Androgen activity and markers of inflammation among men in NHANES III

Inflammatory markers and androstenedione modify the effect of serum testosterone on obesity among men: Findings from a Chinese population

BACKGROUND

Few studies are available on the relationship of androstenedione with inflammation and obesity and the effect of androstenedione and inflammation on the association between testosterone and obesity. This study intended to examine the mediation effect of inflammatory markers on the association of testosterone with obesity and the moderation effect of androstenedione on the association of testosterone with inflammation and obesity in Chinese rural men.

MATERIALS AND METHODS

This cross-sectional research enrolled 2536 male rural inhabitants from the Henan Rural Cohort study. The serum concentrations of testosterone and androstenedione were determined by liquid chromatography-tandem mass spectrometry. Linear and logistic regression were used to examine the relationships between testosterone, inflammatory markers, and obesity. Mediation and moderation analyses were carried out to evaluate the potential effects of inflammatory markers on the relationship between testosterone and obesity, as well as androstenedione on the relationships of testosterone with inflammation and obesity.

RESULTS

After adjusting for confounding factors, the results showed that testosterone and androstenedione were negatively related to obesity, and inflammatory markers were positively associated with obesity. Besides, testosterone and androstenedione were negatively associated with inflammatory markers. Mediation analysis showed that white blood cell, neutrophil, monocyte, and high-sensitivity C-reactive protein had mediating effects on the association between testosterone and obesity. The most vital mediator was high-sensitivity C-reactive protein, and its proportion of the effect was 11.02% (defined by waist circumference), 11.15% (defined by waist-to-hip ratio), 12.92% (defined by waist-to-height ratio), and full mediating effect (defined by body mass index). Moreover, androstenedione played negative moderation effects on the associations of testosterone with inflammation and obesity.

CONCLUSION

Inflammatory markers and androstenedione were first found to have modifying effects on the association of testosterone with obesity. Higher levels of testosterone and androstenedione could reduce the inflammation level and risk of obesity, indicating their potential roles in the prevention and treatment of chronic diseases.

Sex steroids and androgen biomarkers in the healthy man study: within-person variability and impact of fasting

OBJECTIVE

Serum testosterone measurements in clinical practice mostly utilize "direct" (non-extraction) immunoassays which have method-specific bias due to steroid cross-reactivity and nonspecific matrix artifacts. Although more accurate, sensitive, and specific liquid chromatography-mass spectrometry (LCMS) dominates in clinical research, the within-person variability of serum testosterone in healthy men using LCMS measurement is not reported.

DESIGN

Longitudinal multi-sampling observational study of men in excellent health over 3 months.

METHODS

Elite healthy men (n = 325) over 40 years of age in excellent, asymptomatic health provided 9 blood samples over 3 months with serum testosterone, dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) measured by validated LCMS with conventional biochemical and anthropometric variables.

RESULTS

Quantitative estimates of within-person variability within day and between day, week, month, and quarter were stable other than an increase due to fasting. The androgen biomarkers most sensitive to age and testosterone among widely used biochemical and anthropometric variables in middle-aged and older men were identified.

CONCLUSIONS

This study provides estimates of variability in serum testosterone and the best androgen biomarkers that may prove useful for future studies of androgen action in male ageing.

Testosterone Deficiency, Long-Term Testosterone Therapy, and Inflammation

OBJECTIVES

We aimed to evaluate the association of testosterone deficiency with inflammation and how long-term testosterone therapy affects inflammation biomarkers over time.

METHODS

We conducted a 2-component study. First, we conducted a cross-sectional study using the recently released 2015-2016 National Health and Nutrition Examination Survey (NHANES) data to examine the association between testosterone deficiency and inflammation biomarkers including high sensitivity C-reactive protein (hsCRP), liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the US general population. Then we conducted a longitudinal study to investigate the longitudinal effect of testosterone therapy on inflammation biomarkers and the risk of cardiovascular events, using data from 776 hypogonadal men based on a registry study in Germany with up to 11 years' follow-up.

