Correlation of the Serum Testosterone Level with Insulin Resistance and Metabolic Syndrome in Patients of Erectile Dysfunction and Benign Prostatic Hyperplasia

Seo-Yeon Lee; Sae-Chul Kim

doi:10.4111/kju.2008.49.6.556

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Lee and Kim: Correlation of the Serum Testosterone Level with Insulin Resistance and Metabolic Syndrome in Patients of Erectile Dysfunction and Benign Prostatic Hyperplasia

Original Article

Korean J Urol 2008;49(6):556-561.

Published online: 21 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.6.556

Correlation of the Serum Testosterone Level with Insulin Resistance and Metabolic Syndrome in Patients of Erectile Dysfunction and Benign Prostatic Hyperplasia

Seo-Yeon Lee, Sae-Chul Kim

Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea

Received 19 February 2008 Accepted 21 April 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Testosterone deficiency has recently captured attention as a possible risk factor for metabolic syndrome. This study was conducted to investigate a correlation of the serum testosterone level with insulin resistance (IR) and metabolic syndrome (MS).

Materials and Methods

The metabolic risk factors, the blood pressure, the waist circumference and the fasting serum levels of glucose, triglyceride and high density lipoprotein cholesterol were measured for a total of 215 patients (mean age; 61.04±0.54 years) with erectile dysfunction (ED) or/and symptomatic benign prostatic hyperplasia (BPH). The serum total testosterone and insulin were measured at the same time, and the free testosterone, bioavailable testosterone and IR were calculated.

Results

The prevalence of MS and the number of associated MS risk factors were significantly higher in the insulin resistance group (IRG) than in the insulin sensitive group (ISG). The serum testosterone level significantly decreased with more risk factors. The IRG showed a significantly lower level of serum testosterone than the patients with ED and the total patients.

Conclusions

The negative correlation of a decrease in the serum testosterone level with IR and MS suggests that late onset hypogonadism might be a risk factor of MS.

Keywords: Metabolic syndrome, Insulin resistance, Testosterone

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Table 1.

Patient characteristics

	ED (n=41)	BPH＋ED (n=72)	BPH (n=102)	Total (n=215)
Age (years)	59.22±1.26	63.71±0.77	61.50±0.76	61.80±0.54
Testosterone
Total (ng/ml)	4.93±0.21	4.30±0.16	4.95±0.15	4.73±0.10
Free (ng/dl)	7.66±0.32	6.40±0.26	6.86±0.26	6.86±0.16
Bioavailable (ng/ml)	1.79±0.07	1.48±0.06	1.59±0.06	1.59±0.38
Metabolic syndrome risk factor
TG (mg/dl)	146.79±0.21	112.97±7.05	102.76±6.10	114.28±4.53
HDL (mg/dl)	47.41±1.28	47.37±1.39	51.48±1.11	49.33±0.75
FBS (mg/dl)	113.17±6.28	114.28±3.45	100.63±1.00	107.63±1.78
sBP (mmHg)	121.95±1.30	125.80±1.47	124.19±1.26	124.30±0.81
dBP (mmHg)	81.58±1.16	83.62±1.15	82.51±0.82	82.70±0.59
Waist (cm)	90.92±1.29	89.46±0.71	88.23±0.72	89.18±0.49
TC (mg/dl)	193.20±5.21	180.36±4.12	192.45±3.32	188.54±2.34
LDL (mg/dl)	115.02±4.84	108.07±3.11	114.58±2.72	112.48±1.90

ED: erectile dysfunction, BPH: benign prostatic hyperplasia, TG: triglyceride, HDL: high desity lipoprotein, FBS: fasting blood sugar, sBP: systolic blood pressure, dBP: diastolic blood pressure, Waist: waist circumference, TC: total cholesterol, LDL: low density lipoprotein

Table 2.

The relationship between insulin resistance and metabolic syndrome

		Metabolic syndrome		Total
		Yes	No	Total
Insulin resistance	Yes	27	21	48
	No	38	122	160
Total		65	143	208∗

p＜0.01, ∗: seven cases were excluded because homeostasis model assessment-insulin resistances (HOMA-IRs) were not available.

