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El-Shimi BI, Mohareb RM, Ahmed HH, Abohashem RS, Mahmoud KF, Hanna DH. Mechanistic Insights into Bisphenol A-Mediated Male Infertility: Potential Role of Panax Ginseng Extract. Chem Biodivers 2024:e202400480. [PMID: 38818674 DOI: 10.1002/cbdv.202400480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024]
Abstract
Male infertility is identified by the inability of a man to successfully impregnate his fertile female partner, even following a year of regular unprotected sexual intercourse. About half of all infertility cases are attributed to what is known as "male factor" infertility. The escalating prevalence of male infertility in the contemporary era across the globe can be largely attributed to environmental pollution, which is the common etiological factor due to the ubiquitous presence of the environmental contaminants. Bisphenol A is recognized as an endocrine-disrupting chemical that has adverse effects on both male and female reproductive systems. On the other hand, numerous studies have demonstrated that Panax ginseng possessed the potential to improve male infertility parameters; promote spermatogenesis, recover the quality and motility of sperm and enhance testicular functions as it acted as a natural androgen supplement. The objective of this review is to offer a summary of the findings obtained from the current research data on the insult of bisphenol A (BPA) on male infertility and its supposed mode of action, as well as shed light on the potent ameliorative role of Panax ginseng extract, with a special focus on the mechanism behind its action. This review delivers a clear understanding of BPA mechanism of action on male infertility and the presumed risks deriving from its exposure. Also, this review provides evidence for the functional role of Panax ginseng extract in restoring male fertility.
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Affiliation(s)
- Basma I El-Shimi
- Chemistry Department, Faculty of Sciences, Cairo University, Giza, Egypt
| | - Rafat M Mohareb
- Chemistry Department, Faculty of Sciences, Cairo University, Giza, Egypt
| | - Hanaa H Ahmed
- Hormones Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
- Stem Cell Lab., Centre of Excellence for Advanced Science, National Research Centre, Dokki, Giza, Egypt
| | - Rehab S Abohashem
- Hormones Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
- Stem Cell Lab., Centre of Excellence for Advanced Science, National Research Centre, Dokki, Giza, Egypt
| | - Khaled F Mahmoud
- Food Technology Department, National Research Centre, Dokki, Giza, Egypt
| | - Demiana H Hanna
- Chemistry Department, Faculty of Sciences, Cairo University, Giza, Egypt
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Wanjari UR, Gopalakrishnan AV. Cadmium as a male reproductive toxicant and natural and non-natural ways to tackle it: a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:18340-18361. [PMID: 38349491 DOI: 10.1007/s11356-024-32210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
Cadmium (Cd) is a naturally occurring environmental pollutant, a toxic substance that causes oxidative stress. According to epidemiological studies, the data suggested that environmental and occupational Cd exposure may be related to several diseases and severe testicular damage. However, studies are going on to explore the mechanism of Cd-induced male reproductive toxicity and its treatment strategies. Currently, researchers are focusing on naturally occurring bioactive compounds, plant extracts, and biochemical, which have better efficacy, less toxicity, and high bioavailability. This review focuses on the mechanistic effect of Cd on testicular toxicity and different categories of compounds having a beneficial impact on Cd-induced male reproductive toxicity. Some potent bioactive antioxidants are quercetin, caffeic acid phenethyl ester, cyanidin-3-O-glucoside, curcumin, and silymarin. In comparison, plant extracts are Costus afer leaf methanol extract, methanol root extract of Carpolobia lutea, red carrot methanolic extract, Panax ginseng extract, and biochemicals including melatonin, progesterone, glutamine, L-carnitine, and selenium. Advanced and more detailed studies are needed on these compounds to explore their mechanism in attenuating Cd-induced testicular toxicity and can be potential therapeutics in the future.
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Affiliation(s)
- Uddesh Ramesh Wanjari
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India.
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Lee H, Hwang EC, Oh CK, Lee S, Yu HS, Lim JS, Kim HW, Walsh T, Kim MH, Jung JH, Dahm P. Testosterone replacement in men with sexual dysfunction. Cochrane Database Syst Rev 2024; 1:CD013071. [PMID: 38224135 PMCID: PMC10788910 DOI: 10.1002/14651858.cd013071.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Clinical practice guidelines recommend testosterone replacement therapy (TRT) for men with sexual dysfunction and testosterone deficiency. However, TRT is commonly promoted in men without testosterone deficiency and existing trials often do not clearly report participants' testosterone levels or testosterone-related symptoms. This review assesses the potential benefits and harms of TRT in men presenting with complaints of sexual dysfunction. OBJECTIVES To assess the effects of testosterone replacement therapy compared to placebo or other medical treatments in men with sexual dysfunction. SEARCH METHODS We performed a comprehensive search of CENTRAL (the Cochrane Library), MEDLINE, EMBASE, and the trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform, with no restrictions on language of publication or publication status, up to 29 August 2023. SELECTION CRITERIA We included randomized controlled trials (RCTs) in men (40 years or over) with sexual dysfunction. We excluded men with primary or secondary hypogonadism. We compared testosterone or testosterone with phosphodiesterase-5 inhibitors (PDEI5I) to placebo or PDE5I alone. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, assessed the risk of bias, extracted data, and rated the certainty of evidence (CoE) according to GRADE using a minimally contextualized approach. We performed statistical analyses using a random-effects model and interpreted them according to standard Cochrane methodology. Predefined primary outcomes were self-reported erectile dysfunction assessed by a validated instrument, sexual quality of life assessed by a validated instrument, and cardiovascular mortality. Secondary outcomes were treatment withdrawal due to adverse events, prostate-related events, and lower urinary tract symptoms (LUTS). We distinguished between short-term (up to 12 months) and long-term (> 12 months) outcomes. MAIN RESULTS We identified 43 studies with 11,419 randomized participants across three comparisons: testosterone versus placebo, testosterone versus PDE5I, and testosterone with PDE5I versus PDE5I alone. This abstract focuses on the most relevant comparison of testosterone versus placebo. Testosterone versus placebo (up to 12 months) Based on a predefined sensitivity analysis of studies at low risk of bias, and an analysis combing data from the similar International Index of Erectile Function (IIEF-EF) and IIEF-5 instruments, TRT likely results in little to no difference in erectile function assessed with the IIEF-EF (mean difference (MD) 2.37, 95% confidence interval (CI) 1.67 to 3.08; I² = 0%; 6 RCTs, 2016 participants; moderate CoE) on a scale from 6 to 30 with larger values reflecting better erectile function. We assumed a minimal clinically important difference (MCID) of greater than or equal to 4. TRT likely results in little to no change in sexual quality of life assessed with the Aging Males' Symptoms scale (MD -2.31, 95% CI -3.63 to -1.00; I² = 0%; 5 RCTs, 1030 participants; moderate CoE) on a scale from 17 to 85 with larger values reflecting worse sexual quality of life. We assumed a MCID of greater than or equal to 10. TRT also likely results in little to no difference in cardiovascular mortality (risk ratio (RR) 0.83, 95% CI 0.21 to 3.26; I² = 0%; 10 RCTs, 3525 participants; moderate CoE). Based on two cardiovascular deaths in the placebo group and an assumed MCID of 3%, this would correspond to no additional deaths per 1000 men (95% CI 1 fewer to 4 more). TRT also likely results in little to no difference in treatment withdrawal due to adverse events, prostate-related events, or LUTS. Testosterone versus placebo (later than 12 months) We are very uncertain about the longer-term effects of TRT on erectile dysfunction assessed with the IIEF-EF (MD 4.20, 95% CI -2.03 to 10.43; 1 study, 42 participants; very low CoE). We did not find studies reporting on sexual quality of life or cardiovascular mortality. We are very uncertain about the effect of testosterone on treatment withdrawal due to adverse events. We found no studies reporting on prostate-related events or LUTS. AUTHORS' CONCLUSIONS In the short term, TRT probably has little to no effect on erectile function, sexual quality of life, or cardiovascular mortality compared to a placebo. It likely results in little to no difference in treatment withdrawals due to adverse events, prostate-related events, or LUTS. In the long term, we are very uncertain about the effects of TRT on erectile function when compared to placebo; we did not find data on its effects on sexual quality of life or cardiovascular mortality. The certainty of evidence ranged from moderate (signaling that we are confident that the reported effect size is likely to be close to the true effect) to very low (indicating that the true effect is likely to be substantially different). The findings of this review should help to inform future guidelines and clinical decision-making at the point of care.