RESULTS

The adjusted odds ratios (ORs) describing the associations between testosterone deficiency and hsCRP ≥ 3mg/L, ALT > 40U/L, and AST > 40U/L were 1.81 (P-value < 0.001), 1.46 (P-value = 0.009), and 0.99 (P-value = 0.971), respectively. In the control group, CRP, ALT, and AST levels increased by 0.003 (95%CI: -0.001, 0.007) mg/L, 0.157 U/L (95%CI: 0.145, 0.170), and 0.147 (95%CI: 0.136, 0.159) U/L per month, while in the treatment group, CRP, ALT, and AST levels decreased by 0.05 (95%CI: -0.055, -0.046) mg/L, 0.142 U/L (95%CI: -0.154, -0.130), and 0.148 (95%CI: -0.158, -0.137) U/L per month.

CONCLUSION

Testosterone deficiency was associated with an increased level of inflammation; long-term testosterone therapy alleviated inflammation among hypogonadal men, which may contribute to the reduced cardiovascular risk. Future large trials are warranted to confirm our observational study findings.

Testosterone moderates the effects of social support on cardiovascular disease risk factors among older US men

OBJECTIVES

Social support positively affects health through pathways such as shaping intrapersonal emotional and psychological well-being. Lower testosterone often interrelates with psychological and behavioral orientations that are beneficial to participation in emotionally supportive relationships. Yet, little research has considered the ways in which testosterone may contribute to health outcomes related to emotional support.

METHODS

We draw on testosterone, social support data, and cardiovascular disease (CVD)-relevant indicators (inflammatory markers; blood pressure [BP]) from older men (n = 366) enrolled in the National Health and Nutrition Examination Survey, a US nationally representative study. We test whether men's testosterone moderates associations between emotional social support and markers related to CVD risk.

RESULTS

For men with relatively lower testosterone, higher levels of social support predicted lower white blood cell (WBC) counts, consistent with reduced inflammation. In contrast, men with higher testosterone exhibited elevated WBC counts with greater support. In a diverging pattern, men with lower testosterone had higher systolic and diastolic BP with higher support, whereas the slopes for systolic and diastolic BP, respectively, were comparatively flatter for men with higher levels of testosterone.

CONCLUSIONS

We suggest that our findings are theoretically consistent with the idea that testosterone helps shape intrapersonal and interpersonal experiences and perceptions of men's emotional support networks, thereby affecting the health implications of that support. The somewhat divergent results for WBC count vs BP highlight the need for inclusion of other neuroendocrine markers alongside testosterone as well as refined measures of perceived and received support.

Testosterone regulates 3T3-L1 pre-adipocyte differentiation and epididymal fat accumulation in mice through modulating macrophage polarization

Low testosterone levels are strongly related to obesity in males. The balance between the classically M1 and alternatively M2 polarized macrophages also plays a critical role in obesity. It is not clear whether testosterone regulates macrophage polarization and then affects adipocyte differentiation. In this report, we demonstrate that testosterone strengthens interleukin (IL) -4-induced M2 polarization and inhibits lipopolysaccharide (LPS)-induced M1 polarization, but has no direct effect on adipocyte differentiation. Cellular signaling studies indicate that testosterone regulates macrophage polarization through the inhibitory regulative G-protein (Gαi) mainly, rather than via androgen receptors, and phosphorylation of Akt. Moreover, testosterone inhibits pre-adipocyte differentiation induced by M1 macrophage medium. Lowering of serum testosterone in mice by injecting a luteinizing hormone receptor (LHR) peptide increases epididymal white adipose tissue. Testosterone supplementation reverses this effect. Therefore, our findings indicate that testosterone inhibits pre-adipocyte differentiation by switching macrophages to M2 polarization through the Gαi and Akt signaling pathways.

Is male factor infertility associated with midlife low-grade inflammation? A population based study

Male factor infertility is associated with an increased risk of disease and mortality, which has been related to markers of chronic systemic inflammation. The objective of this study was to investigate the association between male factor infertility and low-grade inflammation and furthermore to examine the lifetime prevalence of male factor infertility and overall infertility (also including female and couple infertility). The study population consisted of 2140 members of the Metropolit 1953 Danish Male Birth Cohort who had participated in the Copenhagen Aging and Midlife Biobank data collection in 2009-2011. Information on male factor infertility and overall infertility was obtained from a questionnaire, and low-grade inflammation was evaluated as the highest plasma levels of C-reactive protein, interleukin-6 and tumour necrosis factor-alpha in the population. The level of interleukin-6 was significantly higher among men with male factor infertility compared with other men adjusted for potential confounders. This was not found for the two other inflammatory markers. The lifetime prevalence of male factor infertility and overall infertility were 10.2% and 17.9%, respectively. The findings suggest that male factor infertility might be associated with an increased level of interleukin-6.

The association between physiologic testosterone levels, lean mass, and fat mass in a nationally representative sample of men in the United States

Testosterone deficiency leads to increased muscle loss with aging and increased fat mass. Supraphysiologic levels cause an increase in muscle mass and decrease in fat mass. The difference in lean and fat mass across physiologic levels of testosterone has been under examined in men.

OBJECTIVE

Examine the association between physiologic testosterone levels with lean and fat mass.

METHODS

Data from the 1999-2000 NHANES were used (n=252 men; 18-85yrs). Testosterone and SHBG values were obtained by a morning blood sample. Body composition was measured by DXA. Multivariable linear regression was used to compute unadjusted, minimally adjusted, and extended models of relative upper- and lower-body lean and fat mass.

RESULTS

In the extended model, men with total testosterone levels in the highest 25% (4th quartile) had more lower-body lean mass (LBLM) (β=22.1(%), 95%CI: 9.0, 35.3, p=0.003) and upper-body lean mass (UBLM) (β=5.6(%), 95%CI: 0.1, 11.2, p=0.046), and less lower-body fat mass (LBFM) (β=-9.9(%), 95%CI: -17.7, -2.1, p=0.016) and upper-body fat mass (UBFM) (β=-6.1(%), 95%CI: -10.1, -2.1, p=0.005) than those in the 1st quartile. Men in the 3rd quartile had more LBLM (β=14.2, 95%CI: 5.3, 23.1, p=0.004), UBLM (β=5.6, 95%CI: 2.0, 9.2, p=0.004), and less LBFM (β=-9.7(%), 95%CI: -16.7, -2.7, p=0.010) and UBFM (β=-4.7(%), 95%CI: -8.3, -1.2, p=0.012) than those in the 1st quartile.

CONCLUSION

These findings suggest that, at physiologic levels, an association exists between higher levels of testosterone and favorable lean and fat measures.

Potential Intervention Targets in Utero and Early Life for Prevention of Hormone Related Cancers

Hormone-related cancers have long been thought to be sensitive to exposures during key periods of sexual development, as shown by the vulnerability to such cancers of women exposed to diethylstilbestrol in utero. In addition to evidence from human studies, animal studies using new techniques, such as gene knockout models, suggest that an increasing number of cancers may be hormonally related, including liver, lung, and bladder cancer. Greater understanding of sexual development has also revealed the "mini-puberty" of early infancy as a key period when some sex hormones reach levels similar to those at puberty. Factors driving sex hormones in utero and early infancy have not been systematically identified as potential targets of intervention for cancer prevention. On the basis of sex hormone pathways, we identify common potentially modifiable drivers of sex hormones, including but not limited to factors such as obesity, alcohol, and possibly nitric oxide. We review the evidence for effects of modifiable drivers of sex hormones during the prenatal period and early infancy, including measured hormones as well as proxies, such as the second-to-fourth digit length ratio. We summarize the gaps in the evidence needed to identify new potential targets of early life intervention for lifelong cancer prevention.

Prevalence of Relative Deficiencies in Testosterone and Vitamin B12 Among Patients Referred for Chronic Orchialgia: Implications for Management

Chronic testicular pain (CTP) is a complex pain syndrome that is widely variable in presentation and etiology. Many cases of CTP are thought to be associated with neuropathy and recent data suggest an inflammation-mediated process is more common among patients with CTP. Deficiencies in vitamin B12 and testosterone are common in chronic pain syndromes may play a role in CTP. A retrospective review of men treated for CTP by a single provider over a 2-year period was performed. Patients with serum screening of testosterone and B12 were selected. Patients with total testosterone below 300 ng/dl, free testosterone below 46 pg/ml, or B12 below 400 pg/ml were deemed deficient and offered repletion. Efficacy of treatment was measured based on patient report with a minimum follow-up of either 3 months or resolution of pain symptoms. One hundred and fifty-four (154) men with CTP were identified, with 125 assessed for testosterone and B12 levels. Of these, 95 patients (76%) were deemed deficient. Fifty-six (56) patients elected to receive B12/testosterone replacement. In patients with sufficient follow-up, 24 patients (65%) reported significant improvement of symptoms, 6 patients (16%) reported some improvement, and 7 patients (19%) reported no improvement. The prevalence of testosterone and B12 deficiencies in this study is much higher than that reported for the general population. In addition, when chemical deficiencies were corrected, greater than 80% of patients with sufficient follow-up reported some improvement in pain. This suggests that screening of B12 and testosterone should be incorporated into the assessment of patients with CTP.

Cigarette smoking and testosterone in men and women: A systematic review and meta-analysis of observational studies

Recently Health Canada and the Food and Drug Administration warned about the cardiovascular risk of testosterone, making environmental drivers of testosterone potential prevention targets. Cotinine, a tobacco metabolite, inhibits testosterone breakdown. We assessed the association of smoking with testosterone in a systematic review and meta-analysis, searching PubMed and Web of Science through March 2015 using ("testosterone" or "androgen" or "sex hormone") and ("smoking" or "cigarette"). Two reviewers independently searched, selected, assessed quality and abstracted with differences resolved by consensus or reference to a third reviewer. The initial search yielded 2881 studies; 28 met the selection criteria. In 22 studies of 13,317 men, mean age 18-61years, smokers had higher mean testosterone than non-smokers (1.53nmol/L, 95% confidence interval (CI) 1.11 to 1.96) using a random effects model with inverse variance weighting. In 6 studies of 6089 women, mean age 28-62years, smoking was not clearly associated with testosterone (0.11nmol/L, 95% CI -0.08 to 0.30). Fixed effects models provided similar results, but suggested a positive association in women. Whether products which raise cotinine, such as e-cigarettes or nicotine replacement, also raise testosterone, should be investigated, to inform any regulatory action for e-cigarettes, which emit nicotine into the surrounding air, with relevance for both active and passive smokers.

Influence of sex, age, pubertal maturation and body mass index on circulating white blood cell counts in healthy European adolescents—the HELENA study

Percentiles 10th, 25th, 50th, 75th and 90th are presented for circulating white blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils and basophils in healthy European adolescents (12.5-17.5 years, n = 405, 48.9% boys), considering age, sex, puberty and body mass index (BMI). CD3(+) (mature T cells), CD4(+) (T helper), CD8(+) (T cytotoxic), CD16(+)56(+) (natural killer), CD19(+) (B cells), CD3(+)CD45RA(+), CD4(+)CD45RA(+), CD8(+)CD45RA(+) (naïve), CD3(+)CD45RO(+), CD4(+)CD45RO(+) and CD8(+)CD45RO(+) (memory) lymphocytes were also analysed by immunophenotyping. Girls presented higher WBC, neutrophil, CD3(+)CD45RO(+) and CD4(+)CD45RO(+) cell counts and CD3(+)/CD19(+) ratio, and lower CD3(+)CD45RA(+) and CD4(+)CD45RA(+) counts than boys. Age was associated with higher neutrophil counts and CD3(+)/CD19(+), and lower CD19(+) counts; in boys, with lower CD3(+)CD45RA(+), CD4(+)CD45RA(+) and CD8(+)CD45RA(+) counts as well; in girls, with higher WBC, CD3(+)CD45RO(+) and CD4(+)CD45RO(+) counts. Pubertal maturation in boys was associated with lower WBC and lymphocyte counts; in girls, with higher basophil, CD3(+)CD45RO(+) and CD4(+)CD45RO(+) values. BMI was associated with higher WBC counts; in boys, also with higher lymphocyte counts; in girls, with higher neutrophil, CD4(+), CD3(+)CD45RO(+) and CD4(+)CD45RO(+) counts.

CONCLUSION

Our study provides normative values for circulating immune cells in adolescents, highlighting the importance of considering sex, age, pubertal maturation and BMI when establishing reference ranges for WBC in paediatric populations.

Genetically predicted testosterone and systemic inflammation in men: a separate-sample Mendelian randomization analysis in older Chinese men

Objectives

Observationally, testosterone is negatively associated with systemic inflammation, but this association is open to both residual confounding and reverse causality. Large-scale randomized controlled trials (RCTs), assessing exogenous effects, are presently unavailable. We examined the association of endogenous testosterone with well-established systemic inflammatory markers (white blood cell, granulocyte, lymphocyte and high-sensitivity C-reactive protein (hsCRP)) using a separate-sample Mendelian randomization analysis to minimize reverse causality.

Methods

A genetic prediction rule for serum testosterone was developed in 289 young Chinese men with mean age of 21.0, using selected testosterone-related SNPs (rs10046, rs1008805 and rs1256031). Multivariable linear regression was used to examine the association of genetically predicted serum testosterone with inflammatory markers among 4,212 older Chinese men from the Guangzhou Biobank Cohort Study.

