Open AccessLate‐onset hypogonadism in men with systolic heart failure: prevalence, clinical associates, and impact on long‐term survival
Author(s) -
Jankowska Ewa A.,
Tkaczyszyn Michał,
WęgrzynowskaTeodorczyk Kinga,
Majda Jacek,
Haehling Stephan,
Doehner Wolfram,
Banasiak Waldemar,
Anker Stefan D.,
Ponikowski Piotr
Publication year - 2014
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12002
Subject(s) - medicine , libido , testosterone (patch) , heart failure , morning , concomitant , sexual dysfunction , endocrinology , population , ageing , environmental health
Abstract Background Male ageing is characterized by diminished circulating androgens with several adverse psychosomatic consequences and can be aggravated by concomitant chronic diseases. According to the European Male Aging Study (EMAS) Group, late‐onset hypogonadism (LOH) refers to testosterone deficiency accompanied by sexual complaints. Aim We investigated the prevalence of LOH in men with systolic heart failure (HF), and its clinical determinants and prognostic consequences. Methods Among 201 men with systolic HF (age: 60 ± 11 years), serum total testosterone (TT) was assessed using an immunoassay, and estimated free testosterone (eFT) was calculated using Vermeulen's formula. LOH was diagnosed when TT < 3.2 ng/mL and eFT < 64 pg/mL were accompanied by three sexual symptoms (decrease in the number of morning erections, reduced potency, and low libido) of at least moderate severity assessed using the Aging Males' Symptoms Scale. Results Decreased frequency of morning erections, reduced potency, and low libido were experienced by 56%, 62%, and 55% of men with HF, respectively; whereas 67%, 61%, and 44% of subjects complained of at least one, two, and three symptoms, respectively. Hypogonadal TT and eFT were observed in 34% and 47% of patients, respectively; and in 33% subjects, both TT and eFT were reduced. Finally, 30 men with HF (15%) were diagnosed with LOH as compared with 2% in a European male population (EMAS). In a multivariable model, older age and higher serum uric acid were independently associated with greater LOH prevalence (both P < 0.05). Among men aged ≤60 years (but not in those aged >60 years), LOH increased 5‐year all‐cause mortality in the univariable model; however, when adjusted for HF severity, the association lost its statistical significance. Conclusions Men with systolic HF commonly report sexual complaints. LOH—the combination of sexual dysfunction and testosterone deficiency—occurs more frequently than in a general male population. LOH does not affect long‐term mortality, when adjusted for HF severity.