Background: High rates of serum testosterone deficiency have been reported in men with Chronic Spinal Cord Injury (SCI). Several studies have been conducted investigating the differences between Hypogonadal (HG) and Eugonadal (EG) SCI individuals. However, due to small sample sizes and heterogeneity in study design, it’s difficult to draw significant conclusions. Aim: To provide an overview of factors associated with low testosterone in adult males with SCI. Methods: A systematic literature review using the databases MEDLINE, Scopus, and Web of Science was conducted using the search words “Testosterone AND Spinal Cord Injury” and the filter “humans”. Of the 257 articles assessed 12 met all the inclusion criteria for this review. Among these 12 articles, six were clinical trials and six were cross-sectional studies. In each of the studies included subjects were divided between HG and EG based on serum Total Testosterone (TT) levels. Of the 653 individuals included, 224 had TT values compatible with HG and 429 with EG. Among the 132 variables measured by the studies included, 56 were shared between more than one study and were suitable for combining. Continuous variables were analyzed performing Welsh t-statistics. Categorical variables were analyzed performing Chi-squared test. Results: Significant differences between HG and EG SCI subjects were found for 28 of the 56 variables analyzed. The most significant findings were: - HG and EG populations did not differ significantly in terms of level and grade of injury. - The HG population was significantly older than the EG population - EG individuals practiced significantly more Leisure Time Physical Activity and had higher levels of Sex Hormone Binding Globulin. - HG individuals had significantly higher BMI, Body Fat %, Total Cholesterol, Triglycerides, hepatic enzymes (AST, ALT, GGT, AP), Fasting glucose, Fasting insulin and HbA1c. Conclusions: Hypogonadism is common in SCI individuals. HG subjects showed on average less favorable body compositions and metabolic profiles. Leisure Time Physical activity was the variable by which HG and EG individuals differed the most. Further research is necessary to investigate the relationship between testosterone levels and metabolic alterations in men with chronic SCI.
Background: Negli uomini con lesione cronica del midollo spinale (SCI) si riscontra frequentemente carenza di testosterone sierico, che definisce un quadro di ipogonadismo. In letteratura sono presenti diversi studi che hanno indagato le differenze tra individui con lesioni spinali ipogonadici (HG) ed eugonadici (EG), ma le conclusioni di questi studi sono limitate dal campione ristretto e dall’eterogeneità del protocollo di studio. Obiettivo: Individuare i fattori associati a bassi livelli di testosterone nei maschi adulti con lesione del midollo spinale in fase cronica. Metodi: È stata condotta una revisione sistematica della letteratura attraverso la ricerca dei termini "Testosterone AND Spinal Cord Injury" con filtro "humans" all’interno dei database MEDLINE, Scopus e Web of Science. Dei 257 articoli valutati, 12 rispettavano tutti i criteri di inclusione di questa revisione. Sei di questi articoli riguardavano trials clinici e sei riguardavano studi trasversali. In ciascuno degli studi inclusi in questa revisione i pazienti erano divisi tra ipogonadici (HG) ed eugonadici (EG) in base ai livelli di Testosterone Totale sierico (TT). Dei 653 individui inclusi, 224 avevano valori di TT compatibili con un quadro di HG e 429 di EG. Delle 132 variabili misurate dagli studi inclusi, 56 erano presenti in più di 1 studio e quindi comparabili. Le variabili continue sono state analizzate tramite Welch t-statistics. Le variabili categoriche sono state analizzate tramite Chi-squared-test. Risultati: Sono emerse differenze significative per 28 delle 56 variabili analizzate. I risultati più significativi sono stati: - Le popolazioni HG ed EG osservate non differivano in modo significativo per livello neurologico e completezza della lesione. - Le popolazioni HG ed EG differivano significativamente per età (HG>EG); - Gli individui EG praticavano più attività fisica nel tempo libero e avevano livelli più elevati di globuline legante gli ormoni sessuali; - Gli individui HG avevano indici di massa corporea (BMI), % di grasso corporeo, colesterolo totale, trigliceridi, enzimi epatici (AST, ALT, GGT, FA), glucosio a digiuno, insulina a digiuno ed emoglobina glicata (HbA1c) significativamente più alti. Conclusioni: L'ipogonadismo è comune negli individui con lesioni spinali. I soggetti HG mostrano composizioni corporee e profili metabolici meno favorevoli rispetto a quelli EG. La quantità di attività fisica praticata nel tempo libero è la variabile in base alla quale gli individui HG ed EG differiscono maggiormente. Ulteriori studi sono necessari per indagare la relazione fra bassi livelli di testosterone e alterazioni metaboliche nei soggetti affetti da lesione cronica spinale.
TESTOSTERONE IN MEN WITH CHRONIC SPINAL CORD INJURY:RESULTS OF A SYSTEMATIC REVIEW
MALGRATI, TULLIO
2020/2021
Abstract
Background: High rates of serum testosterone deficiency have been reported in men with Chronic Spinal Cord Injury (SCI). Several studies have been conducted investigating the differences between Hypogonadal (HG) and Eugonadal (EG) SCI individuals. However, due to small sample sizes and heterogeneity in study design, it’s difficult to draw significant conclusions. Aim: To provide an overview of factors associated with low testosterone in adult males with SCI. Methods: A systematic literature review using the databases MEDLINE, Scopus, and Web of Science was conducted using the search words “Testosterone AND Spinal Cord Injury” and the filter “humans”. Of the 257 articles assessed 12 met all the inclusion criteria for this review. Among these 12 articles, six were clinical trials and six were cross-sectional studies. In each of the studies included subjects were divided between HG and EG based on serum Total Testosterone (TT) levels. Of the 653 individuals included, 224 had TT values compatible with HG and 429 with EG. Among the 132 variables measured by the studies included, 56 were shared between more than one study and were suitable for combining. Continuous variables were analyzed performing Welsh t-statistics. Categorical variables were analyzed performing Chi-squared test. Results: Significant differences between HG and EG SCI subjects were found for 28 of the 56 variables analyzed. The most significant findings were: - HG and EG populations did not differ significantly in terms of level and grade of injury. - The HG population was significantly older than the EG population - EG individuals practiced significantly more Leisure Time Physical Activity and had higher levels of Sex Hormone Binding Globulin. - HG individuals had significantly higher BMI, Body Fat %, Total Cholesterol, Triglycerides, hepatic enzymes (AST, ALT, GGT, AP), Fasting glucose, Fasting insulin and HbA1c. Conclusions: Hypogonadism is common in SCI individuals. HG subjects showed on average less favorable body compositions and metabolic profiles. Leisure Time Physical activity was the variable by which HG and EG individuals differed the most. Further research is necessary to investigate the relationship between testosterone levels and metabolic alterations in men with chronic SCI.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/13132