The medicalization of testosterone: reinventing the elixir of life

Anabolic-androgenic steroid use disorder: case for recognition as a substance use disorder with specific diagnostic criteria

Approximately one in three people who use anabolic-androgenic steroids (AASs) develop dependence, characterised by both psychiatric and somatic symptoms. Despite this, AAS use disorder (AASUD) is not distinctly recognised in the latest versions of either the ICD or DSM, impeding both clinical care and research progress. It is clear that AASUD shares many features and correlates with substance use disorders (SUDs) that have specific diagnostic criteria in these classification systems, such as stimulants or opioids. We aim to outline the overlap between AASUD and more 'typical' SUDs as well as highlight the specific concerns related to AASUD that warrant recognition and distinct diagnostic criteria.

Association between the atherogenic index of plasma and testosterone deficiency in American adults: a cross-sectional study from NHANES 2011-2016

Background

A common pathophysiological association between lipid metabolism and sex hormone levels has been revealed in recent research. The atherogenic index of plasma (AIP) is the marker currently used to evaluate metabolism. The purpose of this research was to discover the relationship between the AIP and testosterone deficiency (TD) in a nationwide representative population.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) database from 2011 to 2016 were utilized in this cross-sectional research. The formula, lg [TG (mmol/L)/HDL-C(mmol/L)], was applied to determine the AIP. Total serum testosterone levels were used to define TD. Our researcher utilized smoothed curve fitting and multivariate logistic or linear regression analysis to inspect the relationship between AIP and TD among adult males. The consistency of these results was examined in various population subgroups.

Results

In total, 1,198 individuals (28.6%) were stratified into the TD group. We observed statistically significant differences (P values < 0.05) in the TD population for all variables. After correcting for potential confounders, our researchers discovered a strong positive relationship between the AIP and the probability of developing TD. With each additional unit of the AIP, the incidence of TD increased by 2.81-fold in adult males. Subgroup analyses showed the correlations for the majority of the subgroups remained stable. However, marital status, CKD, smoking, and alcohol consumption may modify this association.

Conclusions

A higher AIP is correlated with a lower level of testosterone in adult males. This correlation may be altered by factors including marriage, chronic kidney disease, alcohol, and smoking consumption.

Negative correlation between cardiometabolic index and testosterone in male adults

Background

Insulin resistance (IR) is closely correlated with a deficiency or decrease of testosterone levels in males. Cardiometabolic index (CMI) is correlated with various diseases correlated with IR. The primary objective of this study is to explore the correlation between CMI and testosterone levels in male adults.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) during the period from 2013 to 2020 were analyzed through a cross-sectional design. CMI was calculated by multiplying waist-to-height ratio (WHtR) with the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C).

Results

A total of 5012 subjects were included in the final analysis. After controlling confounding variables, multiple linear regression analysis indicated an independent negative correlation between CMI and testosterone levels (β= -6.40, 95% CI: -8.95, -3.86, P<0.001) through the. In addition, a negative non-linear correlation was also found between CMI and testosterone (P<0.05), with CMI's inflection point as 0.73. Subgroup analyses indicated a more significant negative correlation among those with normal weight and the elderly (p< 0.05 for all interactions). The area under the ROC curve (AUC) of CMI (AUC =0.724, 95% CI: 0.709-0.740) was the largest compared with those of TG/HDL and WHtR.

Conclusion

Elevated CMI is significantly and negatively correlated with testosterone in male adults.

Association between cardiometabolic index and testosterone levels in adult men: NHANES 2011-2016

OBJECTIVE

Exploring the relationship between the cardiometabolic index (CMI) and serum testosterone levels as well as testosterone deficiency in American adult males. Additionally, comparing the diagnostic value of the CMI with several common obesity and metabolism indices for identifying testosterone deficiency.

METHODS

This cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. Serum testosterone levels and testosterone deficiency were used as dependent variables, with the cardiometabolic index as the independent variable. Multivariable regression was used to assess the relationship between the independent and dependent variables, while subgroup analyses were performed to ensure the stability of the results. Smooth curve fitting was utilized to evaluate the nonlinear relationship between the CMI and testosterone levels. Receiver operating characteristic curves (ROC) were plotted for several obesity and metabolism prediction indices and the area under the curve was calculated to compare the specificity and sensitivity of each diagnostic index in the diagnosis of testosterone deficiency.

RESULTS

Among 3541 adult male participants, CMI is negatively associated with serum testosterone levels and positively associated with testosterone deficiency. In the fully adjusted model, for every unit increase in CMI, serum testosterone decreased by 14.89 ng/dl. Comparing the highest quartile to the lowest quartile of CMI, each unit increase in CMI, serum testosterone decreased by 98.58 ng/dl. Furthermore, each unit increase in CMI was associated with a 16% increase in incidence of testosterone deficiency. By plotting the ROC curves, we found that the AUCs for Lipid Accumulation Product (LAP), Body Mass Index (BMI), Weight Adjusted Waist Index (WWI), CMI, Visceral Adiposity Index (VAI) and Triglyceride glucose index (TyG) were 0.73, 0.72, 0.71, 0.69, 0.66, and 0.66 respectively.

CONCLUSION

Elevated levels of CMI are associated with lower testosterone levels and an increased risk of testosterone deficiency. The predictive value of the LAP was superior to that of CMI, while the predictive value of CMI was higher than VAI and TyG.

Sex Hormones and Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study and Mendelian Randomization Analysis

Background

Sex steroid hormones, including testosterone and estradiol, play significant roles in various aspects of pulmonary health and diseases. However, although there were a few studies trying to link sex hormones with COPD, their effect remained limited due to small sample size and insufficient causal results. This study aims to investigate the association between sex hormones and chronic obstructive pulmonary disease (COPD) based on the National Health and Nutrition Examination Survey (NHANES) database and evaluate causality via a two-sample Mendelian randomization (MR).

Methods

Data from NHANES 2013-2016 were enrolled for the cross-sectional study. The association between sex hormones and COPD was evaluated via multivariable logistic regression. Sex-stratified analysis, subgroup analyses and interaction tests were performed to further evaluate the correlation. For MR analysis, data were collected from genome-wide association studies and FinnGen datasets. The inverse-variance-weighted (IVW) approach, along with four other approaches, was applied in the analysis. Further sensitivity analysis was conducted to assess the existence of pleiotropy and heterogeneity.

Results

7,617 eligible participants were enrolled in the cross-sectional analysis. Negative associations were observed in both testosterone-COPD (OR 0.770, 95% CI 0.626, 0.948, p = 0.018) and estradiol-COPD (OR 0.794, 95% CI 0.688, 0.915, p = 0.005) relationships after covariate adjustments. However, the results from IVW-MR analysis showed that no causal relationship was observed in either the testosterone-COPD (OR 0.83, 95% CI 0.53, 1.29, p = 0.407) or estradiol-COPD (OR 0.74, 95% CI 0.23, 2.38, p = 0.616) relationship, which was also supported by the other four approaches (all p values > 0.05).

Conclusion

Although a significant negative association was observed between sex hormones and COPD, the results of MR analysis did not support the causality of this relationship. Our study suggested that sex hormones may indirectly rather than directly affect the development of COPD via potential covariates, which warranted further investigations.