Total Testosterone and Calculated Estimates for Free and Bioavailable Testosterone: Influence of Age and Body Mass Index and Establishment of Sex-Specific Reference Ranges

T. Deutschbein; K. Mann; S. Petersenn

doi:10.1055/s-0034-1395569

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2015; 47(11): 846-854
DOI: 10.1055/s-0034-1395569

Endocrine Care

Total Testosterone and Calculated Estimates for Free and Bioavailable Testosterone: Influence of Age and Body Mass Index and Establishment of Sex-Specific Reference Ranges

T. Deutschbein

¹Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany

,

K. Mann

²Department of Endocrinology and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

,

S. Petersenn

³ENDOC Center for Endocrine Tumors, Hamburg, Germany

› Author Affiliations

Abstract

Measurement of sex steroids is required to evaluate gonadal function, but normative data are lacking (especially for estimates of physiologically active testosterone). Using modern immunoassays, this study established sex-specific reference ranges (2.5% and 97.5% percentiles) for total testosterone (TOT), bioactive testosterone _Vermeulen (BTV), free androgen index (FAI), free testosterone _Sartorius (FTS), free testosterone _Vermeulen (FTV), and sex hormone binding globulin (SHBG). In the comparative study, subjects were grouped by age (18–30; 31–50; >50 years), BMI (<25; 25–30; >30 kg/m²), and sex. Study participants were selected in such a way that each group comprised 12 subjects (e. g., 12 males between 18 and 30 years with a BMI of <25 kg/m², and so on), resulting in a total of 216 controls (108 males, 108 females; age: 40.3±1.0; BMI: 27.8±0.4). Multiple stepwise regression analyses were performed (covariates: age, BMI, sex), and sex-specific reference ranges were applied to 50 males (age: 46.1±2.3; BMI: 27.4±0.7) with suspected hypogonadism. Regression analysis identified the strongest predictor of each parameter apart from sex, resulting in age-specific (males: FAI, SHBG, BTV, FTV; females: TOT, FTS, SHBG), BMI-specific (males: TOT, FTS; females: FAI, BTV, FTV) and overall cutoffs for both sexes. In male patients, overall agreement between the results derived from the estimates (i. e., BTV, FTS, FTV) was high (with discordant results in only 4%). In summary, if both the endocrine workup and the clinical presentation were taken into account, the newly established reference ranges allowed reliable identification of hypogonadal males.

Key words

hyperandrogenemia - hypogonadism - impaired fertility - lower limit of normal - multiple stepwise regression analysis - polycystic ovary syndrome - upper limit of normal

Full Text

References

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