Hypogonadism is a significant medical condition that has been gaining increased attention in recent years. The prevalence of hypogonadism varies, with estimates ranging from 2.1% to 30% in men ages 40 to 79, depending on the definition and population studied.¹ The severity of hypogonadism can range from mild to severe, with symptoms including reduced libido, erectile dysfunction, decreased energy, depression, and anemia, among others.² The economic burden of hypogonadism is substantial, with one study estimating the 20-year cost of testosterone deficiency in US men ages 45 to 74 at $190 billion to $525 billion.³ The importance of addressing hypogonadism is underscored by its potential long-term health impacts, including increased risk of cardiovascular disease and osteoporosis.⁴ Understanding and addressing hypogonadism are crucial for improving patient quality of life and reducing health care costs.

Despite the growing recognition of hypogonadism as a significant health issue, its prevalence and impact on resident physicians remain largely unexplored. In contrast to the aging male population, little information exists regarding the epidemiology of hypogonadism in young adult males. However, one estimate indicates that testosterone deficiency may be present in up to 20% of adolescent and young adult males ages 15 to 39.⁵ Clinical diagnosis in young adults may be more challenging than in males over 45, as they may present with nonspecific symptoms, such as fatigue, rather than sexual dysfunction more commonly seen in older men. Recent evidence also shows that the cutoff of 300 ng/dL used to determine testosterone deficiency in adult men at any age may be inappropriately low to accurately diagnose hypogonadism in young adults, with a cutoff of 400 ng/dL likely being more appropriate for men ages 20 to 44.⁶

Resident physicians, the majority of whom are under the age of 45, are a group known to experience high levels of stress, irregular sleep patterns, and long working hours. These factors have been associated with hypogonadism in other populations. Nonstandard shift work and insufficient sleep have also been positively associated with urologic complications in males.^7,8 Furthermore, the symptoms of hypogonadism, such as fatigue, depression, and decreased libido, overlap significantly with symptoms of burnout and depression, conditions known to be prevalent among resident physicians.⁹ This overlap may lead to misdiagnosis or underdiagnosis of hypogonadism in this population, potentially exacerbating the health and wellness challenges they face. Therefore, our objective was to evaluate the prevalence and impact of hypogonadism among male resident physicians at our institution.

We conducted a prospective study involving male physicians in medical training at our institution. The data for the study were obtained through a combination of survey questionnaires and laboratory tests. The survey data were collected using the Research Electronic Data Capture (RedCAP) system. After obtaining approval by the Institutional Review Board, potential participants were identified through study protocol distribution to Accreditation Council for Graduate Medical Education resident and fellow program physicians at our institution. The participants were not restricted by age, specialty, or postgraduation year (PGY). Of the 651 eligible male residents and fellows, 27 residents expressed interest in participation. The exposure variables of interest in this study were the working conditions of the resident physicians, assessed through the participants’ specialty and PGY level, as well as overnight call schedule and night shift work within the preceding months.

The primary outcome of interest was the prevalence of hypogonadism among the participants, as measured by testosterone levels in the blood. Participants were asked to complete lab work, including a basic metabolic panel, complete blood count, lipid panel, thyroid panel, and measurements of testosterone, follicle-stimulating hormone, luteinizing hormone, and estradiol. Secondary outcomes included the severity of hypogonadism symptoms, as measured by the Androgen Deficiency in the Aging Male (ADAM) questionnaire, and overall health status, as measured by the 36-Item Short Form Health Survey. The ADAM questionnaire is a sensitive screening tool for hypogonadism in males ages 40 and above.¹⁰ Although this sensitivity has not been demonstrated to the same extent in young adults, we felt the ADAM questionnaire was a reasonable tool for detecting hypogonadism symptoms in our participants. The prevalence of hypogonadism was calculated as the proportion of participants with total testosterone levels below 400 ng/dL.

The characteristics of the study subjects are presented in Table 1. Out of the 651 male residents and fellows contacted, 27 expressed interest in participation, yielding a response rate of 4.1%. Of these, 88.9% (24/27) provided demographic data and 66.7% (18/27) completed the surveys. Among those who filled out the survey, 33.3% (6/18) completed the lab work. The participants were diverse in terms of age, specialty, and PGY. These values are reported independently in Table 1 to maintain anonymity. The results of the laboratory tests are presented in Table 2. Two-thirds (4/6) of the participants who completed the lab work had total testosterone levels below 400 ng/dL. Two participants met the serum criteria (<300 ng/dL) for hypogonadism. The results of the ADAM questionnaire and 36-Item Short Form Health Survey are presented in Table 3. Half (9/18) of the participants scored positively on the ADAM questionnaire, indicating the presence of hypogonadal symptoms. Furthermore, 44.4% (8/18) of the participants reported that their health was worse compared to a year prior. Among the participants who reported not taking any overnight calls, 20% (1/5) scored positively on the ADAM questionnaire. For those who reported regularly taking overnight calls (ie, every third day, every fourth day, etc) or working night float in the past 6 months, 61.5% (8/13) scored positively.

Table 1. Participant Characteristics (n = 24)

Table 2. Results of Serum Testosterone Testing

Table 3. Androgen Deficiency in the Aging Male Questionnaire Positivity Rates and 36-Item Short Form Health Survey^a

The key finding of this study is the presence of hypogonadal symptoms in male resident physicians at our institution. Two-thirds of the participants who completed the lab work had total testosterone levels below 400 ng/dL, and half of the participants scored positively on the ADAM questionnaire. Additionally, residents who reported taking overnight calls or night floats were more likely to score positively. This cohort is too small to provide an accurate estimate of the prevalence of hypogonadism in the male resident population, although our findings suggest that the lifestyle and working conditions of residents may contribute to hypogonadal symptoms or the development of hypogonadism. Our findings also highlight the potential overlap between hypogonadism and other health issues common among resident physicians, such as burnout and depression.

These findings are consistent with previous research showing a link between stressful working conditions and hypogonadism. However, they extend the existing literature by demonstrating this link in a population of resident physicians, a group that has not been extensively studied in this context. This pilot’s data demonstrate a need for further investigation to properly assess the prevalence of hypogonadism in male residents. A repeat of this study in a larger cohort, while controlling for potential confounding factors such as age, lifestyle factors, and comorbidities, can give stronger insight into the effects of residency on young adult males. Despite its limitations, the findings of our study have important implications for the health and wellness of resident physicians, suggesting that male residents may benefit from early screening and education on recognizing symptoms of hypogonadism.

Funding Statement: The authors have indicated that they have no funding or support relevant to this article to disclose.

Disclosure Statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethics Review: This study was conducted in accordance with the ethical standards of the Institutional Review Board at our institution. All participants provided informed consent prior to their inclusion in the study.