# Hypogonadism and associated factors among male Leprosy patients

## TL;DR

This study found that nearly 27% of male leprosy patients had hypogonadism, with overweight and grade-II disability as key risk factors.

## Contribution

The study identifies specific risk factors for hypogonadism in male leprosy patients in Ethiopia.

## Key findings

- 26.7% of male leprosy patients had hypogonadism, with 87.2% being primary hypogonadism.
- Overweight and grade-II disability were independent risk factors for hypogonadism.
- Testosterone levels were inversely correlated with BMI, LH, and FSH.

## Abstract

Leprosy affects various organs in addition to skin, eyes, and peripheral nerves. Testicular involvement in leprosy patients is common and causes disturbance in endocrine function of the testis and results in hypogonadism. Hypogonadism is frequently undiagnosed and underreported.

This study aimed to assess hypogonadism and associated factors among leprosy patients at Alert Comprehensive Specialized Hospital, Ethiopia.

A cross-sectional study design was used in which consecutive 146 male leprosy patients aged between 18 to 65 years attending outpatient follow-up at leprosy outpatient clinic were included. Data was gathered both from patient charts and through patients’ interviews. Androgen deficiency symptoms were assessed by androgen deficiency in the aging male questionnaire, and 5ml of blood samples were taken from study participants and serum total testosterone, LH, and FSH were analyzed by Electrochemiluminescence method. Statistical correlation was assessed by Spearman correlation. A multivariable binary logistic regression model was used to identify the independent factors associated with hypogonadism and P-value <0.05 was used to declare statistical significance.

The prevalence of hypogonadism was 39 (26.7%). Out of this, 34 (87.2%) had primary hypogonadism, whereas 5 (12.8%) had secondary hypogonadism. Total testosterone was inversely correlated with Body mass index (r = -0.37, p = 0.002), Luteinizing hormone (r = -0.43, p <0.001), and Follicular stimulating hormone (r = -0.42, p< 0.001). However, Total testosterone was not significantly correlated with age (r = -0.019, p = 0.81). BMI [AOR = 1.32, 95%CI (1.16–1.51)] and grade-II disability [AOR = 3.80, 95%CI (1.23–11.64)] were identified as independent risk factors for hypogonadism.

Nearly one-fourth of male leprosy patients had hypogonadism. Overweight and grade-II disability were independent risk factors for hypogonadism.

Leprosy affects various organs in addition to skin, eyes and peripheral nerves. Testicular involvement in leprosy patients is common and causes disturbance in endocrine function of the testis and results in hypogonadism.

Mycobacterium leprae reach the testicles through skin tissue invasion, blood or the lymphatic system, and the testes can serve as a reservoir for Mycobacterium leprae. A lower testicular temperature than internal body temperature may promote M. leprae growth in the testicle. It causes thickening and constriction of vessels, interstitial fibrosis, hyalinization and obliteration of seminiferous tubules and Leydig cells. These cause low testosterone productions among leprosy patients.

The prevalence and risk factors of hypogonadism among male leprosy patients vary in different settings. In this study area the prevalence of hypogonadism was 26.7%. Overweight and grade-II disability were identified as independent risk factors for hypogonadism.