Results

Genetically predicted testosterone was unrelated to white blood cell count (-0.01 109/L per nmol/L testosterone, 95% confidence interval (CI) -0.05 to 0.04), granulocyte count (-0.02 109/L, 95% CI -0.06 to 0.02), lymphocyte count (0.005 109/L, 95% CI -0.01 to 0.02) and hsCRP (-0.05 mg/L, 95% CI -0.15 to 0.06).

Conclusion

Our findings did not corroborate any anti-inflammatory effects of testosterone or corresponding potentially protective effects of testosterone on chronic diseases resulting from reduced low-grade systemic inflammation.

Association between circulating levels of sex steroid hormones and Barrett's esophagus in men: a case-control analysis

BACKGROUND & AIMS

Esophageal adenocarcinoma is believed to result from the progression of gastroesophageal reflux disease to erosive esophagitis and re-epithelialization of the esophagus with a columnar cell population termed Barrett's esophagus (BE). Men develop BE and esophageal adenocarcinoma more frequently than women, yet little is known about the mechanisms of this difference. We assessed whether sex steroid hormones were associated with BE in a male population.

METHODS

We analyzed data from the Barrett's Esophagus Early Detection Case Control Study, based at the Walter Reed National Military Medical Center. Blood samples were collected from 174 men with BE and 213 men without BE (controls, based on endoscopic analysis); 13 sex steroid hormones were measured by mass spectrometry and sex hormone binding globulin was measured by enzyme-linked immunosorbent assay. We also calculated free estradiol, free testosterone, and free dihydrotestosterone (DHT). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, race, smoking status, alcohol consumption, body mass index, heartburn, regurgitation, and gastroesophageal symptom score (excluding heartburn and regurgitation).

RESULTS

Levels of free testosterone and free DHT were associated positively with BE risk; patients in the highest quartile for these hormones were most likely to have BE (free testosterone: OR, 5.36; 95% CI, 2.21-13.03; P = .0002; free DHT: OR, 4.25; 95% CI, 1.87-9.66; P = .001). Level of estrone sulfate was associated inversely with BE risk (P for trend = .02). No other hormone was associated with BE risk. Relationships were not modified by age or BMI.

CONCLUSIONS

In an analysis of men, levels of free testosterone and free DHT were significantly associated with BE.

Does falling testosterone with age among men underlie the increase in ischaemic heart disease

BACKGROUND

Observationally, testosterone falls with age among men and ischaemic heart disease (IHD) increases with age, so testosterone is commonly assumed to protect against IHD. Here we examined whether IHD mortality rates among men increased faster with age in the USA than China, where testosterone in men remains stable throughout adulthood, and also whether the increase with age in mortality rates for IHD is faster than for other causes of death.

METHODS

Age-specific mortality rates from all causes, IHD, pneumonia and prostate cancer for men in the USA and China from 1991 to 1995 were obtained from the WHO, and considered in age groups because of non-linearity.

RESULTS

The risk of death from IHD in US men increased with age at the same rate as the risk of death from any cause. In China, the risk of death from IHD increased with age faster than the risk of death from any cause.

CONCLUSION

The data are not consistent with the assumption that a fall in testosterone with age causes IHD.

Is there any relationship between mean platelet volume and varicocele?

Mean platelet volume (MPV) is a parameter that is obtained from an automatic haemogram device during routine blood count and measures platelet reactivity. Increased platelet volume has been considered to be a risk factor for vascular diseases. The aim of this study was to evaluate the relationship between the presence of varicocele and the MPV, platelet count (PLT) and platelet distribution width (PDW) values. We included 264 patients with a diagnosis of varicocele in Group 1, and 220 patients with no varicocele in Group 2. The varicocele diagnosis was performed both with physical examination findings and colour Doppler ultrasonography (CDU). Mean platelet volume values were statistically significantly high (P < 0.001) whereas PLT and PDW values were statistically significantly low (P = 0.011), (P = 0.008) in the varicocele group compared with the control group respectively. However, no significant correlation was found between MPV and PDW in patients diagnosed with varicocele and the varicocele grade on examination and spermatic vein diameter on CDU. Mean platelet volume, which is used widely to measure the size of platelets and indicates platelet reactivity, can provide guidance in the investigation of varicocele pathophysiology and the relevant vascular pathologies.