(041) Characteristics of Secondary Hypogonadism Defined by LH Levels but With Elevated FSH: Results From a Cohort of Men Seeking Specialist Evaluation for Sexual Dysfunction

Introduction The definition of hypogonadism as primary or secondary is based on LH values. The use of FSH has been proposed as an additional parameter to define the primary nature of hypogonadism. Objective To assess whether characterizing subjects with secondary hypogonadism based on FSH values can identify a distinctive phenotype of male hypogonadism. Methods A consecutive series of 4,883 men with sexual dysfunction was considered. Of these, 3,428 (70.2%) were eugonadal (total testosterone ≥12 nmol/L), 162 (3.3%) had primary hypogonadism (total testosterone <12 nmol/L and LH ≥9.4 U/L), and 1,293 (26.5%) had secondary hypogonadism (LH <9.4 U/L). The latter group was subdivided according to FSH values (< or ≥11 U/L) into “pure” secondary hypogonadism or “mixed” hypogonadism. Demographic, andrological, metabolic, and psychological characteristics of these groups were compared with those of eugonadal men. Results Regardless of confounding factors, subjects with primary hypogonadism had a higher frequency of testicular disease in their medical history [OR: 5.91 (3.95; 8.84)], smaller testicular volume [B: -9.35 (-10.08; -8.62)], and more symptoms and signs of hypogonadism [higher ANDROTEST score, lower hemoglobin and PSA values; B: 2.72 (2.00; 3.45), -0.68 (-1.02; -0.35), and -0.69 (-0.79; -0.59), respectively]. They also had a higher estimated cardiovascular risk [B: 3.39 (1.74; 5.03)]. Men with “pure” secondary hypogonadism showed more sexual symptoms, a higher prevalence of metabolic syndrome [B: 2.62 (2.20; 3.12)], and reduced penile blood flow. Men with mixed hypogonadism had a higher frequency of testicular disease and lower testicular volume than eugonadal men, with values intermediate between those with primary and “pure” secondary hypogonadism [OR: 2.59 (1.49; 4.51); B: -5.27 (-6.01; -4.53)]. The ANDROTEST score was also higher than in eugonadal subjects, again with intermediate values between primary and “pure” secondary hypogonadism [B: 2.05 (1.38; 2.73)]. Regarding sexual symptoms, hemoglobin and PSA levels, and penile Doppler parameters, men with mixed hypogonadism behaved similarly to those with “pure” secondary hypogonadism. However, men with mixed hypogonadism showed a higher frequency of metabolic syndrome and a greater estimated cardiovascular risk compared with eugonadal subjects [OR: 4.01 (2.56; 6.30) and B: 3.76 (2.12; 5.39)], with stronger associations than in primary and “pure” secondary hypogonadism. Interestingly, while subjects with primary or “pure” secondary hypogonadism did not show psychopathological characteristics compared with eugonadal men, those with mixed hypogonadism exhibited symptoms of free and phobic anxiety and obsessive traits [B: 0.91 (0.25; 1.56), 0.71 (0.22; 1.20), and 0.79 (0.10; 1.48)], as well as a tendency toward depressive symptoms and somatized anxiety [B: 0.53 (-0.06; 1.13) and 0.47 (-0.04; 0.99)]. Conclusions Among men with hypogonadism, FSH may help identify a group at higher metabolic and cardiovascular risk, and characterized by greater psychopathological symptoms. Disclosure No