• David J Barton, Raj G Kumar, Emily H McCullough, Gary Galang, Patricia M Arenth, Sarah L Berga, and Amy K Wagner.
• Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Messrs Barton and Kumar, Ms McCullough, and Drs Galang, Arenth, and Wagner); Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Berga); and Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Wagner).
• J Head Trauma Rehabil. 2016 Jul 1; 31 (4): 277-87.

ObjectiveTo (1) examine relationships between persistent hypogonadotropic hypogonadism (PHH) and long-term outcomes after severe traumatic brain injury (TBI); and (2) determine whether subacute testosterone levels can predict PHH.SettingLevel 1 trauma center at a university hospital.ParticipantsConsecutive sample of men with severe TBI between 2004 and 2009.DesignProspective cohort study.Main MeasuresPost-TBI blood samples were collected during week 1, every 2 weeks until 26 weeks, and at 52 weeks. Serum hormone levels were measured, and individuals were designated as having PHH if 50% or more of samples met criteria for hypogonadotropic hypogonadism. At 6 and 12 months postinjury, we assessed global outcome, disability, functional cognition, depression, and quality of life.ResultsWe recruited 78 men; median (interquartile range) age was 28.5 (22-42) years. Thirty-four patients (44%) had PHH during the first year postinjury. Multivariable regression, controlling for age, demonstrated PHH status predicted worse global outcome scores, more disability, and reduced functional cognition at 6 and 12 months post-TBI. Two-step testosterone screening for PHH at 12 to 16 weeks postinjury yielded a sensitivity of 79% and specificity of 100%.ConclusionPHH status in men predicts poor outcome after severe TBI, and PHH can accurately be predicted at 12 to 16 weeks.

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