Self-referred older Asian males in a men's health clinic: the inter-relationships between androgens, metabolic parameters and quality of life measures.

Background: Current data on late-onset hypogonadism, derived from healthy males in epidemiological studies, may not reflect the profile of men seen in actual clinical practice.

Objective: To examine androgen levels in relation to metabolic status and quality of life (QOL) measures in self-referred men at a hospital-based Men's Health clinic.

Methods: Cross-sectional study of 238 consecutive Asian males. Fasting total testosterone (TT), sex-hormone binding globulin (SHBG), luteinising (LH) and follicle stimulating (FSH) hormones, glucose (FPG) and lipid profile were measured. Bioavailable (cBT) and free testosterone (cFT) were calculated. Waist circumference (WC) and body mass index (BMI) were collected. Subjects also answered the modified International Index of Erectile Dysfunction (IIEF-5) and Ageing Male Symptom (AMS) questionnaires.

Results: Among non-diabetic males (N = 201), no change was noted for TT, although SHBG and gonadotrophins rose, while cBT and cFT declined, significantly with age. Sex hormones were negatively related with WC, BMI and FPG. SHBG displayed a stronger association with metabolic components than testosterone. Testosterone was not related to lipids, IIEF-5 or AMS scores. WC, not BMI, was a key determinant of TT, cBT and cFT in younger subjects, while FSH seemed a more sensitive indicator of primary hypogonadism than LH in older males.

Conclusion: The preferred measures of serum testosterone in older men are cBT and cFT. Visceral adiposity and SHBG, rather than testosterone, appeared to be the link between androgen deficiency and poorer metabolic status. QOL scores correlate poorly with androgen concentrations.