1
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Osmancevic A, Allison M, Miljkovic I, Vella CA, Ouyang P, Trimpou P, Daka B. Levels of Sex Hormones and Abdominal Muscle Composition in Men from The Multi-Ethnic Study of Atherosclerosis. Sci Rep 2024; 14:16114. [PMID: 38997435 PMCID: PMC11245501 DOI: 10.1038/s41598-024-66948-4] [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: 01/29/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Information on the associations of testosterone levels with abdominal muscle volume and density in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. Therefore, this study aimed to investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Conducted as a cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis, our analyses focused on a community-based sample of 907 men aged 45-84 years, with 878 men having complete data. CT scans of the abdomen were interrogated for muscle characteristics, and multivariable linear regressions were used to test the associations. After adjustment for relevant factors, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.74, 0.1-3.4, and 1.84, 0.4-3.3, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0-0.6, and - 0.33, - 0.6 to - 0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.Clinical Trial: NCT00005487.
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Grants
- 75N92020D00005 NHLBI NIH HHS
- N01HC95160 NHLBI NIH HHS
- N01HC95163 NHLBI NIH HHS
- UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 NCATS NIH HHS
- N01HC95168 NHLBI NIH HHS
- N01HC95165 NHLBI NIH HHS
- N01HC95159 NHLBI NIH HHS
- 75N92020D00007 NHLBI NIH HHS
- HHSN268201500003I NHLBI NIH HHS
- N01HC95167 NHLBI NIH HHS
- UL1 TR000040 NCATS NIH HHS
- 75N92020D00002 NHLBI NIH HHS
- HHSN268201500003C NHLBI NIH HHS
- UL1 TR001079 NCATS NIH HHS
- ALFGBG-966255 VGR Regional Research and Development Council Grants
- 75N92020D00001 NHLBI NIH HHS
- N01HC95169 NHLBI NIH HHS
- 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 NHLBI NIH HHS
- N01HC95164 NHLBI NIH HHS
- N01HC95162 NHLBI NIH HHS
- 75N92020D00003 NHLBI NIH HHS
- N01HC95161 NHLBI NIH HHS
- UL1 TR001420 NCATS NIH HHS
- 75N92020D00004 NHLBI NIH HHS
- 75N92020D00006 NHLBI NIH HHS
- N01HC95166 NHLBI NIH HHS
- The Local Research and Development Council Göteborg och Södra Bohuslän
- National Heart, Lung, and Blood Institute
- National Center for Advancing Translational Sciences
- University of Gothenburg
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Affiliation(s)
- Amar Osmancevic
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Matthew Allison
- Division of Preventive Medicine, School of Medicine, UC San Diego, San Diego, CA, USA
| | - Iva Miljkovic
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chantal A Vella
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
| | - Pamela Ouyang
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Penelope Trimpou
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bledar Daka
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Lopez DS, Taha S, Gutierrez S, Villasante-Tezanos A, Khalife WI, Alzweri L, Markides K, Baillargeon J, Tsilidis KK. Association of total and free testosterone with cardiovascular disease in a nationally representative sample of white, black, and Mexican American men. Int J Impot Res 2024; 36:385-393. [PMID: 36581758 PMCID: PMC10718403 DOI: 10.1038/s41443-022-00660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
Associations of total testosterone (T) and calculated free T with cardiovascular disease (CVD) remain poorly understood. Particularly how these associations vary according to race and ethnicity in a nationally representative sample of men. Data included 7058 men (≥20 years) from NHANES. CVD was defined as any reported diagnosis of heart failure (HF), coronary artery disease (CAD), myocardial infarction (MI), and stroke. Total T (ng/mL) was obtained among males who participated in the morning examination. Weighted multivariable-adjusted logistic regression models were conducted. We found associations of low T (OR = 1.57, 95% CI = 1.17-2.11), low calculated free T (OR = 1.53, 95% CI = 1.10-2.17), total T (Q1 vs Q5), and calculated free T (Q1 vs Q5) with CVD after adjusting for estradiol and SHBG. In disease specific analysis, low T increased prevalence of MI (OR = 1.72, 95% CI = 1.08-2.75) and HF (OR = 1.74, 95% CI = 1.08-2.82), but a continuous increment of total T reduced the prevalence of CAD. Similar inverse associations were identified among White and Mexican Americans, but not Blacks (OR = 0.93, 95% CI = 0.49-1.76). Low levels of T and calculated free T were associated with an increased prevalence of overall CVD and among White and Mexican Americans. Associations remained in the same direction with specific CVD outcomes in the overall population.
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Affiliation(s)
- David S Lopez
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Shaden Taha
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sirena Gutierrez
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Wissam I Khalife
- Division of Cardiology, Internal Medicine- University of Texas Medical Branch, Galveston, TX, USA
| | - Laith Alzweri
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Jacques Baillargeon
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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3
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Ljunggren L, Butler E, Axelsson J, Åström M, Ohlsson L. Effects of probiotic supplementation on testosterone levels in healthy ageing men: A 12-week double-blind, placebo-controlled randomized clinical trial. Contemp Clin Trials Commun 2024; 39:101300. [PMID: 38770015 PMCID: PMC11103415 DOI: 10.1016/j.conctc.2024.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024] Open
Abstract
Levels of the male sex hormone testosterone are generally stable in the age interval 20-70 years, but several studies indicate an earlier, age-dependent decline. Testosterone deficiency is often underdiagnosed and under-treated, but replacement therapy has nonetheless increased during the last couple of years. Owing to possible negative side effects, alternative treatments have been investigated, including different supplementation protocols. The aim of this study was to investigate the effect of probiotic supplementation on the testosterone level in healthy men aged between 55 and 65. Hence, 12 weeks randomized, double-blinded, placebo-controlled trial was conducted to investigate the effect on testosterone levels following supplementation of the recognized probiotic Limosilactobacillus reuteri ATCC PTA 6475 on testosterone levels, using high-, low- or placebo treatment. Venous blood samples were collected at baseline, 6 and 12 weeks, for analysis of bloodwork, lipid profile, hormones, and electrolytes. Subjects were also asked to complete a questionnaire. The supplementation had no effect on testosterone levels, neither using high- or low dose, nor placebo. However, a significant decrease of triglyceride levels was observed in the high-dose group. No other parameters showed any significant change. The present study does not support the hypothesis that a probiotic supplementation can increase testosterone levels in ageing men.
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Affiliation(s)
- Lennart Ljunggren
- Malmö University, Faculty of Health and Society, Department of Biomedical Science, SE-20506, Malmö, Sweden
| | - Eile Butler
- Atlantia Clinical Trials, Heron House, Blackpool Retail Park, Cork, T23R50R, Ireland
| | | | - Mikael Åström
- StatCons, Högerudsgatan 8 B, SE-21618, Limhamn, Sweden
| | - Lars Ohlsson
- Malmö University, Faculty of Health and Society, Department of Biomedical Science, SE-20506, Malmö, Sweden
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Nabid A, Carrier N, Vigneault E, Martin AG, Bahary JP, Van Nguyen T, Vavassis P, Vass S, Brassard MA, Bahoric B, Archambault R, Vincent F, Bettahar R, Duclos M, Wilke D, Souhami L. Testosterone recovery after androgen deprivation therapy in localised prostate cancer: Long-term data from two randomised trials. Radiother Oncol 2024; 195:110256. [PMID: 38552845 DOI: 10.1016/j.radonc.2024.110256] [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: 12/08/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND AND PURPOSE To determine the rate and time of testosterone (T) recovery in patients (pts) with localised prostate cancer treated with radiotherapy plus 0-, 6-, 18- or 36-month of androgen deprivation therapy (ADT). MATERIALS AND METHODS In 1230 pts with prostate cancer randomised into two phase III trials, serum T was measured at baseline, then regularly. T recovery rate was compared between normal vs. abnormal baseline T and with ADT duration with Chi-square test or Fisher's exact test. A multivariable logistic regression model to predict the probability of recovering normal T was performed. RESULTS Overall, 87.4 % (167/191), 75.9 % (293/386), 54.8 % (181/330) and 43.2 % (80/185) of pts, recovered normal T on the 0-, 6-, 18- or 36-month schedule, respectively (p < 0.001). In patients recovering normal T, the median time to T recovery increased with ADT duration ranging from 0.31, 1.64, 3.06 to 5.0 years for the 0-, 6-, 18- or 36-month schedules, respectively (p < 0.001) and was significantly faster for those with a normal T at baseline (p < 0.001). On multivariable analysis, older age and longer ADT duration are associated with a lower T recovery. CONCLUSIONS Testosterone recovery rate after ADT depends on several factors including hormonal duration, normal baseline T, age and medical comorbidities. A longer ADT duration is the most important variable affecting T recovery. The data from this report might be a valuable tool to help physicians and patients in evaluating risks and benefits of ADT.
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Affiliation(s)
- Abdenour Nabid
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
| | - Nathalie Carrier
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Eric Vigneault
- Centre Hospitalier Universitaire de Québec, Québec, Canada
| | | | | | - Thu Van Nguyen
- Centre Hospitalier Universitaire de Montréal, Montréal, Canada
| | - Peter Vavassis
- Hôpital Maisonneuve-Rosemont de Montréal, Montréal, Canada
| | - Sylvie Vass
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada
| | - Marc-André Brassard
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada
| | | | | | - François Vincent
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | | | - Marie Duclos
- McGill University Health Centre, Montréal, Canada
| | | | - Luis Souhami
- McGill University Health Centre, Montréal, Canada
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5
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Osmancevic A, Allison M, Miljkovic I, Vella CA, Ouyang P, Trimpou P, Daka B. Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis. RESEARCH SQUARE 2024:rs.3.rs-3909259. [PMID: 38410430 PMCID: PMC10896404 DOI: 10.21203/rs.3.rs-3909259/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Information on the associations of testosterone levels with abdominal muscle volume and quality in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. To investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. A community-based sample of 907 men aged 45-84 years; 878 men with complete data were included in the analysis. CT scans of the abdomen were interrogated for muscle characteristics. Multivariable linear regressions were used to test the associations. After adjustment, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.79, 0.1-3.4, & 1.79, 0.4-3.2, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0-0.6, & -0.34, -0.6 - -0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.
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6
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Sorokowski P, Kowal M. Relationship between the 2D:4D and prenatal testosterone, adult level testosterone, and testosterone change: Meta-analysis of 54 studies. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:20-38. [PMID: 37795916 DOI: 10.1002/ajpa.24852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/29/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
The ratio between the hands' second to the fourth finger (2D:4D) is commonly hypothesized to result from prenatal testosterone. The 2D:4D has also been hypothesized to relate to adult-level testosterone and, more recently, to the testosterone response to a challenging situation. In the present work, we tested these core assumptions. Drawing from, in total, 54 studies and 8077 participants, we investigated whether the 2D:4D is related to adult level testosterone (44 studies), testosterone change (6 studies), and prenatal testosterone (10 studies). We found no evidence of the relationship between the above testosterone types and digit ratios. Furthermore, there was no relationship between testosterone and the right and left 2D:4D, male and female 2D:4D, and the 2D:4D and testosterone measurement (i.e., measured in blood or saliva). However, we found some evidence that prenatal testosterone measured in amniotic fluid (but not cord blood) might be related to the digit ratios-further studies are necessary to validate this observation. In summary, considering the current state of knowledge, any conclusions drawn from the assumption of the digit ratios as the proxy for testosterone (prenatal, adult level, or testosterone change under a challenging situation) warrant great caution.