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Affiliation(s)
- Hunju Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Cheol Kyu Oh
- Department of Urology, Heaundae Paik Hospital, Inje University, Busan, Korea, South
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Ho Song Yu
- Department of Urology, Chonnam National University, Gwangju, Korea, South
| | - Jung Soo Lim
- Division of Endocrinology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Hong Wook Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea, South
| | - Thomas Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Jae Hung Jung
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Testosterone Therapy in Oncologic Patients. CURRENT SEXUAL HEALTH REPORTS 2023. [DOI: 10.1007/s11930-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Madsen MC, den Heijer M, Pees C, Biermasz NR, Bakker LEH. Testosterone in men with hypogonadism and transgender males: a systematic review comparing three different preparations. Endocr Connect 2022; 11:e220112. [PMID: 35904217 PMCID: PMC9346330 DOI: 10.1530/ec-22-0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
Testosterone therapy is the cornerstone in the care of men with hypogonadism and transgender males. Gel and intramuscular injections are most frequently used and are registered and included in the international guidelines. The specific preparation should be selected according to the patient's preference, cost, availability, and formulation-specific properties. As the majority of men with hypogonadism and transgender males require lifelong treatment with testosterone, it is important to utilize a regimen that is effective, safe, inexpensive, and convenient to use with optimal mimicking of the physiological situation. This systematic review reviews current literature on differences between the three most used testosterone preparations in adult men with hypogonadism and transgender males. Although it appeared hardly any comparative studies have been carried out, there are indications of differences between the preparations, for example, on the stability of testosterone levels, hematocrit, bone mineral density, and patient satisfaction. However, there are no studies on the effects of testosterone replacement on endpoints such as cardiovascular disease in relation to hematocrit or osteoporotic fractures in relation to bone mineral density. The effect of testosterone therapy on health-related quality of life is strongly underexposed in the reviewed studies, while this is a highly relevant outcome measure from a patient perspective. In conclusion, current recommendations on testosterone treatment appear to be based on data primarily from non-randomized clinical studies and observational studies. The availability of reliable comparative data between the different preparations will assist in the process of individual decision-making to choose the most suitable formula.
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Affiliation(s)
- Milou Cecilia Madsen
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Claudia Pees
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Leontine E H Bakker
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Abstract
This article contains a systematic review of the main developments that have occurred in the area of male hypogonadism between the publication of the Endocrine Society Guidelines of 2010 and 2018 and after 2018.
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Affiliation(s)
- Marco Marcelli
- Department of Medicine, Division of Endocrinology, Baylor College of Medicine, Houson, Texas, USA .,Section of Endocrinology, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Sanjay Navin Mediwala
- Department of Medicine, Division of Endocrinology, Baylor College of Medicine, Houson, Texas, USA.,Section of Endocrinology, Michael E DeBakey VA Medical Center, Houston, Texas, USA
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7
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Suarni NMR, Oka IGL, Mahardika IG, Suyadnya IP. Testosterone level and mating capability of male rabbit fed commercial feed substituted with moringa oleifera leaf meal. ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1755-1315/347/1/012014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jensterle M, Podbregar A, Goricar K, Gregoric N, Janez A. Effects of liraglutide on obesity-associated functional hypogonadism in men. Endocr Connect 2019; 8:195-202. [PMID: 30707677 PMCID: PMC6391904 DOI: 10.1530/ec-18-0514] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/25/2022]
Abstract
Lifestyle measures (LSMs) should be the first-line approach offered for obesity-related functional hypogonadism (FH). When LSMs fail, the role of testosterone replacement treatment (TRT) is unclear. GLP1 receptor agonist liraglutide is linked to progressive and sustained weight loss. A potential direct impact of GLP1 on hypothalamus-pituitary-testicular (HPT) axis was reported in animal models. We aimed to compare the effects of liraglutide and TRT on FH in obese men that had been poor responders to LSM, by means of reversal of FH and weight reduction. We designed a 16-week prospective randomized open-label study with 30 men (aged 46.5 ± 10.9 years, BMI 41.2 ± 8.4 kg/m2, mean ± s.d.) that were randomized to liraglutide 3.0 mg QD (LIRA) or 50 mg of 1% transdermal gel QD (TRT). Sexual function and anthropometric measures were assessed. Fasting blood was drawn for determination of endocrine and metabolic parameters followed by OGTT. Model-derived parameters including HOMAIR and calculated free testosterone (cFT) were calculated. Total testosterone significantly increased in both arms (+5.9 ± 7.2 in TRT vs +2.6 ± 3.5 nmol/L in LIRA) and led to improved sexual function. LIRA resulted in a significant increase of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (P < 0.001 for between-treatment effect). Subjects treated with LIRA lost on average 7.9 ± 3.8 kg compared with a 0.9 ± 4.5 kg loss in TRT (P < 0.001). Metabolic syndrome was resolved in two patients in LIRA and in no subjects in TRT. Liraglutide was superior to TRT in improving an overall health benefit in men with obesity-associated FH after LSM failed.
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Affiliation(s)
- M Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Podbregar
- University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
| | - K Goricar
- University of Ljubljana, Faculty of Medicine, Institute of Biochemistry, Pharmacogenetics Laboratory, Ljubljana, Slovenia
| | - N Gregoric
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Correspondence should be addressed to A Janez:
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Ponce OJ, Spencer-Bonilla G, Alvarez-Villalobos N, Serrano V, Singh-Ospina N, Rodriguez-Gutierrez R, Salcido-Montenegro A, Benkhadra R, Prokop LJ, Bhasin S, Brito JP. The efficacy and adverse events of testosterone replacement therapy in hypogonadal men: A systematic review and meta-analysis of randomized, placebo-controlled trials. J Clin Endocrinol Metab 2018; 103:4939466. [PMID: 29562341 DOI: 10.1210/jc.2018-00404] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT The efficacy and safety of testosterone replacement therapy (TRT) in hypogonadal men remain incompletely understood. OBJECTIVE To conduct a systematic review and meta-analysis of randomized clinical trials (RCT) to determine the effects of TRT on patient-important outcomes and adverse events in hypogonadal men. DATA SOURCES We searched Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, and Scopus from inception to March 2th, 2017. STUDY SELECTION RCTs that assessed the efficacy and adverse events of TRT of at least 12 weeks compared with placebo in adult men with hypogonadism, defined by morning testosterone ≤300 ng/dL and at least one symptom or sign of hypogonadism. DATA EXTRACTION Reviewers working independently and in duplicate assessed the quality of the trials and collected data on patient characteristics, interventions, and outcomes. DATA SYNTHESIS We found 11 publications, reporting on 4 eligible trials (including 1,779 patients) at low risk of bias. Compared to placebo, TRT was associated with a small but significant increase in sexual desire or libido [standardized mean difference (SMD): 0.17, 95% CI 0.01, 0.34] (n=1383), erectile function [SMD: 0.16, 95% CI 0.06, 0.27] (n=1344), and sexual satisfaction [SMD: 0.16, 95% CI 0.01, 0.31] (n=676), but had no effect on energy or mood. TRT was associated with an increased risk of developing erythrocytosis [relative risk: 8.14, 95% CI: 1.87, 35.40] (n=1579) compared to placebo, but had no significant effect on lower urinary tract symptoms (LUTS). CONCLUSION In hypogonadal men TRT improves sexual desire, erectile function, and sexual satisfaction, however it increases the risk of erythrocytosis.
