Article

We reported previously that young men with chronic spinal cord injury
(SCI) have a greater prevalence of testosterone deficiency compared with an
age-matched, healthy control population. Young men with SCI also are at increased
risk for developing cardiometabolic dysfunction after injury. It is unclear
whether testosterone deficiency is associated with heightened cardiometabolic
risk in men with SCI. OBJECTIVE: To investigate associations among levels of
testosterone in young men with chronic SCI and surrogate markers of
cardiometabolic risk. DESIGN: Secondary cross-sectional analysis. SETTING:
Rehabilitation research centers in Washington, DC, and Miami, Florida.
PARTICIPANTS: Men (n = 58) aged 18-45 years with chronic (>/=1 year), motor
complete SCI without comorbidities or use of testosterone therapy. METHODS:
Plasma concentrations of testosterone, lipids, inflammatory markers (C-reactive
protein and interleukin-6), percent hemoglobin A1c, glucose, and insulin were
measured in a fasting state using standard assays. A 2-hour oral glucose
tolerance test and Framingham Risk Score were assessed for each subject. Body
composition was assessed by dual X-ray absorptiometry scan. MAIN OUTCOME
MEASUREMENTS: Surrogate markers of cardiometabolic risk among men based on the
level of total testosterone (TT; 500 ng/dL) and free
testosterone (fT; 9 ng/dL). Comparisons were made between men with
normal and low TT or fT. RESULTS: Framingham Risk Score was significantly greater
in men with low fT (P < .05). Percent body fat (P < .05) and waist-to-hip ratio
(P < .05) but not body mass index (P > .08), were greater in men with low TT or
low fT. Men with low TT or low fT had lower high-density lipoprotein cholesterol
levels (P < .05) without differences in fasting triglycerides (P > .1) or
low-density lipoprotein cholesterol (P > .07). Men with low TT had greater levels
of inflammatory markers C-reactive protein (P < .05) and interleukin-6 (P < .05).
Men with low TT or low fT had greater fasting glucose (P < .05) and greater
insulin resistance (P < .04), without differences in percent hemoglobin A1c (P >
.8). CONCLUSIONS: In young men with chronic SCI who undergo an accelerated aging
process postinjury, hypogonadism is associated with an unfavorable
cardiometabolic risk profile. Further research is needed to determine whether a
causal relationship exists between hypogonadism and heightened cardiometabolic
risk in men with SCI and whether routine screening for testosterone deficiency is
warranted in this population. LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS