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Esteves SC, Achermann APP, Miyaoka R, Verza S, Fregonesi A, Riccetto CLZ. Clinical factors impacting microdissection testicular sperm extraction success in hypogonadal men with nonobstructive azoospermia. Fertil Steril 2024:S0015-0282(24)00544-2. [PMID: 38909671 DOI: 10.1016/j.fertnstert.2024.06.013] [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: 02/22/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA). DESIGN A cohort study. SETTING University-affiliated male reproductive health center. PATIENT(S) A total of 616 consecutive patients with NOA and hypogonadism (total testosterone [T] levels <350 ng/dL) underwent micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history. INTERVENTION(S) Patients aged 23-55 years underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts on the basis of pre-SR hormonal stimulation. MAIN OUTCOME MEASURE(S) A multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed to assess the relationship between SR success and relevant predictors. Sperm retrieval rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline follicle-stimulating hormone levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success. RESULT(S) The overall micro-TESE success rate was 56.6%. Baseline follicle-stimulating hormone levels (aOR, 0.97; 95% CI, 0.94-0.99), pre-SR hormonal stimulation (aOR, 2.54; 95% CI, 1.64-3.93), presence of clinical varicocele (aOR, 0.05; 95% CI, 0.01-0.51), history of previous varicocelectomy (aOR, 2.55; 95% CI, 1.26-5.16), and testicular histopathology were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and delta T (an absolute increase in T levels from baseline) were associated with SR success. A pre-micro-TESE T level of 418.5 ng/dL (area under the curve value: 0.78) and a delta T of 258 ng/dL (area under the value: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic. CONCLUSION(S) This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. Although causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and varicocele repair. CLINICAL TRIAL REGISTRATION NUMBER NCT05110391.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Arnold P P Achermann
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Ricardo Miyaoka
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sidney Verza
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil
| | - Adriano Fregonesi
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Cassio L Z Riccetto
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil
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Shenoy MT, Mondal S, Fernandez CJ, Pappachan JM. Management of male obesity-related secondary hypogonadism: A clinical update. World J Exp Med 2024; 14:93689. [PMID: 38948417 PMCID: PMC11212738 DOI: 10.5493/wjem.v14.i2.93689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 06/19/2024] Open
Abstract
The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism (MOSH) with emerging evidence on the role of testosterone therapy. We aim to provide an updated and practical approach towards its management. We did a comprehensive literature search across MEDLINE (via PubMed), Scopus, and Google Scholar databases using the keywords "MOSH" OR "Obesity-related hypogonadism" OR "Testosterone replacement therapy" OR "Selective estrogen receptor modulator" OR "SERM" OR "Guidelines on male hypogonadism" as well as a manual search of references within the articles. A narrative review based on available evidence, recommendations and their practical implications was done. Although weight loss is the ideal therapeutic strategy for patients with MOSH, achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice. Therefore, androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity. However, there is conflicting evidence for the appropriate use of testosterone replacement therapy (TRT), and it can also be associated with complications. This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH. Before starting testosterone replacement in functional hypogonadism of obesity, it would be desirable to initiate lifestyle modification to ensure weight reduction. TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients. Balancing the risks and benefits of TRT should be considered in every patient before and during long-term management.
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Affiliation(s)
- Mohan T Shenoy
- Department of Endocrinology, Sree Gokulam Medical College, and Research Foundation, Trivandrum 695607, Kerala, India
| | - Sunetra Mondal
- Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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Al-Madhagi H, Tarabishi AA. Nutritional aphrodisiacs: Biochemistry and Pharmacology. Curr Res Food Sci 2024; 9:100783. [PMID: 38974844 PMCID: PMC11225857 DOI: 10.1016/j.crfs.2024.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/08/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
In 2022, the global prevalence of erectile dysfunction (ED) was estimated to be at least 150 million cases. This number is greatly suspected to be underestimate as most men withhold information about ED. Also, about 15% of world population have infertility troubles, and male factors are responsible for almost half of these cases. Studies have shown that the quality of semen has decreased in the past several decades owing to various health factors and environmental toxicants. The current medical interventions involve the inhibition of phosphodiesterase 5 which suffer from serious side effects and costly. One of the popular and most sought interventions are the natural and nutritional remedies as they are foods in essence and potentially with no harm to the body. Therefore, the goal of this paper is to provide a review of the most common nutritional aphrodisiacs with increasing libido and fertility highlighting the potential active constituents as well as the underlying mechanisms.
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Lockie AWC, Grice P, Mathur R, Pearce I, Modgil V. Diagnosis and treatment of hypogonadism in men seeking to preserve fertility - what are the options? Int J Impot Res 2024:10.1038/s41443-024-00897-4. [PMID: 38693209 DOI: 10.1038/s41443-024-00897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
Male hypogonadism is a clinical syndrome that results in low testosterone levels and frequently leads to infertility. The syndrome occurs due to disruption at one or more levels of the hypothalamic-pituitary-gonadal axis. Testosterone replacement therapy (TRT) is the most common treatment utilised for male hypogonadism. However, long-acting forms of TRT leads to infertility and so is inappropriate for patients wishing to conceive. For patients who wish to remain fertile, nasal TRT, clomiphene citrate, exogenous gonadotropins, gonadotropin releasing hormone and aromatase inhibitors have been used as alternative treatment options with different degrees of success. A review of the literature was performed to identify the safety and efficacy of alternative treatment options. Gonadotropin releasing hormone can successfully induce spermatogenesis but is impractical to administer. Likewise, aromatase inhibitors have limited use due to inducing osteopenia. Nasal TRT may be a good treatment option for these patients, but its efficacy has so far only been demonstrated in small sample sizes. However, clomiphene citrate and exogenous gonadotropins are safe, offer good symptom control and can successfully induce fertility in hypogonadism patients.
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Affiliation(s)
| | - Peter Grice
- Northampton General Hospital, Northampton, UK
| | - Raj Mathur
- Manchester Royal Infirmary, Manchester, UK
| | - Ian Pearce
- Manchester Royal Infirmary, Manchester, UK
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Esteves SC, Humaidan P, Ubaldi FM, Alviggi C, Antonio L, Barratt CLR, Behre HM, Jørgensen N, Pacey AA, Simoni M, Santi D. APHRODITE criteria: addressing male patients with hypogonadism and/or infertility owing to altered idiopathic testicular function. Reprod Biomed Online 2024; 48:103647. [PMID: 38367592 DOI: 10.1016/j.rbmo.2023.103647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
RESEARCH QUESTION Can a novel classification system of the infertile male - 'APHRODITE' (Addressing male Patients with Hypogonadism and/or infeRtility Owing to altereD, Idiopathic TEsticular function) - stratify different subgroups of male infertility to help scientists to design clinical trials on the hormonal treatment of male infertility, and clinicians to counsel and treat the endocrinological imbalances in men and, ultimately, increase the chances of natural and assisted conception? DESIGN A collaboration between andrologists, reproductive urologists and gynaecologists, with specialization in reproductive medicine and expertise in male infertility, led to the development of the APHRODITE criteria through an iterative consensus process based on clinical patient descriptions and the results of routine laboratory tests, including semen analysis and hormonal testing. RESULTS Five patient groups were delineated according to the APHRODITE criteria; (1) Hypogonadotrophic hypogonadism (acquired and congenital); (2) Idiopathic male infertility with lowered semen analysis parameters, normal serum FSH and normal serum total testosterone concentrations; (3) A hypogonadal state with lowered semen analysis parameters, normal FSH and reduced total testosterone concentrations; (4) Lowered semen analysis parameters, elevated FSH concentrations and reduced or normal total testosterone concentrations; and (5) Unexplained male infertility in the context of unexplained couple infertility. CONCLUSION The APHRODITE criteria offer a novel and standardized patient stratification system for male infertility independent of aetiology and/or altered spermatogenesis, facilitating communication among clinicians, researchers and patients to improve reproductive outcomes following hormonal therapy. APHRODITE is proposed as a basis for future trials of the hormonal treatment of male infertility.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.; Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil.; Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark..
| | - Peter Humaidan
- Fertility Clinic at Skive Regional Hospital, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Filippo M Ubaldi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Leen Antonio
- Department of Endocrinology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Medicine Halle, Halle, Germany
| | - Niels Jørgensen
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan A Pacey
- Faculty of Biology, Medicine and Health, Core Technology Facility, University of Manchester, Manchester, UK
| | - Manuela Simoni
- 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.; Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - Universitaria of Modena, Modena, Italy
| | - Daniele Santi
- 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.; Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - Universitaria of Modena, Modena, Italy
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Ertuglu L, Ikizler TA. Nutrition Management in Geriatric Patients with CKD. KIDNEY360 2024; 5:310-319. [PMID: 38297445 PMCID: PMC10914191 DOI: 10.34067/kid.0000000000000364] [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: 06/05/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
Sarcopenia, defined as age-related decline in skeletal muscle mass and functional capacity, is a hallmark nutritional abnormality observed in patients with moderate-to-advanced CKD. Uremic state and associated medical conditions also predispose older patients with CKD to protein-energy wasting, a nutritional abnormality that could include sarcopenia. Prevention of protein and energy depletion and replenishing the already low nutritional reserves elderly patients with CKD should focus on conventional and innovative strategies. This review aims to provide an overview of the mainstay of nutritional therapy in this patient population, such as intake of adequate amounts of protein and energy along with preserving fluid, electrolyte, and mineral balance, and to discuss more innovative interventions to aid these approaches.