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Affiliation(s)
| | - Marta Kowal
- IDN Being Human Lab, University of Wrocław, Wrocław, Poland
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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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8
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Kanakis GA, Pofi R, Goulis DG, Isidori AM, Armeni E, Erel CT, Fistonić I, Hillard T, Hirschberg AL, Meczekalski B, Mendoza N, Mueck AO, Simoncini T, Stute P, van Dijken D, Rees M, Lambrinoudaki I. EMAS position statement: Testosterone replacement therapy in older men. Maturitas 2023; 178:107854. [PMID: 37845136 DOI: 10.1016/j.maturitas.2023.107854] [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: 10/18/2023]
Abstract
INTRODUCTION Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable. AIM To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12 months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone.
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Affiliation(s)
- George A Kanakis
- Department of Endocrinology & IVF Unit, Athens Naval and Veteran Affairs Hospital, Athens, Greece.
| | - Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece; Royal Free Hospital, London, UK
| | - C Tamer Erel
- İstanbul-Cerrahpaşa University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ivan Fistonić
- Faculty for Health Studies, University of Rijeka, Rijeka, Croatia
| | - Timothy Hillard
- Department of Obstetrics & Gynaecology, University Hospitals Dorset, Poole, UK
| | - Angelica-Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Spain
| | - Alfred O Mueck
- Department of Women's Health, University Hospital Tuebingen, Germany; Beijing OB/GYN Hospital, Capital Medical University, China
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Dorenda van Dijken
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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Hunter SK, S Angadi S, Bhargava A, Harper J, Hirschberg AL, D Levine B, L Moreau K, J Nokoff N, Stachenfeld NS, Bermon S. The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine. Med Sci Sports Exerc 2023; 55:2328-2360. [PMID: 37772882 DOI: 10.1249/mss.0000000000003300] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
ABSTRACT Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%-30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, but remains low in females. The primary goal of this consensus statement is to provide the latest scientific knowledge and mechanisms for the sex differences in athletic performance. This review highlights the differences in anatomy and physiology between males and females that are primary determinants of the sex differences in athletic performance and in response to exercise training, and the role of sex steroid hormones (particularly testosterone and estradiol). We also identify historical and nonphysiological factors that influence the sex differences in performance. Finally, we identify gaps in the knowledge of sex differences in athletic performance and the underlying mechanisms, providing substantial opportunities for high-impact studies. A major step toward closing the knowledge gap is to include more and equitable numbers of women to that of men in mechanistic studies that determine any of the sex differences in response to an acute bout of exercise, exercise training, and athletic performance.
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Affiliation(s)
- Sandra K Hunter
- Exercise Science Program, Department of Physical Therapy, and Athletic and Human Performance Center, Marquette University, Milwaukee, WI
| | | | - Aditi Bhargava
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California, San Francisco, CA
| | - Joanna Harper
- Loughborough University, Loughborough, UNITED KINGDOM
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, SWEDEN
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kerrie L Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, and Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, CO
| | - Natalie J Nokoff
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Stéphane Bermon
- Health and Science Department, World Athletics, Monaco and the LAMHESS, University Côte d'Azur, Nice, FRANCE
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10
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Algburi HD, Alhamza A, Mansour AA. Diurnal Variation of Serum Total Testosterone in Women: A Single-Center Study From Basrah. Cureus 2023; 15:e47677. [PMID: 38021833 PMCID: PMC10673631 DOI: 10.7759/cureus.47677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The diurnal variation of testosterone in women has received limited attention, despite its growing recognition as a crucial factor in female health and well-being. This study aims to investigate the diurnal fluctuations of total testosterone levels in apparently healthy women with regular menstrual cycles. Methodology A cross-sectional study was conducted at Faiha Specialized Diabetes Endocrine and Metabolism Center in July 2023. This study involved 46 apparently healthy women volunteers aged between 21 and 40 years. To explore diurnal variations in total testosterone, blood samples were collected from each participant at two distinct time points, i.e., 8:30 AM and 1:30 PM. These samples were collected regardless of fasting status with the exclusion of the menstruating phase. Results The mean total testosterone level at 8:30 AM was 23.4 ± 12.4 ng/dL and at 1:30 PM was 21.7 ± 12.9 ng/dL, with a p-value of 0.03. Neither age nor body mass index demonstrated a significant impact on testosterone levels. Conclusions This study showed a significant diurnal variation in serum total testosterone levels among apparently healthy women, with higher levels observed in the morning.
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Affiliation(s)
- Hatem D Algburi
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
| | - Ali Alhamza
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
| | - Abbas A Mansour
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
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11
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Aerospace Medicine Clinic. Aerosp Med Hum Perform 2023; 94:800-803. [PMID: 37803511 DOI: 10.3357/amhp.6259.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
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12
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Meamar R, Feizi A, Aminorroaya A, Amini M, Iraj B, Heidarpour M. Reference range of testosterone and dehydroepiandrosterone sulfate levels in women during reproductive age in the Iranian population. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:69. [PMID: 38116488 PMCID: PMC10729679 DOI: 10.4103/jrms.jrms_100_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 12/21/2023]
Abstract
Backgrounds To determine the average cutoff values of serum-free and total testosterone (FT, TT) and dehydroepiandrosterone sulfate (DHEAS) among healthy premenopausal women. Materials and Methods Participants were women aged 18-55 years without signs and symptoms of hyperandrogenism (n = 489). Participants if Ferriman-Gallwey (FG) scores between 6 and 8 were considered a group located in the upper spectrum related to the normal hirsutism score (n = 30). DHEAS, TT, and FT levels were compared between different populations. Upper limits of 97.5 and 95 and lower limits of 5 and 2.5 percentiles were calculated to provide the reference intervals for DHEA, TT, and FT in the total sample and in the population with FG 6-8. Results In the total population, the mean ± standard deviation (SD) serum FT, TT, and DHEAS levels were 1.40 ± 0.63 pg/mL, 0.42 ± 0.17 ng/mL, and 1.5 ± 0.97 µg/ml, respectively. The cutoff values of FT at 1.35 and TT at 0.49 were obtained for differentiating the patients with FG 6-8 scores from the normal population, with the corresponding specificity of 0.60, the sensitivity of 0.67, and area under the ROC curve (AUC) (confidence interval 95%) of 0.63 (0.52-0.73), P = 0.01 and 0.68 (0.58-0.78) P = 0.001, respectively. Conclusions In our study, the mean ± SD serum FT level was 1.40 ± 0.63 pg/mL, the TT level was 0.42 ± 0.17 ng/mL, and the DHEAS level was 1.5 ± 0.97 µg/ml, in premenopausal women between 18 and 49 years of age. Furthermore, in a population with FG 6-8 score, a cutoff value of FT at 1.35 and TT at 0.49 was obtained. Although the irregular menstrual cycle did not change the reference range when compared with the normal group.
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Affiliation(s)
- Rokhsareh Meamar
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Osmancevic A, Daka B, Michos ED, Trimpou P, Allison M. The Association between Inflammation, Testosterone and SHBG in men: A cross-sectional Multi-Ethnic Study of Atherosclerosis. Clin Endocrinol (Oxf) 2023; 99:190-197. [PMID: 37221937 PMCID: PMC10330714 DOI: 10.1111/cen.14930] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/27/2023] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
CONTEXT Earlier studies have investigated the role of obesity-related inflammation and endogenous sex hormones in men. The role of interleukin-6 (IL-6) and C-reactive protein (CRP) with testosterone and sex hormone binding globulin (SHBG) levels in men is still debated. OBJECTIVE To investigate the independent association between levels of high sensitivity CRP (hsCRP) and IL-6 with endogenous sex hormones in men. DESIGN Cross-sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. PATIENTS OR OTHER PARTICIPANTS A community-based sample of 3212 men aged 45-84 years was included. After exclusions, 3041 men remained for the analyses. MAIN OUTCOME MEASURE(S) Serum concentrations of testosterone, SHBG, hsCRP, IL-6, and sTNFR were measured from the baseline exam. Multivariable linear regressions were used to examine the association of inflammatory markers with sex hormones. RESULTS An inverse association was found between levels of hsCRP and levels of testosterone and SHBG, even after adjustment for confounders and IL-6 (Total Testosterone; B = -0.14, Bioavailable Testosterone; B = -0.06, and SHBG; B = -0.66). Similar results were found for IL-6, although a positive association was found for SHBG (B = 0.95). Notably, an inverse association was found for IL-6 with bioavailable testosterone in African Americans and Hispanic Americans aged 45-54 years. No associations were found for sTNFR and endogenous sex hormones. CONCLUSION Our results indicate that inflammatory markers have independent associations with levels of testosterone (total and bioavailable) and furthermore, appear to associate differently with SHBG levels.
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Affiliation(s)
- Amar Osmancevic
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Penelope Trimpou
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew Allison
- Department of Preventive Medicine, School of Medicine, UC San Diego, San Diego, California, USA
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14
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Nikkhah M, Karami S, Khatami SH, Taheri-Anganeh M, Savardashtaki A, Mahmoodzadeh A, Shabaninejad Z, Vakili O, Mousavi P, Ghanizadeh Gerayeli F, Behrouj H, Ghasemi H, Movahedpour A. Review of electrochemical and optical biosensors for testosterone measurement. Biotechnol Appl Biochem 2023; 70:318-329. [PMID: 35484728 DOI: 10.1002/bab.2354] [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: 11/04/2021] [Accepted: 04/09/2022] [Indexed: 11/09/2022]
Abstract
Testosterone is an anabolic steroid and a major sex hormone in males. It plays vital roles, including developing the testis, penis, and prostate, increasing muscle and bone, and sperm production. In both men and women, testosterone levels should be in normal ranges. Besides, testosterone and its analogs are major global contributors to doping in sport. Due to the importance of testosterone testing, novel, accurate biosensors have been developed. This review summarizes the various methods for testosterone measurement. Also, recent optical and electrochemical approaches for the detection of testosterone and its analogs have been discussed.
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Affiliation(s)
- Maryam Nikkhah
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sajedeh Karami
- Department of Chemistry, Shiraz University, Shiraz, Iran
| | - Seyyed Hossein Khatami
- Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mortaza Taheri-Anganeh
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Amir Savardashtaki
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mahmoodzadeh
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Shabaninejad
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Omid Vakili
- Department of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pegah Mousavi
- Department of Medical Genetics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farhad Ghanizadeh Gerayeli
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Behrouj
- Behbahan Faculty of Medical Sciences, Behbahan, Iran
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15
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Giannos P, Prokopidis K, Church DD, Kirk B, Morgan PT, Lochlainn MN, Macpherson H, Woods DR, Ispoglou T. Associations of Bioavailable Serum Testosterone With Cognitive Function in Older Men: Results From the National Health and Nutrition Examination Survey. J Gerontol A Biol Sci Med Sci 2023; 78:151-157. [PMID: 35927217 PMCID: PMC9879757 DOI: 10.1093/gerona/glac162] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Age-associated cognitive decline may be influenced by testosterone status. However, studies evaluating the impact of bioavailable testosterone, the active, free testosterone, on cognitive function are scarce. Our study determined the relationship between calculated bioavailable testosterone and cognitive performance in older men. METHODS We used data from the U.S. National Health and Nutrition Examination Survey (NHANES) between 2013 and 2014. This study consisted of 208 men aged ≥60 years. Bioavailable serum testosterone was calculated based on the total serum testosterone, sex hormone-binding globulin, and albumin levels, whereas cognitive performance was assessed through the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test (WLLT), Word List Recall Test (WLRT), and Intrusion Word Count Test (WLLT-IC and WLRT-IC), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Multiple linear regression analyses were performed upon adjustment for age, ethnicity, socioeconomic status, education level, medical history, body mass index, energy, alcohol intake, physical activity levels, and sleep duration. RESULTS A significant positive association between bioavailable testosterone and DSST (β: 0.049, p = .002) score was detected, with no signs of a plateau effect. No significant associations with CERAD WLLT (p = .132), WLRT (p = .643), WLLT-IC (p = .979), and WLRT-IC (p = .387), and AFT (p = .057) were observed. CONCLUSION Calculated bioavailable testosterone presented a significant positive association with processing speed, sustained attention, and working memory in older men above 60 years of age. Further research is warranted to elucidate the impact of the inevitable age-related decline in testosterone on cognitive function in older men.
