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Hypogonadism, Quadriceps Weakness, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease

Respiratory Rehabilitation and Respiratory Division, University Hospital Gasthuisberg; Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences; and Laboratories of Pneumology, Experimental Immunology, and Experimental Medicine and Endocrinology (LEGENDO), Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium

Correspondence and requests for reprints should be addressed to Marc Decramer, Ph.D., M.D., Respiratory Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium. E-mail address: marc.decramer{at}uz.kuleuven.ac.be

Rationale: Circulating levels of testosterone and gonadotrophins of patients with chronic obstructive pulmonary disease (COPD) have never been compared with those of elderly men with normal pulmonary function. Moreover, the relationship of hypogonadism with quadriceps muscle weakness and exercise intolerance has been studied scarcely in men with COPD.

Objectives: To compare circulating levels of hormones of the pituitary–gonadotrophic axis of men with COPD with those of age-matched control subjects. Moreover, to study the relationship of hypogonadism with quadriceps muscle force, 6-min walking distance, and systemic markers of inflammation in the patients.

Methods and Measurements: Circulating levels of follicle-stimulating hormone, luteinizing hormone, testosterone, and sex homone–binding globulin were determined, and free testosterone was calculated in 78 patients (FEV₁: 44 ± 17% of the predicted values) and 21 control subjects. Moreover, quadriceps muscle force, 6-min walking distance, number of pack-yr, and systemic inflammation were determined.

Main Results: Follicle-stimulating hormone and luteinizing hormone were higher in the patients, whereas testosterone was lower (p 0.05). The latter finding was also present in 48 non–steroid-using patients with normal blood gases. Low androgen status was significantly related to quadriceps muscle weakness (r = 0.48) and C-reactive protein (r = –0.39) in the patients, but not to exercise intolerance, the number of pack-yr, or increased circulating levels of interleukin 8 or soluble receptors of tumor necrosis factor .

Conclusions: In contrast to exercise intolerance, quadriceps muscle weakness is related to low circulating levels of testosterone in men with COPD.

Key Words: follicle-stimulating hormone • luteinizing hormone • quadriceps muscle strength • sex hormone–binding globulin • testosterone

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