INTERNATIONAL JOURNAL OF SCIENTIFIC & TECHNOLOGY RESEARCH VOLUME 2, ISSUE 5, MAY 2013 ISSN 2277-8616 310 IJSTR©2013 www.ijstr.org Primary Hypogonadism In Ghanaian Men With Type 2 Diabetes Mellitus H. Asare-Anane, E.K. Ofori, F.A.Yeboah, E.A. Tagoe, S.B. Bani, A.T. Bawah, R.O Ateko Abstract-Emerging evidence links insulin resistance, a key feature in type 2 diabetes with decreased leydig cell secretion of testosterone. Low gonadal steroids, which include testosterone, dihydrotestosterone and estradiol have also been implicated with metabolic abnormalities such as hyperglycemia, hypertension and cardiovascular risk. The aim of this study was to investigate hypogonadism and its risk factors in Ghanaian men with type 2 diabetes. Two hundred and ten volunteers were used for this study. Total testosterone, Sex hormone binding globulin, prolactin, fasting blood glucose, glycated hemoglobin, total cholesterol, triglyceride, luteinizing hormone, follicle stimulating hormone, estradiol, blood pressure and body mass index were assessed. A questionnaire to assess androgen deficiency was administered to each consenting participant. Total testosterone levels were lower in diabetic men compared with non-diabetic men (10.8 ± 5.0 vs 15.6 ± 3.9, p=0.0001). There was no significant change in follicle stimulating hormone, prolactin, sex hormone binding globulin and estradiol between controls and type 2 diabetics. However, luteinizing hormone was significantly higher in diabetics than non-diabetics (5.4±2.0 vs 4.5±1.5 p≤0.0003). Total testosterone levels were inversely related to BMI (R 2 =3.94, p=0.04), FBG (R 2 =6.492, p=0.0008) and TG (R 2 =31.41, p=0.025). The low testosterone observed in this study was a case of primary hypogonadism. Keywords- Diabetes, Estradiol, Glycated hemoglobin, Hypogonadism, Insulin, Obesity, Prolactin, —————————— ? —————————— INTRODUCTION Male hypogonadism is a clinical condition resulting from testicular failure to produce adequate testosterone levels (1, 2). Testosterone is the primary male sex hormone that is vital for sustaining proper erectile function and libido. It is also critically involved in building muscle, burning fat, and supporting endothelial function, energy level, mood, immune function, red blood cell production and bone density (3). The hypothalamic-pituitary-gonadal axis is responsible for the regulation and maintenance of testosterone levels. The hypothalamus releases gonadotropin-releasing hormone, which stimulates the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In the testes, LH stimulates Leydig cells to release testosterone and Total testosterone comprises free testosterone (2-3%) and testosterone bound to either sex hormone binding globulin (SHBG) (60-80%) or albumin (20-40%) (6,11). Low testosterone levels have been associated with diabetes, dyslipidaemia and hypertension (7-9). This study was aimed at investigating the cause of hypogonadism in Ghanaian men with type 2 diabetes. There is no established data on Ghanaian men with type 2 diabetes who are hypogonal. Data on this research would be a useful tool for the management of hypogonadism in male diabetics. POPULATION, STUDY DESIGN AND METHODS This was a case control study involving a total of 105 type 2 diabetic male and 105 healthy controls between 30 and 60 years. The study was carried out at the National Diabetes Management and Research Center, Korle-Bu Teaching Hospital Accra, Ghana. The hospital serves as a referral hospital for the country. Participants gave their consent and also answered a questionnaire which provided information on their family history of diabetes, reproductive, socio-demographic, anthropomorphic and other medical conditions. The University of Ghana Medical School Ethical and Protocol Review Committee reviewed the consenting process. Participants fasting blood (10mls) samples were drawn between 08.00am and 10.00 a.m. for all assays. Three milliliters (3mls) of whole blood was transferred into ethylene diamine tetra-acetic acid (EDTA) and 2ml of blood into sodium fluoride containing tubes for the estimation of glycated hemoglobin and glucose respectively. The remaining five milliliters (5mls) of whole blood was then put into serum separator tubes and centrifuged after which serum was aliquoted in 1ml portions into a sterile plain tube and stored at -20 ?C until required for use. Serum total testosterone (TT), Sex hormone binding globulin (SHBG), estradiol (E 2 ), luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL) were determined by ___________________________ Author H. Asare-Anane Senior Lecturer, Department of Chemical Pathology, University of Ghana Medical School, P.O. Box 4236 Accra, Ghana Cell.: +233 246024002 Email: henryasare-anane.gh@hotmail.com Co-authors ? R.O Ateko: Department of Chemical Pathology, University of Ghana Medical School, Accra, Ghana. ? F.A Yeboah: Department of Chemical Pathology, University of Ghana Medical School, Accra, Ghana. ? A.T. Bawah : Ministry of Health, Mamprobi Polyclinic Accra, Ghana ? E.K. Ofori: Department of Chemical Pathology, Central Laboratory, Korle-Bu Teaching Hospital, Accra, Ghana. ? S.B. Bani: Chemical Pathology Laboratory, Tamale Teaching Hospital, Ghana ? E.A. Tagoe: Department of Biochemistry, University of Ghana Medical School, Accra, Ghana.