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Affiliation(s)
- Oscar J Ponce
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Neri Alvarez-Villalobos
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José E. Gonzalez", Plataforma INVEST-KER Mexico, Monterrey, Nuevo León, México
| | - Valentina Serrano
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Nutrition, Diabetes and Metabolism, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Naykky Singh-Ospina
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José E. Gonzalez", Plataforma INVEST-KER Mexico, Monterrey, Nuevo León, México
| | - Alejandro Salcido-Montenegro
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José E. Gonzalez", Plataforma INVEST-KER Mexico, Monterrey, Nuevo León, México
| | - Raed Benkhadra
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Shalender Bhasin
- Section of Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Demirtaş Şahin T, Yazir Y, Utkan T, Gacar G, Furat Rençber S, Gocmez SS. TNF-α antagonism with etanercept enhances penile NOS expression, cavernosal reactivity, and testosterone levels in aged rats. Can J Physiol Pharmacol 2017; 96:200-207. [PMID: 29260891 DOI: 10.1139/cjpp-2017-0113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Erectile dysfunction (ED) has been reported to be associated with inflammation. This study investigated the effects of tumor necrosis factor alpha (TNF-α) inhibitor etanercept on penile neuronal nitric oxide synthase (nNOS) and endothelial nitric oxide synthase (eNOS) expressions, testosterone concentrations, neurogenic and endothelium-dependent relaxations of corpus cavernosum (CC), and circulating and cavernosal levels of inflammatory markers in aged rats. Animals were separated into control, aged, and etanercept-treated aged groups. Aged rats displayed significantly increased serum and cavernosal TNF-α, C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1) and intercellular adhesion molecule (ICAM-1) levels, and decreased penile nNOS and eNOS expressions and serum testosterone levels compared with controls. In etanercept-treated aged group, NOS expressions were similar to that of the control group. The circulating and cavernosal concentrations of TNF-α, CRP, MCP-1, ICAM-1, and testosterone were also normalized by etanercept. Neurogenic and endothelium-dependent relaxant responses significantly decreased in aged rats and etanercept treatment markedly improved these relaxation responses. Our findings indicate that aging decreases penile NOS expression, neurogenic and endothelium-dependent relaxations of CC, and also suppresses serum testosterone levels by inducing inflammatory response that may contribute to the development of ED. TNF-α antagonism may be a novel strategy to treat aging-associated ED.
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Affiliation(s)
- Tuğçe Demirtaş Şahin
- a Department of Pharmacology, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey
| | - Yusufhan Yazir
- b Department of Histology and Embryology, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey.,c Stem Cell and Gene Therapy Research and Application Center, Kocaeli University, Kocaeli 41380, Turkey
| | - Tijen Utkan
- a Department of Pharmacology, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey.,d Experimental Medical Research and Application Center, Kocaeli University, Kocaeli 41380, Turkey
| | - Gulcin Gacar
- c Stem Cell and Gene Therapy Research and Application Center, Kocaeli University, Kocaeli 41380, Turkey
| | - Selenay Furat Rençber
- b Department of Histology and Embryology, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey
| | - Semil Selcen Gocmez
- a Department of Pharmacology, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey
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Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:3888-3921. [PMID: 27736313 DOI: 10.1210/jc.2016-2118] [Citation(s) in RCA: 474] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To formulate clinical practice guidelines for hormonal replacement in hypopituitarism in adults. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of six experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology co-sponsored this guideline. EVIDENCE The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. CONCLUSIONS Using an evidence-based approach, this guideline addresses important clinical issues regarding the evaluation and management of hypopituitarism in adults, including appropriate biochemical assessments, specific therapeutic decisions to decrease the risk of co-morbidities due to hormonal over-replacement or under-replacement, and managing hypopituitarism during pregnancy, pituitary surgery, and other types of surgeries.
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Affiliation(s)
- Maria Fleseriu
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Ibrahim A Hashim
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Niki Karavitaki
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Shlomo Melmed
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - M Hassan Murad
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Roberto Salvatori
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Mary H Samuels
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
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12
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Abbas MA. Is the use of plants in Jordanian folk medicine for the treatment of male sexual dysfunction scientifically based? Review of in vitro and in vivo human and animal studies. Andrologia 2016; 49. [PMID: 27312517 DOI: 10.1111/and.12619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 01/10/2023] Open
Abstract
Male sexual dysfunction is a serious problem which has an impact on the quality of life. In Jordanian folk medicine, 56 plant species were reported to be used by males to improve sexual potency and as aphrodisiacs. The aim of this study was to search for scientific evidence justifying their folk use. Of the 15 studied plants, only five were found to enhance spermatogenesis. The other 10 were reported to decrease spermatogenesis at least by one study. The majority of the studied plants possessed a protective effect on testis in different in vivo models as well as antioxidant activities. The effect of these plants on steroidogenesis and the hypothalamic-gonadal axis was also reviewed. The effect of only five plants was studied on sexual behaviour enhancement and three of them were active. Three of the four studied plants enhanced erection. The mechanism of action of active constituents isolated from the studied plants was also investigated. In conclusion, many plants used in Jordanian folk medicine decreased or had no effect on spermatogenesis in animal models. These plants have antioxidant and/or adaptogenic effects, and this may result in a beneficial action on male reproductive system.
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Affiliation(s)
- M A Abbas
- Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
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13
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Seftel A. How Best to Measure and Test for Androgen Deficiency. J Urol 2016; 195:1329-1330. [DOI: 10.1016/j.juro.2016.02.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/15/2022]
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14
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Melehan KL, Hoyos CM, Yee BJ, Wong KK, Buchanan PR, Grunstein RR, Liu PY. Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study. Andrology 2015; 4:55-61. [PMID: 26610430 DOI: 10.1111/andr.12132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/27/2015] [Accepted: 10/18/2015] [Indexed: 12/21/2022]
Abstract
Testosterone (T) deficiency, sexual dysfunction, obesity and obstructive sleep apnea (OSA) are common and often coexist. T prescriptions have increased worldwide during the last decade, including to those with undiagnosed or untreated OSA. The effect of T administration on sexual function, neurocognitive performance and quality of life in these men is poorly defined. The aim of this study was to examine the impact of T administration on sexual function, quality of life and neurocognitive performance in obese men with OSA. We also secondarily examined whether baseline T might modify the effects of T treatment by dichotomizing on baseline T levels pre-specified at 8, 11 and 13 nmol/L. This was a randomized placebo-controlled study in which 67 obese men with OSA (mean age 49 ± 1.3 years) were randomized to receive intramuscular injections of either 1000 mg T undecanoate or placebo at baseline, week 6 and week 12. All participants were concurrently enrolled in a weight loss program. General and sleep-related quality of life, neurocognitive performance and subjective sexual function were assessed before and 6, 12 and 18 weeks after therapy. T compared to placebo increased sexual desire (p = 0.004) in all men, irrespective of baseline T levels. There were no differences in erectile function, frequency of sexual attempts, orgasmic ability, general or sleep-related quality of life or neurocognitive function (all p = NS). In those with baseline T levels below 8 nmol/L, T increased vitality (p = 0.004), and reduced reports of feeling down (p = 0.002) and nervousness (p = 0.03). Our findings show that 18 weeks of T therapy increased sexual desire in obese men with OSA independently of baseline T levels whereas improvements in quality of life were evident only in those with T levels below 8 nmol/L. These small improvements would need to be balanced against potentially more serious adverse effects of T therapy on breathing.