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Affiliation(s)
- Panagiotis Giannos
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, UK.,Society of Meta-research and Biomedical Innovation, London, UK
| | - Konstantinos Prokopidis
- Society of Meta-research and Biomedical Innovation, London, UK.,Department of Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - David D Church
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ben Kirk
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
| | - Paul T Morgan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Mary Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Helen Macpherson
- Deakin University, Geelong, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Victoria, Australia
| | - David R Woods
- Defence Medical Services, Lichfield, UK.,Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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16
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Genetic analyses implicate complex links between adult testosterone levels and health and disease. COMMUNICATIONS MEDICINE 2023; 3:4. [PMID: 36653534 PMCID: PMC9849476 DOI: 10.1038/s43856-022-00226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Testosterone levels are linked with diverse characteristics of human health, yet, whether these associations reflect correlation or causation remains debated. Here, we provide a broad perspective on the role of genetically determined testosterone on complex diseases in both sexes. METHODS Leveraging genetic and health registry data from the UK Biobank and FinnGen (total N = 625,650), we constructed polygenic scores (PGS) for total testosterone, sex-hormone binding globulin (SHBG) and free testosterone, associating these with 36 endpoints across different disease categories in the FinnGen. These analyses were combined with Mendelian Randomization (MR) and cross-sex PGS analyses to address causality. RESULTS We show testosterone and SHBG levels are intricately tied to metabolic health, but report lack of causality behind most associations, including type 2 diabetes (T2D). Across other disease domains, including 13 behavioral and neurological diseases, we similarly find little evidence for a substantial contribution from normal variation in testosterone levels. We nonetheless find genetically predicted testosterone affects many sex-specific traits, with a pronounced impact on female reproductive health, including causal contribution to PCOS-related traits like hirsutism and post-menopausal bleeding (PMB). We also illustrate how testosterone levels associate with antagonistic effects on stroke risk and reproductive endpoints between the sexes. CONCLUSIONS Overall, these findings provide insight into how genetically determined testosterone correlates with several health parameters in both sexes. Yet the lack of evidence for a causal contribution to most traits beyond sex-specific health underscores the complexity of the mechanisms linking testosterone levels to disease risk and sex differences.
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17
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De Vincentis S, Decaroli MC, Fanelli F, Diazzi C, Mezzullo M, Tartaro G, Tagliavini S, De Santis MC, Roli L, Milic J, Trenti T, Pagotto U, Guaraldi G, Rochira V. Primary, secondary and compensated male biochemical hypogonadism in people living with HIV (PLWH): relevance of sex hormone-binding globulin (SHBG) measurement and comparison between liquid chromatography-tandem mass spectrometry (LC-MS/MS) and chemiluminescent immunoassay for sex steroids assay. Aging Male 2022; 25:41-53. [PMID: 35318882 DOI: 10.1080/13685538.2022.2039116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Data about classification of hypogonadism and estrogen deficiency in male people living with HIV (PLWH) are scanty. AIM To investigate the prevalence and characterization of biochemical hypogonadism and relative estrogen deficiency in male PLWH aged < 50 comparing liquid chromatography-tandem mass spectrometry (LC-MS/MS) with chemiluminescent immunoassay (CI), and combining gonadotropin, sex hormone-binding globulin (SHBG) and serum estradiol (E2) measurements. METHODS Prospective, cross-sectional, observational study. Serum total testosterone (TT), E2, gonadotropins, SHBG were measured by CI. TT and E2 were also assessed by LC-MS/MS. Free testosterone (cFT) was calculated by Vermeulen equation. RESULTS A total of 316 PLWH (45.3 ± 5.3 years) were enrolled. TT and cFT by LC-MS/MS were lower compared to CI (p < 0.0001). The prevalence of biochemical hypogonadism was higher with LC-MS/MS than CI, both for TT (5.1% vs 3.2%, p < 0.0001) or cFT (9.5% vs 7%, p < 0.0001). The prevalence of hypogonadism (overt + compensated) was 17.1% for cFT using LC-MS/MS. Secondary form of hypogonadism was more prevalent than primary. The prevalence of relative estrogen deficiency was of 30.0% among hypogonadal patients and 15.5% among eugonadal. CONCLUSIONS The prevalence of male hypogonadism results underestimated by CI compared to LC-MS/MS in PLWH, both for TT and cFT. SHBG and gonadotropins are essential for detecting T deficiency.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Decaroli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Flaminia Fanelli
- Unit of Endocrinology and Prevention and Care of Diabetes, Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Policlinic Bologna, Italy
| | - Chiara Diazzi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Marco Mezzullo
- Unit of Endocrinology and Prevention and Care of Diabetes, Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Policlinic Bologna, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | | | - Laura Roli
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | - Jovana Milic
- Multidisciplinary Metabolic Clinic, Unit of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathology, Azienda USL of Modena, Modena, Italy
| | - Uberto Pagotto
- Unit of Endocrinology and Prevention and Care of Diabetes, Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Policlinic Bologna, Italy
| | - Giovanni Guaraldi
- Multidisciplinary Metabolic Clinic, Unit of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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18
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Urlacher SS, Kim EY, Luan T, Young LJ, Adjetey B. Minimally invasive biomarkers in human and non-human primate evolutionary biology: Tools for understanding variation and adaptation. Am J Hum Biol 2022; 34:e23811. [PMID: 36205445 PMCID: PMC9787651 DOI: 10.1002/ajhb.23811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/21/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The use of minimally invasive biomarkers (MIBs - physiological biomarkers obtained from minimally invasive sample types) has expanded rapidly in science and medicine over the past several decades. The MIB approach is a methodological strength in the field of human and non-human primate evolutionary biology (HEB). Among humans and our closest relatives, MIBs provide unique opportunities to document phenotypic variation and to operationalize evolutionary hypotheses. AIMS This paper overviews the use of MIBs in HEB. Our objectives are to (1) highlight key research topics which successfully implement MIBs, (2) identify promising yet under-investigated areas of MIB application, and (3) discuss current challenges in MIB research, with suggestions for advancing the field. DISCUSSION AND CONCLUSIONS A range of MIBs are used to investigate focal topics in HEB, including energetics and life history variation/evolution, developmental plasticity, and social status and dominance relationships. Nonetheless, we identify gaps in existing MIB research on traits such as physical growth and gut function that are central to the field. Several challenges remain for HEB research using MIBs, including the need for additional biomarkers and methods of assessment, robust validations, and approaches that are standardized across labs and research groups. Importantly, researchers must provide better support for adaptation and fitness effects in hypothesis testing (e.g., by obtaining complementary measures of energy expenditure, demonstrating redundancy of function, and performing lifetime/longitudinal analyses). We point to continued progress in the use of MIBs in HEB to better understand the past, present, and future of humans and our closest primate relatives.
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Affiliation(s)
- Samuel S. Urlacher
- Department of AnthropologyBaylor UniversityWacoTexasUSA
- Human Evolutionary Biology and Health LabBaylor UniversityWacoTexasUSA
- Child and Brain Development ProgramCIFARTorontoOntarioCanada
| | - Elizabeth Y. Kim
- Human Evolutionary Biology and Health LabBaylor UniversityWacoTexasUSA
- Department of BiologyBaylor UniversityWacoTexasUSA
| | - Tiffany Luan
- Human Evolutionary Biology and Health LabBaylor UniversityWacoTexasUSA
| | - Lauren J. Young
- Human Evolutionary Biology and Health LabBaylor UniversityWacoTexasUSA
| | - Brian Adjetey
- Human Evolutionary Biology and Health LabBaylor UniversityWacoTexasUSA
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19
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Fendereski K, Ghaed MA, Calvert JK, Hotaling JM. Hypogonadism and urologic surgeries: a narrative review. Transl Androl Urol 2022; 11:1045-1062. [PMID: 35958902 PMCID: PMC9360521 DOI: 10.21037/tau-22-308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Previous studies indicated that the treatment of male hypogonadism can be beneficial for intraoperative and postsurgical outcomes. In this study, we aimed to determine the impact of male hypogonadism on urologic surgeries. We provided an overview of the key studies in the field with the focus on the outcomes of urologic surgeries in hypogonadal men with/without testosterone replacement therapy (TRT). Methods We performed a literature review in PubMed and Google Scholar databases for the most relevant articles pertaining to the outlined topics without placing any limitations on publication years or study designs. We included full-text English articles published in peer reviewed journals between January 1970 and March 2022. Key Content and Findings Androgen deficiency is a common finding after major urologic surgeries. Although guidelines recommend against TRT in men with prostate carcinoma, recent investigations showed no association between TRT and disease progression and recurrence. Indeed, recent evidence suggested that low androgen levels could be related to high grade prostate carcinoma and increased risk of upgrading from low to high grade disease. Investigations on the application of TRT in benign prostatic hyperplasia (BPH) patients also revealed contrasting results. While some studies suggested higher rates of prostate-related events in men who received TRT, others showed that TRT could alleviate urinary symptoms in hypogonadal men with BPH. Decreased testosterone level is commonly seen in bladder cancer patients. The treatment of perioperative androgen deficiency can reduce postoperative morbidities and lower the risk of recurrence in these patients. Low testosterone levels are observed in approximately half of the men who undergo artificial urinary sphincter (AUS) placement and can increase the risk of complications. Conclusions The role of testosterone treatment in patients with urologic diseases such as prostate carcinoma and BPH is controversial. Further investigations are needed to determine the impact of hypogonadism and TRT on the outcomes of urologic surgeries in patients with androgen deficiency.
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Affiliation(s)
- Kiarad Fendereski
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mohammad Ali Ghaed
- Department of Urology, Rasoul Akram Hospital, Iran university of Medical Sciences, Tehran, Iran
| | - Joshua K Calvert
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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20
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Osmancevic A, Ottarsdottir K, Hellgren M, Lindblad U, Daka B. High C-reactive protein is associated with increased risk of biochemical hypogonadism: a population-based cohort study. Endocr Connect 2022; 11:EC-22-0141. [PMID: 35904226 PMCID: PMC9254292 DOI: 10.1530/ec-22-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 11/11/2022]
Abstract
CONTEXT Obesity seems to decrease levels of testosterone. It is still unknown what role inflammation plays in the secretion of testosterone in men. OBJECTIVE The objective is to study the association between levels of C-reactive protein and testosterone and its role in predicting biochemical hypogonadism in men. DESIGN This was a longitudinal observational study between 2002 and 2014 in Sweden. PATIENTS OR OTHER PARTICIPANTS At the first visit, a random population sample of 1400 men was included, and 645 men fulfilled a similar protocol at a 10-year follow-up visit. After exclusion, 625 men remained to be included in the final analyses. MAIN OUTCOME MEASURE(S) Serum concentrations of testosterone and C-reactive protein (CRP) were measured at both visits. Bioavailable testosterone was calculated. Biochemical hypogonadism was defined as total testosterone levels <8 nmol/L. RESULTS At the first visit and in the longitudinal analyses, a strong association was found between high levels of CRP and low levels of calculated bioavailable testosterone even after adjustments for age, waist-hip ratio, hypertension, smoking, type 2 diabetes, and leisuretime physical activity (B = -0.31, 95% CI -0.49 to -0.13, P = 0.001, B = -0.26, 95% CI -0.41 to -0.11, P = 0.001). Similarly, increase with one s. d. in CRP was associated with increased risk of having hypogonadism after adjustment in the final model (odds ratio (OR) 1.76, 95% CI 1.12-2.78, P = 0.015, OR 1.80, 95% CI 1.16-2.78, P =0.008). CONCLUSIONS In this representative cohort of men in southwestern Sweden, high levels of CRP were longitudinally associated with low concentrations of calculated bioavailable testosterone and increased risk of biochemical hypogonadism.
