Early Changes in Androgen Levels in Individuals with Spinal Cord Injury: A Longitudinal SwiSCI Study

J. Clin. Med., 2022 · DOI: 10.3390/jcm11216559 · Published: November 4, 2022

Spinal Cord Injury Endocrinology Rehabilitation

Simple Explanation

This study aimed to understand how hormone levels change in people with spinal cord injuries (SCI) during their initial rehabilitation. The focus was on androgen hormones like testosterone and DHEA. The researchers looked at the relationship between these hormones and factors like age, injury type, and medication use to see how these factors might affect hormone levels. The study found that testosterone and DHEA-S levels increased in men during rehabilitation, suggesting hormonal changes occur during this period. They also observed differences in hormone levels based on opioid use.

Study Duration

5.6 months median follow up

Participants

70 men and 16 women with SCI

Evidence Level

Not specified

Key Findings

1
Total testosterone and DHEA-S levels increased significantly in men with SCI during initial rehabilitation.
2
At admission to initial rehabilitation, serum SHBG was higher, while DHEA and DHEA-S were lower among opioid users vs. non-users.
3
A non-linear association was observed between age, time since injury, and androgen hormone levels.

Research Summary

This study explores the longitudinal changes in androgen levels in individuals with SCI during initial rehabilitation and identifies clinical characteristics associated with these hormone levels. The study found that total testosterone and DHEA-S levels increased significantly in men during the rehabilitation period, while DHEA levels decreased in women. Opioid use was associated with lower DHEA and DHEA-S levels and higher SHBG levels at the beginning of rehabilitation. These findings suggest a dynamic hormonal environment during initial SCI rehabilitation.

Practical Implications

Targeted Screening

Men with SCI may benefit from testosterone deficiency screening, particularly those with motor complete injuries, cervical injuries, or those using narcotic medications.

Hormone Monitoring with Opioid Use

Hormone levels should be monitored in SCI individuals using opioids, as opioid-induced endocrinopathy symptoms may be masked by the injury itself.

Further Research

Future studies should investigate the influence of sex steroids on metabolic changes and functional recovery in subacute SCI, as well as explore the potential benefits of testosterone or DHEA supplementation in rehabilitation practice.

Study Limitations

1
Androgen levels were measured using ELISA rather than LC-MS, which is the gold standard.
2
ELISA's precision is lower in the hypogonadal range, potentially underestimating the prevalence of low testosterone.
3
The SHBG assay sensitivity is not optimized for the natural range of the analyte.

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