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PSA Test and Hypogonadism

Can a test used to screen for prostate cancer be used to confirm hypogonadism in men with sexual dysfunction? It’s possible, according to new research published in the Journal of Sexual Medicine in July 2013.

What is Hypogonadism?

Hypogonadism occurs when a man’s body doesn’t produce enough – or any - testosterone. The problem may stem from a problem with the testes, which produce the hormone. Or, it may result from problems in the brain, specifically the hypothalamus or pituitary gland, both of which play a role in testosterone production.

Testosterone is important to men’s health. It has a huge effect on sex drive and is involved with erectile function. It gives men their secondary sex characteristics, like facial hair and a deeper voice. It’s also involved with sperm production, strength, and muscle mass.

When men have hypogonadism, they often feel weaker, fatigued, and moody. Their sex drive decreases and they may have trouble getting erections. Their testicles may get smaller; their breasts may get larger. Low testosterone levels also put them at higher risk for osteoporosis.

It’s natural for men’s testosterone levels to gradually decline as they age. Testosterone therapy may help, but should be done under a doctor’s care.

What is the PSA Test?

PSA stands for prostate-specific antigen. Produced by the prostate gland, PSA is a protein that helps liquefy semen. The PSA test is a common, though controversial, screening tool for prostate cancer. A PSA reading above 4.0 ng/mL usually prompts more screening. However, such readings do not always indicate cancer.

What is the connection between PSA and Hypogonadism?

In this study, Italian researchers were interested in late onset hypogonadism. They noted that past research on the relationship between PSA and testosterone levels was “controversial” and set out to investigate whether PSA could be a useful marker for low testosterone in men with sexual problems.

Their study involved almost 3,000 men seeking treatment for sexual dysfunction. None of the men had had prostate disease before the study. Men with PSA levels above 4 ng/mL were excluded. The participants ranged in age from 18 to 85 years (mean age 52.5).

In addition to taking a variety of measurements, such as waist circumference, total testosterone, testis volume, blood pressure, and HDL cholesterol, the researchers interviewed the men and had them complete questionnaires designed to assess hypogonadism.

The researchers found that after adjusting for age, lower PSA levels were linked to conditions associated with hypogonadism, including delayed puberty, lower testis volume, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Men with lower PSA levels were also more likely to have problems with erections.

While these results did show that low PSA might help confirm a hypogonadism diagnosis, the study authors said the efficacy of PSA testing for this purpose was “modest.”

They explained that the relationship between PSA levels and testosterone was more evident when men’s testosterone levels were below average. The link was not as strong for men with normal testosterone levels. In the research, PSA levels did not rise when testosterone readings were above 8 nmol/L.

Also, the findings were more accurate in younger patients. When men are over a certain age, other factors are more likely to affect PSA. In these cases, using PSA to confirm hypogonadism could be less reliable.

With these points in mind, however, PSA testing could still help clinicians evaluate symptoms of hypogonadism in men with sexual dysfunction.

Resources

International Society for Sexual Medicine

“Serum PSA and Testosterone Levels”

(September 2013)

http://www.issm.info/news/sex-health-headlines/serum-psa-and-testosterone-levels

The Journal of Sexual Medicine

Rastrelli, Giulia, MD, et al.

“Serum PSA as a Predictor of Testosterone Deficiency”

(Full-text. First published online: July 16, 2013)

http://onlinelibrary.wiley.com/doi/10.1111/jsm.12266/abstract

National Cancer Institute

“Prostate-Specific Antigen (PSA) Test”

http://www.cancer.gov/cancertopics/factsheet/detection/PSA

Sexual Medicine Society of North America

“Conditions – Low Testosterone”

http://www.sexhealthmatters.org/low-testosterone/conditions-low-testosterone

“Diagnosing Low Testosterone”

http://www.sexhealthmatters.org/low-testosterone/diagnosing-low-testosterone

“Overview – Low Testosterone”

http://www.sexhealthmatters.org/low-testosterone/overview-low-testosterone

“Prostate Cancer – PSA Test Revisited”

(November 11, 2011)

http://www.sexhealthmatters.org/sex-health-blog/prostate-cancer-psa-test-revisited