Low total testosterone levels in adult male thalassemia major patients: An overlooked complication of iron overload

Background: Several studies indicated that elevated serum ferritin levels, which represents iron deposition, associated with the extent of hypogonadism thalassemia major (TM) patients. This study aimed to determine the correlation between serum ferritin levels and total testosterone (TT) levels as a marker of gonadal function in adult male TM patients. Methods: A cross-sectional study was enrolled in all male transfusion dependent TM patients in hematologic outpatient clinics of Dr. Soetomo General Hospital, Surabaya. Total testosterone and serum ferritin levels were measured in the morning, under fasting conditions. Results: A total of 30 male TM patients aged 18-45 years were recruited. Subjects already underwent regular blood transfusion for 16.87±6.72 years along with oral iron chelation regimen. Symptoms related to low testosterone levels, decreased libido and erectile dysfunction, were found on small proportion (10 and 20%, respectively). Short stature was found on 7 subjects. Pubertal delay was detected on 6 subjects. All subjects were severe iron overloaded, with average serum ferritin levels of 4765.4±1955.01 ng/mL. Low TT levels were presented in 6 subjects, although average TT levels was 650.8±287.65 ng/dL. Serum ferritin levels showed no significant correlation with TT levels (p = 0.538), even after adjusted for age and duration of transfusion. Conclusions: The present study did not prove association between serum ferritin levels with TT levels in adult male TM patients. Endocrine complications, especially hypogonadism, should be anticipated in all adult male TM patients.