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Britton RC, Beamish NF. The Impact of Testosterone Therapy on Cardiovascular Risk Among Postmenopausal Women. J Endocr Soc 2023; 8:bvad132. [PMID: 38178905 PMCID: PMC10765381 DOI: 10.1210/jendso/bvad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 01/06/2024] Open
Abstract
Purpose To summarize the current state of knowledge surrounding the impact of testosterone therapy on cardiovascular risk factors in postmenopausal women. Methodology In this scoping review, a comprehensive search of peer-reviewed literature was conducted in adherence to a methodological framework comprising 4 distinct stages: conceptualizing a comprehensive search strategy, screening relevant publications, extracting pertinent data, and organizing and synthesizing the resultant findings. The search used electronic databases, including MEDLINE, Embase, and Google Scholar, to ensure an exhaustive survey of the available literature. Results The database search yielded 150 articles, including systematic reviews, registered trials, and peer-reviewed studies, of which 48 duplicates were removed. Following the title/abstract screening, 36 publications were included in the full-text review. On completion of the full-text review, using the inclusion/exclusion criteria, 29 articles were excluded and 7 remained for data extraction and qualitative synthesis. Main Conclusion Existing research provides promising insights into the benefits of low-dose testosterone therapy, typically combined with estrogen therapy. These benefits may include positive impacts on body composition, functional capacity, insulin sensitivity, inflammatory markers, and cholesterol. However, there remains a substantial lack of knowledge surrounding the effects and mechanisms behind testosterone therapy in postmenopausal women in relation to its impacts on cardiovascular risk. High-quality, evidence-based clinical intervention research is needed to investigate testosterone therapy's potential implication on cardiovascular risk factors in post-menopausal women.
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Affiliation(s)
- Rhys C Britton
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Nicole F Beamish
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
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2
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A review of testosterone supplementation and cardiovascular risk. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:35-40. [PMID: 36476654 DOI: 10.2478/rjim-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 12/14/2022]
Abstract
Testosterone therapy is commonly utilized to treat hypogonadism. After diagnosis with morning serum testosterone level in patients with symptoms of hypogonadism, therapy has been shown to improve symptoms. Research focusing on cardiovascular risks associated with testosterone therapy has produced contradictory statements. We review trials that have investigated the impact of testosterone supplementation on heart failure, coronary artery disease, and myocardial ischemia.
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3
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Wang R, Deng X, Ma Q, Ma F. Association between acrylamide exposure and sex hormones among premenopausal and postmenopausal women: NHANES, 2013-2016. J Endocrinol Invest 2023:10.1007/s40618-022-01976-3. [PMID: 36602706 DOI: 10.1007/s40618-022-01976-3] [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: 07/20/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Acrylamide (AA) is a potential carcinogen that mainly comes from fried, baked and roasted foods, and Hb adducts of AA (HbAA) and its metabolite glycidamide (HbGA) are the biomarkers of its exposure. Increasing evidence suggests that AA is associated with various hormone-related cancers. This study aims to explore the association of HbAA and HbGA with female serum sex hormone concentrations. METHODS 942 women from the National Health and Nutrition Examination Survey cycles (2013-2016) were included in this cross-sectional study. The associations between HbAA or HbGA or HbGA/HbAA and sex hormones were assessed by the multiple linear regression. Further stratified analyses were conducted to figure out the effects of menopausal status, BMI and smoking status on sex hormone levels. RESULTS Among all participants, 597 were premenopausal and 345 were postmenopausal. HbAA was positively associated with both two androgen indicators. Specifically, a ln-unit increase in HbAA was associated with 0.41 ng/dL higher ln(total testosterone, TT) (95% CI 0.00, 0.27) and 0.14 ng/dL higher ln(free testosterone) (95%CI 0.00, 0.28), respectively. However, HbGA concentrations had no association with sex hormones in the overall population. Additionally, HbGA/HbAA was negatively associated with TT and SHBG in the overall population as well as postmenopausal women. In stratified analysis, higher HbAA was associated with rising TT in postmenopausal women (β = 0.29, 95%CI 0.04, 0.53) and underweight/normal-weight women (β = 0.18, 95%CI 0.03, 0.33). Other indicators had no significant association detected in estradiol and sex hormone-binding globulin. CONCLUSION Our results revealed that HbAA was positively associated with androgen concentrations, especially in postmenopausal and BMI < 25 women.
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Affiliation(s)
- R Wang
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - X Deng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China
| | - Q Ma
- Department of Obstetrics/Gynecology, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - F Ma
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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4
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Aribas E, Roeters van Lennep JE, De Rijke YB, Laven JSE, Ikram MA, Peeters RP, Kavousi M. Sex steroids and sex steroid-binding globulin levels amongst middle-aged and elderly men and women from general population. Eur J Clin Invest 2022; 52:e13866. [PMID: 36038500 PMCID: PMC9787498 DOI: 10.1111/eci.13866] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/20/2022] [Accepted: 08/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Availability of age- and sex-specific reference values for sex steroids and sex steroid-binding globulin (SHBG) levels allows for appropriate interpretation of research findings and their clinical applications. We report the sex-specific distribution and reference levels of sex steroids, including total estradiol, total testosterone and (calculated) free androgen index (cFAI), SHBG and other androgens dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and androstenedione across age. METHODS Using data from 3291 participants from the prospective population-based Rotterdam Study (2006-2008), we visualised the distribution of sex steroids and SHBG levels by calculating and depicting the 5th, 25th, 50th, 75th and 95th percentiles per year and per age-year across 5-year age bands to provide reference value ranges in men and women. Total estradiol and SHBG were measured using automated immunoassay and androgens using liquid chromatography-mass spectrometry (LC-MS/MS). RESULT Mean age was 56.8 (range 45.6-79.9) years in men and 56.9 (range 45.7-79.9) years in women. Amongst men, total estradiol and SHBG showed an increasing trend from 45 years onwards. In women, total estradiol and SHBG showed a decreasing trend from 45 years until the age of 60. From 60 years onwards, SHBG showed an increasing trend. For total testosterone, a clear declining trend was observed amongst men but not women. Other androgens showed a similar decreasing trend in both sexes from 45 years onwards. DISCUSSION AND CONCLUSION Our study underlines sex-specific trends in sex steroids and SHBG levels with ageing. This warrants taking into account sex- and age-specific reference values for sex steroids and SHBG when investigating their impact on health outcomes to prevent controversial results and allow for their appropriate clinical application.