Table 3.

Comparison of the serum total, free, and bioavailable testosterone between the insulin resistant and sensitive groups

	Insulin resistance (＋)	Insulin resistance (−)	p-value
Total patients group^∗	(n=48)	(n=160)
Total testosterone	4.31±0.18	4.86±0.12	0.022
Free testosterone	6.53±0.31	7.00±0.19	NS
Bioavailable testosterone	1.52±0.08	1.61±0.04	NS
ED patients group	(n=14)	(n=25)
Total testosterone	4.43±0.32	5.24±0.27	NS
Free testosterone	6.50±0.56	8.34±1.71	0.005
Bioavailable testosterone	1.58±0.52	1.92±0.07	0.020
ED＋BPH patient group	(n=16)	(n=55)
Total testosterone	3.98±0.28	4.38±0.20	NS
Free testosterone	6.16±0.38	6.47±0.31	NS
Bioavailable testosterone	1.38±0.09	1.50±0.07	NS
BPH patient group	(n=18)	(n=80)
Total testosterone	4.50±0.31	5.07±0.17	NS
Free testosterone	6.87±0.63	6.96±0.28	NS
Bioavailable testosterone	1.60±0.15	1.60±0.06	NS

^∗ seven cases (ED: 2 cases, ED＋BPH: 1 case, BPH: 4 cases) were excluded because homeostasis model assessment-insulin resistances (HOMA-IRs) were not available. ED: erectile dysfunction, BPH: benign prostatic hyperplasia, NS: not significant

Table 4.

Correlation of the serum total, free and bioavailable testosterone with insulin resistance

HOMA-IR	Total testosterone	Free testosterone	Bioavailable testosterone
Total
r	−0.21	−0.14	−0.13
p-value	0.001	0.023	0.036
ED
r	−0.31	−0.62	−0.58
p-value	0.030	＜0.001	＜0.001
ED＋BPH
r	−0.18	−0.06	−0.07
p-value	NS	NS	NS
BPH
r	−0.23	−0.07	−0.06
p-value	0.012	NS	NS

NS: not significant, ED: erectile dysfunction, BPH: benign prostatic hyperplasia, HOMA-IR: homeostasis model assessment-insulin resistance, r: Pearson correlation coefficient

Table 5.

Correlation of the serum total, free and bioavailable testosterone with the number of metabolic syndrome risk factors

No. of risk factors of metabolic syndrome	Total testosterone	Free testosterone	Bioavailable testosterone
Total patients group
r	−0.24	−0.02	0.01
p-value	0.001	NS	NS
ED patients group
r	−0.23	−0.46	−0.384
p-value	NS	0.017	NS
ED＋BPH patient group
r	−0.026	−0.007	0.076
p-value	NS	NS	NS
BPH patient group
r	−0.143	−0.013	0.002
p-value	NS	NS	NS

NS: not significant, ED: erectile dysfunction, BPH: benign prostatic hyperplasia, r: Pearson correlation coefficient

Table 6.

Correlation of the serum total, free and bioavailable testosterone with each risk factor

	Total testosterone	Free testosterone	Bioavailable testosterone
Waist
r	−0.11	0.01	0.03
p-value	NS	NS	NS
sBP
r	−0.003	−0.01	0.03
p-value	NS	NS	NS
dBP
r	−0.15	−0.1	−0.11
p-value	NS	NS	NS
TG
r	0.03	−0.02	−0.03
p-value	NS	NS	NS
HDL
r	0.1	−0.05	-0.03
p-value	NS	NS	NS
TC
r	−0.09	0.01	0.02
p-value	NS	NS	NS
LDL
r	0.11	0.03	0.03
p-value	NS	NS	NS
FBS
r	−0.17	−0.23	−0.18
p-value	0.026	0.004	0.020

ED: erectile dysfunction, BPH: benign prostatic hyperplasia, NS: not significant, Waist: waist circumference, sBP: systolic blood pressure, dBP: diastolic blood pressure, TG: triglyceride, HDL: high desity lipoprotein, TC: total cholesterol, LDL: low density lipoprotein, FBS: fasting blood sugar, r: Pearson correlation coefficient

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