Functional and osteometabolic impact of male hypogonadism treated with Testosterone Replacement Therapy (TRT)

Introduction. Hypogonadism is a clinical condition characterized by low levels of testosterone associated with loss of libido, reduced or absent fertility, decrease of bone mass and muscle strength, reduction in the mood with frequent depressive symptoms. An article recently published in Cell has focused the attention on a possible reciprocal regulation gonads-bone, in particular on the regulation of male fertility by bone through the action of osteocalcin. The aim of our study is to evaluate the bone metabolism of patients with hypogonadism, the alterations of body functions and structures related to movement, and any reduction of social participation and consequently in the quality of life. Materials and methods. This observational study was conducted in collaboration with the Department of Clinical and Experimental Medicine of our university. All patients with a diagnosis of hypogonadism, that were sent to our observation, were receiving a pharmacological treatment with testosterone. They underwent a DXA examination, a physical examination including the assessment of muscle strength (MMT scale), presence and intensity of any kind of pain with the Brief Pain Inventory (BPI), disability (Barthel Index), and quality of life with the Short Form -12 (SF-12). Results. Up to date, 15 male patients aged between 17 and 49 years were evaluated; 8 patients were overweight and 1 was obese. Seven patients had a diagnosis of Klinefelter syndrome, 6 Kallmann syndrome, 1 multiple pituitary deficit and 1 a primary hypogonadism after orchiectomy for bilateral testicular cancer. At the DXA examination 4 patients were osteopenic (T-score value between -1 and -2.5). Six patients were practicing a sport. Four patients reported musculoskeletal pain of mild-moderate intensity (BPI range 2.71-4.57), 7 patients had a mild muscle weakness against resistance (MMT = 4/5). No patient had changes in activity and participation (Barthel Index = 100) or of the quality of life. Conclusions. The testosterone replacement therapy in these patients can restore sexual function, lead to an increase of energy, sex drive and sense of wellbeing, but also prevent muscular atrophy and bone loss. Hypogonadism is a clinical syndrome complex which comprises symptoms and signs as well as testosterone deficiency; a multi-dimensional diagnostic evaluation that includes the parameters of the muscular-skeletal metabolism might lead to a more satisfactory therapeutic perspective, and then to a possible improvement of quality of life of these patients. Bibliography 1. Oury,G.Sumara, O.Sumara, M.Ferron, G.Karsenty. Endocrine Regulation of Male Fertility by the Skeleton Cell,Volume144,Issue 5,796-809,17 February 2011. 2. Ware JE Jr., Gandek B. Overwiev of the SF-36 Health Survey and the International Quality of Life Assessment (IQUOLA) Project. J Clin Epidemiol 1998; 51: 903-912. 3. Mahoney FI, Barthel DW (1965) Functional evaluation. The Barthel Index. Md State-Medical J14;61-65.