Year : 2015  |  Volume : 17  |  Issue : 2  |  Page : 236-238

Late-onset hypogonadism: beyond testosterone

1 Department of Medicine and Centre for Human Reproduction Pathology, University of Padova, Padova 35128, Italy
2 Department of Medical and Pediatric Sciences, Section of Endocrinology, Andrology and Internal Medicine, University of Catania, Catania 95123, Italy
3 Department of Experimental Medicine, Section of Medical Pathophysiology and Endocrinology, Sapienza University of Rome, Rome 00185, Italy

Correspondence Address:
Carlo Foresta
Department of Medicine and Centre for Human Reproduction Pathology, University of Padova, Padova 35128
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1008-682X.135985

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Late-onset hypogonadism is defined as a combination of low testosterone (T) levels and typical symptoms and signs. A major area of uncertainty is whether T concentrations are always really sufficient to fully reflect Leydig cell (dys)function. Mild testicular alteration could be diagnosed only by additional biochemical markers, such as luteinizing hormone (LH) and 25-hydroxyvitamin D levels. These markers help in identifying the so-called "subclinical" hypogonadism (normal T, high LH levels). Patients with hypogonadism have frequently low levels of 25-hydroxyvitamin D due to impairment of the hydroxylating enzyme CYP2R1 in the testis. However, no data have been published dealing with the best treatment option (cholecalciferol - the Vitamin D precursor, or calcidiol - 25-hydroxylated form of Vitamin D) in these patients. We studied 66 patients with classic hypogonadism (total T [TT] <12 nmol l−1 , LH ≥ 8 IU l−1 ) (n = 26) and subclinical hypogonadism (TT ≥ 12 nmol l−1 , LH ≥ 8 IU l−1 ) (n = 40) and low 25-hydroxyvitamin D (<50 nmol l−1 ). Subjects received cholecalciferol (5000 IU per week) (n = 20) or calcidiol (4000 IU per week) (n = 46), and 25-hydroxyvitamin D and parathyroid hormone (PTH) were evaluated after 3 months of therapy. Supplementation with calcidiol significantly increased 25-hydroxyvitamin D and significantly decreased PTH levels in both groups of men with hypogonadism (primary, n = 16 and subclinical, n = 30), whereas supplementation with cholecalciferol did not modify their levels. This study shows for the first time that the administration of the 25-hydroxylated form of Vitamin D (calcidiol), and not the administration of the precursor cholecalciferol, restores 25-hydroxyvitamin D levels in subjects with hypogonadism.

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