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Affiliation(s)
- K L Melehan
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - C M Hoyos
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - B J Yee
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - K K Wong
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P R Buchanan
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Department of Respiratory Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - R R Grunstein
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P Y Liu
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
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15
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Nishimatsu H, Suzuki E, Saito Y, Niimi A, Nomiya A, Fukuhara H, Kume H, Homma Y. Senescent Cells Impair Erectile Function through Induction of Endothelial Dysfunction and Nerve Injury in Mice. PLoS One 2015; 10:e0124129. [PMID: 25894557 PMCID: PMC4404101 DOI: 10.1371/journal.pone.0124129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/26/2015] [Indexed: 11/18/2022] Open
Abstract
Erectile dysfunction (ED) is a major health problem, particularly in the elderly population, which is rapidly increasing. It is necessary to elucidate the mechanism by which ED occurs in the elderly. Cellular senescence is commonly detected in old tissues, and it is well known that senescent cells not only withdraw from the cell cycle but also remain viable and actively produce a variety of cytokines. We examined the effect of senescent cells on erectile function after injection of senescent cells into the penises of mice. Human umbilical vein endothelial cells were infected with an adenovirus expressing a constitutively active mutant of Ras to induce senescence, and were injected into the penises of nude mice. These senescent cells expressed proinflammatory cytokines such as interleukin-1β (IL-1β). Injection of senescent cells impaired erectile function, as assessed by the measurement of intracavernous pressure. Although the structure of the cavernous body did not remarkably change, expression of the catalytically active form of endothelial nitric oxide synthase and that of total neural nitric oxide synthase significantly decreased after injection. The penises injected with the senescent cells expressed human IL-1β and subsequently endogenous proinflammatory cytokines such as mouse IL-1β and tumor necrosis factor-α. These results suggested that senescent cells impaired erectile function through induction of endothelial dysfunction and nerve injury. These effects may be mediated by proinflammatory cytokines produced by senescent cells.
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Affiliation(s)
- Hiroaki Nishimatsu
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Etsu Suzuki
- Institute of Medical Science, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Japan
- * E-mail:
| | - Yasuho Saito
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Aya Niimi
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Nomiya
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Fukuhara
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Haruki Kume
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yukio Homma
- The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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16
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Abstract
Numerous studies have sought to examine the relationship between hypogonadal symptoms and total serum testosterone levels in men in order to identify a threshold at which symptoms occur and at which treatment is beneficial. However, the search for a discrete threshold may be futile given emerging evidence. Recent studies suggest that testosterone threshold varies by symptoms and among individuals. In addition, thresholds may vary between young and old men. Therefore, initiation of treatment should rely more on symptoms and less on a discrete numerical threshold.
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Affiliation(s)
- Avinash Maganty
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College , New York, NY , USA and
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17
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Corona G, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, Rochira V, Sforza A, Lenzi A, Mannucci E, Maggi M. Testosterone Supplementation and Sexual Function: A Meta-Analysis Study. J Sex Med 2014; 11:1577-92. [DOI: 10.1111/jsm.12536] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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18
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Al Hayek AA, Khawaja NM, Khader YS, Jaffal SK, Ajlouni KM. The prevalence of Hypogonadism among diabetic and non-diabetic men in Jordan. J Diabetes Complications 2014; 28:135-40. [PMID: 24388552 DOI: 10.1016/j.jdiacomp.2013.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 10/09/2013] [Accepted: 11/07/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Determine the prevalence of hypogonadism among diabetic and non-diabetic men in Jordan. RESEARCH DESIGN AND METHODS A cross-sectional study of 1717 men (1089 participants with type 2 diabetes and 628 non-diabetic subjects). Both groups were inquired to answer the Androgen Deficiency for aging male (ADAM) questionnaire. Early morning Total testosterone, prolactin, sex hormone binding globulin, follicle stimulating hormone, leutinizing hormone, HbA1c and fasting blood sugar were measured. Hypogonadism was defined as total testosterone <3 ng/ml and calculated free testosterone <5 ng/dl. RESULTS The prevalence of Hypogonadism among all study participants was 18.5%. The prevalence of Hypogonadism in diabetic and non-diabetic men was 24.3% and 8.3%, respectively. The mean (SD) total testosterone concentration of diabetic and non-diabetic men was 3.78 ng/ml (1.7) and 4.92 ng/ml (2.5), respectively (P- value <0.005). In response to (ADAM) questionnaire, 19.8% of diabetics and 3% of the non-diabetics had symptomatic androgen deficiency (P value <0.005). Hypogonadism and symptomatic androgen deficiency were negatively and significantly related to diabetes, monthly income and age (P value <0.005). CONCLUSION Hypogonadism is a prevalent disorder among Jordanian diabetic population. Symptoms of androgen deficiency should be corroborated with testosterone level to establish a multidisciplinary approach for management of hypogonadism.
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Affiliation(s)
- Ayman A Al Hayek
- National Center for Diabetes, Endocrinology and Genetics, P.O. Box 13165, Amman 11942, Jordan.
| | - Nahla M Khawaja
- National Center for Diabetes, Endocrinology and Genetics, P.O. Box 13165, Amman 11942, Jordan.
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan.
| | - Sahar K Jaffal
- National Center for Diabetes, Endocrinology and Genetics, P.O. Box 13165, Amman 11942, Jordan.
| | - Kamel M Ajlouni
- National Center for Diabetes, Endocrinology and Genetics, P.O. Box 13165, Amman 11942, Jordan.
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19
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Leung KW, Wong AS. Ginseng and male reproductive function. SPERMATOGENESIS 2013; 3:e26391. [PMID: 24381805 PMCID: PMC3861174 DOI: 10.4161/spmg.26391] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 01/15/2023]
Abstract
Ginseng is often referred to as the King of all herbs, and is found to be a promising agent to improve general well-being. Ginseng has also been reputed as an aphrodisiac, and is used to treat sexual dysfunction as well as to enhance sexual behavior in traditional Chinese medical practices. Data from animal studies have shown a positive correlation among ginseng, libido, and copulatory performances, and these effects have been confirmed in case-control studies in human. In addition, ginseng is found to improve the sperm quality and count of healthy individuals as well as patients with treatment-related infertility. These actions are mostly attributed to ginsenosides, the major pharmacological active components of ginseng. This review compiles the current knowledge about the multifaceted effects of ginseng on male reproductive function, and also focuses on its mechanisms of action that may represent novel therapeutic strategies for the treatment of male reproductive diseases or disorders.
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Affiliation(s)
- Kar Wah Leung
- School of Biological Sciences; University of Hong Kong; Hong Kong, PR China
| | - Alice St Wong
- School of Biological Sciences; University of Hong Kong; Hong Kong, PR China
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20
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Isidori AM, Buvat J, Corona G, Goldstein I, Jannini EA, Lenzi A, Porst H, Salonia A, Traish AM, Maggi M. A critical analysis of the role of testosterone in erectile function: from pathophysiology to treatment-a systematic review. Eur Urol 2013; 65:99-112. [PMID: 24050791 DOI: 10.1016/j.eururo.2013.08.048] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/16/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Androgen modulation of erectile function (EF) is widely accepted. However, the use of testosterone replacement therapy (TRT) in men with erectile dysfunction (ED) has generated an unprecedented debate. OBJECTIVE To summarize the relevant data on the incidence, diagnosis, and management of ED coexisting with hypogonadism and to develop a pathophysiology-based treatment algorithm. EVIDENCE ACQUISITION We reviewed the relevant medical literature, with a particular emphasis on original molecular studies, prospective observational data, and randomized controlled trials performed in the past 20 yr. EVIDENCE SYNTHESIS Testosterone modulates nearly every component involved in EF, from pelvic ganglions to smooth muscle and the endothelial cells of the corpora cavernosa. It also regulates the timing of the erectile process as a function of sexual desire, coordinating penile erection with sex. Epidemiologic studies confirm the significant overlap of hypogonadism and ED; however, most guidelines do not consider the differential diagnosis of hypogonadism or the relevance of subclinical disease. Various clinical tools can help the physician to assess and restore androgen levels in men with ED. Special attention is given to fertility-sparing treatments, due to the increasing number of older men desiring fatherhood. The simultaneous use of phosphodiesterase type 5 inhibitors (PDE5-Is) and TRT has recently been questioned. Originally proposed as a salvage therapy for nonresponders to PDE5-Is, this approach has been inappropriately transformed into a combination therapy. Clinical data are consistent when reinterpreted in the proper framework, whereas molecular evidence remains controversial. CONCLUSIONS A body of molecular and clinical evidence supports the use of TRT in hypogonadal patients with ED, although the benefit-risk ratio is uncertain in advanced age. Critical appraisal of this evidence enabled the development of a pathophysiology-oriented algorithm designed to avoid inappropriate treatments and support whether to start with TRT, PDE5-I only, or both. Apparently divergent findings are reconciled when TRT is correctly indicated. An improved diagnosis and individualized management is desirable in light of the many available options.