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Affiliation(s)
- Amar Osmancevic
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Ottarsdottir
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Hellgren
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Lindblad
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Correspondence should be addressed to B Daka:
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21
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Horiguchi Y, Tsukuda F, Ogata A, Hagiwara K, Sakamoto N, Hama Y, Koga S. The Long-Term Effect of Intensity Modulated Radiation Therapy for Prostate Cancer on Testosterone Levels. Adv Radiat Oncol 2022; 7:100851. [PMID: 35647399 PMCID: PMC9133400 DOI: 10.1016/j.adro.2021.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Concern about a long-term effect of the delivery of intensity modulated radiation therapy (IMRT) for prostate cancer on serum testosterone levels remains unelucidated. We evaluated how IMRT for localized prostate cancer affects serum testosterone levels during a follow-up period of up to 10 years. Methods and Materials We retrospectively evaluated data from 182 patients with localized prostate cancer who underwent definitive IMRT alone between 2007 and 2014. Serum total testosterone (TT) levels were measured by blood draws between 6 AM and 11 AM before treatment and at every posttreatment follow-up for 10 years. Pretreatment values and each posttreatment testosterone value were compared using a Wilcoxon signed rank test. The data set was stratified into 4 groups based on the pretreatment testosterone (pre-TT) values using quartiles. Results The median absolute or relative changes in TT levels from pretreatment were –0.42 ng/mL or –12.0% at 3 months after radiation therapy (P < .0001). Subsequently, TT levels gradually recovered to nearly the pretreatment levels 24 to 36 months after IMRT. When analyzed according to the pre-TT quartile, median TT levels initially decreased at the 3- to 12-month period in all the quartiles; however, median TT levels increased from the 18-month period in the first and second quartile groups, whereas they were maintained at less than the pretreatment levels in the third and the fourth quartile groups throughout the entire decade after radiation therapy. The proportion of patients with hypogonadal status, defined as TT levels <3.00 ng/mL, did not increase over time. Conclusions A transient and modest decrease of TT levels after IMRT spontaneously recovered to the pretreatment levels at the 24- to 36-month period except in patients in the higher quartile of pre-TT. This might have been partly owing to a variable sensitivity of individual testicular function to scattered radiation. Patients with lower pre-TT did not demonstrate a progressive overall rate of hypogonadism until 10 years after radiation therapy.
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Affiliation(s)
- Yutaka Horiguchi
- Department of Urology, Edogawa Hospital, Tokyo, Japan
- Corresponding author: Yutaka Horiguchi, MD
| | - Fumio Tsukuda
- Department of Urology, Edogawa Hospital, Tokyo, Japan
| | - Ayato Ogata
- Department of Urology, Edogawa Hospital, Tokyo, Japan
| | | | | | - Yukihiro Hama
- Department of Radiology, Edogawa Hospital, Tokyo, Japan
| | - Shoji Koga
- Department of Urology, Edogawa Hospital, Tokyo, Japan
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22
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Rappold BA. Review of the Use of Liquid Chromatography-Tandem Mass Spectrometry in Clinical Laboratories: Part I-Development. Ann Lab Med 2022; 42:121-140. [PMID: 34635606 PMCID: PMC8548246 DOI: 10.3343/alm.2022.42.2.121] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/25/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
The process of method development for a diagnostic assay based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) involves several disparate technologies and specialties. Additionally, method development details are typically not disclosed in journal publications. Method developers may need to search widely for pertinent information on their assay(s). This review summarizes the current practices and procedures in method development. Additionally, it probes aspects of method development that are generally not discussed, such as how exactly to calibrate an assay or where to place quality controls, using examples from the literature. This review intends to provide a comprehensive resource and induce critical thinking around the experiments for and execution of developing a clinically meaningful LC-MS/MS assay.
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Affiliation(s)
- Brian A. Rappold
- Laboratory Corporation of America Holdings, Research Triangle Park, NC, USA
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23
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Flores JM, Bernie HL, Miranda E, Nascimento B, Schofield E, Benfante N, Carlsson S, Mulhall JP. The Relationship Between PSA and Total Testosterone Levels in Men With Prostate Cancer. J Sex Med 2022; 19:471-478. [PMID: 35135736 PMCID: PMC9359436 DOI: 10.1016/j.jsxm.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prostate-specific antigen (PSA) secretion is a testosterone (T) dependent process. Published data suggest that a low T level is an independent predictor of higher-grade prostate cancer (PC). AIM To evaluate the relationship between T and PSA in patients with PC. METHODS All men diagnosed with PC with a recorded pre-treatment total T level measurement were included in this analysis. We analyzed demographic, clinical, and pathological data. Patients were stratified according to pretreatment PSA levels: <2 ng/mL, 2-4 ng/mL, >4 ng/mL. Low T was defined as total T < 10.4 nmol/L (300 ng/dL), very low T < 6.9 nmol/L (200 ng/dL). OUTCOMES T levels by PSA groups according to the PC pathology. RESULTS In this retrospective study, mean patient age was 61 years among 646 men. The distribution by PSA group was: 8% (<2), 17% (2-4), and 76% (>4). The mean T level across the entire cohort was 13 nmol/L (374 ng/dL). Overall, 30% had a T level < 10.4 nmol/L (300 ng/dL). The mean total T level by PSA group was: <2 ng/mL, 7 nmol/L (206 ng/dL); 2-4 ng/mL, 13 nmol/L (362 ng/dL); >4 ng/mL, 14 nmol/L (393 ng/dL), P < .001. PSA <4 ng/mL was a significant predictor of low T in men with PC GS ≥8. PSA <2 ng/mL was a significant predictor of very low T independent of the PC pathology. CLINICAL IMPLICATIONS These findings suggest that clinicians should consider measuring T levels when a patient diagnosed with PC GS ≥8 and PSA level <4 ng/mL, and for each patient with PSA level <2 ng/mL independent of the PC pathology. STRENGTHS & LIMITATIONS Our study has several strengths including (i) inclusion of a large population of men, (ii) use of a database which is audited and reviewed for accuracy annually, and (iii) use of an accurate T assay (LCMS). Nonetheless, there are limitations: (i) the subjects of the study are from a single institution, and (ii) we did not measure free T levels. CONCLUSION In men with PC with GS ≥8, PSA level <4 ng/mL predicts low T. PSA <2 ng/mL predicts very low T independent of the PC pathology. Flores JM, Bernie HL, Miranda E, et al. The Relationship Between PSA and Total Testosterone Levels in Men With Prostate Cancer. J Sex Med 2022;19:471-478.
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Affiliation(s)
- Jose M Flores
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Helen L Bernie
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Eduardo Miranda
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Bruno Nascimento
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole Benfante
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Sigrid Carlsson
- Urology Service, Department of Surgery, and Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY USA.
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24
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Schmidt MK, Rohayem J, Zitzmann M, Gelhorn H, Schneider G. German version of the Hypogonadism Impact of Symptoms Questionnaire: Psychometric properties and association with testosterone levels. Andrologia 2022; 54:e14370. [DOI: 10.1111/and.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Martina Kathrin Schmidt
- Psychosomatic Medicine and Psychotherapy Department of Mental Health University Hospital Münster Münster Germany
| | - Julia Rohayem
- Centre for Reproductive Medicine and Andrology University Hospital Münster Münster Germany
| | - Michael Zitzmann
- Centre for Reproductive Medicine and Andrology University Hospital Münster Münster Germany
| | | | - Gudrun Schneider
- Psychosomatic Medicine and Psychotherapy Department of Mental Health University Hospital Münster Münster Germany
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25
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Suarez A MC, Israeli JM, Kresch E, Telis L, Nassau DE. Testosterone therapy in children and adolescents: to whom, how, when? Int J Impot Res 2022; 34:652-662. [PMID: 34997199 DOI: 10.1038/s41443-021-00525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022]
Abstract
Male production of testosterone is crucial for the development of a wide range of functions. External and internal genitalia formation, secondary sexual characteristics, spermatogenesis, growth velocity, bone mass density, psychosocial maturation, and metabolic and cardiovascular profiles are closely dependent on testosterone exposure. Disorders in androgen production can present during all life-stages, including childhood and adolescence, and testosterone therapy (TT) is in many cases the only treatment that can correct the underlying deficit. TT is controversial in the pediatric population as hypoandrogenism is difficult to classify and diagnose in these age groups, and standardized protocols of treatment and monitorization are still lacking. In pediatric patients, hypogonadism can be central, primary, or a combination of both. Testosterone preparations are typically designed for adults' TT, and providers need to be aware of the advantages and disadvantages of these formulations, especially cognizant of supratherapeutic dosing. Monitoring of testosterone levels in boys on TT should be tailored to the individual patient and based on the anticipated duration of therapy. Although clinical consensus is lacking, an approximation of the current challenges and common practices in pediatric hypoandrogenism could help elucidate the broad spectrum of pathologies that lie behind this single hormone deficiency with wide-ranging implications.
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Affiliation(s)
- Maria Camila Suarez A
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Leon Telis
- Department of Urology, Lenox Hill Hospital, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Daniel E Nassau
- Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA.
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26
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Maheshwari A, Nippoldt T, Davidge-Pitts C. An Approach to Nonsuppressed Testosterone in Transgender Women Receiving Gender-Affirming Feminizing Hormonal Therapy. J Endocr Soc 2021; 5:bvab068. [PMID: 34278180 PMCID: PMC8279075 DOI: 10.1210/jendso/bvab068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Nonsuppressed levels of testosterone are seen in up to a quarter of transgender women on gender-affirming feminizing hormonal treatment. Multiple factors contribute to this situation, including patient, medication, laboratory, and organ-specific concerns. We propose a stepwise approach to determine the etiology of nonsuppressed levels of testosterone in transgender women. This may lead to an appropriate feminizing hormonal therapy regimen and diagnosis of manageable medical conditions.
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Affiliation(s)
- Arvind Maheshwari
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Todd Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Caroline Davidge-Pitts
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
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27
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Advances in stem cell research for the treatment of primary hypogonadism. Nat Rev Urol 2021; 18:487-507. [PMID: 34188209 DOI: 10.1038/s41585-021-00480-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
In Leydig cell dysfunction, cells respond weakly to stimulation by pituitary luteinizing hormone, and, therefore, produce less testosterone, leading to primary hypogonadism. The most widely used treatment for primary hypogonadism is testosterone replacement therapy (TRT). However, TRT causes infertility and has been associated with other adverse effects, such as causing erythrocytosis and gynaecomastia, worsening obstructive sleep apnoea and increasing cardiovascular morbidity and mortality risks. Stem-cell-based therapy that re-establishes testosterone-producing cell lineages in the body has, therefore, become a promising prospect for treating primary hypogonadism. Over the past two decades, substantial advances have been made in the identification of Leydig cell sources for use in transplantation surgery, including the artificial induction of Leydig-like cells from different types of stem cells, for example, stem Leydig cells, mesenchymal stem cells, and pluripotent stem cells (PSCs). PSC-derived Leydig-like cells have already provided a powerful in vitro model to study the molecular mechanisms underlying Leydig cell differentiation and could be used to treat men with primary hypogonadism in a more specific and personalized approach.
