Scientific Publications by FDA Staff

PM R 2017 Aug;9(8):751-60

Prevalence and etiology of hypogonadism in young men with chronic spinal cord injury: a cross-sectional analysis from two university-based rehabilitation centers.

Sullivan SD, Nash MS, Tefera E, Tinsley E, Blackman MR, Groah S

BACKGROUND: Spinal cord injury (SCI) triggers an 'accelerated aging' process that may include development of hypogonadism, even among younger men with SCI; however, few studies have investigated the prevalence or etiology of hypogonadism in men with SCI. Young men with SCI are also at increased risk for developing metabolic dysfunction after injury, which may be exacerbated by concomitant testosterone (T) deficiency, thus identifying the prevalence and risk factors for T deficiency in men with SCI is important for their long-term health. OBJECTIVE: To investigate the prevalence, risk factors, and etiology of T deficiency (hypogonadism) in otherwise healthy men with chronic, motor complete SCI. DESIGN: Secondary cross-sectional analysis. SETTING: Rehabilitation research centers in Washington, DC, and Miami, Florida, USA. PARTICIPANTS: Men (n=58) aged 18-45 with chronic (>/=1 year), motor complete SCI without co-morbidities or use of testosterone therapy. METHODS: Plasma concentrations of hormones were measured using standardized assays. Body composition was assessed with DXA scan. MAIN OUTCOME MEASUREMENTS: Serum total testosterone and calculated free T. RESULTS: T deficiency was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI vs 6.7%, non-SCI, P<.001). The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat. The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI. CONCLUSIONS: Hypogonadism is more common in young men with SCI than in similarly-aged men without SCI, suggesting that SCI should be identified as a risk factor for T deficiency and that routine screening for hypogonadism should be performed in the SCI population.