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21
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de Jong PJ, van Overveld M, Borg C. Giving in to arousal or staying stuck in disgust? Disgust-based mechanisms in sex and sexual dysfunction. JOURNAL OF SEX RESEARCH 2013; 50:247-262. [PMID: 23480071 DOI: 10.1080/00224499.2012.746280] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Sex and disgust seem like strange bedfellows. The premise of this review is that disgust-based mechanisms nevertheless hold great promise for improving our understanding of sexual behavior, including dysfunctions. Disgust is a defensive emotion that protects the organism from contamination. Accordingly, disgust is focused on the border of the self, with the mouth and vagina being the body parts that show strongest disgust sensitivity. Given the central role of these organs in sexual behavior, together with the fact that bodily products are among the strongest disgust elicitors, the critical question seems not whether disgust may interfere with sex but rather how people succeed in having pleasurable sex at all. We argue that sexual arousal plays a critical role in counteracting disgust-induced avoidance via lowering the threshold for engaging in "disgusting sex." Following this, all mechanisms that interfere with the generation of sexual arousal or enhance the disgusting properties of sexual stimuli may hamper the functional transition from a sex-avoidance into an approach disposition. Since prolonged contact is the most powerful means to reduce disgust, disgust-based mechanisms that counteract sexual approach may give rise to a self-perpetuating cycle in which enhanced sexual disgust becomes a chronic feature.
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22
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Alhathal N, Elshal AM, Carrier S. Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: A systematic review. Can Urol Assoc J 2012; 6:269-74. [PMID: 23093538 DOI: 10.5489/cuaj.11291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Testosterone deficiency seems to impair the clinical response to phophodiesterase-5 (PDE-5) inhibitors in patients with erectile dysfunction (ED). In hypogonadal men, testosterone repletion was associated with enhanced sexual function in patients who failed initial treatment with sildenafil or tadalafil. We conducted a systematic review of studies that evaluated combination therapy of testosterone and PDE-5 inhibitors in patients with ED and low, low-normal testosterone levels who failed monotherapy. The studies we examine are heterogeneous with several methodological drawbacks and that, overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone <300 ng/dL (10.4 nmol/L) who failed monotherapy. Further studies, with a randomized placebo-controlled and double blind design, are needed to describe the appropriate target patient group, testosterone cut-off and to define the optimal dose and duration of combination therapy.
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Affiliation(s)
- Naif Alhathal
- Division of Urology, Department of Surgery, McGill University, Montreal, QC
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23
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Lopes RAM, Neves KB, Carneiro FS, Tostes RC. Testosterone and vascular function in aging. Front Physiol 2012; 3:89. [PMID: 22514541 PMCID: PMC3322529 DOI: 10.3389/fphys.2012.00089] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/25/2012] [Indexed: 11/13/2022] Open
Abstract
Androgen receptors are widely distributed in several tissues, including vascular endothelial and smooth muscle cells. Through classic cytosolic androgen receptors or membrane receptors, testosterone induces genomic and non-genomic effects, respectively. Testosterone interferes with the vascular function by increasing the production of pro-inflammatory cytokines and arterial thickness. Experimental evidence indicates that sex steroid hormones, such as testosterone modulate the synthesis and bioavailability of NO and, consequently, endothelial function, which is key for a healthy vasculature. Of interest, aging itself is accompanied by endothelial and vascular smooth muscle dysfunction. Aging-associated decline of testosterone levels is accompanied by age-related diseases, such as metabolic and cardiovascular diseases, indicating that very low levels of androgens may contribute to cardiovascular dysfunction observed in these age-related disorders or, in other words, that testosterone may have beneficial effects in the cardiovascular system. However, testosterone seems to play a negative role in the severity of renal disease. In this mini-review, we briefly comment on the interplay between aging and testosterone levels, the vascular actions of testosterone and its implications for vascular aging. Renal effects of testosterone and the use of testosterone to prevent vascular dysfunction in elderly are also addressed.
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Affiliation(s)
- Rhéure A M Lopes
- Department of Pharmacology, Medical School of Ribeirao Preto, Ribeirao Preto São Paulo, Brazil
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24
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Amore M, Innamorati M, Costi S, Sher L, Girardi P, Pompili M. Partial androgen deficiency, depression, and testosterone supplementation in aging men. Int J Endocrinol 2012; 2012:280724. [PMID: 22719760 PMCID: PMC3376477 DOI: 10.1155/2012/280724] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/08/2012] [Accepted: 04/10/2012] [Indexed: 12/12/2022] Open
Abstract
The aim of this review was to summarize current knowledge on the correlation between depressive symptoms with a syndrome called partial androgen deficiency of the aging male (PADAM) and on the potential benefits of testosterone (T) treatment on mood. Despite, the causative nature of the relationship between low T levels and depression is uncertain, many hypogonadal men suffer from depression and vice versa several depressed patients are affected by hypogonadism. Supplementation with testosterone failed to show sound evidence of effectiveness in the treatment of depression. Nevertheless, testosterone supplementation has proved to be effective on some domains significant for the quality of life of aged patients with PADAM (sexual function and cognitive functions, muscular strengths).
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Affiliation(s)
- Mario Amore
- Department of Neurosciences, Institute of Psychiatry, University of Parma, Piazza Matteotti 9, 43100 Parma, Italy
- *Mario Amore:
| | - Marco Innamorati
- Department of Neurosciences, Institute of Psychiatry, University of Parma, Piazza Matteotti 9, 43100 Parma, Italy
| | - Sara Costi
- Department of Neurosciences, Institute of Psychiatry, University of Parma, Piazza Matteotti 9, 43100 Parma, Italy
| | - Leo Sher
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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25
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Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM. Improved Sexual Function with Testosterone Replacement Therapy in Hypogonadal Men: Real‐World Data from the Testim Registry in the United States (TRiUS). J Sex Med 2011; 8:3204-13. [DOI: 10.1111/j.1743-6109.2011.02436.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Sexual Dysfunctions of HIV-Positive Men: Associated Factors, Pathophysiology Issues, and Clinical Management. Adv Urol 2011; 2011:854792. [PMID: 22046183 PMCID: PMC3199204 DOI: 10.1155/2011/854792] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/21/2011] [Indexed: 11/17/2022] Open
Abstract
Sexual dysfunctions in HIV-positive men are associated with an increase in risky sexual behavior and decreased adherence to antiretroviral drug regimens. Because of these important public health issues, we reviewed the literature on the pathophysiology, associated factors and clinical management of sexual dysfunction in HIV-positive men. The goal was to investigate the current research on these issues. Literature searches were performed in June 2011 on PubMed, Web of Science, and PsycInfo databases with the keywords “AIDS” and “sexual dysfunction” and “HIV” and “sexual dysfunction”, resulting in 54 papers. Several researchers have investigated the factors associated with sexual dysfunction in HIV-positive men. The association between sexual dysfunction and antiretroviral drugs, particularly protease inhibitors, has been reported in many studies. The lack of standardized measures in many studies and the varying study designs are the main reasons that explain the controversial results. Despite some important findings, the pathophysiology of sexual dysfunction in the HAART era still not completely understood. Clinical trials of testosterone replacement therapy have shown the treatment to be beneficial to the improvement of sexual dysfunctions related to hypogonadism. However, there are not enough psychological intervention studies to make conclusions regarding the therapeutic effects of psychotherapy.
