Male hypogonadism in patients on maintenance hemodiafiltration: prevalence and therapeutic effect.

Hypogonadism was identified in nearly half of men undergoing maintenance hemodiafiltration.

• 59 out of 121 patients (48.7%) were diagnosed with hypogonadism.
• Hypogonadism was defined by two consecutive measurements of serum total testosterone levels.
• The study enrolled adult men from four dialysis centers in a cross-sectional design.
• Free testosterone was calculated based on serum albumin and sex hormone-binding globulin.

Patients with hypogonadism were significantly older than those without hypogonadism.

• Mean age in hypogonadal patients was 62 ± 15 years versus 57 ± 15 years in non-hypogonadal patients (p < 0.001).
• Age was the only demographic feature that significantly distinguished hypogonadal from non-hypogonadal patients.
• No other significant differences were observed in demographic, clinical, or laboratory features between the two groups.

Patients with hypogonadism had significantly higher prolactin levels compared to those without hypogonadism.

• Median prolactin levels were 22 [13–36] ng/mL in hypogonadal patients versus 14 [10–18] ng/mL in non-hypogonadal patients (p = 0.002).
• Elevated prolactin was one of only two distinguishing characteristics identified between the groups.
• No other laboratory markers were significantly different between hypogonadal and non-hypogonadal patients.

Testosterone supplementation improved androgen deficiency symptoms in the majority of treated patients.

• Among 16 patients who received testosterone supplementation, 66.7% showed improvement in ADAM scores.
• The median ADAM score decreased from 3 (2–4) before treatment to 1 (0–2) after treatment (p = 0.003).
• Symptoms were evaluated using the Androgen Deficiency in Aging Males (ADAM) questionnaire.

Androgen deficiency symptoms were assessed using the ADAM questionnaire across the study population.

• The ADAM questionnaire was used to evaluate symptoms of androgen deficiency in all enrolled patients.
• Symptoms of hypogonadism were used alongside biochemical measurements to characterize the patient population.
• The ADAM score served as the primary outcome measure for assessing response to testosterone supplementation.

The authors concluded that routine assessment of testosterone levels should be considered for all men undergoing dialysis.

• Aside from older age, no other distinguishing characteristics were identified to predict which patients would be hypogonadal.
• Testosterone deficiency in dialysis patients is associated with adverse clinical outcomes including cardiovascular disease, protein energy wasting, and infection complications.
• The authors noted that further studies are needed to determine whether hormone supplementation can improve clinical outcomes beyond symptom relief.