Part of the interindividual variation in serum testosterone levels in healthy men reflects differences in androgen sensitivity and feedback set point: Contribution of the androgen receptor polyglutamine tract polymorphism

Context: There is a large interindividual variation in serum ( free) testosterone ( FT) levels in men, underlain in part by genetic components. Objective: The objective of the study was to explore the hypothesis that this variability results in part from differences in androgen sensitivity and feedback loop set point and assess the role of the androgen receptor (AR) polyglutamine tract polymorphism encoded by a CAG repeat of variable length in exon 1 of the AR gene. Design/Setting/Participants: We performed a cross-sectional analysis in two independent populations of healthy men, consisting of 2322 men aged 35-59 yr (Belstress study) and 358 men aged 25-45 yr (Siblos study), respectively. Main Outcome Measures: Serum hormonal levels and the AR gene CAG repeat length were determined. Results: In the Belstress population, serum testosterone and calculated FT showed a positive linear association with LH (P < 0.001). In the 200 men with lowest FT, CAG repeat number was lower than in the 200 men with highest FT ( P = 0.004). As studied in a larger subset of the population consisting of 857 men covering the whole FT range, FT increased progressively withCAGrepeat length ( P = 0.003). These findings of a positive relation of FT with both LH and CAG repeat length were confirmed in the Siblos study population ( both P <= 0.001). Difference in FT between extreme quartiles of CAG repeat was 10 and 14% in the Belstress and Siblos study, respectively. In both study populations, CAG repeat length was also positively associated with serum total testosterone ( P <= 0.004). Conclusions: The data support the view that between- subject variability in serum FT in healthy men is underlain in part by differences in androgen sensitivity and feedback set point, with a contributory role of AR polymorphism. These findings have potential implications for the interpretation of epidemiological studies, diagnosis of hypogonadism, and pharmacogenetics of androgen treatment in men.