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Affiliation(s)
- Lale Ertuglu
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Nguyen Hoai B, Hoang L, Nguyen Cao T, Pham Minh Q, A Jannini E. Testosterone and aging male, a perspective from a developing country. Aging Male 2023; 26:2223712. [PMID: 37335039 DOI: 10.1080/13685538.2023.2223712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE Hypogonadism is associated with a wide range of physical and psychological symptoms that can affect the overall health of men. However, in a developing country, there are several imposing challenges in the diagnosis and treatment of hypogonadism, including a lack of awareness and understanding of the condition among healthcare providers and patients, limited resources and the high cost of treatment. This review aimed to examine the potential benefits and risks of testosterone replacement therapy (TRT) and provides a perspective of a developing country on the topic. MATERIALS AND METHODS A comprehensive literature review was conducted to gather relevant information on the impact of testosterone deficiency on ageing males and the effectiveness of TRT for treating hypogonadism. Published peer-reviewed articles were analyzed to evaluate the benefits and risks of TRT. Additionally, the unique challenges faced in the diagnosis and treatment of hypogonadism in a developing country were considered. RESULTS Testosterone replacement therapy has been shown to be an effective treatment for hypogonadism, particularly in symptomatic men with low testosterone levels. It offers potential benefits such as improvements in symptoms and overall quality of life. However, there are associated risks and side effects that need to be considered. In a developing country, challenges such as limited awareness and understanding of hypogonadism, resource constraints, and high treatment costs pose additional barriers to accessing TRT and comprehensive care. CONCLUSION In conclusion, TRT holds promise as a treatment for hypogonadism, but its implementation and accessibility face significant challenges in a developing country. Addressing these challenges, including raising awareness, allocating resources, and finding cost-effective solutions, is crucial for ensuring that men with hypogonadism in such settings receive appropriate diagnosis and treatment. Further research and efforts are needed to improve the management of hypogonadism in developing countries and optimize the potential benefits of TRT for affected individuals.
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Affiliation(s)
- Bac Nguyen Hoai
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Long Hoang
- Department of Urology, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Thang Nguyen Cao
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Quan Pham Minh
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Emmanuele A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), University of Rome Tor Vergata, Rome, Italy
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Zamir A, Ben Zeev T, Levi C, Einstein O, Ratamess NA, van Praag H, Hoffman JR. The effect of supraphysiological dose of nandrolone decanoate administration on the inflammatory, neurotrophin and behavioral response in adult and old male mice. Horm Behav 2023; 156:105444. [PMID: 38344953 DOI: 10.1016/j.yhbeh.2023.105444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 02/15/2024]
Abstract
This study examined the effect of 6 weeks of supraphysiological nandrolone decanoate (ND) administration in adult mice (7 months) on cognitive function and neuroinflammation during aging. Male C57BL/6 mice were randomized into ND (10 mg·kg-1·wk-1) or control (CTL) groups. Half of the mice were tested at a young (Y) age (ND-Y and CTL-Y), 1 week following final ND administration, while the remaining mice were tested at 16 months (O) (ND-O and CTL-O). Learning and memory were better in young mice compared to older mice, regardless of treatment. ND-O displayed decreased anxiety as compared to all other groups. TNFα and IL1β expression were higher in older mice, regardless of treatment. ND administration in young mice appeared to attenuate the neuroinflammatory response in aging mice as evidenced by decreased COX2, IL-4 and increased IL-10 expression in ND-O compared to CTL-O. BDNF AR and ER expression increased in ND-O compared to CTL-O. Results of the study indicated that supraphysiological ND administration had no negative effect on learning and memory but may attenuate anxiety in older mice. In addition, ND administration in young adult mice may attenuate the inflammatory response during aging, which may be related to elevations in both AR and ER expression.
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Affiliation(s)
- A Zamir
- Department of Physical Therapy, School of Health Sciences, Ariel University, Israel
| | - T Ben Zeev
- Department of Physical Therapy, School of Health Sciences, Ariel University, Israel
| | - C Levi
- Department of Physical Therapy, School of Health Sciences, Ariel University, Israel
| | - O Einstein
- Department of Physical Therapy, School of Health Sciences, Ariel University, Israel
| | - N A Ratamess
- Department of Kinesiology and Health Sciences, The College of New Jersey, USA
| | - H van Praag
- Stiles-Nicholson Brain Institute, Charles E. Schmidt College of Medicine, Florida Atlantic University, USA
| | - J R Hoffman
- Department of Physical Therapy, School of Health Sciences, Ariel University, Israel.
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Cannarella R, Gusmano C, Leanza C, Garofalo V, Crafa A, Barbagallo F, Condorelli RA, Vignera SL, Calogero AE. Testosterone replacement therapy and vascular thromboembolic events: a systematic review and meta-analysis. Asian J Androl 2023; 26:00129336-990000000-00137. [PMID: 37921515 PMCID: PMC10919420 DOI: 10.4103/aja202352] [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: 03/01/2023] [Accepted: 08/15/2023] [Indexed: 11/04/2023] Open
Abstract
ABSTRACT To evaluate the relationship between testosterone replacement therapy (TRT) and arterial and/or venous thrombosis in patients with pre-treatment total testosterone (TT) <12 nmol l-1, we performed a meta-analysis following the Population Intervention Comparison Outcome model. Population: men with TT <12 nmol l-1 or clear mention of hypogonadism in the inclusion criteria of patients; intervention: TRT; comparison: placebo or no therapy; outcomes: arterial thrombotic events (stroke, myocardial infarction [MI], upper limbs, and lower limbs), VTE (deep vein thrombosis [DVT], portal vein thrombosis, splenic thrombosis, and pulmonary embolism), and mortality. A total of 2423 abstracts were assessed for eligibility. Twenty-four studies, including 14 randomized controlled trials (RCTs), were finally included, with a total of 4027 and 310 288 hypotestosteronemic male patients, from RCTs and from observational studies, respectively. Based on RCT-derived data, TRT did not influence the risk of arterial thrombosis (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 0.47-3.43, P = 0.64), stroke (OR = 1.34, 95% CI: 0.09-18.97, P = 0.83), MI (OR = 0.51, 95% CI: 0.11-2.31, P = 0.39), VTE (OR = 1.42, 95% CI: 0.22-9.03, P = 0.71), pulmonary embolism (OR = 1.38, 95% CI: 0.27-7.04, P = 0.70), and mortality (OR = 0.70, 95% CI: 0.20-2.38, P = 0.56). Meanwhile, when only observational studies are considered, a significant reduction in the risk of developing arterial thrombotic events, MI, venous thromboembolism, and mortality was observed. The risk for DVT remains uncertain, due to the paucity of RCT-based data. TRT in men with TT <12 nmol l-1 is safe from the risk of adverse cardiovascular events. Further studies specifically assessing the risk of DVT in men on TRT are needed.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Carmelo Gusmano
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Claudia Leanza
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Vincenzo Garofalo
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
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Kato Y, Shigehara K, Nakagawa T, Kawaguchi S, Izumi K, Kadono Y, Mizokami A. Relation between athletic club affiliation from school age and future serum free testosterone levels in Japan: A cross-sectional study. Health Sci Rep 2023; 6:e1496. [PMID: 37599654 PMCID: PMC10435685 DOI: 10.1002/hsr2.1496] [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: 10/10/2022] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aims Testosterone deficiency is often related to geriatric syndrome including erectile dysfunction, osteo-porosis, depression, cognitive impairment, cardiovascular diseases and frailty. Despite the existence of many studies on short-term exercise and serum testosterone levels, few research have focused on exercise habits from young age and testosterone values in middle-aged male. In this study, we investigated whether belonging to an athletic club from school age could predict serum-free testosterone (FT) levels. Methods The subjects were 1609 middle-aged male outpatients aged 40 years or older (median: 61 years, interquartile range: 54-69) who visited our hospital. Participants had their FT values measured in the morning hours during the period from December 2007 to June 2009. A questionnaire survey on exercise habits was conducted at the same time as the measurements. The exercise habit questionnaire was created based on whether the patients belonged to an athletic club in (a) elementary school, (b) junior high school, (c) high school, (d) college, (e) adult life, and (f) at the time of the test. Results There was only one positive response to the questionnaire among 456 patients (28% of total), followed by zero for 358 patients (22% of total). The number of patients with low-testosterone levels (FT < 8.5 pg/mL) according to the Japanese diagnostic criteria for late-onset of hypogonadism was 839 (52.1%). In multivariate analysis, it was shown that with low-testosterone levels (FT < 8.5 pg/mL), age (odds ratio [OR]: 1.065, 95% confidence interval [CI]: 1.052-1.079; p < 0.001), hypertension (OR: 3.489, 95% CI: 2.728-4.462; p < 0.001), type-2 diabetes (OR: 3.035, 95% CI: 2.296-4.01; p < 0.001), and dyslipidemia (OR: 2.039, 95% CI: 1.558-2.668; p < 0.001) were risk factors, and more than two positive responses to the questionnaire (OR: 0.886, 95% CI: 0.802-0.980; p = 0.018) were also a significant independent factor. Conclusion A sports club membership during school years may affect future testosterone levels.
