Proportion of Hypogonadism in Transfusion-Dependent Thalassemia Patients and Its Contributing Factors
Abstract
Background: Beta thalassemia is a lifelong disease involving malformed red blood cells (RBC). One of the disease’s complications is hypogonadism, in which adults tend to exhibit regression in sexual characteristics, experience sexual dysfunction, and therefore have a lower quality of life. Around 3-10% of the Indonesian population carries the beta-thalassemia gene. This study aimed to see the proportions of hypogonadism in transfusion-dependent thalassemia patients and its contributing factors. Methods: This is a cross-sectional study involving 60 male patients admitted to three Indonesian general hospitals from July 2022 to July 2023. All patients were diagnosed with beta-thalassemia via chromatography hemoglobin analysis. We performed a single-time physical examination and laboratory examinations to determine FSH, LH, and free testosterone levels. The correlation between Hb and sexual hormone levels was analyzed using Spearman’s rank correlation coefficient. ROC curve analysis was conducted afterward. All statistical analysis was done in SPSS version 29. Results: 31 out of 60 thalassemia patients had hypogonadism. Pre-transfusion Hb count was found to be linearly correlated with FSH (r = 0.388, p = 0.049), LH (r = 0.338, p = 0.008), and free testosterone (r = 0.255, p = 0.049). ROC analysis indicated that pre-transfusion Hb was viable as a predictor for hypogonadism (AUC = 0.655, 65.5% sensitivity, 67.7% specificity). Conclusion: We confirmed the role of pre-transfusion Hb count as a potential predictor for hypogonadism due to the tissue hypoxia mechanism and transfusion-related iron overload in TDT patients. Decreased Hb is linearly correlated with FSH, LH, and testosterone levels. Decreased Hb also downregulates these factors.
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References
Wahidiyat PA, Sari TT, Rahmartani LD, et al. Thalassemia in Indonesia. Hemoglobin. 2022;46(1):39–44.
Srisukh S, Ongphiphadhanakul B, Bunnag P. Endocrinology hypogonadism in thalassemia major patients. J Clin Transl Endocrinol. 2016;5:42–5.
Alassaf A, Michael A, Emanuele A, et al. 4th Ed 2021 Guidelines for the management of transfusion-dependent thalassemia (TDT). Thalassemia International Federation. 2021;1–351.
Machogu EM, Machado RF. How I treat hypoxia in adults with hemoglobinopathies and hemolytic disorders. Blood. 2018;132:1770–80.
Albu A, Barbu CG, Antonie L, Vladareanu F, Fica S. Risk factors associated with hypogonadism in β -thalassemia major patients: predictors for a frequent complication of a rare disease. Postgrad Med. 2014;126:121–7.
Balzer BWR, Garden FL, Amatoury M, et al. Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes. Journal of Pediatric Endocrinology and Metabolism. 2019;32:569–76.
Albu AI, Albu D. Hypogonadism in female patients with beta-thalassemia major. In: Al-Zwaini IJ, editor. Thalassemia and other hemolytic anemias. IntechOpen; 2018:59–76.
Chowdhury R, Iktidar MA, Ahmed MN, et al. Prevalence of hypogonadism in transfusion-dependent β-thalassemia patients of Bangladesh: investigating the role of serum ferritin level as a diagnostic tool. Hematol Transfus Cell Ther. 2022;1–8.
Borgna-Pignatti C, Gamberini M. Complications of thalassemia major and their treatment. Expert Rev Hematol. 2011;4:353–66.
Wanchaitanawong W, Tantiworawit A, Piriyakhuntorn P, et al. The association between pre-transfusion hemoglobin levels and thalassemia complications. Hematology (United Kingdom). 2021;26:1–8.
Yadav J, Bansal D. The high prevalence of endocrinopathies in patients with thalassemia major redraws attention to basic rules of pretransfusion hemoglobin and serum ferritin. Indian J Ped. Springer; 2022;89:964–5.
Roy C, Snyder PJ, Stephens-Shields A, Artz A, Bhasin S, Cohen H. Association of testosterone levels with anemia in older men: a controlled clinical trial. JAMA Intern Med. 2017;177:480.
Shin YS, You JH, Cha JS, Park JK. The relationship between serum total testosterone and free testosterone levels with serum hemoglobin and hematocrit levels: a study in 1221 men. Aging Male. 2016;19:209–14.
B K. The critical hemoglobin value in the therapy of chronic anemia. Beitr Infusionsther. 1992;30:27.
Carson JL, Stanworth SJ, Roubinian N, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database of Systematic Reviews. 2016;1-18.
Debevec T, Millet G, Pialoux V. Hypoxia-induced oxidative stress modulation with physical activity. J Clin Transl Endocrinol. 2016;5:42–5.
Fernandes Negris Lima T, Nackeeran S, Rakitina E, et al. Association of leptin with total and free testosterone: Results from the National Health and Nutrition Examination Surveys. Androgens. 2020;1(1):94–100.
Genchi VA, Rossi E, Lauriola C, et al. Adipose tissue dysfunction and obesity-related male hypogonadism. Int J Mol Sci. MDPI; 2022;23:1-15.
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