(249) Multiple sclerosis (MS) and Hypogonadism (HG): Is There a Relationship? - A Systematic Review
Authors: Hammad MAM , Rush A , Loeb CA , Banton J , Barham DW , Yafi FA , Jenkins LC 
Published: February 2024

Abstract

Introduction
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system and is widely recognized as a disease primarily affecting women. However, recent studies have shown that patients with MS, both male and female, may also suffer from hypogonadism, a condition characterized by decreased testosterone production and decreased gonadal function. The relationship between MS and hypogonadism is complex and not fully understood, with recent evidence showing that hypogonadism may have a significant impact on the quality of life and disease progression of MS patients.

Objective
This review aims to provide an overview of the current knowledge regarding the relationship between MS and hypogonadism, including the mechanisms underlying this relationship, the effects of hypogonadism on MS patients, and the potential benefits and drawbacks of testosterone replacement therapy for MS patients with hypogonadism.

Methods
This scientific review analyzed 19 articles that investigated the potential relationship between MS, testosterone levels, and hypogonadism. The articles were published between November 2008 and March 2022 and were identified through a comprehensive search of the PubMed database. The search terms used included “multiple sclerosis,” “testosterone,” “hypogonadism,” and “MS and testosterone levels.” The inclusion criteria for articles were as follows: (1) articles that investigated the relationship between MS, testosterone levels, and hypogonadism, (2) articles that were published in English, and (3) articles that provided original data. Exclusion criteria included (1) articles that were not related to the topic, (2) reviews and editorials, and (3) articles that did not provide original data.

Results
Of the 19 articles reviewed, 11 described a positive correlation between low testosterone levels and dysfunction within the hypothalamic-pituitary-gonadal axis in individuals with MS. These findings suggest that low testosterone levels may contribute to dysfunction within the hypothalamus-pituitary-gonadal axis, which plays a crucial role in regulating testosterone production. The results also showed a relationship between sexual dysfunction and low testosterone levels, as well as a positive correlative relationship between these two factors.

Conclusions
The reviewed articles indicate a complex relationship between MS, testosterone levels, and the hypothalamic-pituitary-gonadal axis, with low testosterone levels potentially contributing to dysfunction in this axis and to sexual dysfunction. Further research is needed to better understand the effects of testosterone therapy on MS and sexual dysfunction in MS patients.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.