Hypotestosteronemia in chronically critically ill men

Objective: To determine the prevalence of hypotestosteronemia in chronicall y critically ill (CCI) men. Design: Prevalence survey. Setting: Step-down respiratory care unit (RCU) at a tertiary care teaching hospital. Patients: Thirty ventilator-dependent CGI men transferred from intensive ca re units (ICUs) within the same institution. Interventions: None. Measurements and Main Results: Total testosterone and bioavailable testoste rone (bioT) concentrations were measured within 48 hrs of RCU admission. Pa tients were hospitalized a median of 40 days (range, 9-185 days) before RCU admission, with a median ICU length of stay of 25 days (range, 9-177 days) . At RCU admission, total testosterone concentrations averaged 104 +/- 96 n g/dL, with average bioT concentrations of 19 +/- 20 ng/dL (16 +/- 9% of tot al testosterone). Twenty-nine of the 30 patients (95%) had bioT concentrati ons well below the lower limit of normal for their age range. bioT concentr ations, expressed as a percentage of the normal mean for each patient's age range, were positively correlated with the number of days that the patient was in the ICU before transfer to the RCU (n = 30, r(2) = .17, p = .025). However, if the single patient who remained in the ICU for 177 days was exc luded, this correlation disappeared (n = 29, r(2) = .07, p = .09), No other relationship was found between bioT concentrations and any other variable, including type of patient, ICU length of stay, reason for either initial a dmission to the ICU or prolonged mechanical ventilation, type of nutritiona l support, or use of dopamine. Conclusions: CCI men have a very high prevalence of hypotestosteronemia, wh ich may impede their recuperation and rehabilitation. Further studies are n eeded to determine whether additional pharmacologic treatment with testoste rone can improve the recovery of these patients.