Associations of Sex Hormone Concentrations with Health and Life Satisfaction in Elderly Men

Seija I. Eskelinen, MD; Tero J. Vahlberg, MSc; Prof. Raimo E. Isoaho, MD; Prof. Sirkka-Liisa Kivelä, MD; Prof. Kerttu M. Irjala, MD

Disclosures

Endocr Pract. 2007;13(7):743-749. 

In This Article

Abstract and Introduction

Objective: To analyze associations between sex hormone concentrations and self-rated health and life satisfaction, neuropsychiatric symptoms, or diagnosed depression or dementia in elderly men.
Methods: The study subjects were men from the community-based Lieto Study (N = 517). Subjects were excluded from the study if they were taking exogenous sex hormones or medication for prostate cancer or for benign prostatic hyperplasia or if data for calculating body mass index (BMI) were missing. Thus, 466 men (64 to 97 years old; mean age, 72 years; mean BMI, 26.9 kg/m2) remained for further analysis.
Results: After adjustment for age, higher levels of testosterone and free testosterone were associated with better self-rated health. After adjustment for age and BMI, no statistically significant associations were found between sex hormone levels and self-rated health or life satisfaction or most neuropsychiatric symptoms in elderly men. Diagnosed depression was associated with a lower serum testosterone concentration. Higher levels of luteinizing hormone and follicle-stimulating hormone were associated with diagnosed dementia.
Conclusion: In this population-based study with high attendance rate, low serum testosterone concentration was associated with diagnosed depression. Subclinical hypogonadism may be associated with diagnosed dementia. Single questions on neuropsychiatric symptoms commonly associated with androgen deficiency seemed to have weak or no correlation with testosterone or free testosterone levels among this group of elderly men.

Testosterone (T) replacement therapy for older men with symptoms suggestive of androgen deficiency is based on measurement of serum T levels, as well as luteinizing hormone (LH) and free testosterone (fT), if necessary. Controversy surrounds the necessity for the prompt diagnosis and treatment of hypogonadism in elderly men. Symptoms of hypogonadism, such as changes in psychosocial function (for example, depressed mood, anxiety, irritability, reduced cognitive capacity, and loss of sense of well-being), are neither sensitive nor specific for androgen deficiency, especially in older populations. For example, these symptoms can also be associated with thyroid dysfunction. Moreover, statements from the Self-Rating Depression Scale reported by Zung (1), which has often been used in assessment of mood in people 65 years of age or older, also generally can be used to assess the symptoms associated with hypogonadism because the psychiatric symptoms of hypogonadism overlap with symptoms of depression (2). The relationship between declining T levels and symptoms associated with hypogonadism may be causal or coincidental.

Thus, the available operational definitions of androgen deficiency in aging men have considerable measurement error because of the nonspecific nature of the symptoms associated with the syndrome. The Androgen Decline in the Aging Male questionnaire showed 88% sensitivity and 60% specificity (3). A self-administered screener for hypogonadism from the Minnesota Male

Aging Study had 76% sensitivity and 49% specificity (4). Researchers have discussed whether certain symptoms should be given more weight than others (5), but no consensus has yet been published.

A recent evidence-based medicine guideline article on hypogonadism (6) lacked a recommendation about any specific questionnaire to use for screening symptoms possibly related to androgen deficiency. A list of signs and symptoms of androgen decline in elderly men, which included emotional fatigue, sleep disturbances, and impaired memory, was presented in that guideline article.

In the United States, the number of prescriptions for T replacement increased by 1,700% from 1994 to 2003 (7). In Finland, the wholesale turnover for T almost doubled between 1993 and 2004, from 472,900 to 913,400 euros (8). It is unlikely that clinicians primarily caring for aging frail or feeling-frail men require the presence of most of 8 or 12 possible symptoms in specific questionnaires or long lists for initiation of T measurement. In clinical practice, asking and analyzing all these questions take time. Researchers should note this alarming situation in aging male endocrinology and develop a clinically usable short questionnaire with high validity and specificity for everyday clinical practice, if possible.

The aim of this study was to assess whether an association exists between sex hormone concentrations and self-rated health and life satisfaction, certain subjective symptoms, depression, and dementia in a community-dwelling elderly male population. The influence of body mass index (BMI) as a mediator of the associations of sex hormone levels and health was also studied.

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