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Affiliation(s)
- Yuki Kato
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
- Depatment of UrologyWajima Municipal hospitalWajimaJapan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
- Depatment of UrologyWajima Municipal hospitalWajimaJapan
| | - Tomomi Nakagawa
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and UrologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
- Depatment of UrologyWajima Municipal hospitalWajimaJapan
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Baqer Ali E, Alhamza A, Zaboon IA, Alidrisi HA, Mansour AA. Fasting Versus Non-Fasting Total Testosterone Levels in Women During the Childbearing Period. Cureus 2023; 15:e35462. [PMID: 36994254 PMCID: PMC10042517 DOI: 10.7759/cureus.35462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Background Total testosterone in men should be measured in the fasting state early in the morning with at least two samples according to guidelines. For women, no such a recommendation is available despite the importance of testosterone in this demographic. The aim of this study is to evaluate the effect of fasting versus non-fasting state on the total testosterone levels in women during the reproductive period. Methods This study was conducted at Faiha Specialized Diabetes, Endocrine and Metabolism Center in Basrah, (Southern Iraq) between January 2022 to November 2022. The total enrolled women were 109; their age was 18-45 years. The presentation was for different complaints; 56 presented for medical consultation with 45 apparently healthy women accompanying the patients as well as eight volunteering female doctors. Testosterone levels were measured by electrochemiluminescence immunoassays using the Roche Cobas e411 platform (Roche Holding, Basel, Switzerland). Two samples were collected from each woman; one was fasting and another was non-fasting the following day, and all samples were taken before 10 am. Results For all of the participants, the mean ± SD fasting was significantly higher as compared to the non-fasting testosterone (27.39±18.8 ng/dL and 24.47±18.6 ng/dL respectively, p-value 0.01). The mean fasting testosterone level was also significantly higher in the apparently healthy group, (p-value 0.01). In women who presented with hirsutism, menstrual irregularities and or hair fall, no difference was seen in the testosterone levels between fasting and non-fasting states (p-value 0.4). Conclusion In the apparently healthy women of childbearing age, serum testosterone levels were higher in the fasting versus the non-fasting states. In women who presented with complaints of hirsutism, menstrual irregularities, and or hair fall, the serum testosterone levels were not affected by the fasting states.
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12
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Miller JA, Nguyen TT, Loeb C, Khera M, Yafi FA. Oral testosterone therapy: past, present, and future. Sex Med Rev 2023; 11:124-138. [PMID: 36779549 DOI: 10.1093/sxmrev/qead003] [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: 07/26/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Testosterone replacement therapy (TRT) remains a commonly utilized treatment for men with testosterone deficiency (TD). Despite the recent FDA approval of new oral TRT medications, concerns remain regarding their efficacy and safety, and prescription rates for these medications have decreased compared to those for TD medications with other routes of administration. OBJECTIVE In this study we sought to investigate the efficacy and safety of oral testosterone undecanoate (oTU), a new oral TRT medication. METHODS A comprehensive review of the literature was performed using the Medline, EMBASE, and Cochrane Library databases; 1269 articles were identified, with 44 articles included in the final review and 12 used to perform meta-analyses to investigate the change in serum total testosterone (TT) and risk of adverse effects following oral testosterone undecanoate (oTU) use. Articles were also reviewed to investigate the reported effects of oTU on body composition, liver function, hematologic assays, lipid profiles, hormone assays, prostate growth, hypertension, and symptoms of TD. RESULTS Across placebo-controlled randomized trials, there was no significant increase in TT for those receiving oTU vs placebo (mean difference, -0.26 [95% CI, -1.26 to 0.73]). On subanalysis, when eugonadal participants received oTU, a significant decrease in TT was demonstrated (mean difference -0.86 [95% CI, -1.28 to 0.43]). When participants who were hypogonadal at baseline received oTU, a significant increase in TT compared to placebo was seen (mean difference 1.25 [95% CI, 0.22-2.29]). There was no significant risk of adverse effects (RR, -0.03 [95% CI, -0.08 to 0.03]) or serious adverse effects (RR, 0.15 [95% CI, -0.66 to 0.96]) in the oTU groups compared to placebo. CONCLUSION oTU was found to be well tolerated in hypogonadal patients, resulting in improved testosterone levels, height velocity, and sexual symptoms, without significant hepatotoxicity, prostatic enlargement, or worsening hypertension. There was no consensus regarding the effect of oTU on lean and fat mass percentages, hematologic assays, lipid profiles, mood, and general well-being.
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Affiliation(s)
- Jake A Miller
- Department of Urology, University of California, Irvine, CA, United States
| | - Tuan T Nguyen
- Department of Urology, University of California, Irvine, CA, United States
| | - Charles Loeb
- Department of Urology, University of California, Irvine, CA, United States
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, United States
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13
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Ide H, Akehi Y, Fukuhara S, Ohira S, Ogawa S, Kataoka T, Kumagai H, Kobayashi K, Komiya A, Shigehara K, Syuto T, Soh J, Tanabe M, Taniguchi H, Chiba K, Matsushita K, Mitsui Y, Yoneyama T, Shirakawa T, Fujii Y, Kumano H, Ueshiba H, Amano T, Sasaki H, Maeda S, Mizokami A, Suzuki K, Horie S. Summary of the clinical practice manual for late-onset hypogonadism. Int J Urol 2023; 30:422-430. [PMID: 36757880 DOI: 10.1111/iju.15160] [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: 12/06/2022] [Accepted: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Testosterone plays an important role in maintaining both physical and mental function. Age-related testosterone depletion contributes to the development of angina, arteriosclerosis, obesity, metabolic syndrome, dementia, frailty, and a range of other conditions. A condition involving age-related testosterone depletion and the associated clinical symptoms is defined as late-onset hypogonadism (LOH). LOH is treated by testosterone replacement therapy. Indications for testosterone replacement therapy are determined by evaluating symptoms and signs.
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Affiliation(s)
- Hisamitsu Ide
- Department of Urology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Yuko Akehi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shin Ohira
- Department of Urology, Kawasaki Medical School, Okayama, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoya Kataoka
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Hiroshi Kumagai
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akira Komiya
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Takahiro Syuto
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jintetu Soh
- Department of Urology, Japanese Red Cross Society Kyoto Daini, Kyoto, Japan
| | - Makito Tanabe
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Koji Chiba
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhito Matsushita
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yozo Mitsui
- Department of Urology, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tomoya Shirakawa
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Kumano
- Faculty of Human Sciences, Waseda University, Saitama, Japan
| | - Hajime Ueshiba
- Division of Diabetes, Metabolism and Endocrinology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | - Haruaki Sasaki
- Department of Urology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Seiji Maeda
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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14
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Gurayah AA, Dullea A, Weber A, Masterson JM, Khodamoradi K, Mohamed AI, Ramasamy R. Long vs Short Acting Testosterone Treatments: A Look at the Risks. Urology 2023; 172:5-12. [PMID: 36455678 PMCID: PMC9925408 DOI: 10.1016/j.urology.2022.11.016] [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: 08/17/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
Prescriptions for testosterone therapy (TT) to treat testosterone deficiency have increased in recent years. The purpose of this review was to evaluate the risks of several treatment modalities to better counsel patients. Both short-acting and long-acting TT has been shown to restore normal serum testosterone levels and improve symptoms of testosterone deficiency. Short-acting pharmacology mimics normal physiology more closely than long-acting TT but requires multiple doses per day. Long-acting TT has a higher rate of patient adherence but is more likely to create supraphysiologic serum testosterone and pathologic sequelae.
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Affiliation(s)
| | - Alexandra Dullea
- Department of Urology, University of Miami Miller School of Medicine, University of Miami, Miami, FL
| | | | - John M Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kajal Khodamoradi
- Department of Urology, University of Miami Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, University of Miami, Miami, FL.
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15
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Kang J, Chen R, Tharakan T, Minhas S. Novel androgen therapies including selective androgen receptor modulators. Best Pract Res Clin Endocrinol Metab 2022; 36:101686. [PMID: 35981955 DOI: 10.1016/j.beem.2022.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Male hypogonadism is associated with reduced quality of life and the development of co-morbidities including obesity, diabetes mellitus, and dyslipidaemia. The mainstay of treatment for male hypogonadism is testosterone replacement therapy (TRT). However, TRT has recognised side effects including impaired spermatogenesis and there are concerns regarding its use in men with concurrent cardiovascular disease. Thus, there has been an impetus to develop novel androgen therapies for treating male hypogonadism to mitigate the side effects of TRT. This review will discuss the benefits and adverse effects of TRT, and novel therapies including nasal testosterone, aromatase inhibitors, selective oestrogen receptor modulators, and selective androgen receptor modulators.
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Affiliation(s)
- Jungwoo Kang
- Department of Urology, Northwick Park Hospital, London Northwest University Healthcare NHS Trust, Harrow HA1 3UJ, UK.
| | - Runzhi Chen
- Sir Alexander Fleming Building, Faculty of Medicine, Imperial College London, Imperial College Rd, London SW7 2AZ, UK.
| | - Tharu Tharakan
- Department of Urology, Northwick Park Hospital, London Northwest University Healthcare NHS Trust, Harrow HA1 3UJ, UK.
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK.
