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Livingston M, Heald AH. Adult Male Hypogonadism: A Laboratory Medicine Perspective on Its Diagnosis and Management. Diagnostics (Basel) 2023; 13:3650. [PMID: 38132234 PMCID: PMC10743125 DOI: 10.3390/diagnostics13243650] [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: 08/16/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. In this review, we have highlighted factors, both biological and analytical, that introduce variation into the measurement of serum T concentrations in men; these need to be considered when requesting T levels and interpreting results. There is an ongoing need for analytical standardisation of T assays and harmonisation of pre- and post-analytical laboratory practices, particularly in relation to the laboratory reference intervals provided to clinicians. Further, there is a need to share with service users the most up-to-date and evidence-based action thresholds for serum T as recommended in the literature. Estimation of free testosterone may be helpful. Causes of secondary hypogonadism should be considered. A comprehensive approach is required in the management of male hypogonadism, including lifestyle modification as well as medication where appropriate. The goal of treatment is the resolution of symptoms as well as the optimisation of metabolic, cardiovascular, and bone health. The advice of an endocrinologist should be sought when there is doubt about the cause and appropriate management of the hypogonadism.
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Affiliation(s)
- Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
- School of Medicine and Clinical Practice, The University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK;
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford M6 8HD, UK
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Heijboer AC, Hannema SE. Androgen Excess and Deficiency: Analytical and Diagnostic Approaches. Clin Chem 2023; 69:1361-1373. [PMID: 37794651 DOI: 10.1093/clinchem/hvad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/18/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Androgens are synthesized from cholesterol through sequential conversions by enzymes in the adrenal glands and gonads. Serum levels of androgens change during the different phases of life and regulate important developmental and maturational processes. Androgen excess or deficiency can therefore present at various ages in various ways. CONTENT The diagnostic approach for atypical genitalia, premature pubarche, delayed pubertal onset or progression, and hirsutism or virilization, including measurement of androgens (testosterone, androstenedione, 17-OHprogesterone, dehydroepiandrosterone, and dihydrotestosterone) is discussed in the current review. Androgens can be measured in serum, saliva, urine, or dried blood spots. Techniques to measure androgens, including immunoassays and LC-MS, have their own advantages and pitfalls. In addition, pre- and postanalytical issues are important when measuring androgens. SUMMARY During clinical interpretation of androgen measurements, it is important to take preanalytical circumstances, such as time of blood withdrawal, into account. As immunoassays have major drawbacks, especially in samples from women and neonates, concentrations measured using these assays should be interpreted with care. Reference intervals can only be used in relation to the measurement technique and the standardization of the assay. In the near future, new androgens will probably be added to the current repertoire to further improve the diagnosis and follow-up of androgen excess or deficiency.
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Affiliation(s)
- Annemieke C Heijboer
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Sabine E Hannema
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Amsterdam UMC location Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands
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Knight EL, Graham-Engeland JE, Sliwinski MJ, Engeland CG. Greater Ecologically Assessed Positive Experiences Predict Heightened Sex Hormone Concentrations Across Two Weeks in Older Adults. J Gerontol B Psychol Sci Soc Sci 2023; 78:1007-1017. [PMID: 36715104 PMCID: PMC10214649 DOI: 10.1093/geronb/gbad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Sex hormones are important components of healthy aging, with beneficial effects on physical and mental health. Positive experiences such as elevated mood, lowered stress, and higher well-being also contribute to health outcomes and, in younger adults, may be associated with elevated sex hormone levels. However, little is known about the association between positive experiences and sex hormones in older adults. METHODS In this study, older men and women (N = 224, 70+ years of age) provided blood samples before and after a 2-week period of ecological momentary assessment (EMA) of positive and negative experiences (assessed based on self-reporting items related to affect, stress, and well-being). Concentrations of a panel of steroid sex hormones and glucocorticoids were determined in blood. RESULTS Higher levels of positive experiences reported in daily life across 2 weeks were associated with increases in free (biologically active) levels of testosterone (B = 0.353 [0.106, 0.601], t(221.3) = 2.801, p = .006), estradiol (B = 0.373 [0.097, 0.649], t(225.1) = 2.645, p = .009), and estrone (B = 0.468 [0.208, 0.727], t(224.3) = 3.535, p < .001) between the start and the end of the 2-week EMA period. DISCUSSION These findings suggest that sex hormones may be a pathway linking positive experiences to health in older adults.
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Affiliation(s)
- Erik L Knight
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania, USA
- Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
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Hackett G, Kirby M, Rees RW, Jones TH, Muneer A, Livingston M, Ossei-Gerning N, David J, Foster J, Kalra PA, Ramachandran S. The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice. World J Mens Health 2023:41.e33. [PMID: 36876744 DOI: 10.5534/wjmh.221027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 03/02/2023] Open
Abstract
Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but its diagnosis and management can be challenging. A multi-disciplinary panel from BSSM reviewed the available literature on TD and provide evidence-based statements for clinical practice. Evidence was derived from Medline, EMBASE and Cochrane searches on hypogonadism, testosterone therapy (T Therapy) and cardiovascular safety from May 2017 to September 2022. This revealed 1,714 articles, including 52 clinical trials and 32 placebo-controlled randomised controlled trials. A total of twenty-five statements are provided, relating to five key areas: screening, diagnosis, initiating T Therapy, benefits and risks of T Therapy, and follow-up. Seven statements are supported by level 1 evidence, eight by level 2, five by level 3, and five by level 4. Recent studies have demonstrated that low levels of testosterone in men are associated with increased risk of incident type 2 diabetes mellitus, worse outcomes in chronic kidney disease and COVID 19 infection with increased all-cause mortality, along with significant quality of life implications. These guidelines should help practitioners to effectively diagnose and manage primary and age-related TD.