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Affiliation(s)
- Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Yolanda B De Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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5
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Li G, Lv Y, Su Q, You Q, Yu L. The effect of aerobic exercise on pulse wave velocity in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:960096. [PMID: 36061566 PMCID: PMC9433655 DOI: 10.3389/fcvm.2022.960096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
A growing body of research examines the effect of aerobic exercise on pulse wave velocity (PWV) in middle-aged and elderly people, while findings of available studies were conflicting. The aim of this study was to explore the effect of aerobic exercise on PWV in middle-aged and elderly people. Searches were performed in PubMed, Web of Science, and EBSCO databases. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. We included studies that satisfied the following criteria: (1) eligible studies should be randomized controlled trials (RCTs); (2) eligible studies should include both an intervention and a control group; (3) eligible studies should use the middle-aged or elderly people as subjects; and (4) eligible studies should use PWV as the outcome measure. From 972 search records initially identified, 11 studies with a total of 12 exercise groups (n = 245) and 11 control groups (n = 239) were eligible for meta-analysis. There was a significant effect of aerobic exercise on reducing PWV in middle-aged and elderly people [weighted mean difference (WMD), –0.75 (95% CI, –1.21 to –0.28), p = 0.002]. Specifically, a higher intensity [vigorous-intensity, –0.74 (–1.34 to –0.14), p = 0.02; moderate-intensity, –0.68 (–1.49 to 0.12), p = 0.10], a younger age [45 years ≤ age < 60 years, –0.57 (–0.78 to –0.37), p < 0.00001; age ≥ 60 years, –0.91 (–2.10 to 0.27), p = 0.13], a better health status [healthy, –1.19 (–2.06 to –0.31), p = 0.008; diseased, –0.32 (–0.64 to –0.01), p = 0.04], and a lower basal body mass index (BMI) [BMI < 25, –1.19 (–2.06 to –0.31), p = 0.008; 25 ≤ BMI < 30, –0.52 (–0.92 to –0.12), p = 0.01; BMI ≥ 30, –0.09 (–0.93 to 0.76), p = 0.84] were associatedwith larger reductions in PWV. Aerobic exercise, especially vigorous-intensity aerobic exercise, contributed to reducing PWV in middle-aged and elderly people. The effect of aerobic exercise on improving PWV was associated with characteristics of the participants. Specifically, a younger age, a better health status, and a lower basal BMI contributed to more significant reductions in PWV.
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Affiliation(s)
- Gen Li
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Qing Su
- Ersha Sports Training Center of Guangdong Province, Guangzhou, China
| | - Qiuping You
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
- *Correspondence: Laikang Yu,
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6
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The relationship between serum sex hormone and cardiac echocardiographic findings in healthy men. Sci Rep 2022; 12:12787. [PMID: 35896587 PMCID: PMC9329341 DOI: 10.1038/s41598-022-17101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
Serum sex hormones are known to be associated with cardiovascular disease (CVD), but effects in healthy men on cardiac function have not been well quantified. The authors sought to evaluate an association of sex hormones with cardiac structure and function. Study participants were 857 Korean men without significant cardiovascular diseases participating in the Healthy Twin Study. We estimated the associations of total testosterone (TT) and sex hormone-binding globulin (SHBG) with cardiac structure and function measured by echocardiography using a linear mixed regression model with consideration of random and fixed effects of covariates. The ratio of peak early diastolic velocity of mitral inflow over peak early diastolic mitral annular velocity (E/e') and left atrial volume index (LAVI), functional parameters reflecting left ventricle (LV) filling pressure, were inversely associated with TT even after further cross-adjustment for SHBG level. There was a positive association between LAVI and SHBG, regardless of TT adjustment. These findings suggest that serum testosterone level is positively associated with LV diastolic function independent of SHBG level.
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7
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Elfimova AE, Tipisova EV, Molodovskaya IN, Alikina VA. Adaptive potential of cardiovascular system and its relationship with sex hormones and dopamine levels in women of Arkhangelsk Oblast and Yamalo-Nenets Autonomous Okrug. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess the adaptive potential of cardiovascular system in female population of the Russian Arctic territory and its relationship with sex hormones and dopamine levels.Material and methods. The study involved 253 women living in European North (Arkhangelsk Oblast) and Asian North (Yamalo-Nenets Autonomous Okrug), who were divided into groups of fertile (n=58 and n=70, respectively) and postmenopausal women (n=59 and n=66, respectively). Enzyme immunoassay of serum was used to determine the levels of follicle-stimulating and luteinizing hormones (LH), progesterone, prolactin, total and free testosterone, estradiol, sex hormone-binding globulin. In plasma, dopamine level was identified. Adaptive potential (AP) was estimated according to R. M. Baevsky method.Results. A significant disadaptation was revealed in residents of Asian North compared to European North as follows: the proportion of persons with poor adaptation increases from 16% in European North to 26% in Asian North in fertile women, while the proportion of persons with adaptation failure increases from 9 to 23% in postmenopausal women. The strongest relationships between hormonal parameters and AP level were found in postmenopausal women: in European North, adaptation impairment is associated with higher levels of testosterone at lower concentrations of follicle-stimulating hormone, LH and sex hormone-binding globulin; in Asian North, adaptation failure is associated with lower values of LH, prolactin, testosterone, and dopamine.Conclusion. A greater AP impairment, which characterizes cardiovascular system adaptation, was noted among Asian North residents. We revealed significant relationships between cardiovascular function and hormonal parameters. In European North residents, poor adaptation is associated with a more androgenic sex hormone profile, while in Asian North — with lower values of LH, prolactin, testosterone and dopamine.
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Affiliation(s)
- A. E. Elfimova
- N. Laverov Federal Center for Integrated Arctic Research
| | - E. V. Tipisova
- N. Laverov Federal Center for Integrated Arctic Research
| | | | - V. A. Alikina
- N. Laverov Federal Center for Integrated Arctic Research
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8
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Aribas E, Kavousi M, Laven JSE, Ikram MA, Roeters van Lennep JE. Aging, Cardiovascular Risk, and SHBG Levels in Men and Women From the General Population. J Clin Endocrinol Metab 2021; 106:2890-2900. [PMID: 34197576 PMCID: PMC8475196 DOI: 10.1210/clinem/dgab470] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Indexed: 12/16/2022]
Abstract
AIMS Prior studies have reported inconsistent results for the association between sex hormone-binding globulin (SHBG) and cardiovascular disease among men and women. Although it is suggested that SHBG levels change with aging, the exact trend of SHBG across age and cardiovascular risk and the underlying mechanisms of these changes remain to be elucidated. METHODS Using data of 3264 men and women from a large population-based cohort study, we first visualized the distribution of serum SHBG levels across age. Second, we computed a cardiovascular risk factor sum score and investigated the mean SHBG levels across categories of the risk factor sum score and stratified per age-category. Next, linear regression models were used to investigate the associations between serum SHBG levels and age and potential regulators of SHBG, including body mass index (BMI), fasting insulin, sex steroids, thyroxine, and triglycerides. RESULTS Among men, a linear increase in SHBG levels with age and among women a U-shaped pattern was observed. Participants with larger number of cardiovascular risk factors had lower SHBG levels. When stratified by age, older participants had higher SHBG levels. A multivariate model including total testosterone and triglyceride levels in men and total testosterone, triglycerides, BMI, and fasting insulin in women explained, respectively, 46.2% and 31.8% of the variance in SHBG levels. CONCLUSION We observed a clear sex-specific pattern for SHBG levels with age. Our findings highlight the importance of taking into account the age-related changes in SHBG levels to avoid controversial results in the assessment of the cardiovascular risk associated with SHBG.