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27
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Male and Female Sexual Function and Dysfunction; Andrology. J Urol 2010. [DOI: 10.1016/j.juro.2010.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Seftel A. Male and Female Sexual Function and Dysfunction; Andrology. J Urol 2010; 184:2081-4. [DOI: 10.1016/j.juro.2010.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Aswar U, Bodhankar SL, Mohan V, Thakurdesai PA. Effect of furostanol glycosides from Trigonella foenum-graecum
on the reproductive system of male albino rats. Phytother Res 2010; 24:1482-8. [DOI: 10.1002/ptr.3129] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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30
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Herzog AG, Farina EL, Drislane FW, Schomer DL, Smithson SD, Fowler KM, Dworetzky BA, Bromfield EB. A comparison of anastrozole and testosterone versus placebo and testosterone for treatment of sexual dysfunction in men with epilepsy and hypogonadism. Epilepsy Behav 2010; 17:264-71. [PMID: 20096638 DOI: 10.1016/j.yebeh.2009.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/04/2009] [Accepted: 12/13/2009] [Indexed: 11/25/2022]
Abstract
Hyposexuality is commonly associated with low bioavailable testosterone (BAT) and relative estradiol elevation in men with epilepsy. This prospective, randomized, double-blind trial compared the effects of depotestosterone+the aromatase inhibitor anastrozole (T-A) versus depotestosterone+placebo (T-P) on sexual function, hormone levels, mood, and seizure frequency in men with epilepsy. Forty men with focal epilepsy, hyposexuality, and hypogonadism were randomized 1:1 to two groups (T-A or T-P) for a 3-month treatment trial of depotestosterone+either anastrozole or matching placebo. Outcomes included both efficacy and safety measures. Normalization of sexual function (S-score) occurred with greater frequency in the T-A (72.2%) than in the T-P (47.4%) group, but the difference was not statistically significant. T-A resulted in significantly lower estradiol levels and S-scores correlated inversely with estradiol levels at baseline and during treatment. Beck Depression Inventory II (BDI-II) scores improved significantly in both groups and changes in S-score correlated inversely with changes in BDI-II score. Changes in seizure frequency correlated with changes in BDI-II score. Seizure frequency decreased with both treatments and showed significant correlations with estradiol levels. Triglyceride levels increased with T-P and decreased with T-A. The difference in triglyceride changes between the two treatments was significant and correlated with changes in estradiol levels. Significant correlations between estradiol levels and S-scores, as well as seizure outcomes and triglyceride levels, suggest further study regarding a potential role for anastrozole in the treatment of men with epilepsy who have hyposexuality and hypogonadism.
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Affiliation(s)
- Andrew G Herzog
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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31
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Lakshman KM, Basaria S. Safety and efficacy of testosterone gel in the treatment of male hypogonadism. Clin Interv Aging 2009; 4:397-412. [PMID: 19966909 PMCID: PMC2785864 DOI: 10.2147/cia.s4466] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Indexed: 11/23/2022] Open
Abstract
Transdermal testosterone gels were first introduced in the US in 2000. Since then, they have emerged as a favorable mode of testosterone substitution. Serum testosterone levels reach a steady-state in the first 24 hours of application and remain in the normal range for the duration of the application. This pharmacokinetic profile is comparable to that of testosterone patch but superior to injectable testosterone esters that are associated with peaks and troughs with each dose. Testosterone gels are as efficacious as patches and injectable forms in their effects on sexual function and mood. Anticipated increases in prostate-specific antigen with testosterone therapy are not significantly different with testosterone gels, and the risk of polycythemia is lower than injectable modalities. Application site reactions, a major drawback of testosterone patches, occur less frequently with testosterone gels. However, inter-personal transfer is a concern if appropriate precautions are not taken. Superior tolerability and dose flexibility make testosterone gel highly desirable over other modalities of testosterone replacement. Androgel and Testim, the two currently available testosterone gel products in the US, have certain brand-specific properties that clinicians may consider prior to prescribing.
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Affiliation(s)
- Kishore M Lakshman
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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32
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Sadovsky R, Brock GB, Gutkin SW, Sorsaburu S. Toward a new 'EPOCH': optimising treatment outcomes with phosphodiesterase type 5 inhibitors for erectile dysfunction. Int J Clin Pract 2009; 63:1214-30. [PMID: 19624789 PMCID: PMC2779984 DOI: 10.1111/j.1742-1241.2009.02119.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Despite the marked adverse impacts of erectile dysfunction (ED) on quality of life and well-being, many patients (and/or their partners) do not seek medical attention for this problem, do not receive treatment or discontinue such treatment even when it has effectively restored erectile responses to sexual stimulation. Phosphodiesterase type 5 (PDE5) inhibitors are considered first-line therapies for men with ED. To help physicians maximise the likelihood of treatment success with these agents, we conducted an English-language PubMed search of articles involving approved PDE5 inhibitors dating from 1 January 1998 (the year in which sildenafil citrate was introduced), through 31 August 2008. In addition to sildenafil, tadalafil and vardenafil, search terms included 'adhere*', 'couple*', 'effect*', 'effic*', 'partner*', 'satisf*', 'succe*' and 'treatment outcome.' Based on our analysis, physician activities to promote favourable treatment outcomes may be captured under the mnemonic 'EPOCH': (i) Evaluating and educating patients and partners to ensure realistic expectations of therapy; (ii) Prescribing a treatment individualised to the couple's lifestyle needs and other preferences; (iii) Optimising treatment outcomes by scheduling follow-up visits with the patient to 'fine-tune' dosages and revisit key educational messages; (iv) Controlling comorbidities via lifestyle counselling, medications and/or referrals and (v) Helping patients and their partners to meet their health and psychosocial needs, potentially referring them to a specialist for other forms of therapy if they are not satisfied with PDE5 inhibitors.
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Affiliation(s)
- R Sadovsky
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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Schmidt PJ, Steinberg EM, Negro PP, Haq N, Gibson C, Rubinow DR. Pharmacologically induced hypogonadism and sexual function in healthy young women and men. Neuropsychopharmacology 2009; 34:565-76. [PMID: 18354393 PMCID: PMC2626158 DOI: 10.1038/npp.2008.24] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 01/04/2008] [Accepted: 01/24/2008] [Indexed: 11/08/2022]
Abstract
Studies fail to find uniform effects of age-related or induced hypogonadism on human sexual function. We examined the effects of induced hypogonadism on sexual function in healthy men and women and attempted to identify predictors of the sexual response to induced hypogonadism or hormone addback. The study design used was a double-blind, controlled, crossover (self-as-own control). The study setting was an ambulatory care clinic in a research hospital, and the participants were 20 men (average+/-SD age=28.5+/-6.2 years) and 20 women (average+/-SD age=33.5+/-8.7 years), all healthy and with no history of psychiatric illness. A multidimensional scale assessing several domains of sexual function was the main outcome measure. Participants of the study received depot leuprolide acetate (Lupron) every 4 weeks for 3 months (men) or 5 months (women). After the first month of Lupron alone, men received (in addition to Lupron) testosterone enanthate (200 mg intramuscularly) or placebo every 2 weeks for 1 month each. Women received Lupron alone for 2 months, and then, in addition to Lupron, they received estradiol and progesterone for 5 weeks each. The results of the study: in women, hypogonadism resulted in a significant decrease in global measures of sexual functioning, principally reflecting a significant decrease in the reported quality of orgasm. In men, hypogonadism resulted in significant reductions in all measured domains of sexual function. Testosterone restored sexual functioning scores in men to those seen at baseline, whereas neither estradiol nor progesterone significantly improved the reduced sexual functioning associated with hypogonadism in women. Induced hypogonadism decreased sexual function in a similar number of men and women. No predictors of response were identified except for levels of sexual function at baseline. In conclusion, our data do not support a simple deficiency model for the role of gonadal steroids in human sexual function; moreover, while variable, the role of testosterone in sexual function in men is more apparent than that of estradiol or progesterone in women.
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Affiliation(s)
- Peter J Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, NIH, DHHS, Bethesda, MD 20892-1276, USA.
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34
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Partial androgen deficiency, depression and testosterone treatment in aging men. Aging Clin Exp Res 2009; 21:1-8. [PMID: 19225262 DOI: 10.1007/bf03324891] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study provides a critical review of the literature on depressive symptoms of partial androgen deficiency (PADAM) and their treatment with Testosterone (T). PADAM in aging males is responsible for a variety of behavioral symptoms, such as weakness, decreased libido and erectile dysfunction, lower psychological vitality, depressive mood, anxiety, insomnia, difficulty in concentrating, and memory impairment. The psychological and behavioural aspects of PADAM may overlap with signs and symptoms of major depression. Evidence of the relationship between androgen deficiency and male depression comes from studies that have assessed depression in hypogonadal subjects, the association between low T level and male depressive illness, and the antidepressant action of androgen replacement. The etiology of depressive symptoms of PADAM is multifactorial, and results from the interaction of the biological and psychosocial changes that take place during the mid-life transition. Although data derived from androgen treatment trials and androgen replacement do not support T treatment or replacement as more efficacious than placebo for major depressive disorder (MDD), the clinical impression is that, in some sub-threshold depressive syndromes, T may lead to antidepressant benefits.
