Critical Illness and Low Testosterone: Effects of Human Serum on Testosterone Transport into Rat Brain and Liver*

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Abstract
Patients with acute illness, e.g. general surgery, burns, or respiratory failure, are known to manifest a marked decrease of their plasma testosterone level which is corrected after the initial insult is eliminated. Since nonthyroidal illness is associated with an inhibition of thyroid hormone-binding plasma proteins, the present study was undertaken to examine the effects of acute illness on testosterone-binding plasma proteins. Serum was obtained from 10 patients (mean age, 43 yr) hospitalized in the intensive care unit and from 9 male controls (mean age, 31 yr). The patient sera were characterized by the following changes, compared with the control sera: total serum testosterone was decreased 66% from 441 ± 68 to 151 ± 34 ng/100 ml; serum sex hormone-binding globulin (SHBG) was increased 35%, and albumin was decreased 24%; and the free (dialyzable) testosterone fraction was not significantly changed, but the non-SHBG-bound fraction was decreased 35%. The effects of patient and control sera on the unidirectional extraction of [3H]testosterone by brain and liver were examined in vivo in anesthetized rats. The exchangeable testosterone fraction was significantly decreased 24% and 35% in brain and liver, respectively. These studies indicate 1) the free (dialyzable) fraction of testosterone is not increased in acute illness as is the case for the thyroid hormones, 2) the non-SHBG-bound fraction is not significantly different from the exchangeable fraction in vivo in either brain or liver, and 3) the non-SHBG-bound assay provides a more accurate measure of the effects of testosteronebinding plasma proteins in vivo than does the measurement of free testosterone by equilibrium dialysis. (J Clin Endocrinol Metab56: 710, 1983)

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