Hypogonadotropic Hypogonadism in Diabesity: Pathogenic Factors and Therapeutic Implications.

Hypogonadotropic hypogonadism (HH) was found to occur in 33% male patients with type 2 diabetes. 1 These patients had low total and free testosterone concentrations with inappropriately low or normal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) concentrations. Since the occurrence of hypogonadism was not related to either HbA1c or the duration of diabetes but to body mass index (BMI), a study in nondiabetic obese patients was carried out, which revealed a prevalence of HH in 25%. 2 Thus, this is the commonest cause of hypogonadism in the community. These observations have added * 18 million hypogonadal patients in the United States alone, based on the prevalence of type 2 diabetes and obesity. In a study comparing type 1 and type 2 diabetic patients, it was shown that the occurrence of HH was confined to type 2 diabetes. 3 Since these observations were made in middle aged to older populations, a study in obese young males between 14 and 20 years of age was conducted. 4 These patients were found to have similar prevalence of HH as reflected in the total and free testosterone, LH, and FSH concentrations.