Compensated Hypogonadism

A group of Italian researchers feel that compensated (subclinical) hypogonadism should be not considered a new clinical entity, according to a recent report in The Journal of Sexual Medicine.

Compensated hypogonadism occurs when men have normal levels of testosterone, but higher levels of luteinizing hormone (LH), a substance that stimulates the production of testosterone.

It has been suggested that compensated hypogonadism be considered a clinical subgroup of late-onset hypogonadism. In this study, the researchers looked at the relationship between compensated hypogonadism and characteristics of men with sexual dysfunction. They also investigated possible connections to major adverse cardiovascular events (MACEs).

Over 4,100 heterosexual men participated. The researchers evaluated their hypogonadism status and erectile function using two structured interview assessments. The men were asked about their sexual intercourse frequency and their experiences with premature or delayed ejaculation. They also underwent a psychological evaluation.

Each participant had a full physical examination as well, which included measurements of LH and total testosterone.

Criteria from the European Male Ageing study were used to determine gonadal status. Men were categorized as having compensated hypogonadism if their testosterone levels were greater than or equal to 10.5 nmol/liter and their LH levels were less than 9.4 U/liter.

About three quarters of the men were considered eugonadal. Almost 20% had overt hypogonadism. Just over 4% fell into the compensated hypogonadism category. The mean age across the three groups was about 55 years.

After adjusting for confounding factors, the researchers discovered sexual issues were not associated with compensated hypogonadism. Cases of erectile dysfunction, hypoactive sexual desire, and delayed ejaculation were more common among the men with overt hypogonadism and less common in the eugonadal men.

However, the men with compensated hypogonadism did have more psychiatric symptoms (particularly somatized anxiety and obsessive-compulsive symptoms) when compared to men in the eugonadal and overt hypogonadal groups, a finding that surprised the researchers.

Also, men in the compensated and overt hypogonadal groups were at higher risk for cardiovascular events than the men in the eugonadal group.

Overall, the authors concluded that compensated hypogonadism was not a “genuine clinical entity” but rather a milder form of overt hypogonadism.

“Boosting the [testosterone] level to suppress LH compensatory activity is, at present, not advisable in clinical practice,” they added.

They suggested that compensated hypogonadism could be “a normal response of the hypothalamus-pituitary-testis axis to somatic illness” and that future research could explore this idea further.


The Journal of Sexual Medicine

Corona, Giovanni, PhD, MD, et al.
“Characteristics of Compensated Hypogonadism in Patients with Sexual Dysfunction”
(Full-text. First published online: April 29, 2014)