Elevated luteinizing hormone despite normal testosterone levels in older men - natural history, risk factors, and clinical features

Eendebak, R. J.A.H. et al. (2018) Elevated luteinizing hormone despite normal testosterone levels in older men - natural history, risk factors, and clinical features. Clinical Endocrinology, 88(3), pp. 479-490. (doi: 10.1111/cen.13524) (PMID:29178359)

Abstract

Objective: Elevated LH with normal testosterone (T) suggests compensated dysregulation of the gonadal axis. We describe the natural history, risk factors and clinical parameters associated with the development of high LH (HLH, LH>9.4 U/L) in ageing men with normal T (T≥10.5 nmol/L). Design, Patients and Measurements: We conducted a 4.3 year prospective observational study of 3,369 community-dwelling European men aged 40-79 years. Participants were classified as: incident (i) HLH (n=101, 5.2%); persistent (p) HLH (n=128, 6.6%); reverted (r) HLH (n=46, 2.4%); or persistent normal LH (pNLH, n=1667, 85.8%). Potential predictors and changes in clinical features associated with iHLH and rHLH were analysed using regression models. Results: Age >70 years (OR=4.12[2.07–8.20]), diabetes (OR=2.86[1.42–5.77]), chronic pain (OR=2.53[1.34–4.77]), pre-degree education (OR=1.79[1.01–3.20]) and low physical activity (PASE≤78, OR=2.37[1.24–4.50]) predicted development of HLH. Younger age (40-49 years, OR=8.14[1.35-49.13]) and non-smoking (OR=5.39[1.48–19.65]) predicted recovery from HLH. Men with iHLH developed erectile dysfunction, poor health, cardiovascular disease (CVD) and cancer more frequently than pNLH men. In pHLH men, co-morbidities, including CVD, developed more frequently, and cognitive and physical function deteriorated more, than in pNLH men. Men with HLH developed primary hypogonadism more frequently (OR=15.97[5.85–43.60]) than NLH men. Men with rHLH experienced a small rise in BMI. Conclusions: Elevation of LH with normal T is predicted by multiple factors, reverts frequently and is not associated with unequivocal evidence of androgen deficiency. High LH is a biomarker for deteriorating health in aged men who tend to develop primary hypogonadism.

• Item Type: Articles
• Keywords: Ageing, hypogonadism, luteinizing hormone, physical function, testosterone.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lean, Professor Michael
• Authors: Eendebak, R. J.A.H., Ahern, T., Swiecicka, A., Pye, S. R., O'Neill, T. W., Gyorgy, B., Casanueva, F. F., Maggi, M., Forti, G., Giwercman, A., Han, T. S., Słowikowska-Hilczer, J., Lean, M. E.J., Punab, M., Pendleton, N., Keevil, B. G., Vanderschueren, D., Rutter, M. K., Tampubolon, G., Goodacre, R., Huhtaniemi, I. T., and Wu, F. C.W.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Clinical Endocrinology
• Publisher: Wiley
• ISSN: 0300-0664
• ISSN (Online): 1365-2265
• Published Online: 27 November 2017
• Copyright Holders: Copyright © 2017 John Wiley and Sons Ltd
• First Published: First published in Clinical Endocrinology 88(3):479-490
• Publisher Policy: Reproduced in accordance with the publisher copyright policy