The influence of age on bioavailable and free testosterone is independent of body mass index and glucose levels

Factors predictive of Cutibacterium periprosthetic shoulder infections: a retrospective study of 342 prosthetic revisions

BACKGROUND

Cutibacterium are the most common cause of periprosthetic shoulder infections, as defined by ≥2 deep cultures. Established Cutibacterium periprosthetic infections cannot be resolved without prosthesis removal. However, the decision for implant removal must be made from an assessment of infection risk before the results of intraoperative cultures are finalized. We hypothesized that the risk for a Cutibacterium infection is associated with characteristics that are available at the time of revision arthroplasty.

METHODS

In a retrospective review of 342 patients having prosthetic revisions between 2006 and 2018 for whom definitive deep culture results were available, we used univariate and multivariate analyses to compare the preoperative and intraoperative characteristics of 101 revisions with Cutibacterium periprosthetic infections to the characteristics of 241 concurrent revisions not meeting the definition of infection.

RESULTS

Patients with definite Cutibacterium periprosthetic infections were younger (59 ± 10 vs. 64 ± 12, P < .001), were more likely to be male (91% vs. 44%, P < .001), were more likely to have had their index procedure performed for primary osteoarthritis (54% vs. 39%, P = .007), were more likely to be taking testosterone supplements (8% vs. 2%, P = .02), had lower American Society of Anesthesiologists scores (1.9 ± 0.7 vs. 2.3 ± 0.7, P < .001), and had lower body mass indices (29 ± 5 vs. 31 ± 7, P = .005). Patients with definite Cutibacterium periprosthetic infections also had significantly higher preoperative loads of Cutibacterium on their unprepared skin surface (1.7 ± 0.9 vs. 0.4 ± 0.8, P < .001) and were more likely to have the surgical finding of synovitis (41% vs. 16%, P < .001).

CONCLUSIONS

The risk of definite Cutibacterium periprosthetic infections is associated with observations that can be made before or at the time of revision arthroplasty.

Gender differences in cognitive outcome after cardiac arrest: A retrospective cohort study

Introduction: Recent studies have suggested gender disparities in neurologic outcome after cardiac arrest (CA). However, the relation between gender and cognitive outcome has been rarely examined. Here we investigated whether sex is associated with cognitive outcome after CA events.Methods: A retrospective analysis was conducted using data collected at our institution from January 2006 to May 2017. Patients were included if they had a documented CA and were able to participate in structured neuropsychological testing. Cognitive status was assessed at about 2.1 month after CA and included tests of attention as well as short and long-term memory. Gender was used as the main predictor of outcome and was studied in relation to age, depressive mood, therapeutic hypothermia (TH), and other potential confounders.Results: Males were more likely to show favorable cognitive outcome in both univariate and multivariate analyses. Women were more likely to exhibit depressive mood. Patients who underwent TH (31% of the patients) did not show any gender differences in benefits from the treatment. Among males and females, no significant differences between age groups could be observed.Conclusions: Male sex was associated with favorable cognitive outcome after CA which could not be attributed to baseline characteristics.

Serum variations of anti-mullerian hormone and total testosterone with aging in healthy adult Iranian men: A population-based study

Background

Literature proves anti-mullerian hormone (AMH) and total testosterone (TT) as two important reproductive hormones in male development, however evidence regarding age variations of these hormones is lacking.

Aims

To estimate the normal serum AMH values and to assess the age-specific TT levels in men aged 30–70, we conducted the present population-based study.

Methods

A total of 831 healthy eligible men, aged 30–70 years, were recruited from Tehran Lipid and Glucose study cohort. Centiles for AMH were estimated according to the exponential normal 3-parameter model. The parametric method of Royston available in general software was applied for the first time to estimate the age-specific AMH and TT percentiles of 5^th, 10^th, 25^th, 50^th, 75^th, 90^th and 95^th.

Results

Mean AMH level was 6.93, ranging from 0.1 to 40.1 ng/ml. Serum AMH concentrations followed a steady reduction with increasing age. Mean TT level was 4.8, ranging from 0.44 to 11.4 ng/ml.

Discussion

A measurable serum concentrations of AMH in healthy males throughout lifespan with variations, based on age, confirming a slight age-related AMH decline. Fractional polynomial (FP) regression models revealed that the mean and standard deviation (SD) of the TT were not associated with age, so the percentiles estimated were not age-specific.

Conclusion

We presented a nomogram of age-specific AMH values in a healthy cohort of Iranian men. This finding might have clinical importance in dealing hormonal disorders in men.