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Affiliation(s)
- Elif Aribas
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
- Correspondence: Jeanine E. Roeters van Lennep, MD, PhD, Department of Internal Medicine, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands.
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9
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Arathimos R, Millard LAC, Bell JA, Relton CL, Suderman M. Impact of sex hormone-binding globulin on the human phenome. Hum Mol Genet 2021; 29:1824-1832. [PMID: 32533189 PMCID: PMC7372548 DOI: 10.1093/hmg/ddz269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Sex hormone-binding globulin (SHBG) is a circulating glycoprotein and a regulator of sex hormone levels, which has been shown to influence various traits and diseases. The molecular nature of SHBG makes it a feasible target for preventative or therapeutic interventions. A systematic study of its effects across the human phenome may uncover novel associations. Methods: We used a Mendelian randomization phenome-wide association study (MR-pheWAS) approach to systematically appraise the potential functions of SHBG while reducing potential biases such as confounding and reverse causation common to the literature. We searched for potential causal effects of SHBG in UK Biobank (N = 334 977) and followed-up our top findings using two-sample MR analyses to evaluate whether estimates may be biased due to horizontal pleiotropy. Results: Results of the MR-pheWAS across over 21 000 outcome phenotypes identified 12 phenotypes associated with genetically elevated SHBG after Bonferroni correction for multiple testing. Follow-up analysis using two-sample MR indicated the associations of increased natural log SHBG with higher impedance of the arms and whole body, lower pulse rate, lower bone density, higher odds of hip replacement, lower odds of high cholesterol or cholesterol medication use and higher odds of gallbladder removal. Conclusions: Our systematic MR-pheWAS of SHBG, which was comprehensive to the range of phenotypes available in UK Biobank, suggested that higher circulating SHBG affects the body impedance, bone density and cholesterol levels, among others. These phenotypes should be prioritized in future studies aiming to investigate the biological effects of SHBG or develop targets for therapeutic intervention.
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Affiliation(s)
- Ryan Arathimos
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
| | - Louise A C Millard
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Intelligent Systems Laboratory, University of Bristol, Bristol, UK
| | - Joshua A Bell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Caroline L Relton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Matthew Suderman
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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10
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Harrison S, Davies NM, Howe LD, Hughes A. Testosterone and socioeconomic position: Mendelian randomization in 306,248 men and women in UK Biobank. SCIENCE ADVANCES 2021; 7:7/31/eabf8257. [PMID: 34321204 PMCID: PMC8318368 DOI: 10.1126/sciadv.abf8257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/10/2021] [Indexed: 05/02/2023]
Abstract
Men with more advantaged socioeconomic position (SEP) have been observed to have higher levels of testosterone. It is unclear whether these associations arise because testosterone has a causal impact on SEP. In 306,248 participants of UK Biobank, we performed sex-stratified genome-wide association analysis to identify genetic variants associated with testosterone. Using the identified variants, we performed Mendelian randomization analysis of the influence of testosterone on socioeconomic position, including income, employment status, neighborhood-level deprivation, and educational qualifications; on health, including self-rated health and body mass index; and on risk-taking behavior. We found little evidence that testosterone affected socioeconomic position, health, or risk-taking. Our results therefore suggest that it is unlikely that testosterone meaningfully affects these outcomes in men or women. Differences between Mendelian randomization and multivariable-adjusted estimates suggest that previously reported associations with socioeconomic position and health may be due to residual confounding or reverse causation.
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Affiliation(s)
- Sean Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Hughes
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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11
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Aribas E, Ahmadizar F, Mutlu U, Ikram MK, Bos D, Laven JSE, Klaver CCW, Ikram MA, Roeters van Lennep JL, Kavousi M. Sex steroids and markers of micro- and macrovascular damage among women and men from the general population. Eur J Prev Cardiol 2021; 29:1322-1330. [PMID: 33580786 DOI: 10.1093/eurjpc/zwaa031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/11/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Abstract
AIMS The contribution of sex hormones to micro- and macrovascular damage might differ among women and men. In particular, little is known about the association between sex hormones and small vessel disease. Therefore, we examined the association of total oestradiol, total testosterone, free-androgen index (FAI), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), and androstenedione levels with micro- and macrovascular diseases. METHODS AND RESULTS This cross-sectional study included 2950 women and 2495 men from the population-based Rotterdam Study. As proxy of microvascular damage, we measured diameters of retinal arterioles and venules. Markers of macrovascular damage included carotid intima-media thickness and carotid plaque, coronary artery calcification (CAC), and peripheral artery disease. Linear and logistic regression models were used and adjusted for age, cardiovascular risk factors, and years since menopause. Associations with microvasculature: In women, total testosterone [mean difference per 1-unit increase in natural-log transformed total testosterone (95% confidence interval, CI): 2.59 (0.08-5.09)] and androstenedione [4.88 (1.82-7.95)] and in men DHEAS [2.80 (0.23-5.37)] and androstenedione [5.83 (2.19-9.46)] were associated with larger venular caliber. Associations with markers of large vessel disease: In women, higher total testosterone [-0.29 (-0.56 to -0.03)], FAI [-0.33 (-0.56 to -0.10)], and androstenedione levels [-0.33 (-0.64 to -0.02)] were associated with lower CAC burden and FAI [odds ratio (95% CI): 0.82 (0.71-0.94)] was associated with lower prevalence of plaque. CONCLUSION A more androgenic profile was associated with more microvascular damage in both women and men. Among women, however, higher androgen levels were also associated with less macrovascular damage. Our findings suggest that androgens might have distinct effects on the vasculature, depending on the vascular bed and stages of the atherosclerosis process.
