Background Gonadal steroids may modulate disease course in multiple sclerosis (MS). Objective To assess the prevalence and clinical associations of hypogonadism in MS men. Methods Males, aged 18-65 years, with relapsing remitting MS or CIS and first symptom <10 years prior, were selected from a longitudinal clinical study, Hormones were measured in stored morning blood samples. Expanded Disability Status Scale (EDSS) scores were collected every 6 months, and Symbol Digit Modalities test (SDMT) annually. Results The analysis included 96 men with a mean age of 40 years, EDSS of 1.1, and disease duration of 4.6 years. Of these men, 39% were hypogonadal (total testosterone <288 ng/dL); none showed compensatory elevations in luteinizing hormone. Low testosterone levels and testosterone:estradiol ratios were negatively correlated with body mass index and leptin, and showed no correlation with 25-hydroxyvitamin D levels. In the primary cross-sectional analyses, there was a negative age-adjusted correlation between total testosterone and EDSS (p=0.044). In the age-adjusted longitudinal analyses, higher baseline testosterone levels were associated with less decline in SDMT (p=0.012). Conclusion Men with MS may experience hypogonadotropic hypogonadism. Low testosterone levels may be associated with worse clinical outcomes. A potential neuroprotective role for testosterone warrants further investigation.

At the Partners MS center, we have been using Daclizumab in an open-label fashion in patients who fail first line therapy or non-standard immunosuppressive treatment. Our aim was to assess its safety and tolerability in our patient population.