Journal
MULTIPLE SCLEROSIS JOURNAL
Volume 20, Issue 12, Pages 1584-1592Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/1352458514527864
Keywords
Body mass index; cognition; cognitive impairment; disability; hormones; hypogonadism; leptin; multiple sclerosis; testosterone
Categories
Funding
- National Multiple Sclerosis Society [RG-4256A4/2]
- National Multiple Sclerosis Society/American Brain Foundation [FAN 1761-A-1]
- Harvard Catalyst/The Harvard Clinical and Translational Science Center
- National Center for Research Resources
- National Center for Advancing Translational Sciences, National Institutes of Health (NIH) [8UL1TR000170-05]
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Background: Gonadal steroids may modulate disease course in multiple sclerosis (MS). Objective: To assess the prevalence and clinical associations of hypogonadism in men with MS. Methods: Male patients, aged 18-65 years, with relapsing remitting MS (RRMS) or clinically-isolated syndrome (CIS) and their first symptom < 10 years prior were selected from a longitudinal clinical study. We measured their hormones in stored morning blood samples, and collected their Expanded Disability Status Scale (EDSS) scores every 6 months and their Symbol Digit Modalities Test (SDMT) results annually. Results: Our analysis included 96 men with a mean age of 40 years, EDSS of 1.1 and disease duration of 4.6 years. Of these men, 39% were hypogonadal (total testosterone < 288 ng/dL); none showed compensatory elevations in luteinizing hormone. Their low testosterone levels and testosterone:estradiol ratios were negatively correlated with body mass index (BMI) and leptin, and showed no correlation with 25-hydroxy-vitamin D levels. In our primary cross-sectional analyses, there was a negative age-adjusted correlation between total testosterone and EDSS (p = 0.044). In the age-adjusted longitudinal analyses, higher baseline testosterone levels were associated with less decline in SDMT (p = 0.012). Conclusions: Men with MS may experience hypogonadotropic hypogonadism. Low testosterone levels may be associated with worse clinical outcomes. A potential neuroprotective role for testosterone warrants further investigation.
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