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This version published online on November 9, 2004
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-0970
A more recent version of this article appeared on February 1, 2005
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Submitted on May 21, 2004
Accepted on November 3, 2004

The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study

David E. Laaksonen, Leo Niskanen, Kari Punnonen, Kristiina Nyyssönen*, Tomi-Pekka Tuomainen, Veli-Pekka Valkonen, and Jukka T. Salonen

Departments of Medicine (D.E.L., L.N.), and Clinical Chemistry (K.P.), Kuopio University Hospital, Kuopio, Finland; Research Institute of Public Health (K.N., T.-P.T., V.-P.V., J.T.S.), Departments of Physiology (D.E.L.) and Public Health and General Practice (J.T.S.), University of Kuopio, Kuopio, Finland; and Oy Jurilab Ltd. (J.T.S.), Kuopio, Finland

* To whom correspondence should be addressed.
Kristiina Nyyssönen, E-mail: Kristiina.Nyyssonen{at}uku.fi

In men, hypoandrogenism is associated with features of the metabolic syndrome. It is not known whether men with the metabolic syndrome are at a higher risk of developing hypogonadism. We therefore assessed whether the metabolic syndrome predicts development of hypogonadism 11 yr later in 651 middle-aged Finnish men participating in a population-based cohort study. Men with the metabolic syndrome at baseline as defined by the World Health Organization (n = 114, 20%) had a 2.6-fold increased risk of developing hypogonadism as defined by total testosterone levels < 11 nmol/l at the 11-year follow up independently of age, smoking and other potential confounders. Further adjustment for body mass index (OR 2.0, 95% CI 1.1 - 3.8) or baseline total testosterone levels (OR 1.9, 95% CI 1.0 - 3.4) attenuated the association. The association of the metabolic syndrome with hypogonadism as defined by calculated free testosterone levels < 225 pmol/l was similar, but weaker. The adjusted decrease in testosterone concentrations during the 11-year follow up was also greater in men with than without the metabolic syndrome. Smokers had a nonsignificantly lower risk of developing hypogonadism during follow up, whereas a decrease in smoking increased the risk of hypogonadism. The metabolic syndrome predisposes to development of hypogonadism in middle-aged men. Prevention of abdominal obesity and the accompanying metabolic syndrome in middle age may decrease the risk of hypogonadism in men, especially in those who quit smoking.
Key words: metabolic syndrome • abdominal obesity • insulin resistance • smoking • testosterone • sex-hormone binding globulin • hypogonadism




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