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28
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Kalra S, Kalhan A, Dhingra A, Kapoor N. Management of late-onset hypogonadism: person-centred thresholds, targets, techniques and tools. J R Coll Physicians Edinb 2021; 51:79-84. [PMID: 33877144 DOI: 10.4997/jrcpe.2021.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Late-onset hypogonadism (LOH) is a complex and highly debatable syndrome in ageing men, which is characterised by reduced testosterone levels associated with classical symptoms of androgen deficiency. This article discusses the complex issues surrounding its management related to patient-centric thresholds and therapeutic targets. It specifically highlights the need to consider symptoms as the starting point, the key milestones in the management and the target of treatment, while ensuring safety at all times. The diagnosis of LOH requires a high index of suspicion and early identification of symptoms followed by appropriate investigations. The threshold for initiation of treatment has to be person centric and requires individualised decisions. The dose, preparation, route and follow up after testosterone initiation also may vary among different people. A person-centred approach is key to the successful management of this complex, nebulous yet debilitating disease.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, India,
| | - Atul Kalhan
- Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Atul Dhingra
- Department of Endocrinology, Gangaram Bansal Hospital, Sri Ganganagar, Rajasthan, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India; Non communicable disease unit, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Australia
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29
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Asfour HA, Shaqoura EI, Said RS, Mustafa AG, Emerald BS, Allouh MZ. Differential response of oxidative and glycolytic skeletal muscle fibers to mesterolone. Sci Rep 2021; 11:12301. [PMID: 34112889 PMCID: PMC8192902 DOI: 10.1038/s41598-021-91854-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Oxidative and glycolytic muscle fibers differ in their ultrastructure, metabolism, and responses to physiological stimuli and pathological insults. We examined whether these fibers respond differentially to exogenous anabolic androgenic steroids (AASs) by comparing morphological and histological changes between the oxidative anterior latissimus dorsi (ALD) and glycolytic pectoralis major (PM) fibers in adult avian muscles. Adult female White Leghorn chickens (Gallus gallus) were randomly divided into five groups: a vehicle control and four mesterolone treatment groups (4, 8, 12, and 16 mg/kg). Mesterolone was administered orally every three days for four weeks. Immunocytochemical techniques and morphometric analyses were employed to measure the changes in muscle weight, fiber size, satellite cell (SC) composition, and number of myonuclei. Mesterolone increased both body and muscle weights and induced hypertrophy in glycolytic PM fibers but not in oxidative ALD fibers. Mesterolone induced SC proliferation in both muscles; however, the myonuclear accretion was noticeable only in the PM muscle. In both muscles, the collective changes maintained a constant myonuclear domain size and the changes were dose independent. In conclusion, mesterolone induced distinct dose-independent effects in avian oxidative and glycolytic skeletal muscle fibers; these findings might be clinically valuable in the treatment of age-related sarcopenia.
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Affiliation(s)
- Hasan A Asfour
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Université Paris-Saclay, UVSQ, Inserm, END-ICAP, 78000, Versailles, France
| | - Emad I Shaqoura
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Raed S Said
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayman G Mustafa
- Basic Medical Science Department, College of Medicine, QU Health, Qatar University, Doha, Qatar.,Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | - Bright Starling Emerald
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. .,Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
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30
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Mali S, Irani K, Mohammadi SM, Sarebanhassanabadi M. Serum free testosterone level in coronary artery disease in candidates for coronary artery bypass graft surgery: A cross-sectional study. Int J Reprod Biomed 2021; 19:293-302. [PMID: 33842826 PMCID: PMC8023009 DOI: 10.18502/ijrm.v19i3.8577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 09/09/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background Due to the controversy over the effect of serum testosterone levels on coronary artery diseases, this survey explores the serum levels of free testosterone, luteinizing hormone, and follicle-stimulating hormone in candidates for coronary artery bypass graft compared with an age-matched control group and evaluates the associated factors in these participants.
Objective To determine the testosterone level in elective coronary artery bypass grafting participants. Materials and Methods In this cross-sectional study, all male patients aged > 40 yr as candidates for elective coronary artery bypass grafting, who were referred to the Afshar Hospital, Yazd, Iran, from March 2018 to March 2019, were included. In total, 100 men were enrolled (50 cases and 50 controls). Their serum levels of free and total testosterone, luteinizing hormone, and follicle-stimulating hormone were measured and the results were compared. Results The findings indicated a significant difference between the two groups in total and free testosterone (both p < 0.001); they were lower in the case group. There was also a significant difference in the total testosterone of the participants with diabetes mellitus compared with no-diabetic individuals (p = 0.007). Free testosterone of diabetic subjects taking insulin was lower compared with those taking no insulin (p = 0.04). There was also an association between the body mass index and free testosterone, left ventricular ejection fraction and total testosterone, and a significant and negative relation between the duration of hospital admissions and free testosterone (p < 0.05). Conclusion This study illustrates that participants with coronary artery disease bear a significantly low testosterone level in comparison with the healthy control group.
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Affiliation(s)
- Shahriar Mali
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Kurosh Irani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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31
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Salonia A, Pontillo M, Capogrosso P, Gregori S, Tassara M, Boeri L, Carenzi C, Abbate C, Cignoli D, Ferrara AM, Cazzaniga W, Rowe I, Ramirez GA, Tresoldi C, Mushtaq J, Locatelli M, Santoleri L, Castagna A, Zangrillo A, De Cobelli F, Tresoldi M, Landoni G, Rovere-Querini P, Ciceri F, Montorsi F. Severely low testosterone in males with COVID-19: A case-control study. Andrology 2021; 9:1043-1052. [PMID: 33635589 PMCID: PMC8013327 DOI: 10.1111/andr.12993] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
Background Circulating androgens could have a relevant pathobiological role in clinical outcomes in men with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection (COVID‐19). Objectives We aimed to assess: (a) circulating sex steroids levels in a cohort of 286 symptomatic men with laboratory‐confirmed COVID‐19 at hospital admission compared to a cohort of 281 healthy men; and (b) the association between serum testosterone levels (tT), COVID‐19, and clinical outcomes. Materials and Methods Demographic, clinical, and hormonal values were collected for all patients. Hypogonadism was defined as tT ≤9.2 nmol/l. The Charlson Comorbidity Index (CCI) was used to score health‐significant comorbidities. Severe clinical outcomes were defined as patients either transferred to intensive care unit (ICU) or death. Descriptive statistics and multivariable linear and logistic regression models tested the association between clinical and laboratory variables and tT levels. Univariable and multivariable logistic regression models tested the association between tT and severe clinical outcomes. Results Overall, a significantly lower levels of LH and tT were found in patients with COVID‐19 compared to healthy controls (all p < 0.0001); conversely, healthy controls depicted lower values of circulating E2 (p < 0.001). Testosterone levels suggestive for hypogonadism were observed in 257 (89.8%) patients at hospital admission. In as many as 243 (85%) cases, hypogonadism was secondary. SARS‐CoV‐2 infection status was independently associated with lower tT levels (p < 0.0001) and greater risk of hypogonadism (p < 0.0001), after accounting for age, BMI, CCI, and IL‐6 values. Lower tT levels were associated with higher risk of ICU admission and death outcomes (all p ≤ 0.05), after accounting for clinical and laboratory parameters. Conclusions We unveil an independent association between SARS‐CoV‐2 infection status and secondary hypogonadism already at hospital admission, with lower testosterone levels predicting the most severe clinical outcomes.
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Affiliation(s)
- Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Marina Pontillo
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Silvia Gregori
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michela Tassara
- Immunohematology and Transfusion Medicine, IRRCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, IRCCS Foundation Ca' Granda, Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | - Cristina Carenzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Anna Maria Ferrara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Isaline Rowe
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe A Ramirez
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Junaid Mushtaq
- University Vita-Salute San Raffaele, Milan, Italy.,Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Santoleri
- Immunohematology and Transfusion Medicine, IRRCS Ospedale San Raffaele, Milan, Italy
| | - Antonella Castagna
- University Vita-Salute San Raffaele, Milan, Italy.,Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- University Vita-Salute San Raffaele, Milan, Italy.,Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco De Cobelli
- University Vita-Salute San Raffaele, Milan, Italy.,Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Landoni
- University Vita-Salute San Raffaele, Milan, Italy.,Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere-Querini
- University Vita-Salute San Raffaele, Milan, Italy.,Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, Milan, Italy.,Hematology and Bone Marrow Transplant Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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Jenkins CR, Rittel A, Sturdivant RX, Wan J, Clerc PG, Manning E, Jenkins LM, Wardian JL, Graybill SD. Glycemic benefits with adherence to testosterone therapy in men with hypogonadism and type 2 diabetes mellitus. Andrology 2021; 9:1076-1085. [PMID: 33606360 DOI: 10.1111/andr.12990] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND While previous studies have demonstrated testosterone's beneficial effects on glycemic control in men with hypogonadism and Type 2 Diabetes, the extent to which these improvements are observed based on the degree of treatment adherence has been unclear. OBJECTIVES To evaluate the effects of long-term testosterone therapy in A1C levels in men with Type 2 Diabetes Mellitus and hypogonadism, controlling for BMI, pre-treatment A1C, and age among different testosterone therapy adherence groups. MATERIALS AND METHODS We performed a retrospective analysis of 1737 men with diabetes and hypogonadism on testosterone therapy for 5 years of data from 2008-2018, isolating A1C, lipid panels, and BMI results for analysis. Subjects were categorized into adherence groups based on quartiles of the proportion of days covered (> 75% of days, 51-75% of days, 26-50% of days and 0-25% of days), with >75% of days covered considered adherent to therapy. RESULTS Pre-treatment median A1C was 6.8%. Post-treatment median A1C was 7.1%. The adherent group, >75%, was the only group notable for a decrease in A1C, with a median decrease of -0.2 (p = 0.0022). BMI improvement was associated with improved post-treatment A1C (p = 0.007). When controlling for BMI, age, and pre-treatment A1C, the >75% adherence group was associated with improved post-treatment A1C (p < 0.001). DISCUSSION When controlling for all studied variables, testosterone adherence was associated with improved post-treatment A1C. The higher the initial A1C at the initiation of therapy, the higher the potential for lowering the patient's A1C with >75% adherence. Further, all groups showed some reduction in BMI, which may indicate that testosterone therapy may affect A1C independent of weight loss. CONCLUSION Even when controlling for improved BMI, pre-treatment A1C, and age, testosterone positively impacted glycemic control in diabetes patients with hypogonadism, with the most benefit noted in those most adherent to therapy (>75%).
