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Cited by 40

The DOI matches its Crossref record; 10 of the 10 references it cites were found in a registry or an index.

Reversible male hypogonadotropic hypogonadism due to energy deficit

Wong, Henry K., Hoermann, Rudolf, Grossmann, Mathis·2019·Clinical Endocrinology
DOI 10.1111/cen.13973
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Abstract

Summary: Context: Calorie restriction and overtraining are increasingly seen in young men who suffer from increasing societal pressure to attain a perceived ideal male body image. The resulting energy deficit can lead to multiple endocrine consequences, including suppression of the male gonadal axis. Design: We reviewed the literature, including two unpublished cases. Results: We identified 23 cases, aged median (range) 20 years (16‐33), with a body mass index of 15.9 kg/m 2 (12.5‐20.5). Total testosterone was 3.0 nmol/L (0.6‐21.3), and luteinizing hormone (LH) 1.2 mIU/L (<0.2‐7.5), with 91% of cases demonstrating hypogonadotropic hypogonadism. Associated findings included evidence of growth hormone resistance (increased growth hormone in 57% and low insulin‐like growth factor‐1 in 71%), hypercortisolaemia (50%) and a nonthyroidal illness picture (67%). In cases with longitudinal measurements following weight regain, serum testosterone (n = 14) increased from median [interquartile range] 3.2 nmol/L [1.9‐5.1] to 14.3 nmol/L [9.3‐21.2] (P < 0.001), and LH (n = 8) from 1.2 IU/L [0.8‐1.8] to 3.5 IU/L [3.3‐4.3] (P = 0.008). Conclusions: Hypogonadotropic hypogonadism can occur in the context of energy deprivation in young otherwise healthy men and may be underrecognized. The evidence suggests that gonadal axis suppression and associated hormonal abnormalities represent an adaptive response to increased physiological stress and total body energy deficit. The pathophysiology likely involves hypothalamic suppression due to dysregulation of leptin, ghrelin and pro‐inflammatory cytokines. The gonadal axis suppression is functional, because it can be reversible with weight gain. Treatment should focus on reversing the existing energy deficit to achieve a healthy body weight, including psychiatric input where required.

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Metadata

Authors
Wong, H. K., Hoermann, R., & Grossmann, M.
Affiliations
  • Department of Endocrinology Austin Health Heidelberg Victoria Australia
  • Department of Medicine Austin Health University of Melbourne Heidelberg Victoria Australia
ORCID
Grossmann, Mathis
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2019-04-11
Volume
91
Issue
1
Pages
3-9
ISSN
  • 0300-0664
  • 1365-2265
DOI
10.1111/cen.13973
Cited by
40
References
10
Language
en
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)

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