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16
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Testosterone Deficiency as One of the Major Endocrine Disorders in Chronic Kidney Disease. Nutrients 2022; 14:nu14163438. [PMID: 36014945 PMCID: PMC9415930 DOI: 10.3390/nu14163438] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
Reduced testosterone concentration is nowadays thought to be one of the main endocrine disorders in chronic kidney disease (CKD). It is caused by the dysfunction of the hypothalamic-pituitary-gonadal axis. The role of testosterone is multifactorial. Testosterone is responsible not only for reproductive processes, but it is a hormone which increases bone and muscle mass, improves lipid profile, insulin sensitivity, erythropoiesis, reduces blood pressure, and ameliorates mood and perception. The implications of hypogonadism in CKD are infertility and loss of libido, reduction of muscle mass and strength, disorders in bone mineralization, the development of sarcopenia and protein energy wasting (PEW), progression of atherosclerosis, increased visceral adiposity, insulin resistance, and anaemia. Reduced testosterone serum concentrations in CKD are associated with increased mortality rate. Testosterone supplementation improves sexual functions, reduces the level of inflammatory markers and blood pressure, stimulates muscle protein synthesis, improves insulin sensitivity and lipid profile, and increases muscle mass, bone mineral density, and haemoglobin concentration. It positively affects mood and well-being. The modes of testosterone supplementation are intramuscular injections, subcutaneous pellets, and percutaneous methods—patches and gels. Successful kidney transplantation may improve gonadal function and testosterone production, however, half of men with low testosterone concentrations before kidney transplantation do not restore hormonal function.
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17
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Fallara G, Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Montorsi F, Salonia A. Cardiovascular Morbidity and Mortality in Men – Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone. J Sex Med 2022; 19:1243-1254. [DOI: 10.1016/j.jsxm.2022.05.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
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18
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Hassoun O, Starostka M, Shearer H, Millar A, Hassoun S, Isles C. Improving the annual monitoring rates of testosterone replacement therapy patients in primary care. BMJ Open Qual 2022; 11:bmjoq-2021-001784. [PMID: 35914817 PMCID: PMC9345085 DOI: 10.1136/bmjoq-2021-001784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Testosterone replacement therapy (TRT) is the treatment of choice for male hypogonadism. British Society for Sexual Medicine (BSSM) guidelines on adult testosterone deficiency recommend that TRT patients undergo annual monitoring of their testosterone levels and potential complications of treatment; though evidence suggests that substantial numbers of men on TRT are not monitored adequately. Methods Review of the electronic patient record from a single general practice in southwest Scotland revealed that only 1 of 26 (4%) TRT patients had been monitored as per BSSM guidelines in the previous 12 months. Additionally, when monitoring was undertaken there was inconsistency in the blood tests requested. The use of quality improvement (QI) tools including process mapping and cause-and-effect diagram identified staff and patient knowledge of monitoring requirements and the lack of an effective recall system as areas for improvement. We tested three change ideas: the utilisation of an existing recall system for long-term therapies; a TRT Ordercomms blood group template (OBGT) to standardise monitoring; and a patient information leaflet (PIL) to improve patient education. The aim of this project was to achieve 60% annual monitoring rate. Results The percentage of patients monitored for testosterone levels and potential TRT complications increased from 4% (1/26) to 65% (17/26) over a 7-week test period. The utilisation of the existing recall system was a particularly effective intervention, leading to an increase from 4% (1/26) to 31% (8/26) in the first 2 weeks. Conclusion The use of QI tools was associated with over 60% of male TRT patients receiving comprehensive annual monitoring, as per BSSM guidelines. Our findings support the hypothesis that a patient recall system, combined with an OBGT and a PIL led to this increase.
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Affiliation(s)
- Omar Hassoun
- School of Medicine, University of Dundee, Dundee, UK
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Heather Shearer
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Angela Millar
- School of Medicine, University of Dundee, Dundee, UK
| | - Salman Hassoun
- Endocrinology Department, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Chris Isles
- Dumfries and Galloway Acute Hospitals, Dumfries, UK
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19
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Huhtaniemi IT, Wu FCW. Ageing male (part I): Pathophysiology and diagnosis of functional hypogonadism. Best Pract Res Clin Endocrinol Metab 2022; 36:101622. [PMID: 35210191 DOI: 10.1016/j.beem.2022.101622] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This narrative review summarizes key points of the pathogenesis and diagnosis of the ageing-related decline of testosterone (T) in men. The condition is commonly termed late-onset hypogonadism (LOH), but because it is more often caused by other factors than chronological ageing (obesity and other comorbidities), a more appropriate term is functional hypogonadism (FH). Unlike the classical organic hypogonadism, no anatomical or genetic aberrations are found in FH, and the suppression of T is milder. Moreover, FH can be reversible if the underlying cause (e.g. obesity, chronic disease) is removed/treated. Low serum total T in connection with more specific hypogonadism-associated symptoms (primarily sexual) form the basis of the diagnosis of FH. When T concentrations are borderline, the accuracy of diagnosis can be improved by assessment of free or calculated free T, especially when suppressed SHBG levels (usually related to obesity) are likely. Current data indicate that FH (low T and sexual symptoms) is not a common condition, and it is detectable in about 2% of community-dwelling men aged 40-80 years.
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Affiliation(s)
- Ilpo T Huhtaniemi
- Department of Digestion, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Hammersmith Campus, Imperial College London, London W12 0NN, UK.
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK
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20
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Wu S, Hilton O, Pereira B, Girometti N, Milinkovic A, Ollandini G, Boffito M. Correlation between different equations to calculate free testosterone for improved detection of hypogonadism in people living with HIV. Int J STD AIDS 2022; 33:613-617. [PMID: 35379047 DOI: 10.1177/09564624221083760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of hypogonadism in people living with HIV (PLWH) remains challenging by the lack of a standardised diagnostic algorithm. Since sexual hormone-binding globulin levels are commonly increased in PLWH, guidelines recommend assessing free testosterone (FT) along with total testosterone levels. We compared different online equations available to estimate FT levels and found a good correlation amongst all algorithms. Estimating FT levels increased diagnostic accuracy of hypogonadism and therefore should be encouraged in clinical practice in PLWH with clinical symptoms of hypogonadism, even when total testosterone levels are normal.
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Affiliation(s)
- Shuang Wu
- 4615Department of Infectious Diseases, Imperial College London, London, UK
| | - Orla Hilton
- 4615Department of Infectious Diseases, Imperial College London, London, UK
| | - Branca Pereira
- 4615Department of Infectious Diseases, Imperial College London, London, UK.,HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicolo Girometti
- HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ana Milinkovic
- HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Giangiacomo Ollandini
- Urology Department, 156774Milton Keynes University Hospital, Milton Keynes, UK.,Department of HIV and Sexual Health, 577312King's College Hospital, London, UK
| | - Marta Boffito
- 4615Department of Infectious Diseases, Imperial College London, London, UK.,HIV/GUM Directorate, 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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21
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Sharma A, Ul-Haq Z, Sindi E, Al-Sharefi A, Kamalati T, Dhillo WS, Minhas S, Jayasena CN. Clinical characteristics and comorbidities associated with testosterone prescribing in men. Clin Endocrinol (Oxf) 2022; 96:227-235. [PMID: 34816471 DOI: 10.1111/cen.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/12/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Testosterone replacement therapy (TRT) is recommended for the treatment of symptomatic hypogonadism in men. Data on prescription behaviours are, however, limited and conflicting. The objective of this study was to investigate clinical characteristics associated with the likelihood of being prescribed TRT by general practitioners (GP) in North-West London (NWL). DESIGN Retrospective cohort study using Discover database of GP-registered patients in NWL between 2015 and 2019. PATIENTS We identified 20,299 men aged ≥18 years with serum total testosterone measurement (TT) and without prior TRT prescription records. MEASUREMENTS We determined whether TRT was subsequently commenced, while analysing clinical characteristics related to hypogonadism. RESULTS Of all men having TT measurement, 19,583 (96.4%) were not commenced on TRT (Group A) and 716 (3.5%) men were commenced on TRT (Group B). Men prescribed TRT (Group B) had higher mean age, body mass index (BMI) and higher risks of hypertension, depression type 2 diabetes and ischaemic heart disease; conversely, men in Group B had lower mean pretreatment TT and were less likely to have prostate cancer. Four-hundred and thirty-six men (24.3%) with TT < 8 nmol/L and symptoms of low libido were not prescribed TRT. CONCLUSIONS Our study highlights several factors which may influence the decisions made by clinicians when initiating TRT in primary care. Clearer guidance for clinicians may help to improve the consistency of treatment of men with hypogonadism.
