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Relationship Between Gonadal Function and Cardiometabolic Risk in Young Men with Chronic Spinal Cord Injury

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  • English
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    Details:

    • Alternative Title:
      PM R
    • Personal Author:
    • Description:
      Background

      We previously reported that young men with chronic spinal cord injury (SCI) have a higher prevalence of testosterone deficiency when compared to an age-matched healthy control population. Young men with SCI are also at increased risk for developing cardiometabolic dysfunction after injury. It is unclear whether or not testosterone deficiency is associated with heightened cardiometabolic risk in men with SCI.

      Objective

      To investigate associations among levels of testosterone in young men with chronic SCI and surrogate markers of cardiometabolic risk.

      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 comorbidities or use of testosterone therapy.

      Methods

      Plasma concentrations of testosterone, lipids, inflammatory markers (CRP and IL-6), HbA1C%, glucose, and insulin were measured in a fasting state using standard assays. A two-hour oral glucose tolerance test (OGTT) and Framingham Risk Score (FRS) were assessed for each subject. Body composition was assessed by DXA scan.

      Main Outcome Measurements

      Surrogate markers of cardiometabolic risk among men based on the level of total testosterone (TT)(≤300, 301–500, or >500 ng/dL) and free testosterone (fT) (≤9 or >9 ng/dL). Comparisons were made between men with normal and low TT or fT.

      Results

      FRS was significantly higher in men with low fT (P<.05). Percent body fat (P<.05) and waist-to-hip ratio (P<.05), but not body mass index (BMI) (P>.08), were higher in men with low TT or low fT. Men with low TT or low fT had lower high density lipoprotein cholesterol (HDL) levels (P<.05) without differences in fasting triglycerides (P>.1) or low density lipoprotein cholesterol (LDL) (P>.07). Men with low TT had higher levels of inflammatory markers CRP (P<.05) and IL-6 (P<.05). Men with low TT or low fT had higher fasting glucose (P<.05) and greater insulin resistance (P<.04), without differences in HbA1C% (P>.8).

      Conclusions

      In young men with chronic SCI, who undergo an accelerated aging process post-injury, hypogonadism is associated with an unfavorable cardiometabolic risk profile. Further research is needed to determine if a causal relationship exists between hypogonadism and heightened cardiometabolic risk in men with SCI, and whether routine screening for testosterone deficiency is warranted in this population.

    • Subjects:
    • Source:
      PM R. 10(4):373-381
    • Pubmed ID:
      28827206
    • Pubmed Central ID:
      PMC5817036
    • Document Type:
      Journal Article
    • Funding:
      R04 DD323280/DD/NCBDD CDC HHSUnited States/
    • Collection(s):
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