Hypogonadism in COPD

Abstract and Introduction

Abstract

Purpose of Review This review summarizes the literature on hypogonadism in men with chronic obstructive pulmonary disease (COPD).
Recent Findings COPD is a systemic disease with effects beyond the lungs. Many prior studies have shown that middleaged and elderly COPD patients may develop hypogonadism. Prevalence of hypogonadism in men with COPD can range from 22 to 69% and has been associated with several other systemic manifestations including osteoporosis, depression, and muscle weakness. Recent studies have revealed conflicting results with regards to these previous perceptions. The discrepancies in the findings can be mainly attributed to small sample size, differences in patient selection, and inconsistent findings. Testosterone replacement therapy may result in modest improvements in fat-free mass and limb muscle strength but its therapeutic efficacy in COPD patients still remains controversial.
Summary The relationship between hypogonadism and COPD still remains poorly understood. The current literature is at best circumstantial.

Introduction

Hypogonadism in men, otherwise known as testosterone deficiency, is a clinical syndrome that results from failure of the testis to produce physiological levels of testosterone and a normal number of spermatozoa due to disruption of one or more levels of the hypothalamic–pituitary–testicular axis.^[1•]

Low testosterone level is associated with increased risk of all-cause [relative risk (RR) = 1.35; 95%, confidence interval (CI) = 1.15–1.62] and cardiovascular disease (CVD) death (RR = 1.23; 95%, CI = 0.97–1.6) in community-based studies of men.^[2••] Testosterone deficiency has been described in chronic illnesses, including chronic obstructive pulmonary disease (COPD). Patients with COPD are usually hypoxemic, chronically ill and receive glucocorticoids. Each of these factors can result in hypogonadism, which, in turn, may worsen COPD and erode quality of life.

Symptoms and signs of testosterone deficiency in adults include: reduced sexual desire; gynecomastia; loss of body (axillary and pubic) hair; hot flushes; sweats; low trauma fracture; low bone mineral density (BMD); decreased energy, motivation, initiative and self-confidence; depressed mood; poor concentration and memory; reduced muscle bulk and strength; increased body fat; and diminished physical or work performance.^[1•,3]

The diagnosis of testosterone deficiency should be made only in men with consistent symptoms and signs of testosterone deficiency and unequivocally low serum testosterone levels.^[1•] The threshold testosterone level below which adverse health outcomes occur is not known, and hence considerable variability exists in its use and interpretation in various studies. The impact of testosterone administration in improving outcomes in the general population is not clear either, although several epidemiologic studies have reported an association of low testosterone levels with higher all-cause mortality.^[1•]

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