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Affiliation(s)
- E Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F Ahmadizar
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - U Mutlu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M K Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C C W Klaver
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute for Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - M A Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J L Roeters van Lennep
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lv Y, Zhao W, Yu L, Yu JG, Zhao L. Angiotensin-Converting Enzyme Gene D/I Polymorphism in Relation to Endothelial Function and Endothelial-Released Factors in Chinese Women. Front Physiol 2020; 11:951. [PMID: 33041838 PMCID: PMC7526498 DOI: 10.3389/fphys.2020.00951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Many studies have investigated the relationship between angiotensin-converting enzyme (ACE) D/I polymorphism and cardiovascular disease or endothelial dysfunction; however, hardly any of these studies has taken aging or menopause into consideration. Furthermore, despite that many studies have examined the regulatory effects of endothelial-released factors (ERFs) on endothelial function, no study has evaluated the relationship between ERFs and endothelial function with respect to ACE D/I polymorphism and menopause status. To answer these questions, 391 healthy Chinese women over a wide range of ages (22-75 years) were enrolled and divided into pre-menopause group and post-menopause group. After ACE D/I genotype being identified, the women were then classified into either DI/II or DD genotype. Flow-mediated dilatation (FMD) of brachial endothelium and plasma levels of ERFs: nitric oxide (NO), endothelin-1 (ET-1), and angiotensin II (Ang II) were measured. The results showed that frequencies of ACE D/I genotypes were in accordance with the Hardy-Weinberg equilibrium, and the frequency of I allele was higher than D allele. In pre-menopause group, FMD was significantly higher in women of DI/II than DD (P = 0.032), and age-dependent in both genotypes (DD, P = 0.0472; DI/II, P < 0.0001). In post-menopause group, FMD was similar between women of DI/II and DD, and age-dependent only in women of DI/II (P < 0.0001). In pre-menopause group, Ang II level was significantly higher in women of DD than DI/II (P = 0.029), and FMD was significantly correlated with all ERFs in women of DD (NO, P = 0.032; ET-1, P = 0.017; Ang II, P = 0.002), but only with Ang II in women of DI/II (P = 0.026). In post-menopause group, no significant difference was observed in any ERF between women of DI/II and DD, and FMD was only significantly correlated with ET-1 in women of DD (P = 0.010). In summary, FMD in women of DI/II was superior to DD in pre-menopause and more age-dependent than DD in post-menopause, and FMD was closely associated with ERFs. In conclusion, Chinese women of DI/II seem to have lower risk than DD in pre-menopause, but similar risk as DD in post-menopause in developing cardiovascular disease.
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Affiliation(s)
- Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | | | - Laikang Yu
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Ji-Guo Yu
- Department of Community Medicine and Rehabilitation, Section of Sports Medicine, Umeå University, Umeå, Sweden
| | - Li Zhao
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
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13
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Stewart CE, Sohrabji F. Gonadal hormones and stroke risk: PCOS as a case study. Front Neuroendocrinol 2020; 58:100853. [PMID: 32640267 DOI: 10.1016/j.yfrne.2020.100853] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/20/2023]
Abstract
It is well known that stroke incidence and outcome is sex-dependent and influenced by age and gonadal hormones. In post-menopausal and/or aged females, declining estrogen levels increases stroke risk. However, women who experience early menopause also have an increase in stroke risk. This suggests that, regardless of age, gonadal hormones regulate stroke risk and severity. This review discusses prolonged gonadal hormone dysfunction in a common female endocrine disorder known as polycystic ovarian syndrome, PCOS, and the associated increased risk of stroke due to resulting hyperandrogenism and metabolic comorbidities.
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Affiliation(s)
- Courtney E Stewart
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX 77807, USA
| | - Farida Sohrabji
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX 77807, USA.
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Kurniawan AL, Lee YC, Shih CK, Hsieh RH, Chen SH, Chang JS. Alteration in iron efflux affects male sex hormone testosterone biosynthesis in a diet-induced obese rat model. Food Funct 2020; 10:4113-4123. [PMID: 31233037 DOI: 10.1039/c8fo01870g] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study was motivated by clinical observations that dysmetabolic iron overload syndrome (DIOS) and an androgen deficiency are common features observed in obese adult men; however, the molecular mechanism underlying the effects of DIOS on androgen deficiency remains to be elucidated. We established a DIOS animal model by feeding Sprague-Dawley rats an iron/fat-enriched diet (50% fat plus 0.25, 1, or 2 g ferric iron per kg diet) for 12 weeks to induce iron dysfunction (indicated by decreased tissue iron efflux) in obese rats. Obese rats fed an iron/fat-enriched diet showed decreased levels of testicular total Testosterone (T) and iron exporter ferroportin but increased levels of testicular iron and hepcidin, and these effects were more evident with a >1 g ferric iron per kg diet. A western blot analysis showed that an iron/fat-enriched diet triggered testicular endoplasmic reticular (ER) stress but decreased mitochondrion biogenesis proteins (PGC1α and TFAM) and T-converting proteins (StAR, CYP11A, and 17β-HSD). TUNEL staining showed that >1 g ferric iron induced apoptosis mainly in germ cells and Leydig's cells. Uncontrolled testicular iron efflux may cause mitochondrial-ER dysfunction and affect T biosynthesis. Future study targeting the testicular hepcidin-ferroportin axis may offer a therapeutic tool to alleviate testicular iron retention and mitochondrial-ER stress in Leydig's cells.
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Affiliation(s)
- Adi Lukas Kurniawan
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Chieh Lee
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Kuang Shih
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan. and School of Food Safety, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Rong-Hong Hsieh
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
| | - Seu-Hwa Chen
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan. and Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan and Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan and Chinese Taipei Society for the Study of Obesity, CTSSO, Taipei, Taiwan
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15
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Barrientos G, Llanos P, Basualto-Alarcón C, Estrada M. Androgen-Regulated Cardiac Metabolism in Aging Men. Front Endocrinol (Lausanne) 2020; 11:316. [PMID: 32499759 PMCID: PMC7243157 DOI: 10.3389/fendo.2020.00316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
The prevalence of cardiovascular mortality is higher in men than in age-matched premenopausal women. Gender differences are linked to circulating sex-related steroid hormone levels and their cardio-specific actions, which are critical factors involved in the prevalence and features of age-associated cardiovascular disease. In women, estrogens have been described as cardioprotective agents, while in men, testosterone is the main sex steroid hormone. The effects of testosterone as a metabolic regulator and cardioprotective agent in aging men are poorly understood. With advancing age, testosterone levels gradually decrease in men, an effect associated with increasing fat mass, decrease in lean body mass, dyslipidemia, insulin resistance and adjustment in energy substrate metabolism. Aging is associated with a decline in metabolism, characterized by modifications in cardiac function, excitation-contraction coupling, and lower efficacy to generate energy. Testosterone deficiency -as found in elderly men- rapidly becomes an epidemic condition, associated with prominent cardiometabolic disorders. Therefore, it is highly probable that senior men showing low testosterone levels will display symptoms of androgen deficiency, presenting an unfavorable metabolic profile and increased cardiovascular risk. Moreover, recent reports establish that testosterone replacement improves cardiomyocyte bioenergetics, increases glucose metabolism and reduces insulin resistance in elderly men. Thus, testosterone-related metabolic signaling and gene expression may constitute relevant therapeutic target for preventing, or treating, age- and gender-related cardiometabolic diseases in men. Here, we will discuss the impact of current evidence showing how cardiac metabolism is regulated by androgen levels in aging men.
