Failure: Evidence for a Role of Vitamin D 25-Hydroxylase in Human TestisJournal of Clinical Endocrinology & Metabolism, 2011
- Elevated LH predicts ischaemic heart disease events in older men: the Health in Men StudyActa Endocrinologica, 2011
- Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2010
- Characteristics of Secondary, Primary, and Compensated Hypogonadism in Aging Men: Evidence from the European Male Ageing StudyJournal of Clinical Endocrinology & Metabolism, 2010
- Published by Springer Science and Business Media LLC