Follicle stimulating hormone, its novel association with sex hormone binding globulin in men and postmenopausal women

PURPOSE

Follicle stimulating hormone plays direct roles in a variety of nongonadal tissues and sex hormone binding globulin is becoming the convergence of the crosstalk among metabolic diseases. However, no studies have explored the association between follicle stimulating hormone and sex hormone binding globulin. We aimed to study this association among men and women.

METHODS

SPECT-China is a population-based study conducted since 2014. This study included 4206 men and 2842 postmenopausal women. Collected serum was assayed for gonadotropins, sex hormone binding globulin, sex hormones etc. Regression analyses were performed to assess the relationship between sex hormone binding globulin and follicle stimulating hormone and other variables including metabolic factors, thyroid function and sex hormones. Treatment with follicle stimulating hormone at different concentrations of 0, 5, 50 and 100 IU/L for 24 h was performed in HepG2 cells.

RESULTS

In Spearman correlation, sex hormone binding globulin was significantly correlated with FSH, triglycerides, thyroxins, body mass index and blood pressure in men and postmenopausal women (all P < 0.05). In regression analyses, follicle stimulating hormone was a significant predictor of sex hormone binding globulin in men and postmenopausal women (P < 0.05), independent of above variables. Follicle stimulating hormone induced sex hormone binding globulin expression in a dose-dependent fashion in HepG2 cells.

CONCLUSION

Serum follicle stimulating hormone levels were positively associated with circulating sex hormone binding globulin levels in men and postmenopausal women. This association is independent of age, insulin resistance, hepatic function, lipid profile, thyroid function, adiposity, blood pressure, and endogenous sex hormones.

The association of obesity with sex hormone-binding globulin is stronger than the association with ageing--implications for the interpretation of total testosterone measurements

OBJECTIVE

Total testosterone concentrations are influenced by sex hormone-binding globulin (SHBG) concentrations, which are decreased by obesity and increased with ageing. Therefore, we sought to understand and compare the associations of ageing and obesity with SHBG.

DESIGN

We performed a retrospective, cross-sectional analysis of the associations of obesity and age on SHBG and testosterone measurements in men being evaluated for hypogonadism.

PATIENTS, MEASUREMENTS AND ANALYSIS

A total of 3671 men who underwent laboratory testing for testosterone deficiency from the Veterans Administration Puget Sound Health Care System from 1997 through 2007 was included. Univariate and multivariate linear regression modelling of the associations between age and body mass index (BMI) and SHBG was performed.

RESULTS

Obesity was associated with a significantly lower SHBG [β = -1·26 (95% CI -1·14, -1·38) nmol/l] per unit increase in BMI. In contrast, ageing was associated with a significantly increased SHBG [β = 0·46 (95% CI 0·39, 0·53) nmol/l per year] (P < 0·001 for both effects). The association of obesity with lower SHBG was two to three times larger than the association of ageing with increased SHBG in both univariate and multivariate modelling. On average, obese men (BMI >30 kg/m(2)) had significantly lower SHBG and total testosterone concentrations than nonobese men [(mean ± SD) SHBG: 36 ± 22 vs 50 ± 27 nmol/l and total testosterone: 10·5 ± 5·4 nmol/l vs 14·1 ± 7·4 nmol/l; (P < 0·001 for both comparisons)], but calculated free testosterone concentrations did not differ between obese and nonobese men.

CONCLUSIONS

We found that the association between obesity and lowered SHBG is greater than the association of ageing with increased SHBG. These competing effects may impact total testosterone measurements for the diagnosis of low testosterone, particularly in obese men.

Dynamic alteration of serum testosterone with aging: a cross-sectional study from Shanghai, China

BACKGROUND

Level of the testosterone in a man's life span is very important. Studies on the serum testosterone concentrations in different age groups of healthy men were controversial. The aim of this study was to investigate dynamic changes of serum reproductive hormones with aging in healthy Chinese male and to compare its correlation with age.

METHODS

Total of 1,093 healthy Chinese men from Shanghai aged from 20 to 87  years old was enrolled in the study. Concentrations of serum total testosterone (T), luteinizing hormone (LH) and sex hormone binding globulin (SHBG) were quantified by EIA. Testosterone secretion index (TSI) and free testosterone index (FTI) were then calculated. Data were analyzed by SPSS program. Non-parametric tests and univariate linear regression analyses were used.

