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Jathal I, Wang Y, Binongo JNG, Cobb C, Hunt WR, Khan FN, Tangpricha V. Testosterone concentrations and associated predictors in men with cystic fibrosis: a retrospective, single-center study. Am J Med Sci 2024:S0002-9629(24)01346-6. [PMID: 38997066 DOI: 10.1016/j.amjms.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Men with cystic fibrosis (CF) have sexual health concerns such as delayed puberty, infertility, and hypogonadism. The causes and prevalence of hypogonadism have not been well studied. The purpose of this study was to determine the prevalence of a low testosterone concentration in men with CF. METHODS This retrospective study was approved by the Emory University Institutional Review Board (IRB). Data were extracted from the electronic medical records of adult men with CF receiving care at the Emory Cystic Fibrosis Center. A total of 129 men with CF were followed at our center from 2016 to 2023. Of these individuals, 76 men with CF (58.9%) had at least one serum total testosterone measurement. Seven individuals were excluded from this study since they were currently receiving testosterone therapy, leaving a final sample size of 69 individuals for the analysis. Demographic data, serum testosterone concentrations, and other factors associated with low testosterone concentrations were collected. Low testosterone was defined as a value below 300 ng/dL. Regression analyses were used to determine factors associated with low testosterone levels. RESULTS The mean (± SD) age of the 69 eligible participants was 33.34 ± 10.98 years. The mean testosterone concentration was 421 ± 158.5 ng/dL with 27.54 percent of men with a testosterone value below 300 ng/dL. The mean hemoglobin level was 14.23 ± 2.18 g/dL. Testosterone levels were positively related to hemoglobin levels. Time of day of measurement and age were not associated with testosterone levels. CONCLUSION Roughly a quarter of men with CF demonstrated low testosterone in our sample. Low hemoglobin was associated with low testosterone levels in men with CF. Neither time of day nor age influenced testosterone concentrations in this sample.
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Affiliation(s)
| | - Yanhua Wang
- Renal Division, Department of Medicine, Emory University
| | - José Nilo G Binongo
- Department of Biostatics and Bioinformatics, Rollins School of Public Health
| | - Crystal Cobb
- Division of Endocrinology, Department of Medicine, Emory School of Medicine
| | - William R Hunt
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University
| | - Farah N Khan
- Division of Metabolism, Endocrinology and Nutrition, University of Washington
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University; Atlanta VA Medical Center, Decatur, GA.
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Woods BM, Bray LA, Campbell SB, Li P, Kazmerski TM, Hovater C, Pitts LN, Ladores S. Implementation and evaluation of a fertility preservation telehealth counseling intervention for males with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00780-X. [PMID: 38942720 DOI: 10.1016/j.jcf.2024.06.011] [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: 04/06/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Most males with cystic fibrosis (MwCF) have congenital bilateral absence of the vas deferens and require assisted reproductive technology to conceive, yet many have limited knowledge about how CF affects sexual and reproductive health (SRH). This study evaluates the feasibility, acceptability, and potential effectiveness of telehealth fertility preservation (FP) counseling for MwCF. METHODS Pre-lung transplant MwCF ≥18 years, recruited from U.S. CF centers, social media, and via snowball sampling, received individualized telehealth counseling. Participants completed intervention feasibility/acceptability one week post-counseling and FP knowledge, care satisfaction, and self-efficacy assessments at baseline and two months post-counseling. We completed acceptability interviews one-week post-counseling and audio-recorded, transcribed, and thematically analyzed results. We descriptively analyzed survey results and conducted pre/post comparisons using paired t-tests. RESULTS Thirty MwCF (ages 22-49 years) completed counseling. Most were in a relationship (70 %) and White (86.7 %). Telehealth FP counseling was acceptable (M = 4.38/5 ± 0.60), appropriate (M = 4.37/5 ± 0.60), and feasible (M = 4.60/5 ± 0.45) to MwCF. FP knowledge (9.53 vs. 10.40/12; p = .010), care satisfaction (20.23 vs 26.67/32; p<.001), and self-efficacy (22.87 vs 25.20/30; p = .016) improved at two months post-counseling. Despite desiring provider-initiated SRH, wanting children (81 %), and perceiving the CF team as their primary care provider (97 %), 44 % report not receiving information about infertility by the CF team. CONCLUSIONS Integrating FP counseling into CF care is feasible and acceptable to MwCF and can improve FP knowledge, self-efficacy, and care satisfaction. MwCF desire early and regular provider-initiated SRH education.