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Affiliation(s)
- Aditi Sharma
- Section of Investigative Medicine, Imperial College London, London, UK
| | - Zia Ul-Haq
- Imperial College Health Partners, London, UK
| | - Emad Sindi
- Section of Investigative Medicine, Imperial College London, London, UK
| | - Ahmed Al-Sharefi
- Section of Investigative Medicine, Imperial College London, London, UK
| | | | - Waljit S Dhillo
- Section of Investigative Medicine, Imperial College London, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, London, UK
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22
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Matai A, Abdullahi M, Beahm NP, Sadowski CA. Practice guideline for pharmacists: The management of late-onset hypogonadism. Can Pharm J (Ott) 2022; 155:26-38. [PMID: 35035640 PMCID: PMC8756369 DOI: 10.1177/17151635211047468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Aakriti Matai
- Faculty of Pharmacy & Pharmaceutical Sciences, Edmonton, Alberta
| | - Mariam Abdullahi
- Faculty of Pharmacy & Pharmaceutical Sciences, Edmonton, Alberta
| | - Nathan P Beahm
- Faculty of Pharmacy & Pharmaceutical Sciences, Edmonton, Alberta
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23
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Biomarkers in metabolic syndrome. Adv Clin Chem 2022; 111:101-156. [DOI: 10.1016/bs.acc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Kolind MI, Christensen LL, Caserotti P, Andersen MS, Glintborg D. Muscle function following testosterone replacement in men on opioid therapy for chronic non-cancer pain: A randomized controlled trial. Andrology 2021; 10:551-559. [PMID: 34933416 DOI: 10.1111/andr.13147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/07/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic pain and opioid treatment are associated with increased risk of male hypogonadism and subsequently decreased muscle function. A diagnosis of hypogonadism is based on the presence of low total testosterone and associated symptoms. The effect of testosterone replacement therapy on muscle function in men with chronic pain and low total testosterone remains to be investigated. OBJECTIVES To investigate the effects of testosterone replacement therapy on muscle function and gait performance in men treated with opioids for chronic non-cancer pain. MATERIALS AND METHODS A double-blind, placebo-controlled study. Forty-one men (>18 years) with opioid-treated chronic pain and serum total testosterone < 12 nmol/L were randomized to 24 weeks testosterone replacement therapy (testosterone undecanoate injection three times/6 months, n = 20) or placebo injections (n = 21). Muscle function was measured as leg press maximal voluntary contraction, leg extension power using the Nottingham power rig and handgrip strength using a handheld dynameter. Gait performance was measured at usual and maximal gait speed on a 10-m track. Body composition (lean body mass and fat mass) was determined by dual-energy X-ray absorptiometry. Mann-Whitney tests were performed on ∆-values (24-0 weeks) between testosterone replacement therapy and placebo. RESULTS At baseline, median (interquartile range) age was 55 ± 13 years and BMI was 30.7 ± 5.2 kg/m2 . ∆-muscle function and ∆-gait performance were similar between testosterone replacement therapy and placebo. Median ∆-leg press maximal voluntary contraction was 174.2 ± 406.7 Newton, following testosterone replacement therapy, and 7.6 ± 419.1 Newton, after placebo, p = 0.091. ∆-lean body mass was significantly higher following testosterone replacement therapy compared to placebo, 3.6 ± 2.7 versus 0.1 ± 3.5 kg, respectively (p < 0.001). DISCUSSION Testosterone replacement therapy, compared to placebo, did not improve muscle function or gait performance despite increased lean body mass. Changes in body composition did not infer any changes in muscle function. CONCLUSION 24 weeks testosterone replacement therapy in opioid-treated men with pain-related male hypogonadism did not improve muscle function.
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Affiliation(s)
- Mikkel Iwanoff Kolind
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,OPEN, Open, Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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25
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Taniguchi H, Shimada S, Kinoshita H. Testosterone Therapy for Late-Onset Hypogonadism Improves Erectile Function: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:539-552. [PMID: 34856556 DOI: 10.1159/000520135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) of testosterone therapy (TTh) for late-onset hypogonadism are systematically reviewed and a meta-analysis to assess the efficacy of TTh in improving erectile function is performed. METHODS The PubMed, Cochrane Library, and Web of Science databases were searched to identify RCTs published from 2007. RCTs that assessed erectile function using the erectile function domain of the International Index of Erectile Function (IIEF-EFD) were included in the meta-analysis. RESULTS The systematic review included 18 RCTs and the meta-analysis included 6 studies that enrolled a total of 1,458 patients. The overall meta-analysis revealed that the IIEF-EFD score was significantly improved in the TTh group compared with the placebo group (mean difference 1.86; 95% confidence interval 1.01-2.72; p < 0.0001). Compared with patients receiving placebo, there was a significant improvement in the IIEF-EFD of patients who received TTh using testosterone gel, those who received TTh for over 30 weeks, and those without diabetes mellitus or metabolic syndrome. CONCLUSION TTh achieved a significant improvement in the IIEF-EFD score of hypogonadal men compared with placebo, especially in those who received testosterone gel, were treated for over 30 weeks, and had no comorbidities.
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Affiliation(s)
- Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan,
| | - Seiji Shimada
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Kato Y, Shigehara K, Inaba T, Sakamoto J, Iijima M, Kawaguchi S, Izumi K, Kadono Y, Namiki M, Mizokami A. Low free testosterone level as a predictor of cardiovascular events in Japanese men with coronary risk factors. Aging Male 2021; 24:8-14. [PMID: 34000968 DOI: 10.1080/13685538.2021.1920912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aim: We investigated whether low plasma free testosterone (FT) levels could predict cardiovascular events (CVE) in Japanese men with coronary risk factors.Methods: Male patients with classical coronary risk factors who had undergone serum FT testing were enrolled. New incidences of CVE were retrospectively investigated among all eligible participants based on their medical records.Results: Overall, 466 male outpatients with coronary risk factors without a previous history of CVE were identified. Throughout the follow-up period (median = 92 months), 126 CVE occurred. The Kaplan-Meier survival analysis according to the tertiles of plasma FT levels revealed that patients with the lowest FT tertile (<6.5 pg/mL) had a higher likelihood of developing CVE than those with the highest tertile (>9.3 pg/mL) (p<.01). Multivariate analysis showed that increased frequency of CVE was observed with lower FT tertiles, independent of other coronary risk factors, with hazard ratios of 0.617 (95% CI, 0.389-0.976; p=.030) and 0.524 (95% CI, 0.309-0.887; p=.016) for the second and highest tertile relative to the lowest FT tertile, respectively.Conclusion: Among Japanese men with coronary risk factors, a lower FT level was a predictor for the development of cardiovascular diseases independent of other coronary risk factors and age.
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Affiliation(s)
- Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Inaba
- Department of Urology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Jiro Sakamoto
- Department of Urology, Hokuriku Hospital, KKR Kanazawa, Kanazawa, Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Mikio Namiki
- Department of Urology, Hasegawa Hospital, Toyama, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Zamir A, Ben-Zeev T, Hoffman JR. Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations. Nutrients 2021; 13:3375. [PMID: 34684376 PMCID: PMC8538516 DOI: 10.3390/nu13103375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
Elevations in the circulating concentration of androgens are thought to have a positive effect on the anabolic processes leading to improved athletic performance. Anabolic-androgenic steroids have often been used by competitive athletes to augment this effect. Although there has been concerted effort on examining how manipulating training variables (e.g., intensity and volume of training) can influence the androgen response to exercise, there has been much less effort directed at understanding how changes in both macronutrient and micronutrient intake can impact the androgen response. Thus, the focus of this review is to examine the effect that manipulating energy and nutrient intake has on circulating concentrations of testosterone and what the potential mechanism is governing these changes.
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Affiliation(s)
| | | | - Jay R. Hoffman
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, 40700 Ariel, Israel; (A.Z.); (T.B.-Z.)
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Pastuszak AW, Gittelman M, Tursi JP, Jaffe JS, Schofield D, Miner MM. Pharmacokinetics of testosterone therapies in relation to diurnal variation of serum testosterone levels as men age. Andrology 2021; 10:209-222. [PMID: 34510812 PMCID: PMC9293229 DOI: 10.1111/andr.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Background To improve symptoms associated with testosterone deficiency, many testosterone therapies are available that aim to restore serum testosterone (T) levels to the normal physiologic range. The magnitude, frequency, and duration between peak and trough T concentrations vary with route of administration, and none reflect normal endogenous daily diurnal T variations. Objective To compare pharmacokinetic profiles of serum T from approved T formulations with endogenous diurnal T variations in young and older men, and to consider whether there may be value in mimicking the diurnal T rhythmicity with exogenous testosterone therapies as men age. Materials and methods A literature search of studies examining the diurnal variation of endogenous T in healthy men and men with testosterone deficiency was performed using PubMed in January 2020. Additional searches for serum T pharmacokinetic profiles of various testosterone therapy formulations were also conducted. Prescribing information for various T formulations was also reviewed. Discussion and conclusion Endogenous diurnal T variation is well described and appears to be blunted naturally as men age. Men with testosterone deficiency lack diurnal T variation and exhibit a flatter T profile compared with eugonadal men. Some T replacement options provide intraday T level variations similar to normal circadian secretion, and others provide a flatter exposure profile reflective of depot release. Others provide profiles that exceed the frequency and physiologic range of the natural diurnal variation of T. All exogenous T replacement dosing targets an increase in average T levels to within the normal physiologic range and improves symptoms associated with low T, but no single testosterone therapy can exactly mimic the normal diurnal T patterns seen in younger men and the blunted circadian T secretion of older men.
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Affiliation(s)
| | - Marc Gittelman
- 21st Century Oncology, Uro-Medix/GenesisCare, Aventura, Florida, USA
| | | | | | | | - Martin M Miner
- Men's Health Center, Miriam Hospital, Providence, Rhode Island, USA
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Déficit en testostérone. Quels bénéfices et risques et pour quels patients ? SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Burté C, Lejeune H, Faix A, Desvaux P, Almont T, Cuzin B, Huyghe E. Les recommandations pour la prise en charge du déficit en testostérone. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Le déficit en testostérone en pratique sexologique. Populations cibles et signes cliniques évocateurs. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nattiv A, De Souza MJ, Koltun KJ, Misra M, Kussman A, Williams NI, Barrack MT, Kraus E, Joy E, Fredericson M. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clin J Sport Med 2021; 31:335-348. [PMID: 34091537 DOI: 10.1097/jsm.0000000000000946] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
ABSTRACT The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.