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Affiliation(s)
- Craig R Jenkins
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Alex Rittel
- Data Innovation Branch, Defense Healthcare Management Systems, San Antonio, TX, USA
| | - Rodney X Sturdivant
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jen Wan
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Philip G Clerc
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Evan Manning
- Department of Medicine, Internal Medicine, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Lydia M Jenkins
- Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Jana L Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA
| | - Sky D Graybill
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
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Amadi C, Green KI, Odum EP. Is serum PSA a predictor of male hypogonadism? Testing the hypothesis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:144-151. [PMID: 33587836 PMCID: PMC10065314 DOI: 10.20945/2359-3997000000326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Male hypogonadism (MH) is common among infertile men. Besides testosterone, limited MH biomarkers are available, while researchers have suggested the use of prostate-specific antigen (PSA) to help diagnose MH. Hence, we sought to evaluate the potential use of PSA to predict MH among relatively young men with infertility in Nigeria. Methods The study included 707 male partners (35-44 years) in infertile couples seeking infertility evaluation at a third-level care center in Nigeria. MH was diagnosed using standard guidelines. Receiver operating characteristic (ROC) and regression analyses explored the potential of serum free PSA (fPSA) and total PSA (tPSA) in predicting MH and MH-related clinical features. Results In all, 29.7% of the patients had MH (MH+ve). The MH+ve group had lower mean values of fPSA and tPSA than the group without MH (MH-ve). The best fPSA threshold of < 0.25 μg/L compared with the best tPSA threshold of < 0.74 μg/L had higher accuracy (area under the curve [AUC] 0.908 versus 0.866, respectively), sensitivity (87% versus 83%, respectively), and specificity (42% versus 37%, respectively) for MH diagnosis. After adjustment for confounders, fPSA level ≤ 0.25 μg/L was more likely to predict MH-related decreased libido (odds ratio [OR] 2.728, p<0.001) and erectile dysfunction (OR 3.925, p<0.001) compared with tPSA ≤ 0.74 μg/L in the MH+ve group. Conclusion For MH diagnosis, fPSA and tPSA had good sensitivity but very poor specificity, although fPSA had better potential for MH diagnosis and association with MH-related clinical features than tPSA. Hence, fPSA could complement other biomarkers for MH diagnosis in men 35-44 years, although we recommend further studies to confirm these findings.
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Affiliation(s)
- Collins Amadi
- Department of Chemical Pathology, Rivers State University, Port Harcourt, Rivers State, Nigeria,
| | - Kinikanwo I Green
- Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Ehimen P Odum
- Department of Chemical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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Abstract
Over the past two decades several large cohort studies have been performed to disclose the changes of sex hormone in elderly and their clinical significance. Beyond the decline of total testosterone, aging is accompanied by a sex hormone binding globulin (SHBG) increase, a steeper free testosterone decline, while gonadotropins may be increased or inappropriately normal, with important contribution of comorbidities (e.g., obesity) to these changes. Actually, it has become firm the concept that the biochemical finding of testosterone deficiency alone is not sufficient for diagnosing hypogonadism in older men. The definition of late-onset hypogonadism (LOH) includes low serum testosterone levels coupled with signs and symptoms related to hypogonadism. Indeed, the combination of multiple factors all contributing to the testosterone decline, with other concurrent comorbidities further overlapping, makes the clinical correlates of LOH highly heterogeneous. For all these reasons both the diagnosis and the therapeutic management of LOH, especially the decision about starting testosterone replacement treatment, remain challenging.
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35
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Lecaplain B, Badran Z, Soueidan A, Prud'homme T, Gaudin A. Periodontitis, erectile dysfunction, reproductive hormones, and semen quality: A systematic review. Andrology 2021; 9:769-780. [PMID: 33319469 DOI: 10.1111/andr.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing evidence that periodontitis may affect male sexual health (MSH) (erectile function, production of sex hormones, and semen quality). However, a limited number of clinical studies demonstrate the association between MSH and periodontitis. OBJECTIVES The aim of this study was to explore the relationship between periodontitis and MSF. MATERIALS AND METHODS A comprehensive systematic review of the published literature in MEDLINE, PubMed, Scopus, Cochrane, EMBASE, and Web of Science databases from the earliest available online indexing year until October 2020 was performed, in accordance with the PRISMA guidelines. Keywords related to periodontitis were combined with words describing MSH. RESULT A total of 19 studies were included and discussed in the systematic review. The number of study participants ranged from 53 to 197,136 individuals, aged between 18 and 95 years (mean age, 41.2 years). Six studies did not report the age of the participants. Out of nine studies, eight found a significant association between erectile dysfunction (ED) and periodontitis. Only three studies evaluated the association between sex hormone levels and periodontitis, and two of these studies showed that patients with periodontitis are expected to exhibit higher levels of testosterone. Finally, out of five studies, two demonstrated a significant association between semen quality and periodontitis. DISCUSSION The findings in this review were limited by the quality and the few available studies. Results from the observational studies might have been affected by recall bias and confounded by cofactors. CONCLUSION The results of this systematic review revealed a significant association between periodontitis and ED, although the responsible mechanisms remain unclear. The potential associations between sex hormone levels, semen quality, and periodontitis are yet to be demonstrated. In order to improve patient management, dentists and physicians need to be aware of the association between male sexual health problems and periodontitis.
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Affiliation(s)
- Bastien Lecaplain
- Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France
| | - Zahi Badran
- Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,Faculty of Dentistry, McGill University, Montreal, Canada
| | - Assem Soueidan
- Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
| | - Tony Prud'homme
- Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France.,Inserm, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
| | - Alexis Gaudin
- Université de Nantes, UFR Odontologie, Nantes, France.,CHU Nantes, PHU4 OTONN, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
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36
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Stanhewicz AE, Wong BJ. Counterpoint: Investigators should not control for menstrual cycle phase when performing studies of vascular control that include women. J Appl Physiol (1985) 2020; 129:1117-1119. [DOI: 10.1152/japplphysiol.00427.2020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Anna E. Stanhewicz
- Department of Health & Human Physiology, University of Iowa, Iowa City, Iowa
| | - Brett J. Wong
- Department of Kinesiology & Health, Georgia State University, Atlanta, Georgia
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Wang L, Deng Y. The applications of androgen in the treatment of dry eye disease: a systematic review of clinical studies. Endocr J 2020; 67:893-902. [PMID: 32814731 DOI: 10.1507/endocrj.ej20-0178] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Androgen regulates the function of lacrimal and meibomian glands, and its deficiency is a pathological factor underlying dry eye disease (DED). However, no androgen has been approved for treating DED due to lack of definite evidence regarding its efficacy and safety in clinics. In this systematic review, we have summarized the clinical studies on the safety and efficacy of androgen replacement therapy (ART) for DED. Medline (via Pubmed), Embase, Clinicaltrials.gov, Wanfang and Chinese Clinical Trials Registry Database were searched for the relevant prospective studies, and 7 studies wherein androgen was applied topically via eye drops or systemically via oral or transdermal administration were included. The quality of these studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias and methodological index for non-randomized studies. Most studies showed that androgen effectively improved dry eye-related symptoms and increased tear secretion. Furthermore, elderly men and peri-menopausal women with lower levels of circulating androgens responded better to ART. However, one study involving patients with Sjögren's syndrome showed no improvement in the ART group compared to the placebo control, or to the baseline level. Adverse effects were also common but limited to mild skin problems. In conclusion, androgen is a potential treatment for dry eye disease, especially for people with primary androgen deficiency. Short-term application is relatively safe.
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Affiliation(s)
- Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Neto FTL, Marques RA, de Freitas Cavalcanti Filho A, Araujo LCN, Lima SVC, Pinto L, Silva RO. 1H NMR-based metabonomics for infertility diagnosis in men with varicocele. J Assist Reprod Genet 2020; 37:2233-2247. [PMID: 32715373 PMCID: PMC7492286 DOI: 10.1007/s10815-020-01896-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE "Omics" techniques have been used to understand and to identify biomarkers of male infertility. We report on the first metabonomics models created to diagnose varicocele and infertility among men with varicocele. METHODS We recruited 35 infertile men with varicocele (VI group), 21 fertile men with varicocele (VF group) and 24 fertile men without varicocele (C group). All men underwent standard semen analysis, scrotal duplex ultrasonography, and sexual hormone level measurement. Hydrogen-1 nuclear magnetic resonance (1H NMR) spectra of seminal plasma were used to create metabonomics models to discriminate between men with and without varicocele, and between fertile and infertile men with varicocele. RESULTS Using the statistical formalisms partial least square discriminants analysis and genetic algorithm-based linear discriminant analysis (GA-LDA), we created two models that discriminated the three groups from each other with accuracy of 92.17%. We also created metabonomics models using orthogonal partial least square discriminants analysis and GA-LDA that discriminated VF group from VI group, with an accuracy of 94.64% and 100% respectively. We identified 19 metabolites that were important in group segregation: caprate, 2-hydroxy-3-methylvalerate, leucine, valine, 3-hydroxybutyrate, lactate, alanine, 4-aminobutyrate, isoleucine, citrate, methanol, glucose, glycosides, glycerol-3-phosphocoline, n-acetyltyrosine, glutamine, tyrosine, arginine, and uridine. CONCLUSIONS 1HNMR-based metabonomics of seminal plasma can be used to create metabonomics models to discriminate between men with varicocele from those without varicocele, and between fertile men with varicocele from those infertile with varicocele. Furthermore, the most important metabolites for group segregation are involved in the oxidative stress caused by varicocele.
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Affiliation(s)
- Filipe Tenorio Lira Neto
- Department of Surgery, Universidade Federal de Pernambuco, Rua Guilherme Salazar, n 150, apt 601E, Recife, PE ZIP 52061-275 Brazil
- Instituto de Medicina Integral Prof. Fernando Figueira, Rua dos Coelho, 300, Coelhos, Recife, PE ZIP 50070-902 Brazil
| | - Ronmilson Alves Marques
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
| | | | | | - Salvador Vilar Correia Lima
- Department of Surgery, Universidade Federal de Pernambuco, Hospital das Clínicas - Campus UFPE, Av. Prof. Moraes Rego,”s/n° - Bloco “A” - Térreo Cidade Universitária, Recife, PE ZIP 50670-420 Brazil
| | - Licarion Pinto
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
| | - Ricardo Oliveira Silva
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
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Giagulli VA, Castellana M, Lisco G, Triggiani V. Critical evaluation of different available guidelines for late‐onset hypogonadism. Andrology 2020; 8:1628-1641. [DOI: 10.1111/andr.12850] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Vito Angelo Giagulli
- Interdisciplinary Department of Medicine‐Section of Internal Medicine Geriatrics, Endocrinology and Rare Diseases School of Medicine University of Bari “Aldo Moro” Bari Italy
- Outpatients Clinic of Endocrinology and Metabolic Disease Conversano Hospital Bari Italy
| | - Marco Castellana
- National Institute of Gastroenterology "Saverio de Bellis" Research Hospital Bari Italy
| | - Giuseppe Lisco
- Hospital Unit of Endocrinology Perrino Hospital Brindisi Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine‐Section of Internal Medicine Geriatrics, Endocrinology and Rare Diseases School of Medicine University of Bari “Aldo Moro” Bari Italy
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40
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Xia K, Chen H, Wang J, Feng X, Gao Y, Wang Y, Deng R, Wu C, Luo P, Zhang M, Wang C, Zhang Y, Zhang Y, Liu G, Tu X, Sun X, Li W, Ke Q, Deng C, Xiang AP. Restorative functions of Autologous Stem Leydig Cell transplantation in a Testosterone-deficient non-human primate model. Theranostics 2020; 10:8705-8720. [PMID: 32754273 PMCID: PMC7392013 DOI: 10.7150/thno.46854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
Rationale: Stem Leydig cells (SLCs) transplantation can restore testosterone production in rodent models and is thus a potential solution for treating testosterone deficiency (TD). However, it remains unknown whether these favorable effects will be reproduced in more clinically relevant large-animal models. Therefore, we assessed the feasibility, safety and efficacy of autologous SLCs transplantation in a testosterone-deficient non-human primate (NHP) model. Methods: Cynomolgus monkey SLCs (CM-SLCs) were isolated from testis biopsies of elderly (> 19 years) cynomolgus monkeys by flow cytometry. Autologous CM-SLCs were injected into the testicular interstitium of 7 monkeys. Another 4 monkeys were injected the same way with cynomolgus monkey dermal fibroblasts (CM-DFs) as controls. The animals were then examined for sex hormones, semen, body composition, grip strength, and exercise activity. Results: We first isolated CD271+ CM-SLCs which were confirmed to expand continuously and show potential to differentiate into testosterone-producing Leydig cells (LCs) in vitro. Compared with CM-DFs transplantation, engraftment of autologous CM-SLCs into elderly monkeys could significantly increase the serum testosterone level in a physiological pattern for 8 weeks, without any need for immunosuppression. Importantly, CM-SLCs transplantation recovered spermatogenesis and ameliorated TD-related symptoms, such as those related to body fat mass, lean mass, bone mineral density, strength and exercise capacity. Conclusion: For the first time, our short-term observations demonstrated that autologous SLCs can increase testosterone levels and ameliorate relevant TD symptoms in primate models. A larger cohort with long-term follow-up will be required to assess the translational potential of autologous SLCs for TD therapy.