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Affiliation(s)
- Brittany M Woods
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, US.
| | - Leigh A Bray
- University of Alabama Capstone, College of Nursing, Tuscaloosa, AL, US
| | - Sukhkamal B Campbell
- Director of Fertility Preservation Services, University of Alabama at Birmingham Medicine, Women and Infants Center, Birmingham, AL, US
| | - Peng Li
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, US
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, US; Center for Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, US
| | - Cade Hovater
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, US
| | - Leslie N Pitts
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, US
| | - Sigrid Ladores
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, US
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Kazmerski TM, Stransky OM, Lavage DR, Hughan KS, Jain R, Ladores SL, Stalvey MS, Tangpricha V, Taylor-Cousar JL, West NE, Sawicki GS. Clinician perspectives and practices related to sexual and reproductive care provision for males with cystic fibrosis. J Cyst Fibros 2024; 23:417-423. [PMID: 37953183 DOI: 10.1016/j.jcf.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Males with cystic fibrosis (MwCF) have unique sexual and reproductive health (SRH) concerns. This study investigates multidisciplinary CF clinician perspectives related to SRH for MwCF in the current era of CF care. METHODS We surveyed multidisciplinary clinicians exploring attitudes, practices, and preferences toward male CF SRH care. We compared responses across groups by population served (pediatric vs. adult vs. both pediatric and adult MwCF) using chi square/Fisher's exact tests. RESULTS A total of 297 clinicians completed the survey (41 % pediatric, 36 % adult, 23 % both; 27 % physicians, 24 % social workers, 11 % nurses, 41 % other). Nearly all (98 %) believed the CF team had a role in SRH care with 75 % believing they should be primarily responsible. Pediatric clinicians were less likely to deem SRH topics important and less likely to report annual discussions compared to adult colleagues (all p<0.05). Pediatric clinicians reported less comfort in their SRH knowledge than adult colleagues (p<0.001) and in their ability to provide SRH care (p<0.05). Common barriers endorsed by respondents included lack of SRH knowledge (75 %) and presence of family/partners in exam room (64 %). A majority rated SRH screening tools (91 %), partnerships with SRH specialists (90 %), clinician training (83 %), and management algorithms (83 %) as potential facilitators. CONCLUSION Multidisciplinary CF clinicians perceive SRH for MwCF as important but report suboptimal SRH discussions. Pediatric clinicians report significantly less comfort and skill in discussing and managing male SRH. Identified barriers and facilitators should be used to improve SRH care for MwCF.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States.
| | - Olivia M Stransky
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States; UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave. Pittsburgh, PA, 15224, United States.
| | - Danielle R Lavage
- Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States; Department of Anesthesia and Perioperative Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Kara S Hughan
- Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue Suite M060 Pittsburgh, PA, 15213, United States.
| | - Raksha Jain
- University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX 75390-8558, United States.
| | - Sigrid L Ladores
- School of Nursing, The University of Alabama at Birmingham, 1720 S. 2nd Ave., NB485-A, Birmingham, AL 35294, United States.
| | | | - Vin Tangpricha
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle Atlanta, 30322, United States.
| | | | - Natalie E West
- The Johns Hopkins University, 1830 Building 5th Floor Pulmonary, Baltimore, MD 21287, United States.
| | - Gregory S Sawicki
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, United States.
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Campbell K, Deebel N, Kohn T, Passarelli R, Velez D, Ramasamy R. Prevalence of Low Testosterone in Men With Cystic Fibrosis and Congenital Bilateral Absence of the Vas Deferens: A Cross-sectional Study Using a Large, Multi-institutional Database. Urology 2023; 182:143-148. [PMID: 37716455 PMCID: PMC10842516 DOI: 10.1016/j.urology.2023.08.039] [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: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To investigate the prevalence and treatment rates of low testosterone (T) in men with cystic fibrosis (CF). CF is a genetic disease with highly variable presentation that results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Phenotypic manifestations of CF include alterations in function of the lungs, liver, pancreas, and reproductive system. Despite the well-described association between CF and infertility secondary to congenital bilateral absence of the vas deferens (CBAVD), men with CF report further sexual and reproductive health concerns, many of which are often associated with low testosterone. METHODS We queried the TrinetX database for men over 18years old with CF or CBAVD to assess what percentage of men had a T level measured, and if hypogonadal (below 300 ng/dL), what percentage received T therapy (TT). We hypothesized that low T would be under-evaluated in the CF population. RESULTS Serum T levels were measured in 10.1% of men with CF and 8.9% of men with CBAVD. Within each group, 464 men with CF (32.7%) and 132 with CBAVD (43.0%) demonstrated low T. The majority of men with T < 300 ng/dL went on to appropriately receive TT: 59.3% of men with CF and 78% with CBAVD. CONCLUSION Our data suggests that hypogonadism is highly prevalent in men with CF and CBAVD. Investigation and appropriate treatment of testosterone deficiency may significantly improve quality of life.
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Affiliation(s)
| | - Nicholas Deebel
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Taylor Kohn
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD
| | - Rachel Passarelli
- Department of Urology, Rutgers - Robert Wood Johnson, New Brunswick, NJ
| | - Danielle Velez
- Department of Urology, Rutgers - Robert Wood Johnson, New Brunswick, NJ
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Clarke AR, Stransky OM, Bernard M, Hughan KS, Ladores S, Sawicki GS, Stalvey MS, Kazmerski TM. Men's sexual and reproductive health in cystic fibrosis in the era of highly effective modulator therapies–A qualitative study. J Cyst Fibros 2022; 21:657-661. [DOI: 10.1016/j.jcf.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/31/2021] [Accepted: 02/05/2022] [Indexed: 11/15/2022]
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