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Affiliation(s)
- Genaro Barrientos
- Programa de Fisiología y Biofísica, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer (CEMC), Universidad de Chile, Santiago, Chile
| | - Paola Llanos
- Centro de Estudios en Ejercicio, Metabolismo y Cáncer (CEMC), Universidad de Chile, Santiago, Chile
- Facultad de Odontología, Instituto de Investigación en Ciencias Odontológicas (ICOD), Universidad de Chile, Santiago, Chile
| | - Carla Basualto-Alarcón
- Departamento de Ciencias de la Salud, Universidad de Aysén, Coyhaique, Chile
- Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Manuel Estrada
- Programa de Fisiología y Biofísica, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
- *Correspondence: Manuel Estrada
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Abstract
The cardiovascular system is particularly sensitive to androgens, but some controversies exist regarding the effect of testosterone on the heart. While among anabolic abusers, cases of sudden cardiac death have been described, recently it was reported that low serum level of testosterone was correlated with increased risk of cardiovascular diseases (CVD) and mortality rate. This review aims to evaluate the effect of testosterone on myocardial tissue function, coronary artery disease (CAD), and death. Low testosterone level is associated with increased incidence of CAD and mortality. Testosterone administration in hypogonadal elderly men and women has a positive effect on cardiovascular function and improved clinical outcomes and survival time. Although at supraphysiologic doses, androgen may have a toxic effect, and at physiological levels, testosterone is safe and exerts a beneficial effect on myocardial function including mechanisms at cellular and mitochondrial level. The interaction with free testosterone and estradiol should be considered. Further studies are necessary to better understand the interaction mechanisms for an optimal androgen therapy in CVD.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Clinical Center Stella Maris, Laboratory of Physiology of Exercise, Strada Rovereta 42, 47891, Falciano, Republic of San Marino.
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17
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Testosterone-Associated Dietary Pattern Predicts Low Testosterone Levels and Hypogonadism. Nutrients 2018; 10:nu10111786. [PMID: 30453566 PMCID: PMC6266690 DOI: 10.3390/nu10111786] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/31/2022] Open
Abstract
Obesity and low serum testosterone (T) levels are interrelated and strongly influenced by dietary factors, and their alteration entails a great risk of hypogonadism. Substantial evidence suggests a bidirectional relationship between nutrient metabolism (e.g., glucose, lipids, and iron) and T levels in men; however, T-related dietary patterns remain unclear. This study investigated the dietary patterns associated with serum total T levels and its predictive effect on hypogonadism and the body composition. Anthropometry, blood biochemistry, and food frequency questionnaires were collected for 125 adult men. Dietary patterns were derived using a reduced rank regression from 32 food groups. Overall prevalence rates of central obesity and hypogonadism were 48.0% and 15.7%, respectively. An adjusted linear regression showed that age, insulin, red blood cell (RBC) aggregation, and transferrin saturation independently predicted serum total T levels (all p < 0.01). The total T-related dietary pattern (a high consumption of bread and pastries, dairy products, and desserts, eating out, and a low intake of homemade foods, noodles, and dark green vegetables) independently predicted hypogonadism (odds ratio: 5.72; 95% confidence interval: 1.11‒29.51, p < 0.05) for those with the highest dietary pattern scores (Q4) compared to those with the lowest (Q1). Scores were also negatively correlated with the skeletal muscle mass (p for trend = 0.002) but positively correlated with the total body fat mass (p for trend = 0.002), visceral fat mass (p for trend = 0.001), and to a lesser extent, subcutaneous fat mass (p for trend = 0.035) after adjusting for age. Randomized controlled trials are needed to confirm that improvement in dietary pattern can improve T levels and reduce hypogonadism.
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18
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Meun C, Franco OH, Dhana K, Jaspers L, Muka T, Louwers Y, Ikram MA, Fauser BCJM, Kavousi M, Laven JSE. High Androgens in Postmenopausal Women and the Risk for Atherosclerosis and Cardiovascular Disease: The Rotterdam Study. J Clin Endocrinol Metab 2018; 103:1622-1630. [PMID: 29408955 DOI: 10.1210/jc.2017-02421] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/26/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is closely linked to hyperandrogenism (HA). In PCOS, HA has been associated with metabolic disturbances that increase the risk for cardiovascular disease (CVD). OBJECTIVE To assess the association of high serum androgen levels, as a postmenopausal remnant of PCOS, with the prevalence of atherosclerosis and incidence of CVD in postmenopausal women. DESIGN The Rotterdam Study, a prospective population-based cohort study. Median follow-up was 11.36 years. SETTING General community. PARTICIPANTS A total of 2578 women aged >55 years. Exclusion criteria were missing informed consent or follow-up data, perimenopausal status, and menopause by surgical intervention or at an unnatural age (age <40 or >62). INTERVENTION None. MAIN OUTCOMES AND MEASURES Linear, logistic, and Cox regression models assessed the association of top quartiles (P75) of serum testosterone, free androgen index (FAI), dehydroepiandrosterone, and androstenedione and sex hormone-binding globulin with coronary artery calcium, carotid intima-media thickness (IMT), pulse wave velocity, peripheral artery disease, and incidence of coronary heart disease (CHD), stroke, and CVD. RESULTS Mean age (standard deviation) was 70.19 (8.71) years, and average time since menopause was 19.85 (9.94) years. Highest quartile FAI was associated with higher pulse wave velocity (β [95% confidence interval (CI)], 0.009 [0.000 to 0.018]). Highest quartile dehydroepiandrosterone [β (95% CI), -0.008 (-0.015 to -0.001)] and androstenedione [β (95% CI), -0.010 (-0.017 to -0.003)] levels were associated with a lower IMT. We found no association between high androgen levels and incident stroke, CHD, or CVD. CONCLUSION Postmenopausal high androgen levels were not associated with an elevated risk for CVD. Cardiovascular health in women with PCOS might be better than was anticipated.