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41
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Boeri L, Capogrosso P, Cazzaniga W, Pozzi E, Candela L, Belladelli F, Oreggia D, Ventimiglia E, Schifano N, Fallara G, Pontillo M, Abbate C, Montanari E, Montorsi F, Salonia A. SHBG levels in primary infertile men: a critical interpretation in clinical practice. Endocr Connect 2020; 9:658-666. [PMID: 32520727 PMCID: PMC7424340 DOI: 10.1530/ec-20-0183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to test the association between age, BMI and sex-hormone-binding globulin (SHBG) in a homogenous cohort of white-European men presenting for primary couple's infertility. DESIGN Retrospective study. METHODS Data from 1547 infertile men were analysed. Health-significant comorbidities were scored with the Charlson comorbidity index (CCI). Fasting serum hormones were measured in every patient. Age was considered according to quartile groups (<33, 33-41, >41 years) and BMI as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obesity (>30 kg/m2). Descriptive statistics and linear regression analysis tested the associations between age, BMI and SHBG. RESULTS Median SHBG levels increased across quartiles of age and decreased along with BMI increases (all P < 0.001). For each year increase in age, SHBG increased 0.32 nmol/L; conversely, for each unit increase in BMI, SHBG decreased by 1.1 nmol/L (all P < 0.001). SHBG levels decline with increasing BMI was greater than SHBG progressive increase with age. Overall, BMI explained 3.0 times more of the variability in SHBG than did ageing. At multivariate linear model, age and BMI were the most significant factors influencing SHBG concentration (all P < 0.001), after accounting for CCI, albumin levels and smoking status. CONCLUSIONS We found a wide distribution of SHBG concentrations across age and BMI values in primary infertile men. The association between BMI and lowered SHBG levels seems to be greater than the association of ageing with increased SHBG.
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Affiliation(s)
- Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, Foundation IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Davide Oreggia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Marina Pontillo
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Xu HY, Jiang H, Feng GS, Feng Y, Han Y, Tang WH, Zhang HX, Chen FH, Zhang HX, Liu DF, Li R, Qiao J. Establishing the lower limits of total serum testosterone among Chinese proven fertile men who received treatment of assisted reproductive technology. Asian J Androl 2020; 22:396-400. [PMID: 31571639 PMCID: PMC7406106 DOI: 10.4103/aja.aja_100_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/04/2019] [Indexed: 11/15/2022] Open
Abstract
Testosterone (T) plays a crucial role in spermatogenesis because extremely low levels of intratesticular T lead to correspondingly low serum levels of total T (tT), severe disorders of spermatogenesis, and male sterility. However, there is little consensus on the lower limits of serum tT in proven fertile men undergoing assisted reproductive technology treatments in Chinese or other Asian populations. We aimed to establish the reference range of serum tT based on a population of 868 fertile Chinese men undergoing in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) treatments. We defined a fertile man as having had a live baby with his partner as recorded in our IVF registration system. The lower limits of serum tT were established using a Siemens IMMULITE 2000 chemiluminescent system. The 1st, 2.5th, and 5th percentiles and their 95% confidence intervals (CIs) were 3.6 (95% CI: 2.7-4.1) nmol l-1, 4.3 (95% CI: 4.1-5.0) nmol l-1, and 5.6 (95% CI: 4.8-5.8) nmol l-1, respectively. Using the linear correlation of serum tT between the Siemens platform and a liquid chromatography-tandem mass spectrometry platform, the calculated lower limits of serum tT were also established for fertile Chinese men undergoing IVF/ICSI-ET treatments, which will benefit the clinical diagnosis and treatment of male infertility during such procedures.
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Affiliation(s)
- Hui-Yu Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Hui Jiang
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Guo-Shuang Feng
- Center for Clinical Epidemiology and Evidence-Based Medicine Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Ying Feng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Yong Han
- Clinical Research Institute, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
| | - Wen-Hao Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Feng-Hua Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Hong-Xia Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - De-Feng Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
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Keihani S, Wright LN, Alder NJ, Jiang J, Cheng PJ, Stoddard GJ, Pastuszak AW, Deibert CM, Hotaling JM. Baseline Gonadotropin Levels and Testosterone Response in Hypogonadal Men Treated With Clomiphene Citrate. Urology 2020; 142:119-124. [PMID: 32353397 DOI: 10.1016/j.urology.2020.04.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of baseline gonadotropins in predicting the biochemical response to clomiphene citrate (CC) treatment. METHODS We conducted a retrospective review of data from hypogonadal men treated with CC in 2 high-volume fertility centers between 2013 and 2018. Patient age, body mass index, and baseline hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], and total testosterone [TT]) were obtained. Response to treatment was measured as changes in TT levels within 6 months of initiating CC treatment. Linear regression models adjusted for age, body mass index, and time on CC therapy were fitted to assess the associations between baseline LH and FSH levels with treatment response. RESULTS A total of 332 men with mean ± standard deviation age of 36.2 ± 8.2 years were included. Median time to initial follow-up was 6 weeks (25th-75th interquartile range [IQR]: 4-9 weeks). TT levels increased significantly on CC treatment (mean change: 329.2 ng/dL, 95% CI: 307.4-351.0) with 73% of men having at least 200 ng/dL increase over baseline TT levels. In univariable linear regression models, only age was significantly associated with TT response. Neither the baseline LH nor FSH significantly predicted TT response in linear regression models. CONCLUSION CC treatment results in significant increases in testosterone levels in most men. Baseline gonadotropins are not strong predictors for treatment response to CC. Adequate biochemical response with CC trial can be expected in most patients with normal or slightly elevated baseline gonadotropin levels.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | - Lindsey N Wright
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Nathan J Alder
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jinfeng Jiang
- Division of Urologic Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | | | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
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Yu EJ, Yamaguchi T, Lee JH, Lim AR, Lee JH, Park H, Oh TJ. Enzymatic Synthesis of Anabolic Steroid Glycosides by Glucosyltransferase from Terribacillus sp. PAMC 23288. J Microbiol Biotechnol 2020; 30:604-614. [PMID: 31893610 PMCID: PMC9728329 DOI: 10.4014/jmb.1911.11057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The application of steroids has steadily increased thanks to their therapeutic effects. However, alternatives are required due their severe side effects; thus, studies on the activities of steroid derivatives are underway. Sugar derivatives of nandrolone, which is used to treat breast cancer, as well as cortisone and prednisone, which reduce inflammation, pain, and edema, are unknown. We linked O-glucose to nandrolone and testosterone using UDP-glucosyltransferase (UGT-1) and, then, tested their bioactivities in vitro. Analysis by NMR showed that the derivatives were 17β-nandrolone β-D-glucose and 17β-testosterone β-D-glucose, respectively. The viability was higher and cytotoxicity was evident in PC12 cells incubated with rotenone and, testosterone derivatives, compared to the controls. SH-SY5Y cells incubated with H2O2 and nandrolone derivatives remained viable and cytotoxicity was attenuated. Both derivatives enhanced neuronal protective effects and increased the amounts of cellular ATP.
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Affiliation(s)
- Eun-Ji Yu
- Department of Life Science and Biochemical Engineering, SunMoon University, Asan 31460, Republic of Korea
| | - Tokutaro Yamaguchi
- Department of Life Science and Biochemical Engineering, SunMoon University, Asan 31460, Republic of Korea,Department of Pharmaceutical Engineering and Biotechnology, SunMoon University, Asan 31460, Republic of Korea,Genome-Based BioIT Convergence Institute, Asan 31460, Republic of Korea
| | - Joo-Ho Lee
- Genome-Based BioIT Convergence Institute, Asan 31460, Republic of Korea
| | - A-Rang Lim
- Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Jun Hyuck Lee
- Unit of Research for Practical Application, Korea Polar Research Institute, Incheon 21990, Republic of Korea,Department of Polar Sciences, University of Science and Technology, Incheon 21990, Republic of Korea
| | - Hyun Park
- Division of Biotechnology, College of Life Science and Biotechnology, Korea University, Seoul 02841, Republic of Korea,Corresponding authors H.P. Phone: +82 2 3290 3051 E-mail: T.-J.O. Phone: +82 41 530 2677 E-mail:
| | - Tae-Jin Oh
- Department of Life Science and Biochemical Engineering, SunMoon University, Asan 31460, Republic of Korea,Department of Pharmaceutical Engineering and Biotechnology, SunMoon University, Asan 31460, Republic of Korea,Genome-Based BioIT Convergence Institute, Asan 31460, Republic of Korea,Corresponding authors H.P. Phone: +82 2 3290 3051 E-mail: T.-J.O. Phone: +82 41 530 2677 E-mail:
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Prescott H, Khan I. Medicinal plants/herbal supplements as female aphrodisiacs: Does any evidence exist to support their inclusion or potential in the treatment of FSD? JOURNAL OF ETHNOPHARMACOLOGY 2020; 251:112464. [PMID: 31881322 DOI: 10.1016/j.jep.2019.112464] [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: 06/19/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Female Sexual Dysfunction is a complex condition with biopsychosocial origins. Plants traditionally used as aphrodisiacs may be promising as routes to develop therapeutic options which are lacking. AIM To distinguish the plants commonly used in (AP) on the market in the United States, and to evaluate their ethnobotanical and clinical evidence as a basis for their inclusion. METHODS This study is a narrative review of 53 species commonly found in AP on the market in the United States. Most species listed have anecdotal use as aphrodisiacs throughout history; therefore, a systematic search was done for clinical evidence. The primary outcome assessed is the clinical efficacy of plants in the treatment of libido desire disorders. RESULTS There is little to no evidence from the literature to substantiate claims of plants currently on the market as AP for female libido desire disorders. CONCLUSIONS The biggest problem in the literature is the lack of botanical verification and consistency in material across studies. Any botanical, commercial or otherwise must be tested for chemical markers exhibited by individual species; however, if no markers exist, work must first be done to determine these. Appropriate analytical techniques for this would include high pressure liquid chromatography, and mass spectroscopy. It would also be sufficient to taxonomically authenticate species provided the plant material. Further research should aim to standardize plant material and extraction methods utilized in order to compare studies effectively and allow for reproducibility to draw conclusions. While clear interest into investigation the aphrodisiac potential of plants exists, a translatable in vivo animal model does not. Clinical trials rely on patient reported outcomes to determine efficacy but cost and length of such trials deem a necessity for development of an animal model to first screen botanicals. We suggest development of screening tools utilizing the evident neurobiological underpinnings of FSD as the first step. In general, studies of plants currently used as ingredients for AP are severely lacking, and even so the evidence that exists is weak.