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Affiliation(s)
- Aurelia Nattiv
- Division of Sports Medicine and Non-Operative Orthopaedics, Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Mary Jane De Souza
- Department of Kinesiology, Penn State University, University Park, Pennsylvania
| | - Kristen J Koltun
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrea Kussman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Nancy I Williams
- Department of Kinesiology, Penn State University, University Park, Pennsylvania
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California; and
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | | | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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Fredericson M, Kussman A, Misra M, Barrack MT, De Souza MJ, Kraus E, Koltun KJ, Williams NI, Joy E, Nattiv A. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play. Clin J Sport Med 2021; 31:349-366. [PMID: 34091538 DOI: 10.1097/jsm.0000000000000948] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
ABSTRACT The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.
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Affiliation(s)
- Michael Fredericson
- Division of Physical Medicine & Rehabiilitation, Stanford University, Stanford, California
| | - Andrea Kussman
- Division of Physical Medicine & Rehabiilitation, Stanford University, Stanford, California
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
| | - Mary Jane De Souza
- Department of Kinesiology and Physiology Penn State University, University Park, Pennsylvania
| | - Emily Kraus
- Division of Physical Medicine & Rehabiilitation, Stanford University, Stanford, California
| | | | - Nancy I Williams
- Department of Kinesiology and Physiology Penn State University, University Park, Pennsylvania
| | | | - Aurelia Nattiv
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
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Livingston M, Hackett G, Ramachandran S, Heald A. Is a fasting testosterone level really necessary for the determination of androgen status in men? Clin Chim Acta 2021; 521:64-69. [PMID: 34181890 DOI: 10.1016/j.cca.2021.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As circulating testosterone may be suppressed in the post-prandial state, it has been recommended that measurements are carried out with the patient fasted. OBJECTIVES In this regard, we assessed the effect of fasting/non-fasting status on total testosterone (T) levels in men. MATERIALS AND METHODS Data was collected in a single UK Hospital in men with two serum T requests taken within a 6-month period of each other and sampled at a time of day ≤ 2 h apart. Three groups were established, with T levels compared via signed-rank test in men with both a fasting and non-fasting sample (Group 1; n = 69), and in men with paired non-fasting (Group 2; n = 126) and paired fasting (Group 3; n = 18) samples. The differences in T levels between the paired samples was compared between the three groups using the rank-sum test and also via multiple regression analysis with the groups factorised. RESULTS Median (Interquartile Range, IQR) age did not vary significantly between Groups 1, 2 and 3 at 49 (38-56), 51.5 (42-60) and 51.5 (40-59) years, respectively. No significant difference (p = 0.89) was found between the T levels in Group 1 with non-fasting (median (IQR) T = 11.1 (9.3-13.6) nmol/L) versus fasting samples T = 10.8 (8.9-14.1) nmol/L). Paired T levels did not significantly differ in each of the other two groups (2 and 3). There was no significant association between the differences in paired T levels between the three groups, even when the model was adjusted for age and time, with Group 1 (as reference) versus Group 2 (p = 0.79) and versus Group 3 (p = 0.63). DISCUSSION We found no significant differences between fasting and non-fasting T levels. A definitive confirmatory study is required to determine whether fasting status is necessary to diagnose hypogonadism. CONCLUSION Non-requirement of fasting status when checking testosterone levels would remove a major hurdle in the diagnosis of hypogonadism.
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Affiliation(s)
- Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall, United Kingdom; School of Medicine and Clinical Practice, Faculty of Science & Engineering, The University of Wolverhampton, United Kingdom.
| | - Geoffrey Hackett
- School of Health and Life Sciences, Aston University, Birmingham, England, United Kingdom
| | - Sudarshan Ramachandran
- Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, West Midlands, United Kingdom; Department of Clinical Biochemistry, University Hospitals of North Midlands/ Institute of Science and Technology, Keele University / Faculty of Health Sciences, Staffordshire University, Staffordshire, United Kingdom; College of Engineering, Design and Physical Sciences, Brunel University London, United Kingdom
| | - Adrian Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom; Department of Endocrinology and Diabetes, Salford Royal Hospital, Manchester, United Kingdom
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Burte C, Lejeune H, Faix A, Desvaux P, Almont T, Cuzin B, Huyghe E. [Practical recommendations for the management of testosterone deficiency]. Prog Urol 2021; 31:458-476. [PMID: 34034926 DOI: 10.1016/j.purol.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The Francophone Society of Sexual Medicine (SFMS) and the Andrology and Sexual Medicine Committee (CAMS) of the French Association of Urology (AFU) have brought together a panel of experts to develop French recommendations for the management of testosterone deficiency (TD). METHODS Systematic review of the literature between 01/2000 and 07/2019. Use of the method of recommendations for clinical practice (RPC) and the AGREE II grid. RESULTS TD is defined as the association of clinical signs and symptoms suggestive of TD with a decrease in testosterone levels or serum androgen activity. Diagnosis requires a T lower than the reference values in young men on 2 successive assays. Sexual disorders are often at the forefront, and concern the whole male sexual function (desire, arousal, pleasure and orgasm). The most evocative symptoms are: decrease in sexual desire, disappearance of nocturnal erections, fatigue, loss of muscle strength. Overweight, depressed mood, anxiety, irritability and malaise are also frequently found. TD is more common in cases of metabolic, cardiovascular, chronic, andrological diseases, and in cases of corticosteroid, opioid, antipsychotic, anticonvulsant, antiretroviral, or cancer treatment. Since SHBG is frequently abnormal, we recommend that free or bioavailable T is preferred over total T. The treatment of TD requires a prior clinical (DRE, breast examination) and biological (PSA, CBC) assessment. Contraindications to T treatment are: progressive prostate or breast cancer, severe heart failure or recent cardiovascular event, polycytemia, complicated BPH, paternity project. It is possible in cases of sleep apnea syndrome, psychiatric history, stable heart disease, prostate cancer under active surveillance and after one year of complete remission of a low or intermediate risk localized prostate cancer treated in a curative manner. It includes long-term testosterone supplementation and life-style counseling. Treatment is monitored at 3, 6, 12 months and annually thereafter. It is clinical (annual DRE) and biological (total T, PSA, CBC), the most frequent side effect being polyglobulia. CONCLUSION These recommendations should help improve the management of TD.
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Affiliation(s)
- C Burte
- Cabinet de médecine sexuelle, 4, rue des États-Unis, Cannes, France
| | - H Lejeune
- Service de médecine de la reproduction, hôpital Femme-Mère-Enfant, HCL, Bron, France
| | - A Faix
- Cabinet d'urologie, 265, avenue des États-du-Languedoc, Montpellier, France
| | - P Desvaux
- Cabinet de médecine sexuelle, 11, rue Magellan, 75008 Paris, France
| | - T Almont
- Service d'oncologie, CHU de Martinique, Fort-de-France, Martinique
| | - B Cuzin
- Service d'urologie, chirurgie de la transplantation, hôpital Édouard-Herriot, CHU de Lyon, France
| | - E Huyghe
- Médecine de la reproduction, CHU de Toulouse, site de Paule-de-Viguier, Toulouse, France; Département d'urologie, transplantation rénale et andrologie, hôpital Rangueil, CHU de Toulouse, France.
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Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, Arafa M, Panner Selvam MK, Shah R. Male infertility. Lancet 2021; 397:319-333. [PMID: 33308486 DOI: 10.1016/s0140-6736(20)32667-2] [Citation(s) in RCA: 406] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
It is estimated that infertility affects 8-12% of couples globally, with a male factor being a primary or contributing cause in approximately 50% of couples. Causes of male subfertility vary highly, but can be related to congenital, acquired, or idiopathic factors that impair spermatogenesis. Many health conditions can affect male fertility, which underscores the need for a thorough evaluation of patients to identify treatable or reversible lifestyle factors or medical conditions. Although semen analysis remains the cornerstone for evaluating male infertility, advanced diagnostic tests to investigate sperm quality and function have been developed to improve diagnosis and management. The use of assisted reproductive techniques has also substantially improved the ability of couples with infertility to have biological children. This Seminar aims to provide a comprehensive overview of the assessment and management of men with infertility, along with current controversies and future endeavours.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Chak-Lam Cho
- SH Ho Urology Center, Department of Surgery, Chinese University of Hong Kong, Hong Kong
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Medical Bioscience, University of Western Cape, Bellville, South Africa; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sarah Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Arafa
- Male Infertility Unit, Urology Department, Hamad Medical Corporation, Doha, Qatar; Andrology Department, Cairo University, Cairo, Egypt
| | | | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Center, Mumbai, India
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Vogiatzi M, Tursi JP, Jaffe JS, Hobson S, Rogol AD. Testosterone Use in Adolescent Males: Current Practice and Unmet Needs. J Endocr Soc 2021; 5:bvaa161. [PMID: 33294762 PMCID: PMC7705876 DOI: 10.1210/jendso/bvaa161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Indexed: 02/07/2023] Open
Abstract
Testosterone replacement therapy (TRT) is routinely prescribed in adolescent males with constitutional delay of growth and puberty (CDGP) or hypogonadism. With many new testosterone (T) formulations entering the market targeted for adults, we review current evidence and TRT options for adolescents and identify areas of unmet needs. We searched PubMed for articles (in English) on testosterone therapy, androgens, adolescence, and puberty in humans. The results indicate that short-term use of T enanthate (TE) or oral T undecanoate is safe and effective in inducing puberty and increasing growth in males with CDGP. Reassuring evidence is emerging on the use of transdermal T to induce and maintain puberty. The long-term safety and efficacy of TRT for puberty completion and maintenance have not been established. Current TRT regimens are based on consensus and expert opinion, but evidence-based guidelines are lacking. Limited guidance exists on when and how T should be administered and optimal strategies for monitoring therapy once it is initiated. Only TE and T pellets are US Food and Drug Administration approved for use in adolescent males in the United States. Despite the introduction of a wide variety of new T formulations, they are designed for adults, and their metered doses are difficult to titrate in adolescents. In conclusion, TRT in adolescent males is hindered by lack of long-term safety and efficacy data and limited options approved for use in this population. Additional research is needed to identify the route, dose, duration, and optimal timing for TRT in adolescents requiring androgen therapy.
