[en] BACKGROUND: The measurement of bioavailable testosterone (BT) or free testosterone (FT) levels is currently considered the gold standard for the diagnosis of androgen deficiency in elderly men. While the impact of age on circulating testosterone levels (total, bioavailable and free) has been strongly documented, the existence of seasonal variations in testosterone levels remains debated. OBJECTIVE: We investigated whether seasonal variations in serum calculated free testosterone (cFT) levels may translate into variations in the prevalence of low testosterone levels. Diagnosis was on the basis of biochemical determinations and was cross-checked with the prevalence of clinical signs and symptoms of 'andropause', as assessed by the Androgen Deficiency in Aging Males (ADAM) questionnaire. METHODS: The study recruited 5028 men aged 50 years and over from September 2000 to January 2003. Their serum FT levels were assessed and they completed the French ADAM test. Men were considered eugonadal when cFT was > or =70 ng/l. The ADAM test was scored as described originally. The prevalence of 'andropause', diagnosed by the two methods, was compared throughout the year, on a month by month basis. RESULTS: The percentage of subjects with cFT levels below 70 ng/l increased significantly with age (P<0.001). Serum cFT levels (mean [SD]) varied significantly with the month of sampling (P<0.0001), the highest (88.1 [30.2] ng/l) and lowest (76.9 [28.0] ng/l) mean values occurring in April and in October, respectively. Conversely, the prevalence of testosterone deficiency (cFT<70 ng/l) reached a peak in October (45.7%) and a nadir in April (29.7%). Although the prevalence of 'andropause', based on the ADAM questionnaire, increased significantly with age (P<0.0001), no influence of the month of the year was noticed. CONCLUSIONS: Our results confirm a progressive age-related decline in FT levels. The monthly variations in serum FT values, observed throughout the year, do not show a major seasonal rhythm in elderly community-dwelling males, since the magnitude of the variations (<15%) remains marginal. This slight variation may, however, have an impact on the number of elderly men diagnosed with Partial Androgen Deficiency in Aging Males (PADAM).
G. Abbaticchio, M. de Fini, V.A. Giagulli, G. Santoro, G. Vendola, and R. Giorgino Circannual rhythms in reproductive function of human males, correlations among hormones and hormone-dependent parameters Andrologia 19 1987 353 361
A.-M. Andersson, E. Carlsen, J.H. Petersen, and N.E. Skakkebaek Variation in levels of serum inhibin B testosterone, estradiol, luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin in monthly samples from healthy men during a 17-month period: possible effects of seasons J. Clin. Endocrinol. Metab. 88 2003 932 937
H.W.G. Baker, H.G. Burger, D.M. de Krestser, B. Hudson, S. O'Connor, C. Wang, A. Mirovics, J. Court, M. Dunlop, and G.C. Rennie Changes in the pituitary-testicular system with age Clin. Endocrinol. 5 1976 349 372
D.G. Blazer, R.C. Kessler, and M.S. Swartz Epidemiology of recurrent major and minor depression with a seasonal pattern. The National Comorbidity Survey Br. J. Psychiatr. 172 1998 164 167
J.L. Carroll, D.J. Ellis, and D.H. Bagley Age-related changes in hormones in impotent men Urology 26 1990 42 46
J.M. Dabbs Age and seasonal variation in serum testosterone concentration among men Chronobiol. Int. 7 1990 245 249
M. Delhez, M. Hansenne, F. Luyckx, and J.-J. Legros Que penser d'un test ADAM positif en l'absence d'hypogonadisme? Ann. Endocrinol. 62 2001 177
M. Delhez, M. Hansenne, and J.-J. Legros Andropause and psychopathology: minor symptoms rather than pathological ones Psychoneuroendocrinology 28 2002 863 874
J.P. Deslypere, and A. Vermeulen Leydig cell function in normal men: effect of age life-style, residence, diet, and activity J. Clin. Endocrinol. Metab. 59 1984 955 962
H.A. Feldman, C. Longcope, C.A. Derby, C.B. Johannes, A.B. Araujo, A.D. Coviello, W.J. Bremner, and J.B. McKinlay Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the massachusetts male aging study J. Clin. Endocrinol. Metab. 87 2002 589 598
A. Gray, H.A. Feldman, J.B. McKinlay, and C. Longcope Age, disease, and changing sex hormone levels in middle-aged men: results of the massachusetts male aging study J. Clin. Endocrinol. Metab. 73 1991 1016 1025
S.M. Harman, E.J. Metter, J.D. Tobin, J. Pearson, and M.R. Blackman Longitudinal effects of aging on serum total and free testosterone levels in healthy men J. Clin. Endocrinol. Metab. 86 2001 724 731
M.G. Harmatz, A.D. Well, C.E. Overtree, K.Y. Kawamura, M. Rosal, and I.S. Ockene Seasonal variation of depression and other moods: a longitudinal approach J. Biol. Rhythms. 15 2000 344 350
