674 - Low Free Testosterone (T) and dehydroepiandrosterone (DHEA) levels found in late middle-aged adult males presenting with chronic arthritic pain and fatigue - Tip of the Iceberg? A Case Series.

Case Diagnosis: Metabolic Syndrome in Male Chronic Pain Patients

Case Description:

Three males aged 56-61 presented with chronic spine, hip, and/or knee arthritic pain to a University based spine and musculoskeletal clinic. All three related fatigue and difficulty losing weight - which was part of the holistic multi-pronged physiatry treatment plan designed to reduce pain. Serum dehydroepiandrosterone (DHEA), Total-T and Free-T, Hemoglobin A1C, Cortisol, Thyroid studies were completed. BMI values were recorded.  No subjects were ever offered hormone testing by their primary care provider.  None of the subjects were on opioids at the time of testing. All three tested with high BMI, DHEA below normal and had low free-T or low normal free-T. 

Discussions:

Many anecdotal reports suggest low testosterone (T) in aging males is associated with chronic pain. Multiple studies have suggested as many as 55% of men aged 40-70 suffer from Low-T.  As many as 79% suffer low-T if they possess one of the following co-morbidities: arterial hypertension, obesity, type II diabetes, metabolic syndrome, and chronic obstructive pulmonary disease (COPD). Additionally, the prevalence of chronic pain due to arthritic conditions overall in the aging male is reported as 40-60%.  Yet male hormonal profiles are not part of the typical musculoskeletal practitioner diagnostic profile.

Conclusions:

While this review does not show a causal connection between low male hormone levels, high BMI, metabolic syndrome and chronic pain, the possibility that such an association could be identified in increased numbers should be considered. As Physiatry spine and musculoskeletal providers prescribe holistic treatments that include exercise and weight loss, Low-T levels certainly would hinder the success of such treatment at a minimum and could add to pain levels in the worst case.  Further studies are needed to better quantify diagnostic and treatment protocols.