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35
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Chiang HS, Cho SL, Lin YC, Hwang TIS. Testosterone gel monotherapy improves sexual function of hypogonadal men mainly through restoring erection: evaluation by IIEF score. Urology 2009; 73:762-6. [PMID: 19118875 DOI: 10.1016/j.urology.2008.10.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 10/09/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To use the International Index of Erectile Function (IIEF) to evaluate the improvement of erectile function and other sexual functions after testosterone monotherapy. Testosterone replacement therapy alone was reported to be effective for the improvement in sexual function in hypogonadal males. However, it is still unclear that which kind of the sexual function is most beneficial and to what extent the sexual function could be improved. METHODS A double-blind, randomized, placebo-controlled study was conducted with a treatment group (n = 20) and control group (n = 20). Using a critical review of the different sexual functional domain scores of the IIEF-15 and the scores of the IIEF-5, we evaluated the sexual function of men in hypogonadal status before and after 3 months of testosterone gel treatment. Effect size was used to compare the drug effects for each sexual functional domain, and the results were confirmed by multivariate analysis. RESULTS A total of 30 men remained at the end of the study. After 3 months of testosterone gel therapy for the hypogonadal men, the most beneficial effect on sexual function was erectile function, with sexual desire and orgasmic satisfaction insignificantly affected. CONCLUSIONS The results of our study have shown that transdermal testosterone gel treatment for hypogonadal patients can improve their sexual dysfunction mainly through restoring erectile function.
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Affiliation(s)
- Han-Sun Chiang
- Fu Jen Catholic University College of Medicine, Taipei, Taiwan
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36
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Miner M, Canty DJ, Shabsigh R. Testosterone replacement therapy in hypogonadal men: assessing benefits, risks, and best practices. Postgrad Med 2008; 120:130-53. [PMID: 18824832 DOI: 10.3810/pgm.2008.09.1914] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypogonadism is a common condition, especially among older men, but often goes undiagnosed and untreated. It can be associated with a number of signs and symptoms that affect health and quality of life, including feelings of low energy and fatigue; decreased sex drive and performance; decreased muscle mass and strength; decreased bone mineral density; and increased body fat, particularly abdominal fat, a putative risk factor for metabolic syndrome and type 2 diabetes mellitus. The evidence supporting testosterone replacement therapy (TRT) in improving these and related conditions is strong and consistent for body composition and sexual function; moderately consistent for bone mineral density; inconsistent for insulin sensitivity, glycemic control, and lipid profiles; and weak and inconsistent for mood and cognitive function. The concern of some physicians about the potential for TRT to stimulate prostate cancer is not supported by decades of data accumulated to date, though studies of longer duration (eg, 10 years or more) would be even more convincing. Other research needs are discussed. As the front line of health care delivery, primary care physicians need to be vigilant in diagnosing and treating symptomatic hypogonadism. Based on current guidelines, we recommend assessing testosterone levels when an adult man exhibits signs of hypogonadism, and as part of normal medical screening in men starting at age 40 to 50 years, to establish a baseline. A physician should discuss the possibility of TRT with symptomatic patients who have a serum total testosterone level < 300 ng/dL. If TRT is initiated, a patient's response and adverse events should be assessed every 3 to 6 months, and therapy adjusted accordingly.
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Affiliation(s)
- Martin Miner
- Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA.
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37
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38
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Wald M, Miner M, Seftel AD. State of the Art Reviews: Male Menopause: Fact or Fiction? Am J Lifestyle Med 2008. [DOI: 10.1177/1559827607311513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The possible existence of a menopause-like process in aging men has been speculated, given certain age-related hormonal and other biological changes noted to occur. Specifically, a slow decline in serum testosterone levels has been reported to occur with normal male aging. Androgen deficiency, which may result from this process, could have an effect on various systems and physiologic parameters, including bone density, body composition, sexual function, and the cardiovascular system, thus significantly affecting health and quality-of-life issues in older men. There has been an increasing interest in evaluating the possible use of testosterone replacement in preventing some detrimental aspects of aging and age-related hypogonadism, as well as in the investigation of the potential adverse effects of this therapy on different target organs. It is the purpose of this review to summarize currently available information with regard to the changes in testosterone and other hormones in older men, discuss their possible clinical manifestations and relationship with other age-related changes, and provide an updated description of testosterone replacement therapy for older men, including its indications, formulations, and safety considerations.
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Affiliation(s)
- Moshe Wald
- University of Iowa, Department of Urology, Iowa City, Iowa,
| | - Martin Miner
- Department of Family Medicine, Brown University School of Medicine, Swansea Family Practice, Swansea, Massachusetts
| | - Allen D. Seftel
- epartment of Urology, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio
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39
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40
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Seftel AD, Miner MM, Kloner RA, Althof SE. Office Evaluation of Male Sexual Dysfunction. Urol Clin North Am 2007; 34:463-82, v. [DOI: 10.1016/j.ucl.2007.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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41
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The role for intramuscular testosterone injection in the gel era. CURRENT SEXUAL HEALTH REPORTS 2007. [DOI: 10.1007/s11930-007-0014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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42
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Miner MM, Seftel AD. Testosterone and ageing: what have we learned since the Institute of Medicine report and what lies ahead? Int J Clin Pract 2007; 61:622-32. [PMID: 17343664 DOI: 10.1111/j.1742-1241.2007.01317.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A 2003 report by the Institute of Medicine (IOM) surveyed the literature on the benefits and risks of testosterone replacement therapy in older men and identified knowledge gaps and research needs. This review summarises some key studies published since the IOM report. The possible relationship of testosterone to risk of prostate cancer remains a concern; however, no new evidence has emerged to suggest that testosterone replacement therapy increases the risk. Recent studies have demonstrated that hypogonadism in men may be more prevalent than previously thought, is strongly associated with metabolic syndrome, and may be a risk factor for type 2 diabetes and cardiovascular disease. Clinical studies have shown that testosterone replacement therapy in hypogonadal men improves metabolic syndrome indicators and cardiovascular risk factors. Maintaining testosterone concentrations in the normal range has been shown to contribute to bone health, lean muscle mass, and physical and sexual function, suggesting that testosterone replacement therapy may help to prevent frailty in older men. Based on current knowledge, testosterone replacement therapy is unlikely to pose major health risks in patients without prostate cancer and may offer substantial health benefits. Larger, longer-term randomised studies are needed to fully establish the effects of testosterone replacement therapy.
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Affiliation(s)
- M M Miner
- Department of Family Medicine, Brown University School of Medicine, Providence, RI, USA.
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43
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Boloña ER, Uraga MV, Haddad RM, Tracz MJ, Sideras K, Kennedy CC, Caples SM, Erwin PJ, Montori VM. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc 2007; 82:20-8. [PMID: 17285782 DOI: 10.4065/82.1.20] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of randomized placebo-controlled trials to measure the effect of testosterone use on sexual function in men with sexual dysfunction and varying testosterone levels. METHODS Librarian-designed search strategies were used to search the MEDLINE (1966 to October 2004), EMBASE (1988 to October 2004), and Cochrane CENTRAL (inception to October 2004) databases. The MEDLINE search was rerun in March 2005. We also reviewed reference lists from included studies and content expert files. We selected randomized placebo-controlled trials of testosterone vs placebo that enrolled men with sexual dysfunction and measured satisfaction with erectile function and libido and overall sexual satisfaction. RESULTS We included 17 trials (N = 862 participants) in this review. Trials that enrolled participants with low testosterone levels showed (1) a moderate nonsignificant and inconsistent effect of testosterone use on satisfaction with erectile function (random-effects pooled effect size, 0.80; 95% confidence interval [CI], -0.10 to 1.60), (2) a large effect on libido (pooled effect size, 1.31; 95% CI, 0.40 to 2.25), and (3) no significant effect on overall sexual satisfaction. Trials that enrolled patients with low-normal and normal testosterone levels at baseline showed testosterone that caused (1) a small effect on satisfaction with erectile function (pooled effect size, 0.34; 95% CI, 0.03 to 0.65), (2) moderate nonsignificant effect on libido (pooled effect size, 0.41; 95% CI, -0.01 to 0.83), and (3) no significant effect on overall sexual satisfaction. CONCLUSION Testosterone use in men is associated with small improvements in satisfaction with erectile function and moderate improvements in libido. Unexplained inconsistent results across trials, wide CIs, and possible reporting bias weaken these inferences.