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Affiliation(s)
- Hayley Prescott
- The University of Mississippi, School of Pharmacy, 1558 University Circle, P.O. Box 1848, University, MS, 38677, United States.
| | - Ikhlas Khan
- The University of Mississippi, School of Pharmacy, 1558 University Circle, P.O. Box 1848, University, MS, 38677, United States.
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Gharahdaghi N, Rudrappa S, Brook MS, Idris I, Crossland H, Hamrock C, Abdul Aziz MH, Kadi F, Tarum J, Greenhaff PL, Constantin-Teodosiu D, Cegielski J, Phillips BE, Wilkinson DJ, Szewczyk NJ, Smith K, Atherton PJ. Testosterone therapy induces molecular programming augmenting physiological adaptations to resistance exercise in older men. J Cachexia Sarcopenia Muscle 2019; 10:1276-1294. [PMID: 31568675 PMCID: PMC6903447 DOI: 10.1002/jcsm.12472] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The andropause is associated with declines in serum testosterone (T), loss of muscle mass (sarcopenia), and frailty. Two major interventions purported to offset sarcopenia are anabolic steroid therapies and resistance exercise training (RET). Nonetheless, the efficacy and physiological and molecular impacts of T therapy adjuvant to short-term RET remain poorly defined. METHODS Eighteen non-hypogonadal healthy older men, 65-75 years, were assigned in a random double-blinded fashion to receive, biweekly, either placebo (P, saline, n = 9) or T (Sustanon 250 mg, n = 9) injections over 6 week whole-body RET (three sets of 8-10 repetitions at 80% one-repetition maximum). Subjects underwent dual-energy X-ray absorptiometry, ultrasound of vastus lateralis (VL) muscle architecture, and knee extensor isometric muscle force tests; VL muscle biopsies were taken to quantify myogenic/anabolic gene expression, anabolic signalling, muscle protein synthesis (D2 O), and breakdown (extrapolated). RESULTS Testosterone adjuvant to RET augmented total fat-free mass (P=0.007), legs fat-free mass (P=0.02), and appendicular fat-free mass (P=0.001) gains while decreasing total fat mass (P=0.02). Augmentations in VL muscle thickness, fascicle length, and quadriceps cross-section area with RET occured to a greater extent in T (P < 0.05). Sum strength (P=0.0009) and maximal voluntary contract (e.g. knee extension at 70°) (P=0.002) increased significantly more in the T group. Mechanistically, both muscle protein synthesis rates (T: 2.13 ± 0.21%·day-1 vs. P: 1.34 ± 0.13%·day-1 , P=0.0009) and absolute breakdown rates (T: 140.2 ± 15.8 g·day-1 vs. P: 90.2 ± 11.7 g·day-1 , P=0.02) were elevated with T therapy, which led to higher net turnover and protein accretion in the T group (T: 8.3 ± 1.4 g·day-1 vs. P: 1.9 ± 1.2 g·day-1 , P=0.004). Increases in ribosomal biogenesis (RNA:DNA ratio); mRNA expression relating to T metabolism (androgen receptor: 1.4-fold; Srd5a1: 1.6-fold; AKR1C3: 2.1-fold; and HSD17β3: two-fold); insulin-like growth factor (IGF)-1 signalling [IGF-1Ea (3.5-fold) and IGF-1Ec (three-fold)] and myogenic regulatory factors; and the activity of anabolic signalling (e.g. mTOR, AKT, and RPS6; P < 0.05) were all up-regulated with T therapy. Only T up-regulated mitochondrial citrate synthase activity (P=0.03) and transcription factor A (1.41 ± 0.2-fold, P=0.0002), in addition to peroxisome proliferator-activated receptor-γ co-activator 1-α mRNA (1.19 ± 0.21-fold, P=0.037). CONCLUSIONS Administration of T adjuvant to RET enhanced skeletal muscle mass and performance, while up-regulating myogenic gene programming, myocellular translational efficiency and capacity, collectively resulting in higher protein turnover, and net protein accretion. T coupled with RET is an effective short-term intervention to improve muscle mass/function in older non-hypogonadal men.
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Affiliation(s)
- Nima Gharahdaghi
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Supreeth Rudrappa
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Matthew S Brook
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Iskandar Idris
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Hannah Crossland
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Claire Hamrock
- Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Muhammad Hariz Abdul Aziz
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Fawzi Kadi
- Division of Sports Sciences, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Janelle Tarum
- Division of Sports Sciences, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul L Greenhaff
- MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Nottingham, Nottingham, UK
| | - Dumitru Constantin-Teodosiu
- MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Nottingham, Nottingham, UK
| | - Jessica Cegielski
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Bethan E Phillips
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Daniel J Wilkinson
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Nathaniel J Szewczyk
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Kenneth Smith
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
| | - Philip J Atherton
- MRC-ARUK Centre for Musculoskeletal Ageing Research and Nottingham NIHR BRC, School of Medicine, University of Nottingham, Derby, UK
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Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: A retrospective study using penile Doppler imaging. Rev Int Androl 2019; 18:91-95. [PMID: 31272908 DOI: 10.1016/j.androl.2019.01.002] [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: 09/27/2018] [Revised: 12/07/2018] [Accepted: 01/29/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p<0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p=0.002). CONCLUSION The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic.
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Nascimento B, Miranda EP, Jenkins LC, Benfante N, Schofield EA, Mulhall JP. Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer. J Sex Med 2019; 16:872-879. [PMID: 31080102 DOI: 10.1016/j.jsxm.2019.03.273] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is frequently used in the treatment of prostate cancer worldwide. Variable testosterone (T) recovery profiles after ADT cessation have been cited. AIM To evaluate T recovery after cessation of ADT. METHODS We reviewed our institutional prospectively maintained database of patients with prostate cancer who received ADT. Serum early morning total T (TT) levels, collected at baseline and periodically after ADT cessation, were analyzed. Patient age, baseline T level, duration of ADT, and presence of diabetes and sleep apnea were selected as potential predictors of T recovery. 3 metrics of T recovery after 24 months of ADT cessation were analyzed: return to non-castrate level (TT > 50 ng/dL), return to normal (T > 300 ng/dL), and return back to baseline level (BTB). Multivariable time-to-event analysis (Cox proportional hazards), χ2 test, logistic regression model, and Kaplan-Meier curve were performed to define impact of the above predictors on time and chance of T recovery. MAIN OUTCOME MEASURES Time and chance of T recovery to non-castrate level (TT > 50 ng/dL), return to normal (T > 300 ng/dL), and return BTB. RESULTS 307 men with a mean age of 65 ± 8 years were included. Mean duration of ADT was 17 ± 25 months, and median follow-up was 31 ± 35 months. Mean TT values were 379 ng/dL at baseline and 321 ng/dL at >24 months. At 24 months after cessation of ADT, 8% of men remained at castrate level, 76% returned to TT >300 ng/dL, and 51% had returned BTB. Lower baseline T levels (TT < 400 ng/dL) and ADT duration >6 months were associated with a lower likelihood of recovery to normal TT at 24 months. Age >65 years and receiving ADT for >6 months were significantly associated with a slower T recovery. CLINICAL IMPLICATIONS T recovery after ADT is not certain and may take longer than expected. Considering the range of side effects of low T, we believe that these findings must be discussed with patients before initiating such therapies. STRENGTHS & LIMITATIONS Our strengths consisted of a relatively large database, long follow-up, and clinically meaningful endpoints. Limitations included the retrospective design of the study. CONCLUSION T recovery rates after ADT cessation vary according to patient age, ADT duration, and baseline T levels. Approximately one-quarter of patients failed to normalize their TT level, and one-tenth of men remained at castrate levels 24 months after ADT cessation. Nascimento B, Miranda EP, Jenkins LC, et al. Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer. J Sex Med 2019;16:872-879.
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Affiliation(s)
- Bruno Nascimento
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA; Sexual Medicine Service, Division of Urology, Hospital das Clinicas - University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo P Miranda
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA; Division of Urology, Federal University of Ceara, Ceara, Brazil
| | - Lawrence C Jenkins
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA; Urology Service, Ohio State University, Columbus, OH, USA
| | - Nicole Benfante
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA
| | - Elizabeth A Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA.
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Anupam B, Shivaprasad C, Sridevi A, Aiswarya Y, Gautham K, Ramdas B, Kejal S. Association of total and calculated free testosterone with androgen deficiency symptoms in patients with type 2 diabetes. Int J Impot Res 2019; 32:289-296. [PMID: 31000814 DOI: 10.1038/s41443-019-0144-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 12/13/2022]
Abstract
The Androgen Deficiency in the Aging Male (ADAM) questionnaire is commonly used to screen type 2 diabetes mellitus (T2DM) patients for androgen deficiency symptoms, but the association of low total (TT) and free testosterone (FT) levels with divergent responses to the ADAM questionnaire remains unclear. The aim of this study was to assess the predictive ability of TT and calculated FT (cFT) levels for accurately classifying ADAM status. We recruited 70 patients each with positive (group A) and negative (group B) responses to the ADAM questionnaire and 70 age-matched healthy controls (group C) (mean age, 50.5 years); serum levels of TT were estimated and cFT were estimated using Vermeulen equation. Hypogonadism was defined as the presence of symptoms (positive ADAM score) along with TT level < 300 ng/dL or calculated (cFT) <6.35 ng/dL. BMI was highest in group A (P < 0.05), followed by groups B and C. Group A had longer diabetes durations (P < 0.05) and higher fasting plasma glucose (FPG) and HbA1c levels than group B (P < 0.001). TT levels and cFT were significantly lower in Group A than in the other two groups. In group A, 51 (73%) men had low TT levels (<300 ng/dL) and 48 (69%) had low cFT (<6.35 ng/dL). TT levels < 300 ng/dL had higher sensitivity and specificity (73 and 96%, respectively) than cFT < 6.35 ng/dL (69 and 90%, respectively) for predicting ADAM status. Multivariate-adjusted logistic regression showed that diabetes duration, HbA1c level, and BMI predicted low TT levels, whereas diabetes duration and HbA1c and high-density lipoprotein levels were significant predictors of low cFT. TT levels were a better predictor of ADAM responses than cFT in male T2DM patients. Our results suggest that TT level is better than cFT for diagnosing hypogonadism in T2DM patients when equilibrium dialysis is not feasible.
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Affiliation(s)
- Biswas Anupam
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Channabasappa Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
| | - Atluri Sridevi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Yalamanchi Aiswarya
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Kolla Gautham
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Barure Ramdas
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Shah Kejal
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
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The Optimal Indication for Testosterone Replacement Therapy in Late Onset Hypogonadism. J Clin Med 2019; 8:jcm8020209. [PMID: 30736442 PMCID: PMC6406807 DOI: 10.3390/jcm8020209] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 12/21/2022] Open
Abstract
The use of testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH) is increasing every year; however, the literature shows that many men are using testosterone (T) without a clear indication. Previous studies have estimated that up to 25% of men who receive TRT do not have their T tested prior to initiation of the therapy. Given the growing concern and need for proper TRT, clinicians need evidence-based information that informs them on the optimal indication for TRT in LOH patients. The diagnosis of LOH requires the presence of characteristic signs and symptoms, in combination with decreased serum total testosterone (TT). Based on the recent guidelines by the International Society for the Study of Aging Male (ISSAM), the European Association of Urology (EAU), the European Society of Endocrinology (ESE), the European Academy of Andrology (EAA), and the American Association of Urology (AUA), a TT of 250–350 ng/dL is the proper threshold value to define low T. The optimal indication for TRT in LOH is the presence of signs and symptoms of hypogonadism, and low T without contraindications for TRT.
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