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Affiliation(s)
- Maria Vogiatzi
- Children’s Hospital of Philadelphia, Division of Endocrinology and Diabetes, Philadelphia, Pennsylvania, USA
| | | | | | - Sue Hobson
- Antares Pharma, Inc, Ewing, New Jersey, USA
| | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
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Caliber M, Hackett G. Important lessons about testosterone therapy- weight loss vs. testosterone therapy for symptom resolution, classical vs. functional hypogonadism, and shortterm vs. lifelong testosterone therapy. Aging Male 2020; 23:585-591. [PMID: 30651008 DOI: 10.1080/13685538.2018.1549211] [Citation(s) in RCA: 2] [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: 12/16/2022] Open
Abstract
In this commentary, we highlight important findings from a notable RCT by Ng Tang Fui et al. 2016 which investigated the effects of testosterone treatment in dieting obese men. First, a myopic focus on weight loss can detract from important improvements in body composition. Second, while weight loss in obese men may increase testosterone levels, this increase is commonly not enough to result in an improvement in symptoms associated with testosterone deficiency. Third, the RCT by Ng Tang Fui et al. adds evidence to the growing number of clinical trials showing that testosterone therapy should not be restricted to men with classical hypogonadism. Finally, the beneficial effects of testosterone therapy are not maintained after cessation of treatment. Currently, the British Society for Sexual Medicine guidelines are the only clinical guidelines which acknowledge that weight loss per se does not automatically translate to resolution of hypogonadal symptoms, that testosterone therapy can greatly benefit men with testosterone deficiency who do not have classical hypogonadism, and that cessation of testosterone therapy causes reappearance of symptoms and reversal of benefits. Lifelong testosterone therapy is therefore recommended for persistent health benefits in most men with testosterone deficiency. Physicians and patients need to be informed of this.
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Affiliation(s)
- Monica Caliber
- American Medical Writers Association, Fort Lauderdale, FL, USA
| | - Geoff Hackett
- Good Hope Hospital, Birmingham, UK
- Department of Urology, Aston University, Birmingham, UK
- Heart of England NHS Foundation Trust, Birmingham, UK
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Abstract
PURPOSE OF REVIEW The prevalence of metabolic syndrome and hypogonadism continues to rise in the United States and around the world. These two conditions are inexorably linked, and understanding their relationship with each other is key to treating men with either of these conditions. RECENT FINDINGS Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. A large volume of research has found that testosterone deficiency is closely linked to metabolic syndrome through complex physiologic mechanisms of endothelial dysfunction, inflammation, and glucose metabolism. SUMMARY Interventions through lifestyle modification and testosterone replacement in hypogonadal men may reduce the morbidity and mortality risks associated with metabolic syndrome.
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Affiliation(s)
- William T Berg
- Department of Urology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Martin Miner
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Islands, USA
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Hackett G, Kirby M. Testosterone deficiency in men infected with
COVID
‐19. TRENDS IN UROLOGY & MEN'S HEALTH 2020. [PMCID: PMC7753528 DOI: 10.1002/tre.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As our understanding of the SARS‐CoV‐2 virus develops, recent research has highlighted the potential role of testosterone in the severity of illness. Here, the authors explain the role of testosterone in men infected with COVID‐19.
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Livingston M, Downie P, Hackett G, Marrington R, Heald A, Ramachandran S. An audit of the measurement and reporting of male testosterone levels in UK clinical biochemistry laboratories. Int J Clin Pract 2020; 74:e13607. [PMID: 32649008 DOI: 10.1111/ijcp.13607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A number of guidance documents have been published in recent years for the diagnosis and management of hypogonadism (HG). Laboratory practice has a major role in supporting guidelines with accurate and precise serum total testosterone (TT) methods and standardised pre- and post-analytical protocols. Our study investigated whether laboratory practice currently supports the management guidelines for HG. METHODS An internet-based questionnaire survey of senior laboratory biochemists (UK/Republic of Ireland) was conducted (April-May 2018). Questions reflected sampling, laboratory practice, reference ranges and reporting of results. The results were analysed in conjunction with data obtained from the UK National External Quality Assurance Service (UK NEQAS) on testosterone assay performance. RESULTS Analyses of 96 laboratory surveys returned the following: 74 laboratories stated that the optimal sampling time was communicated to users; 81 laboratories used immunoassays; 76 laboratories included reference ranges for adult men (31 had dual/multiple age-related intervals). Wide variability in lower/upper limits was evident in the common immunoassays; the majority of reference ranges were from manufacturers (50.0%) or historical (18.8%). Action limits based on TT levels were used by 64 laboratories, but 63 did not report a borderline range as suggested by the guidelines. Protocols for cascading tests based on TT were evident in 58 laboratories, with 50 laboratories offering estimated free testosterone; interpretative comments were provided by 67 laboratories, but no references were made to the management guidelines. Data from UK NEQAS demonstrated considerable variation in testosterone assay performance. CONCLUSIONS Our survey has highlighted inconsistencies that could lead to HG (and other conditions requiring measurement of TT) not being managed appropriately. The results from this survey and from UK NEQAS reinforce the requirement for action to be considered regarding the standardisation of testosterone assays and harmonisation of laboratory practice.
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Affiliation(s)
- Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
- The School of Medicine and Clinical Practice & Department of Biomedical Science and Physiology, The University of Wolverhampton, Wolverhampton, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Paul Downie
- Department of Clinical Biochemistry, Bristol Royal Infirmary, Bristol, UK
| | - Geoff Hackett
- School of Health and Life Sciences, Aston University, Birmingham, UK
| | - Rachel Marrington
- Birmingham Quality (UK NEQAS) University Hospitals NHS Foundation Trust, Birmingham, UK
| | - Adrian Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Manchester, UK
| | - Sudarshan Ramachandran
- Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK
- Institute of Science and Technology, Keele University, Keele, UK
- Faculty of Health Sciences, Staffordshire University, Staffordshire, UK
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
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Castle G, Stammers J. Testosterone prescribing in UK general practice: Are patients being monitored correctly for associated risks whilst on treatment? Basic Clin Pharmacol Toxicol 2020; 127:434-437. [DOI: 10.1111/bcpt.13448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/17/2020] [Accepted: 05/25/2020] [Indexed: 11/28/2022]
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Kharaba ZJ, Buabeid MA, Ibrahim NA, Jirjees FJ, Obaidi HJA, Kaddaha A, Khajehkarimoddini L, Alfoteih Y. Testosterone therapy in hypogonadal patients and the associated risks of cardiovascular events. Biomed Pharmacother 2020; 129:110423. [PMID: 32570122 DOI: 10.1016/j.biopha.2020.110423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022] Open
Abstract
Since the male secondary sex characters, libido and fertility are attributed to their major androgen hormone testosterone, the sub-optimum levels of testosterone in young adults may cause infertility and irregularities in their sexual behaviour. Such deficiency is often secondary to maladies involving testes, pituitary or hypothalamus that could be treated with an administration of exogenous testosterone. In the last few decades, the number of testosterone prescriptions has markedly increased to treat sub-optimal serum levels even though its administration in such conditions is not yet approved. On account of its associated cardiovascular hazards, the food and drug authority in the United States has issued safety alerts on testosterone replacement therapy (TRT). Owing to a great degree of conflict among their findings, the published clinical trials seem struggling in presenting a decisive opinion on the matter. Hence, the clinicians remain uncertain about the possible cardiovascular adversities while prescribing TRT in hypogonadal men. The uncertainty escalates even further while prescribing such therapy in older men with a previous history of cardiovascular ailments. In the current review, we analysed the pre-clinical and clinical studies to evaluate the physiological impact of testosterone on cardiovascular and related parameters. We have enlisted studies on the association of cardiovascular health and endogenous testosterone levels with a comprehensive analysis of epidemiological studies, clinical trials, and meta-analyses on the cardiovascular risk of TRT. The review is aimed to assist clinicians in making smart decisions regarding TRT in their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | - Nihal A Ibrahim
- Department of Clinical Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | | | | | | | | | - Yassen Alfoteih
- City University College of Ajman, Ajman, 18484, United Arab Emirates.