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Affiliation(s)
- Enrique R Boloña
- Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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44
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Perleth M. [Testosterone--a "fountain of youth" for ageing men? Brief assessment of the efficacy and safety of androgen substitution in healthy men]. ZEITSCHRIFT FUR ARZTLICHE FORTBILDUNG UND QUALITATSSICHERUNG 2007; 101:487-97. [PMID: 18183870 DOI: 10.1016/j.zgesun.2007.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Testosterone levels decline gradually with age in men. A number of manifestations such as reduced libido or depression have been attributed to subphysiological testosterone levels. Hence, testosterone supplementation has been proposed in these cases. OBJECTIVE To assess the efficacy and safety of testosterone supplementation therapy in hypogonadal healthy men. METHODS Non-systematic review of randomised controlled trials (RCTs), systematic reviews/meta-analyses and HTA reports investigating testosterone supplementation in hypogonadal healthy men. RESULTS Five systematic reviews/meta-analyses and seven additional RCTs were included. The evidence suggests a consistent but weak positive effect on sexual function, lean body mass and vertebral bone mass. However, the clinical significance of these findings remains unclear and some clinically relevant outcomes were not included in these studies. On the other hand, testosterone substitution was associated with an increase in prostata-related adverse events, increased hematocrit and allergic skin reactions due to testosterone patches. CONCLUSIONS The efficacy of testosterone supplementation for healthy hypogonadal men remains unclear. Only sexual function may improve in men with unequivocally reduced testosterone levels after supplementation therapy, but the clinical significance of this finding remains unclear. Long-term experience (i.e. more than three years) with effects and side effects is lacking.
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Affiliation(s)
- Matthias Perleth
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Auf dem Seidenberg 3a, 53721 Siegburg.
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45
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Abstract
To review the role and significance of hypogonadism, defined as a low testosterone (T) level, in erectile dysfunction (ED). Review of literature. Serum T is below 3 ng/ml in 12% of ED patients, including 4% before and 15% after the age of 50. Replacement studies in men with severe hypogonadism demonstrate that sexual desire and arousal, as well as the frequency of sexual activity and spontaneous erections are clearly T-dependant. Psychic erections are partly T-dependant. The effects of T upon sexual function are dose-dependant up to a threshold level that is consistent within an individual, but markedly variable between individuals, ranging from 2 to 4.5 ng/ml. More evidence is required to confirm a significant impact of T on the intrapenile vascular mechanisms of erections in men as it is the case in animals. No convincing association of T with ED has been found in epidemiological studies. As concerns clinical experience, although a meta-analysis of the randomized controlled trials established that T therapy consistently restores erectile function in young hypogonadal patients with T below 3.46 ng/ml, the effects of this treatment have been mostly disappointing when used alone in older patients consulting for ED who are subsequently diagnosed to have hypogonadism following routine T measurement. These poor results may probably be explained by the high prevalence of co-morbidities, and by the fact that ED itself may induce hypogonadism. Combination therapy with T and PDE5 inhibitor (PDE5I) may be effective in the hypogonadal ED patients when T therapy alone fails. However, more evidence is required to confirm the hypothesis that a minimum level of T is required for a complete effect of PDE5I in certain men, since a PDE5I was able to restore complete erections in severely hypogonadal men. Though a low T level is not always the only cause of ED in hypogonadal ED patients, there are important benefits in screening for hypogonadism in ED. A low T level justifies a 3 month trial of T therapy, before combining a PDE5I if T therapy alone fails.
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46
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Köhn FM. Gibt es eine Pharmakotherapie bei Libidostörungen des Mannes? Urologe A 2006; 45:999-1001. [PMID: 16832642 DOI: 10.1007/s00120-006-1126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
For men with a reduced testosterone level, treatment with testosterone usually improves sexual appetency. This has been demonstrated for gel and plaster as well as intramuscular and oral forms of treatment. However, from our current stand point such disturbances in sexual appetency can only be treated pharmacologically if these result from an endocrinological or other disease.
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Affiliation(s)
- F-M Köhn
- Andrologicum München, Burgstrasse 7, 80331, München.
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47
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Travison TG, Morley JE, Araujo AB, O'Donnell AB, McKinlay JB. The relationship between libido and testosterone levels in aging men. J Clin Endocrinol Metab 2006; 91:2509-13. [PMID: 16670164 DOI: 10.1210/jc.2005-2508] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although it is known that serum testosterone (T) concentrations are related to libido, the strength of that relationship in community-dwelling men has not yet been determined. OBJECTIVE Our objective was to assess the strength and significance of the association between aging men's self-reports of libido and serum T concentrations. DESIGN Our study was a community-based evaluation of men's health and aging, including three data collection waves: baseline (T1, 1987-1989) and follow-ups (T2, 1995-1997; T3, 2002-2004). Libido was measured on a 14-point scale assessing self-reported frequency of desire and thoughts/fantasies; low libido was defined as a score of less than 7 of 14. SETTING We conducted an epidemiological study in greater Boston, Massachusetts. PARTICIPANTS There were 1632 men aged 40-70 yr at baseline, with follow-up on 922 (56%) at 9 yr (T2) and 623 (38%) at 15 yr (T3). MAIN OUTCOME MEASURES We assessed total and calculated bioavailable T . RESULTS Three hundred eighteen (19%) subjects reported low libido at baseline. Libido and T displayed a significant association. However, the difference in mean T levels between those subjects with low libido and those without was small; analyses indicated a 3.4 ng/dl (0.12 nmol/liter) increase in total T per unit increase in libido. Subjects reporting low libido exhibited an increased but modest probability of exhibiting low T. Dividing T concentrations by the number of androgen receptor gene cytosine, adenine, guanine repeats did not enhance associations. CONCLUSIONS Libido and T concentrations are strongly related at the population level. However, the value of individual patient reports of reduced libido as indicators of low T levels is open to question.
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Affiliation(s)
- Thomas G Travison
- New England Research Institutes, 9 Galen Street, Watertown, Massachusetts 02472, USA.
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Mas M. El efecto placebo en andrología. Rev Int Androl 2006. [DOI: 10.1016/s1698-031x(06)73574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Hypogonadism is a common problem in men. It affects 2% to 30% of men aged 40 to 59 years, 20% to 45% aged 60 to 69 years, 34% to 70% aged 70 to 79 years, and most men aged >80 years. Hypogonadism is also highly prevalent in men with chronic illnesses, such as HIV infection. The low testosterone (T) levels associated with hypogonadism impair sexual function and many other aspects of health and well-being. In aging men and in those who are chronically ill, impaired gonadal function is characterized by subtle changes at many stages of T regulation. T therapy reverses the effects of hypogonadism, improving sexual function, body composition, mood, and well-being. Although many forms of T therapy are available, some therapies have limitations that render them ineffective or inconvenient. A new type of T gel has improved pharmacokinetic and clinical profiles compared with other forms of T therapy. This T gel has been shown to be effective in older men and in men with HIV infection, despite unsatisfactory response to earlier T-gel therapy.
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Affiliation(s)
- Jed C Kaminetsky
- Department of Urology NewYork University Medical Center, New York, New York 10016, USA.
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