S.G. Korenman, J.E. Morley, A.D. Mooradian, S.S. Davis, F.E. Kaiser, A.J. Silver, S.P. Viosca, and D. Garza Secondary hypogonadism in older men: its relation to impotence J. Clin. Endocrinol. Metab. 71 1990 963 969
J.-J. Legros, and M. Delhez Détection de la déficience androgénique chez l'homme de plus de 50 ans: utilisation d'une version française du test ADAM Med. Hyg. 60 2002 1490 1495
M. Maes, K. Mommen, D. Hendrickx, D. Peeters, P. D'Hondt, R. Ranjan, F. De Meyer, and S. Scharpé Components of biological variation, including seasonality, in blood concentrations of TSH, TT3, FT4, PRL, cortisol and testosterone in healthy volunteers Clin. Endocrinol. 46 1997 587 598
R.D. McClure Endocrine evaluation and therapy of erectile dysfunction Urol. Clin. North Am. 15 1988 53 64
M.C. Meriggiola, E.A. Noonan, C.A. Paulsen, and W.J. Bremner Annual patterns of luteinizing hormone, follicle stimulating hormone, testosterone and inhibin in normal men Hum. Reprod. 11 1996 248 252
A. Morales, J.P. Heaton, and C.C. Carson 3 rd Andropause: a misnomer for a true clinical entity J. Urol. 163 2000 705 712
G. Morken, S. Lilleeng, and O.M. Linaker Seasonal variation in suicides and in admissions to hospital for mania and depression J. Affective Disord. 69 2002 39 45
J.E. Morley, F.E. Kaiser, H.M. Perry III, P. Patrick, P.M.K. Morley, P.M. Stauber, B. Vellas, R.N. Baumgartner, and P.J. Garry Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men Metabolism 46 1997 410 413
J.E. Morley, E. Charlton, P. Patrick, F.E. Kaiser, P. Cadeau, D. McCready, and H.M. Perry III Validation of a screening questionnaire for androgen deficiency in aging males Metabolism 49 2000 1239 1242
H.R. Nankin, and J.H. Calkins Decreased bioavailable testosterone in aging normal and impotent men J. Clin. Endocrinol. Metab. 63 1986 1418 1420
G.Y. Nicolau, D. Lakatua, L. Sackett-Lundeen, and E. Haus Circadian and circannual rhythms of hormonal variables in elderly men and women Chronobiol. Int. 1 1984 301 319
G.Y. Nicolau, E. Haus, D.J. Lakatua, C. Bogdan, L. Sackett-Lundeen, M. Popescu, H. Berg, E. Petrescu, and E. Robu Circadian and circannual variations of FSH, LH, testosterone, dehydroepiandrosterone-sulfate (DHEA-S) and 17-hydroxy progesterone (17 OH-Prog) in elderly men and women Rev. Roum. Méd.-Endocrinol. 23 1985 223 246
H.M. Perry III, D.K. Miller, P. Patrick, and J.E. Morley Testosterone and leptin in older african-american men: relationship to age, strength, function, and season Metabolism 49 2000 1085 1091
A.G.H. Smals, P.W.C. Kloppenborg, and Th.J. Benraad Circannual cycle in plasma testosterone levels in man J. Clin. Endocrinol. Metab. 42 1976 979 982
D.I. Spratt, L.S.T. O'Dea, D. Schoenfeld, J. Butler, P.N. Rao, and W.F. Crowley Jr Neuroendocrine-gonadal axis in men: frequent sampling of LH, FSH and testosterone Am. J. Physiol. 254 1988 E658 E666
J. Svartberg, R. Jorde, J. Sundsfjord, K.H. Bønaa, and E. Barrett-Connor Seasonal variation of testosterone and waist to hip ratio in men: The Tromsø Study J. Clin. Endocrinol. Metab. 88 2003 3099 3104
R.S. Tan Andropause: introducing the concept of 'relative hypogonadism' in aging males Int. J. Impot. Res. 14 2002 319
R.S. Tan, and S.-J. Pu Is it andropause? Recognizing androgen deficiency in aging men Postgrad. Med. 115 2004 62 66
A. Tancredi, J.-Y. Reginster, F. Schleich, G. Pire, P. Maassen, F. Luyckx, and J.-J. Legros Interest of the androgen deficiency in aging males (adam) questionnaire for the identification of hypogonadism in elderly community-dwelling male volunteers Eur. J. Endocrino. 151 2004 355 360
J.S. Tenover, A.M. Matsumoto, D.K. Clifton, and W.J. Bremner Age-related alterations in the circadian rhythms of pulsatile luteinizing hormone and testosterone secretion in healthy men J. Gerontol. 43 1988 M163 M169
B.E. Thalen, B.F. Kjellman, L. Morkrid, and L. Wetterberg Seasonal and non-seasonal depression. A comparison of clinical characteristics in Swedish patients Eur. Arch. Psychiatr. Clin. Neurosci. 245 1995 101 108
A. Vermeulen Clinical review 24 - androgens in the aging male J. Clin. Endocrinol. Metab. 73 1991 221 224
A. Vermeulen Commentary. Androgen replacement therapy in the aging male-a critical evaluation J. Clin. Endocrinol. Metab. 86 2001 2380 2390
A. Vermeulen, S. Goemaere, and J.M. Kaufman Testosterone, body composition and aging J. Endocrinol. Invest. 22 1999 110 116
A. Vermeulen, L. Verdonck, and J.M. Kaufman A critical evaluation of simple methods for the estimation of free testosterone in serum J. Clin. Endocrilnol. Metab. 84 1999 3666 3672
B. Zumoff, G.W. Strain, J. Kream, J. O'Connor, R.S. Rosenfeld, J. Levin, and D.K. Fukushima Age variation of the 24-hour mean plasma concentrations of androgens, estrogens, and gonadotropins in normal adult men J. Clin. Endocrinol. Metab. 54 1982 534 538