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Affiliation(s)
- Cindy Meun
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Klodian Dhana
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Loes Jaspers
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Taulant Muka
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Yvonne Louwers
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Elagizi A, Köhler TS, Lavie CJ. Testosterone and Cardiovascular Health. Mayo Clin Proc 2018; 93:83-100. [PMID: 29275030 DOI: 10.1016/j.mayocp.2017.11.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/29/2022]
Abstract
There is an ongoing debate in the medical community regarding the effects of testosterone on cardiovascular (CV) health. For decades, there has been conflicting evidence regarding the association of endogenous testosterone levels and CV disease (CVD) events that has resulted in much debate and confusion among health care providers and patients alike. Testosterone therapy has become increasingly widespread, and after the emergence of studies that reported increased CVD events in patients receiving testosterone therapy, the US Food and Drug Administration (FDA) released a warning statement about testosterone and its potential risk regarding CV health. Some of these studies were later found to be critically flawed, and some experts, including the American Association of Clinical Endocrinologists and an expert panel regarding testosterone deficiency and its treatment, reported that some of the FDA statements regarding testosterone therapy were lacking scientific evidence. This article summarizes the current evidence regarding the relationship between testosterone (endogenous and supplemental) and CV health. A literature review was conducted via search using PubMed and specific journal databases, including the New England Journal of Medicine and the Journal of the American College of Cardiology. Key search terms included testosterone and cardiovascular health, coronary artery disease, heart failure, androgen deprivation therapy, intima-media thickness, and adrenal androgens. Initial study selection was limited to publications within the past 10 years (January 1, 2007, through December 31, 2016); however, key publications outside of this time frame were selected if they provided important quantitative data or historical perspectives for the review of this topic. The search was further supplemented by reviewing references in selected articles.
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Affiliation(s)
- Andrew Elagizi
- Department of Internal Medicine, Leonard J. Chabert Medical Center, Houma, LA
| | - Tobias S Köhler
- Department of Urology, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
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20
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Sex-specific metabolic profiles of androgens and its main binding protein SHBG in a middle aged population without diabetes. Sci Rep 2017; 7:2235. [PMID: 28533544 PMCID: PMC5440388 DOI: 10.1038/s41598-017-02367-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/10/2017] [Indexed: 01/21/2023] Open
Abstract
The role of androgens in metabolism with respect to sex-specific disease associations is poorly understood. Therefore, we aimed to provide molecular signatures in plasma and urine of androgen action in a sex-specific manner using state-of-the-art metabolomics techniques. Our study population consisted of 430 men and 343 women, aged 20-80 years, who were recruited for the cross-sectional population-based Study of Health in Pomerania (SHIP-TREND), Germany. We used linear regression models to identify associations between testosterone, androstenedione and dehydroepiandrosterone-sulfate (DHEAS) as well as sex hormone-binding globulin and plasma or urine metabolites measured by mass spectrometry. The analyses revealed major sex-specific differences in androgen-associated metabolites, particularly for levels of urate, lipids and metabolic surrogates of lifestyle factors, like cotinine or piperine. In women, in particular in the postmenopausal state, androgens showed a greater impact on the metabolome than in men (especially DHEAS and lipids were highly related in women). We observed a novel association of androstenedione on the metabolism of biogenic amines and only a small sex-overlap of associations within steroid metabolism. The present study yields new insights in the interaction between androgens and metabolism, especially about their implication in female metabolism.
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Bonilla-Becerra SM, de Oliveira MG, Calmasini FB, Rojas-Moscoso JA, Zanesco A, Antunes E. Micturition dysfunction in four-month old ovariectomized rats: Effects of testosterone replacement. Life Sci 2017; 179:120-129. [PMID: 28487215 DOI: 10.1016/j.lfs.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/13/2017] [Accepted: 05/05/2017] [Indexed: 01/01/2023]
Abstract
AIMS Androgen deficiency has been implicated in urological complications of postmenopausal women. This study examined the effects of testosterone replacements on the lower urinary tract dysfunction in 4-month old ovariectomized (OVX) rats. MAIN METHODS Sprague-Dawley female rats were OVX bilaterally. Three months later, rats received single intramuscular injections of testosterone undecanoate. Cystometric study, and bladder and urethra smooth muscle reactivities were evaluated. KEY FINDINGS Ovariectomy reduced by 65% (p<0.05) the serum testosterone levels. Testosterone replacement at 5mg/kg restored serum hormone levels to baseline, whereas 10mg/kg produced 14-fold higher testosterone levels. OVX rats exhibited significant increases of body weight, perigonadal fat and blood pressure, and reduced uterus weight, but none of these parameters were changed by testosterone replacements. OVX rats exhibited micturition dysfunction characterized by increases of basal pressure, threshold pressure, voiding frequency and post-voiding pressure. In addition, the bladder contractions induced by electrical-field stimulation (EFS) and carbachol were significantly reduced, whereas angiotensin II-induced urethral contractions were significantly increased in OVX rats. Testosterone replacement at 10mg/kg (but not at 5mg/kg) dose fully normalized the in vivo micturition dysfunction, as well as the in vitro bladder and urethral alterations. Testosterone (10mg/kg) also significantly potentiated the bladder relaxations induced by the β3-adrenoceptor agonist mirabegron. The protective effects of testosterone were not modified by concomitant treatment with the aromatase inhibitor letrozole (2.5mg/kg, 4weeks). SIGNIFICANCE The improvement of micturition dysfunction by testosterone replacement suggests that androgen therapy might be of therapeutic benefit for urological complications associated with post-menopause.
