Low testosterone in non-responsive coeliac disease: A case series, case-control study with comparisons to the National Health and Nutrition Examination Survey

BackgroundAdults with coeliac disease (CD) often report persistent fatigue, even when CD appears well controlled for unknown reasons.AimsTo evaluate common indications for testosterone panel (TP) testing and prevalence of low testosterone (T) in CD.MethodsIn our case series, we determined common indications for checking TP in CD. Next, we conducted a case-control study to compare TP in CD vs. healthy controls (HC). We compared mean total T (TT), free T (FT) based on serologic, histologic disease activity. Finally, we assessed TT in tissue transglutaminase (tTG)+ vs. tTG− subjects and CD vs. HC obtained from the National Health and Nutrition Examination Survey (NHANES).Results53 coeliac males had TP tested. Common indications included osteoporosis and fatigue. Low FT was observed in 7/13 men with osteoporosis and 5/6 with fatigue. In our case-control study (n = 26 each), there was no difference in mean TT or FT between CD vs. HC, tTG+ vs tTG− or Marsh 0 vs. Marsh 3 groups. NHANES data showed no difference in mean TT between tTG+ vs tTG− (n = 16 each) or CD vs. HC subjects (n = 5 each).ConclusionsLow T occurs in CD patients at a similar rate as the general population. Common presentations of low T may mimic non-responsive CD symptoms.