Relationship between insulin and hypogonadism in men with metabolic syndrome

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Abstract

OBJECTIVE: To evaluate the incidence of hypogonadism in men with metabolic syndrome and its correlation with serum insulin levels. METHODS: Observational, transversal study with 80 men with metabolic syndrome. The individuals were divided into two groups: Group 1: 56 patients (70%) with total testosterone > 300 ng/dL (normal gonadal function); Group 2: 24 patients (30%) with total testosterone < 300 ng/dL (hypogonadic). RESULTS: The subjects from Group 2 compared to Group 1 presented higher body mass index (BMI), waist and hip circumferences, insulin, homeostasis model assessment insulin resistance index (Homa-IR) and beta cell (Homa-β), and triglycerides, but lower SHBG and free testosterone values. Inverse correlations between insulin levels and total testosterone and SHBG, as well as between Homa-IR and total testosterone were observed. CONCLUSION: In this series of men with metabolic syndrome, hypogonadism was associated with insulin resistance and may be a marker of metabolic abnormalities.

Translated abstract

OBJETIVO: Avaliar a frequência de hipogonadismo em homens portadores da síndrome metabólica e a sua correlação com a concentração sérica de insulina. MÉTODOS: Estudo observacional e transversal com 80 homens portadores da síndrome metabólica. Os sujeitos foram estratificados em dois grupos: Grupo 1: 56 pacientes (70%) com testosterona total > 300 ng/dL (função gonadal normal); Grupo 2: 24 pacientes (30%) com testosterona < 300 ng/dL (hipogonádicos). RESULTADOS: Os sujeitos do Grupo 2 comparados ao Grupo 1 tinham maior índice de massa corporal (IMC), de circunferências do quadril e da cintura, insulina, Homa-IR, Homa-β e triglicerídeos, mas tinham valores menores de SHBG e testosterona livre. Observou-se correlação inversa da concentração de insulina com a de testosterona total e SHBG, e do Homa-IR com a concentração de testosterona total. CONCLUSÃO: Nos indivíduos estudados, a presença de hipogonadismo esteve associada à resistência à insulina, podendo ser um marcador de alterações metabólicas.

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Most cited references 59

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Obesity and androgens: facts and perspectives.

Renato Pasquali (2006)

This review discusses androgen status in male and female obesity, according to their specific phenotype, and the main mechanisms responsible. Published data in the literature of the last 20 years represented the basis of most of the data and concepts incorporated in the review. Obesity is associated with profound alterations in androgen secretion, transport, metabolism, and action, according to a dichotomous behavior depending on sex. Obese men are characterized by a progressive decrease of testosterone levels with increasing body weight, whereas obese women, particularly those with the abdominal phenotype, tend to develop a condition of functional hyperandrogenism. Reduced sex hormone-binding globulin synthesis and circulating blood levels represent the sole common mechanism which is responsible in both sexes. Among other still partially undefined factors, mechanisms potentially responsible for the sex dichotomy in androgen levels involve specific alterations of gonadotropin secretion, estrogens, the hypothalamic-pituitary-adrenal axis, leptin, androgen receptors, specific steroidogenic enzymes in the peripheral tissues, and, possibly, ghrelin. In both sexes, androgens play an important role in determining the sex-dependent pattern of body fat distribution. Moreover there are theoretical possibilities that low testosterone in men and high free testosterone fraction in women may play a role in the development of the metabolic syndrome. This is exemplified by the well defined association between obesity and other features of the metabolic syndrome in women with polycystic ovary syndrome and in hypogonadal men. The effects of androgen and antiandrogens in obese men and women also represent arguments in favor of this association. Given the fundamental role of sex hormones in the regulation of body composition, fuel homeostasis, and reproduction in humans, more emphasis should be placed on the potential role of androgen dysregulation in the pathophysiology of different obesity phenotypes and the metabolic syndrome.

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Lower endogenous androgen levels and dyslipidemia in men with non-insulin-dependent diabetes mellitus.

Rebecca E. Connor (1992)

To compare plasma androgen levels in diabetic and nondiabetic men and to determine their relation to diabetic dyslipidemia. A population-based, case-control study. Community. Men 53 to 88 years of age from the Rancho Bernardo, California, cohort who were screened for diabetes using an oral glucose tolerance test. Plasma androgen levels were compared in 44 men with untreated non-insulin-dependent diabetes mellitus and 88 age-matched men who had a normal glucose tolerance test. The relation of lipid and lipoprotein levels to androgen level and diabetic status was assessed before and after adjusting for covariates. Men with diabetes had significantly lower plasma levels of free (4.96 nmol/L compared with 5.58 nmol/L) and total testosterone (14.7 nmol/L compared with 17.4 nmol/L), dihydrotestosterone (428 pg/mL compared with 533 pg/mL), and dehydroepiandrosterone sulfate (DHEA-S) (1.92 mumol/L compared with 2.42 mumol/L) than nondiabetic men. They also had significantly lower high-density lipoprotein (HDL) cholesterol and significantly higher triglyceride levels. Differences were not explained by obesity, alcohol use, or cigarette habit. Overall, the total testosterone level, but not the free testosterone level, was positively correlated with the HDL cholesterol level (P = 0.009) and negatively correlated with the triglyceride level (P = 0.0001). Similar associations were seen in analyses restricted to the men without diabetes. Lower levels of endogenous androgens are seen in older diabetic men, and low androgen levels are associated with diabetic dyslipidemia.