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Affiliation(s)
- Sandra M Bonilla-Becerra
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mariana G de Oliveira
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fabiano B Calmasini
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Julio A Rojas-Moscoso
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
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22
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Muka T, Nano J, Jaspers L, Meun C, Bramer WM, Hofman A, Dehghan A, Kavousi M, Laven JSE, Franco OH. Associations of Steroid Sex Hormones and Sex Hormone-Binding Globulin With the Risk of Type 2 Diabetes in Women: A Population-Based Cohort Study and Meta-analysis. Diabetes 2017; 66:577-586. [PMID: 28223343 DOI: 10.2337/db16-0473] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/04/2016] [Indexed: 12/20/2022]
Abstract
It remains unclear whether endogenous sex hormones (ESH) are associated with risk of type 2 diabetes (T2D) in women. Data of 3,117 postmenopausal women participants of the Rotterdam Study were analyzed to examine whether ESH and sex hormone-binding globulin (SHBG) were associated with the risk of incident T2D. Additionally, we performed a systematic review and meta-analysis of studies assessing the prospective association of ESH and SHBG with T2D in women. During a median follow-up of 11.1 years, we identified 384 incident cases of T2D in the Rotterdam Study. No association was observed between total testosterone (TT) or bioavailable testosterone (BT) with T2D. SHBG was inversely associated with the risk of T2D, whereas total estradiol (TE) was associated with increased risk of T2D. Similarly, in the meta-analysis of 13 population-based prospective studies involving more than 1,912 incident T2D cases, low levels of SHBG and high levels of TE were associated with increased risk of T2D, whereas no associations were found for other hormones. The association of SHBG with T2D did not change by menopause status, whereas the associations of ESH and T2D were based only in postmenopausal women. SHBG and TE are independent risk factors for the development of T2D in women.
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Affiliation(s)
- Taulant Muka
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jana Nano
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Loes Jaspers
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Cindy Meun
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Joop S E Laven
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
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Associations of androgens with health care utilization and costs in women—Perspectives of a population-based cohort study. Maturitas 2016; 89:5-8. [DOI: 10.1016/j.maturitas.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/29/2016] [Accepted: 04/02/2016] [Indexed: 11/24/2022]
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24
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Olszanecka A, Kawecka-Jaszcz K, Czarnecka D. Association of free testosterone and sex hormone binding globulin with metabolic syndrome and subclinical atherosclerosis but not blood pressure in hypertensive perimenopausal women. Arch Med Sci 2016; 12:521-8. [PMID: 27279843 PMCID: PMC4889686 DOI: 10.5114/aoms.2016.59925] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Data on the role of androgens as potential mediators of increasing cardiovascular risk in women at midlife are controversial. The aim of the study was to analyze the relationship of free testosterone (FT) and sex hormone binding globulin (SHBG) with blood pressure and subclinical organ damage and metabolic syndrome (MS) in middle aged hypertensive women. MATERIAL AND METHODS One hundred and fifty-two women with newly diagnosed arterial hypertension were included in the study. In all subjects blood pressure measurements were performed as well as echocardiographic examination with left ventricular structure and function assessment (GE Vivid 7.0), carotid ultrasound with measurement of intima-media thickness (IMT), and carotid-femoral pulse wave velocity (PWV) measurement (Sphygmocor). A fasting blood sample was taken to measure glucose and lipid concentrations. Serum testosterone and SHBG were measured. Free testosterone was calculated according to the Vermeulen formula. Metabolic syndrome was defined following the International Diabetes Federation (IDF) recommendations. RESULTS Free testosterone was significantly higher and SHBG lower in women with MS independently of menopausal status. The odds ratio of MS per quartile increment in FT after adjustment for covariates was 2.06 (95% CI: 1.16-3.65). There was no correlation between FT, SHBG and blood pressure. Free testosterone was associated with decreased left ventricular diastolic function (E/A ratio β = -0.19, p = 0.05) and subclinical atherosclerosis (IMT β = 0.34, p = 0.009), but not arterial stiffness. CONCLUSIONS Free testosterone and SHBG independently of menopause status are related to MS. Free testosterone is associated with worse metabolic profile, subclinical atherosclerosis and impaired diastolic function of the left ventricle.
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Affiliation(s)
- Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Danuta Czarnecka
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
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Kische H, Gross S, Wallaschofski H, Völzke H, Dörr M, Nauck M, Felix SB, Haring R. Serum androgen concentrations and subclinical measures of cardiovascular disease in men and women. Atherosclerosis 2016; 247:193-200. [PMID: 26926599 DOI: 10.1016/j.atherosclerosis.2016.02.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/09/2016] [Accepted: 02/17/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Most of the observed associations of androgens and sex hormone-binding globulin (SHBG) with subclinical cardiovascular disease (CVD) stem from selected study samples with immunoassay-based hormone measurements. Thus, we used a large population-based sample with total testosterone (TT) and androstenedione (ASD) concentrations measured by liquid chromatography-tandem mass spectrometry. DESIGN Data of 2140 individuals (mean age: 60,8 years) from the cohort Study of Health in Pomerania were assessed at baseline and 5-year follow-up. METHODS Multivariable regression models were implemented to assess cross-sectional and longitudinal associations of TT, free testosterone (fT), ASD, SHBG and dehydroepiandrosterone-sulphate (DHEAS) with measures of subclinical CVD including intima media thickness (IMT), carotid plaques, left ventricular mass (LVM), fractional shortening (FS), relative wall thickness (RWT), and left ventricular geometry. RESULTS Cross-sectional analyses yielded an association of TT with IMT in women (β-coefficient per log unit increase: 0.02; 95% CI: 0.007; 0.45) and ASD with FS in both sexes (men: β-coefficient: -2.94; 95% CI: -4.75; -1.12; women: β-coefficient: 1.64; 95% CI: 0.55; 2.73). In longitudinal analyses, DHEAS was positively associated with FS change (β-coefficient: 2.34; 95% CI: -0.59; 4.08). In women, SHBG was positively associated with incident plaques (Q1 vs. Q3 (Ref.): β-coefficient: 1.35; 95% CI: 1.04; 1.74). In both sexes, longitudinal analyses showed no consistent association of TT with subclinical CVD. CONCLUSIONS Despite several sex-specific associations of androgens and SHBG with subclinical CVD, the present representative study for the age group ≥45 years among men and women from the general population detected no consistent associations in longitudinal analyses.
