Relevance. Androgen deficiency is a pervasive problem in the older male population and is thought to be responsible for many symptoms once considered to be the result of normal aging. Numerous methods have been proposed to facilitate the detection of men at risk for androgen deficiency. [2].
Currently, in the scientific literature and clinical practice, there is growing interest in the problem of testosterone deficiency in women and its solution, unfortunately, is still far from the final resolution and the formation of a general consensus. [1]. In 2001, the Princeton consensus on androgen deficiency coined the term female androgen insufficiency to describe the clinical manifestations of androgen deficiency in women, which was defined as a set of clinical symptoms in the presence of a decrease in bioavailable testosterone and normal estrogen levels. [2].
Professor S. Y. Kalinchenko in his review [4] agrees with the opinions of world experts, and offers a solution to the methodological problems of correct measurement of testosterone concentration in women (as in men) by wider introduction into clinical practice of the most accurate method for determining the levels of steroid hormones in the blood — chromatography-mass spectrometry [3, 5].
Aim - to study clinical and diagnostic value of the questionnaire for determining testosterone deficiency in women of fertile age.
Materials and methods. We evaluated 60 women with deficiency of testosterone without other associated pathology. Mean age of patients was 28,3 years-old. Control group constituted by 20 healthy women with different age. The patients were divided by BMI into 3 groups:
Group 1 - 20 women with pre-obesity
Group 2 - 20 women-with grade I obesity
Group 3 - 20 women with grade II obesity.
The control group consisted of 20 women of the same age without menstrual disorders and with a normal body weight.
All patients underwent clinical and biochemical evaluations including endocrine check, lipids profile, hormonal profile in 14 day of menstrual cycle (LH, FSH, prolactin, free testosterone, estradiol, progesterone, etc), genitalia ultrasonography, height (sm), weight (kg), BMI, waist circumference (WC), hip circumference (HC), waist-hip ratio, questioning and other studies. We used the questionnaire, which proposed by Professor S. Y. Kalinchenko.
Results. Testosterone measurements were performed using the Beckman Access II platform assay (Beckman Coulter, Fullterton, CA, USA). Only testosterone levels that were drawn on the day that the questionnaires were completed were used in our analysis.
Direct correlation of testosterone deficiency with the degree of obesity. Thus, the lowest values of testosterone were found in patients of group 3 (< 0.05 nmol/l) (with a norm of 0.31-3.78 nmol, l), while in patients of groups 1 and 2, testosterone levels were also significantly reduced-from 0, 1 to 0, 2 nmol/l and from 0, 05 to 0, 1 nmol/l, respectively
The questionnaire consists of 17 questions, each of which has 5 possible answers: none ( 1 point), weak (2 points), moderate (3 points), pronounced (4 points), very pronounced (5 points).
We found a direct correlation between the severity of the questionnaire scores in groups of patients with the degree of testosterone deficiency. The highest scores on the androdeficiency questionnaire in women were found in patients of group 3 - 85 points, while in groups 1 and 2, the scores on the questionnaire were lower : 34 points and 51 points.
Although these initial results have been promising, some aspects of the questionnaire should be explored more thoroughly. In particular, future study will be conducted to evaluate the ability of the questionnaire to monitor response to treatment over time. Further work to define the sensitivity and specificity of the questionnaire using a larger group of patients will also be needed.
Conclusions. The questionnaire offers a useful alternative to existing tools for screening and assessing hypogonadism. Unlike most other commonly used questionnaires, it provides results that may be quantified and, thus, more easily followed over time. We have shown that the questionnaire correlates well with several existing screening tools, as well as with serum testosterone levels. In light of these results, we believe that questionnaire may be implemented safely and effectively.
List of references
- O Mohamed,1 R E Freundlich,1 H K Dakik,1 E D Grober,2 B Najari,3 L I Lipshultz,1 and M Khera1,*The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism//Int J Impot Res. 2010 Jan; 22(1): 20–24. Published online 2009 Aug 6. doi: 10.1038/ijir.2009.35
- Chueh KS, Huang SP, Lee YC, et al. The comparison of the aging male symptoms (AMS) scale and androgen deficiency in the aging male (ADAM) questionnaire to detect androgen deficiency in middle-aged men. J Androl. 2012;33:817–823.
- Rabah DM, Arafa MA. Validation of an Arabic ADAM questionnaire for androgen deficiency screening in the Arab community. Aging Male. 2009;12:95–99.
- Калинченко С.Ю., Тюзиков И.А., Тишова Ю.А., Ворслов Л.О. Роль тестостерона в женском организме. //Общая и возрастная эндокринология тестостерона у женщин. Номер: 14 (115) Год: 2015 Страницы: 59-64
- С.Ю. Калинченко, Аркадий Верткин. Приобретенный возрастной дефицит андрогенов. Конспект врача. //Международный Эндокринологический журнал 2(4) 2006, стр. 28-33