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Al-Sharefi A, Quinton R. Current National and International Guidelines for the Management of Male Hypogonadism: Helping Clinicians to Navigate Variation in Diagnostic Criteria and Treatment Recommendations. Endocrinol Metab (Seoul) 2020; 35:526-540. [PMID: 32981295 PMCID: PMC7520594 DOI: 10.3803/enm.2020.760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022] Open
Abstract
Male hypogonadism-rebadged by some as testosterone deficiency syndrome-is a clinical and biochemical diagnosis of increasing worldwide interest. Organic male hypogonadism-usually permanent-is well-established, but aging men may also exhibit lower serum testosterone levels; principally due to burden of extra-gonadal comorbidities such as obesity, diabetes and metabolic syndrome, but with an underlying intact hypothalamo-pituitary-testicular (HPT) axis capable of springing back into operation once comorbidities are addressed. Despite encouraging observational data and plausible theoretical underpinning, evidence for efficacy and safety of testosterone in this "aging" group of men is lacking; addressing comorbid illnesses remains the key priority instead. Nevertheless, in recent years, accumulation of misleading information online has triggered a global tsunami of testosterone prescriptions. Despite this, many men with organic hypogonadism remain undiagnosed or untreated; many more face a diagnostic odyssey before achieving care by the appropriate specialist. As testosterone therapy is not without risk several clinical practice guidelines have been published specialist societies to guide physicians on best practice. However, these are heterogeneous in key areas, reflecting divergent approaches to the same evidence basis. Herein, we navigate the major clinical practice guidelines on male hypogonadism and test their respective recommendations against current best evidence.
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Affiliation(s)
- Ahmed Al-Sharefi
- Department of Endocrinology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Richard Quinton
- Department of Endocrinology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Translational & Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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White A, Kirby M. COVID‐19: biological factors in men's vulnerability. TRENDS IN UROLOGY & MENS HEALTH 2020. [DOI: 10.1002/tre.757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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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Kirby M, Kalhan A, Hackett G. New testosterone 2% gel using Ferring Advanced Skin Technology (FAST), for the treatment of testosterone deficiency in men, with a novel applicator. Expert Rev Endocrinol Metab 2020; 15:217-226. [PMID: 32552045 DOI: 10.1080/17446651.2020.1773259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Testosterone deficiency (TD) is an increasing problem that can affect a man's physical and psychological health, and quality of life. Testosterone replacement therapy (TRT), combined with weight reduction, lifestyle advice, and the treatment of co-morbidities, is the treatment of choice in men who are not concerned about fertility. However, there remains an unmet need in this therapeutic area, relating to factors such as inconvenient or painful administration, fluctuations in testosterone levels, supra-physiologic testosterone levels, poor tolerability, and secondary safety issues, which may be associated with the current TRT options. Advances in transdermal delivery systems have resulted in the development of a new 2% transdermal testosterone gel, that may offer some additional features over the other currently available TRTs. AREAS COVERED We performed a comprehensive review of the published and gray literature to identify randomized studies and non-randomized studies (NRS) involving adult men receiving treatment for low testosterone levels. EXPERT OPINION Topical gels are often the most convenient first-line treatment for testosterone deficiency, but options are important as patient preference is more important than virtually any other clinical area of medicine. The chosen therapy must be convenient to use and reach reliable therapeutic levels to effectively and consistently relieve symptoms. Testavan, a new 2% testosterone gel, goes some way to achieving these goals.
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Affiliation(s)
- Michael Kirby
- Editor Trends in Urology & Men's Health, John Wiley & Sons, The Atrium , Chichester, West Sussex
| | - Atul Kalhan
- Department of Diabetes and Endocrinology, Royal Glamorgan Hospital , Llantrisant, UK
| | - Geoffrey Hackett
- University Hospitals Birmingham NHS Foundation Trust , Birmingham, UK
- Aston University Medical School , Birmingham, UK
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Ramachandran S, Hackett GI, Strange RC. Testosterone replacement therapy: Pre-treatment sex hormone-binding globulin levels and age may identify clinical subgroups. Andrology 2020; 8:1222-1232. [PMID: 32384175 DOI: 10.1111/andr.12813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/26/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Testosterone replacement therapy (TRT) improves health in some but not all men with type 2 diabetes (T2DM) and adult-onset testosterone deficiency (TD). Such heterogeneity is compatible with the concept of patient subgroups that respond differently to therapy. OBJECTIVES Use baseline SHBG and age to identify putative subgroups that demonstrate different responses in variables such as waist circumference and HbA1c following TRT. MATERIALS AND METHODS A randomized double-blind trial approach was used to recruit and randomize men with T2DM and adult-onset TD into placebo and TRT-treated groups. Multiple regression was used to study differences between groups. RESULTS Baseline SHBG and change in SHBG (∆SHBG) were inversely related in the TRT group. Both median values of SHBG and age mediated the effect of TRT on ∆SHBG depending on whether baseline values were ≤ or>median (28.1 nmol/L, 63 years, respectively). In men with both SHBG ≤ 28.1 nmol/L and age ≤ 63 years (subgroup 1), TRT was positively associated with ∆SHBG (c = 4.67, 95%CI 1.17-8.16, P = .010) while in those with SHBG > 28.1 nmol/L and age > 63.1 years (subgroup 4) the association was inverse (c = -7.07, 95%CI -11.64 to -2.49, P = .003). The association between TRT and change (∆) in waist circumference, HbA1c and International Index of Erectile Function (IIEF) score differed between subgroups; in subgroup 4 but not subgroup 1, the therapy was significantly associated with ∆waist circumference, ∆HbA1c and ∆IIEF. DISCUSSION Though the mechanism remains unclear, our finding of different responses to TRT in terms of change in waist circumference, HbA1c and IIEF score supports the concept of subgroups in men with T2DM and adult-onset TD. CONCLUSION Our approach may provide a basis for identifying men who will or will not derive benefit from TRT though a larger study is required.
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Affiliation(s)
- Sudarshan Ramachandran
- Department of Clinical Biochemistry, Faculty of Health Sciences, University Hospitals of North Midlands, Staffordshire University, Stoke-on-Trent, UK.,Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Mechanical and Aerospace Engineering, Brunel University London, London, UK.,Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | | | - Richard C Strange
- Institute for Science and Technology in Medicine, Keele University, Keele, UK
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Di Luigi L, Pigozzi F, Sgrò P, Frati L, Di Gianfrancesco A, Cappa M. The use of prohibited substances for therapeutic reasons in athletes affected by endocrine diseases and disorders: the therapeutic use exemption (TUE) in clinical endocrinology. J Endocrinol Invest 2020; 43:563-573. [PMID: 31734891 DOI: 10.1007/s40618-019-01145-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
To protect sporting ethics and athletes' health, the World Anti-Doping Agency (WADA) produced the World Anti-Doping Code and The Prohibited List of substances and methods forbidden in sports. In accordance with the International Standards for Therapeutic Use Exemption (ISTUE), to avoid rule violations and sanctions, athletes affected by different endocrine diseases and disorders (e.g., adrenal insufficiency, diabetes, male hypogonadisms, pituitary deficit, thyroid diseases, etc.) who need to use a prohibited substance for therapeutic reasons (e.g., medical treatments, surgical procedures, clinical diagnostic investigations) must apply to their respective Anti-Doping Organizations (ADOs) to obtain a Therapeutic Use Exemption (TUE), if specific criteria are respected. The physicians who treat these athletes (i.e., endocrinologists, andrologists and diabetologists) are highly involved in these procedures and should be aware of their specific role and responsibility in applying for a TUE, and in adequately monitoring unhealthy athletes treated with prohibited substances. In this paper, the prohibited substances commonly used for therapeutic reasons in endocrine diseases and disorders (e.g., corticotropins, beta-blockers, glucocorticoids, hCG, insulin, GnRH, rhGH, testosterone, etc.), the role of physicians in the TUE application process and the general criteria used by ADO-Therapeutic Use Exemption Committees (TUECs) for granting a TUE are described.
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Affiliation(s)
- L Di Luigi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy.
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy.
| | - F Pigozzi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy
| | - P Sgrò
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy
| | - L Frati
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy
- Mediterranean Neurology Institute (NEUROMED)-I.R.C.C.S, Pozzilli, Isernia, Italy
| | - A Di Gianfrancesco
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy
| | - M Cappa
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy
- Unit of Endocrinology, Bambino Gesù Children's Hospital, Rome, Italy
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Biers S, Walton T, Belal M, Keeley FX, Alnajjar HM, Muneer A. Urology highlights 2017 to 2018. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819887050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The final clinical session of the British Association of Urological Surgeons (BAUS) annual meeting is the Updates and Highlights session, where the most important advances in the main urological sub-specialities are summarised and presented by sub-specialist experts representing each BAUS section. The aim of the session is to disseminate knowledge on the latest research, new guidelines and changes to general and specialist clinical practice. This paper covers contemporary urological advances as presented at the Liverpool BAUS meeting in June 2018.
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Affiliation(s)
- Suzanne Biers
- Urology Department, Addenbrooke’s Hospital, Cambridge, UK
| | - Tom Walton
- Urology Department, Nottingham City Hospital, UK
| | - Mohammed Belal
- Urology Department, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Asif Muneer
- Division of Surgery and Interventional Science UCL, NIHR Biomedical Research Centre University College London Hospitals, UK
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