RESULTS

The 1,039 male participants were grouped into 12 groups by 5-year apart for each group. Significant differences in T, LH, SHBG, FTI and TSI were found between the 12 different age groups. Average of serum total T was 15.36 ± 4.86 nmol/L; LH was 4.76 ± 2.76 IU/L, SHBG was 32.61 ± 17.24 nmol/L. Compared to age 20 ~ 24 group, serum T level of age 35 ~ 39, 40 ~ 44, 45 ~ 49, 50 ~ 54, and 55 ~ 59 was significantly decreased (p < 0.05). Intriguingly, however, serum T level of age 60 or older did not significantly reduced compared to the age of 20 ~ 24 group. Serum LH and SHBG were positively correlated with aging (p <0.01), while TSI and FTI were negatively correlated with aging (p <0.01). In addition, BMI was negatively and significantly correlated with levels of T (r = -0.585, p < 0.001), LH (r = -0.090, p < 0.001), SHBG (r = - 1.817, p < 0.001), and TSI (r = - 0.104, p < 0.001), but positively and significantly correlated with FTI level (r = 0.011, p < 0.001).

CONCLUSION

Serum total testosterone fluctuated with aging in adult men, and FTI and TSI decreased gradually with aging. While age was not significantly correlated with T level, BMI was significantly and negatively correlated with T level, suggesting body weight may affect testosterone level.

A validated age-related normative model for male total testosterone shows increasing variance but no decline after age 40 years

The diagnosis of hypogonadism in human males includes identification of low serum testosterone levels, and hence there is an underlying assumption that normal ranges of testosterone for the healthy population are known for all ages. However, to our knowledge, no such reference model exists in the literature, and hence the availability of an applicable biochemical reference range would be helpful for the clinical assessment of hypogonadal men. In this study, using model selection and validation analysis of data identified and extracted from thirteen studies, we derive and validate a normative model of total testosterone across the lifespan in healthy men. We show that total testosterone peaks [mean (2.5-97.5 percentile)] at 15.4 (7.2-31.1) nmol/L at an average age of 19 years, and falls in the average case [mean (2.5-97.5 percentile)] to 13.0 (6.6-25.3) nmol/L by age 40 years, but we find no evidence for a further fall in mean total testosterone with increasing age through to old age. However we do show that there is an increased variation in total testosterone levels with advancing age after age 40 years. This model provides the age related reference ranges needed to support research and clinical decision making in males who have symptoms that may be due to hypogonadism.

Total testosterone may not decline with ageing in Korean men aged 40 years or older

OBJECTIVE

It is generally believed that gonadal function in men declines with ageing. However, observations on ageing-related decrease in total testosterone (TT) are not consistent. The aim of this study is to examine the ageing-related changes of testosterone and to investigate the influence of the ageing-related factors on TT.

DESIGN

Changes of TT with ageing were observed in longitudinal design in a single health promotion centre.

SUBJECTS

A total of 220 Korean men aged ≥40 years were included between 2002 and 2011. TT assay was repeated for all subjects, with an interval of ≥3 years.

MEASUREMENTS

Information of medical history and lifestyle habits was collected. Anthropometry and blood pressure were measured. TT, glucose, creatinine, highly sensitive C-reactive protein, liver enzymes and lipid profiles were tested.

RESULTS

Mean TT level did not decline significantly with ageing during median 4·3 years follow-up (18·1 vs 17·8 nm, P = 0·439). Longitudinal change of TT was approximately + 0·8% per year. TT was negatively correlated with body mass index (BMI), waist circumference and glucose. With mixed effects model, diabetes (P = 0·038) and BMI (P = 0·007) affected TT level, but age and follow-up interval did not.

CONCLUSIONS

TT did not change significantly in 220 Korean men for a median 4·3 years follow-up. TT was not influenced by the age and follow-up interval. BMI and diabetes mellitus affected TT decline.

The Interactions between Insulin and Androgens in Progression to Castrate-Resistant Prostate Cancer

An association between the metabolic syndrome and reduced testosterone levels has been identified, and a specific inverse relationship between insulin and testosterone levels suggests that an important metabolic crosstalk exists between these two hormonal axes; however, the mechanisms by which insulin and androgens may be reciprocally regulated are not well described. Androgen-dependant gene pathways regulate the growth and maintenance of both normal and malignant prostate tissue, and androgen-deprivation therapy (ADT) in patients exploits this dependence when used to treat recurrent and metastatic prostate cancer resulting in tumour regression. A major systemic side effect of ADT includes induction of key features of the metabolic syndrome and the consistent feature of hyperinsulinaemia. Recent studies have specifically identified a correlation between elevated insulin and high-grade PCa and more rapid progression to castrate resistant disease. This paper examines the relationship between insulin and androgens in the context of prostate cancer progression. Prostate cancer patients present a promising cohort for the exploration of insulin stabilising agents as adjunct treatments for hormone deprivation or enhancers of chemosensitivity for treatment of advanced prostate cancer.