Prevalence and Etiology of Hypogonadism in Young Men with Chronic Spinal Cord Injury: A Cross-Sectional Analysis from Two University-Based Rehabilitation Centers

PM R, 2017 · DOI: 10.1016/j.pmrj.2016.11.005 · Published: August 1, 2017

Spinal Cord Injury Endocrinology Rehabilitation

Simple Explanation

Spinal cord injury (SCI) can lead to accelerated aging, potentially causing hypogonadism (testosterone deficiency) even in young men. This study investigates how common this is in men with SCI. The study found that hypogonadism is more prevalent in young men with SCI compared to those without, suggesting SCI as a risk factor and advocating for routine screening. The research also explored factors contributing to hypogonadism in men with SCI, such as injury severity, body fat, and hormone levels, to understand the underlying causes.

Study Duration

2008-2013

Participants

58 men aged 18-45 with chronic (≥1 year), motor complete SCI

Evidence Level

Cross-sectional analysis

Key Findings

1
Hypogonadism was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI vs 6.7%, non-SCI, P<.001).
2
The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat.
3
The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI.

Research Summary

This study investigated the prevalence and etiology of hypogonadism in young men with chronic SCI, finding a significantly higher prevalence compared to non-SCI men. Risk factors identified include more extensive injuries (tetraplegia), higher body fat percentage, and lower SHBG values. Central suppression of the HPT axis may be a common cause. The authors conclude that SCI should be considered a risk factor for T deficiency, recommending routine screening in this population to address potential long-term health consequences.

Practical Implications

Clinical Screening

Routine screening for hypogonadism should be performed in young men with SCI to identify and manage testosterone deficiency.

Risk Factor Awareness

SCI should be recognized as a significant risk factor for the development of male hypogonadism, particularly with tetraplegia.

Further Research

Further investigations are needed to determine the extent to which T deficiency contributes to the accelerated aging process and increased cardiovascular disease risk in men with SCI.

Study Limitations

1
Small sample size (n=58)
2
Single measurements of serum testosterone and gonadotropin levels
3
Lack of detailed physical exam or history to assess potential physical manifestations of low T

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