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Testicular Volume in Relation to Hormonal Indices of Gonadal Function in Community-Dwelling Elderly Men

Department of Internal Medicine, Endocrinology Section (A.M.M., Y.E.-G., I.V.P., F.H.C., J.M.K.), and Unit for Osteoporosis and Metabolic Bone Diseases (S.G.), Ghent University Hospital, B-9000, Ghent, Belgium; and Andrology Department (Y.E.-G.), Faculty of Medicine, Alexandria University, Alexandria, Egypt 21544

Address all correspondence and requests for reprints to: Dr. Jean-Marc Kaufman, Ghent University Hospital, Department of Internal Medicine, Section Endocrinology, De Pintelaan 185 B-9000, Ghent, Belgium. E-mail: jean.kaufman{at}rug.ac.be.

Aging is accompanied by involutional changes in testicular function; limited data suggest a decrease in bilateral testicular volume (BTV). We studied BTV by ultrasonography in relation to serum gonadal hormones in 115 healthy elderly men (median age, 78 yr) and 42 young men (median age, 26.5 yr). Elderly men had a clearly smaller BTV (mean, 20.6 vs. 29.7 ml; P < 0.001), whereas serum inhibin B was slightly but significantly decreased (mean, 176.8 vs. 212.8 ng/liter; P = 0.04); lower values in the elderly were observed for bioavailable (Bio) testosterone (T), Bio 17ß-estradiol, inhibin B/FSH (mean, 18 vs. 58 ng/mU; P < 0.001), and T/LH ratios. In the elderly and the young, respectively, BTV was associated with inhibin B (r = 0.53, P < 0.001; r = 0.41, P < 0.01), FSH (r = -0.53, P < 0.001; r = -0.48, P < 0.01), and inhibin B/FSH ratio. Only in the old men was BTV significantly associated with LH (r = -0.32; P < 0.001), Bio T (r = 0.26; P < 0.01), and T/LH (r = 0.48; P < 0.001). In a multivariate analysis, FSH, inhibin B, and Bio T were independently associated with BTV in the elderly (R² = 0.34). Receiver operating characteristics curve analysis indicated that BTV at a criterion value of 14.3 ml had a sensitivity of 46% and a specificity of 79% to predict low serum Bio T levels in the elderly. In conclusion, the moderately decreased BTV observed in elderly men, strongly associated with a decrease of the inhibin B/FSH ratio, is consistent with a reduced Sertoli cell mass, compensated by increased FSH stimulation resulting in only limited decrease of Sertoli cell function. Finding of a low testicular volume in elderly men can contribute to the diagnosis of hypogonadism, but this criterion has low sensitivity to detect decreased T production.

This work was supported by Grant G0058-97 of the Fonds voor Wetenschappelijk Onderzoek Vlaanderen. I.V.P. is a research fellow for the Fund for Scientific Research (Fonds Voor Wetenschappelijk Onderzoek Vlaanderen).

Parts of this work were presented at the 84th Annual Meeting of The Endocrine Society, San Francisco, CA, 2002 (Abstract P3-310) and the Third World Congress on the Aging Male, Berlin, Germany, 2002.

Abbreviations: Bio, Bioavailable; CI, confidence interval; E2, 17ß- estradiol; ROC, receiver operating characteristics; T, testosterone.

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