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Affiliation(s)
- Geoffrey Hackett
- Department of Urology, Spire Hospital, Little Aston, Birmingham, UK.,Department of Urology, Aston University, Birmingham, UK.
| | - Michael Kirby
- Trends in Urology and Men's Health, Letchworth, UK.,Faculty of Health & Human Sciences, University of Hertfordshire & The Prostate Centre, London, UK
| | - Rowland W Rees
- Department of Urology, University Hospital Southampton and UCLH, London, UK
| | - T Hugh Jones
- Department of Endocrinology, Barnsley Hospital, Barnsley, UK.,Department of Biochemistry, Royal Hallamshire Hospital, University of Sheffield Medical School, Sheffield, UK
| | - Asif Muneer
- Division of Surgery and Interventional Science, NIHR Biomedical Research Centre UCLH, London, UK
| | - Mark Livingston
- Department of Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
| | - Nick Ossei-Gerning
- Cardiff and Vale NHS Trust, Cardiff, UK.,University of South Wales TDS, Bridgend, UK.,Department of Cardiology, University of Cape Coast, Cape Coast, Ghana
| | | | | | - Philip A Kalra
- Department of Nephrology, NCA, Salford Royal Hospital, Salford, UK
| | - Sudarshan Ramachandran
- Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, West Midlands, UK
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Benderradji H, Barbotin AL, Leroy-Billiard M, Prasivoravong J, Marcelli F, Decanter C, Robin G, Mitchell V, Rigot JM, Bongiovanni A, Sauve F, Buée L, Maurage CA, Cartigny M, Villers A, Prevot V, Catteau-Jonard S, Sergeant N, Giacobini P, Pigny P, Leroy C. Defining Reference Ranges for Serum Anti-Müllerian Hormone on a Large Cohort of Normozoospermic Adult Men Highlights New Potential Physiological Functions of AMH on FSH Secretion and Sperm Motility. J Clin Endocrinol Metab 2022; 107:1878-1887. [PMID: 35396994 PMCID: PMC9202722 DOI: 10.1210/clinem/dgac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies to date have attempted to measure serum anti-Müllerian hormone (AMH) levels in adult men, and solid references ranges have not yet been defined in a large cohort. OBJECTIVE In this study, we aimed, first, to establish the reference ranges for serum AMH and AMH-to-total testosterone ratio (AMH/tT) in adult males. Second, we investigated the relationship between serum AMH and both reproductive hormones and semen parameters. METHODS This single-center retrospective study included 578 normozoospermic adult men. Serum AMH concentrations were determined with an automated sandwich chemiluminescent immunoassay. RESULTS The median serum AMH was 43.5 pmol/L. The 2.5th and 97.5th percentile values for serum AMH and AMH/tT were 16.4 and 90.3 pmol/L and 0.45 and 3.43, respectively. AMH was positively correlated with inhibin B and sperm concentration and negatively correlated with age, follicle-stimulating hormone (FSH), and progressive sperm motility. Interestingly, using immunofluorescence, we documented for the first time that AMH type II receptor (AMH-R2) is expressed in ejaculated human spermatozoa and gonadotrophic cells in the postmortem pituitary gland. CONCLUSIONS We establish a new age-specific reference range for serum AMH and AMH/tT. Moreover, AMH-R2 expression in human spermatozoa and gonadotrophic cells, together with the relationship between serum AMH levels and sperm motility or mean FSH levels, highlight new potential functions of AMH in regulating sperm motility or FSH secretion in adult men.
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Affiliation(s)
- Hamza Benderradji
- Hamza Benderradji, MD, PhD, Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun 59045 Lille Cedex, France.
| | - Anne-Laure Barbotin
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- Department of Reproductive Biology-Spermiology-CECOS, University of Lille, CHU Lille, Lille, France
| | - Maryse Leroy-Billiard
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Julie Prasivoravong
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - François Marcelli
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - Christine Decanter
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Geoffroy Robin
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Valérie Mitchell
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- Department of Reproductive Biology-Spermiology-CECOS, University of Lille, CHU Lille, Lille, France
| | - Jean-Marc Rigot
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - Antonino Bongiovanni
- University of Lille, Institut Pasteur de Lille, BioImaging Center Lille, Lille, France
| | - Florent Sauve
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Luc Buée
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Claude-Alain Maurage
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- University of Lille, CHU Lille, Department of Pathological Anatomy, Lille, France
| | - Maryse Cartigny
- Department of Pediatric Endocrinology, DevGen, Reference Centre for Genital Development Abnormalities, University of Lille, CHU Lille, Lille, France
| | - Arnauld Villers
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - Vincent Prevot
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Sophie Catteau-Jonard
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Nicolas Sergeant
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Paolo Giacobini
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | | | - Clara Leroy
- Correspondence: Clara Leroy, MD, Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun 59045 Lille Cedex, France.
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