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Affiliation(s)
- Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine, Germany.
| | - Stefan Gross
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Institute for Community Medicine, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany; Department of Cardiology, University Medicine Greifswald, Germany
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine, Germany; European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
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Fenske B, Kische H, Gross S, Wallaschofski H, Völzke H, Dörr M, Nauck M, Keevil BG, Brabant G, Haring R. Endogenous Androgens and Sex Hormone-Binding Globulin in Women and Risk of Metabolic Syndrome and Type 2 Diabetes. J Clin Endocrinol Metab 2015; 100:4595-603. [PMID: 26445113 DOI: 10.1210/jc.2015-2546] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT AND OBJECTIVES The association of endogenous androgens and sex hormone-binding globulin (SHBG) with metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) mostly 23562 refers to small and selected study samples with immunoassay-based measurements. Thus, we investigated the association of hormone levels with MetS and T2DM in women from a large population-based sample. DESIGN, SETTING, AND PARTICIPANTS A total of 2077 women from the Study of Health in Pomerania were assessed at baseline (N = 3160, 1997-2001) and 5-year follow-up (N = 1711, 2002-2006). MAIN OUTCOMES AND MEASURES We investigated associations of total testosterone (T) and androstenedione measured by liquid chromatography-tandem mass spectrometry, SHBG by immunoassay, and free T and free androgen index with MetS and T2DM. RESULTS Baseline prevalence of MetS and T2DM was 23.1% (N = 365) and 9.5% (N = 196), with an incidence of 17.7 and 7.0 per 1.000 person-years, respectively. Cross-sectional analyses yielded inverse associations of SHBG with MetS (relative risk [RR], 0.67; 95% confidence interval [CI], 0.60-0.74) and T2DM (RR, 0.61; 95% CI, 0.50-0.74) after multivariable adjustment. In longitudinal analyses, only age-adjusted models showed an inverse association of baseline SHBG with incident MetS (RR, 0.61; 95% CI, 0.51-0.73) and T2DM (RR, 0.58; 95% CI, 0.43-0.78). Multivariable-adjusted models stratified by menopausal status revealed an inverse association between SHBG and incident MetS risk in postmenopausal women (RR, 0.65; 95% CI, 0.51-0.81). CONCLUSIONS This longitudinal population-based study revealed independent inverse associations of SHBG with MetS and T2DM, suggesting low SHBG as a potential risk marker for cardiometabolic morbidity, especially among postmenopausal women.
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Affiliation(s)
- Benjamin Fenske
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Hanna Kische
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Stefan Gross
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Henry Völzke
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Marcus Dörr
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Brian G Keevil
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Georg Brabant
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine (B.F., H.K. H.W., M.N., R.H.), DZHK (German Centre for Cardiovascular Research) (S.G., H.W., H.V., M.D., M.N., R.H.), Greifswald, Germany 17475, Institute for Community Medicine (H.V.), Department of Cardiology (S.G., M.D.), University Medicine Greifswald, Germany 17475; Department of Clinical Chemistry (B.G.K.), University Hospital, South Manchester, United Kingdom M23 9LT; Department of Internal Medicine I (G.B.), University Lübeck, Germany 23562; and European University of Applied Sciences (R.H.), Faculty of Applied Public Health, Rostock, Germany 18057
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Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial. Menopause 2015; 21:612-23. [PMID: 24281237 DOI: 10.1097/gme.0000000000000093] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aims to determine the dose-dependent effects of testosterone on sexual function, body composition, muscle performance, and physical function in hysterectomized women with or without oophorectomy. METHODS Seventy-one postmenopausal women who previously underwent hysterectomy with or without oophorectomy and had total testosterone levels less than 31 ng/dL or free testosterone levels less than 3.5 pg/mL received a standardized transdermal estradiol regimen during the 12-week run-in period and were randomized to receive weekly intramuscular injections of placebo or 3, 6.25, 12.5, or 25 mg of testosterone enanthate for 24 weeks. Total and free testosterone levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. The primary outcome was change in sexual function measured by the Brief Index of Sexual Functioning for Women. Secondary outcomes included changes in sexual activity, sexual distress, Derogatis Interview for Sexual Functioning, lean body mass, fat mass, muscle strength and power, and physical function. RESULTS Seventy-one women were randomized; five groups were similar at baseline. Sixty-two women with analyzable data for the primary outcome were included in the final analysis. The mean on-treatment total testosterone concentrations were 19, 78, 102, 128, and 210 ng/dL in the placebo, 3-mg, 6.25-mg, 12.5-mg, and 25-mg groups, respectively. Changes in composite Brief Index of Sexual Functioning for Women scores, thoughts/desire, arousal, frequency of sexual activity, lean body mass, chest-press power, and loaded stair-climb power were significantly related to increases in free testosterone concentrations; compared with placebo, changes were significantly greater in women assigned to the 25-mg group, but not in women in the lower-dose groups. Sexual activity increased by 2.7 encounters per week in the 25-mg group. The frequency of androgenic adverse events was low. CONCLUSIONS Testosterone administration in hysterectomized women with or without oophorectomy for 24 weeks was associated with dose and concentration-dependent gains in several domains of sexual function, lean body mass, chest-press power, and loaded stair-climb power. Long-term trials are needed to weigh improvements in these outcomes against potential long-term adverse effects.
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Huang G, Tang E, Aakil A, Anderson S, Jara H, Davda M, Stroh H, Travison TG, Bhasin S, Basaria S. Testosterone dose-response relationships with cardiovascular risk markers in androgen-deficient women: a randomized, placebo-controlled trial. J Clin Endocrinol Metab 2014; 99:E1287-93. [PMID: 24712568 PMCID: PMC4079305 DOI: 10.1210/jc.2013-4160] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine dose-dependent effects of T administration on cardiovascular risk markers in women with low T levels. METHODS Seventy-one hysterectomized women with or without oophorectomy with total T < 31 ng/dL and/or free T < 3.5 pg/mL received a standardized transdermal estradiol regimen during the 12-week run-in period and were then randomized to receive weekly im injections of placebo or 3-, 6.25-, 12.5-, or 25-mg T enanthate for 24 weeks. Total and free T levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. Insulin resistance and inflammatory markers were measured at baseline and 24 weeks. In a subset of women, magnetic resonance imaging of the abdomen was performed to quantify abdominal fat volume. RESULTS Fifty-nine women who completed the 24-week intervention were included in the final analysis. The five groups were similar at baseline. Mean on-treatment nadir total T concentrations were 14, 79, 105, 130, and 232 ng/dL in the placebo group and the 3-, 6.25-, 12.5-, and 25-mg groups, respectively. No significant changes in fasting glucose, fasting insulin, homeostatic model assessment of insulin resistance, high sensitivity C-reactive protein, adiponectin, blood pressure, and heart rate were observed at any T dose when compared to placebo. Similarly, no dose- or concentration-dependent changes were observed in abdominal fat on magnetic resonance imaging. CONCLUSION Short-term T administration over a wide range of doses for 24 weeks in women with low T levels was not associated with worsening of cardiovascular risk markers.
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Affiliation(s)
- Grace Huang
- Section of Men's Health: Aging and Metabolism (G.H., M.D., H.S., T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; and Department of Radiology (E.T., A.A., S.A., H.J.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118
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Poels S, Bloemers J, van Rooij K, Koppeschaar H, Olivier B, Tuiten A. Two novel combined drug treatments for women with hypoactive sexual desire disorder. Pharmacol Biochem Behav 2014; 121:71-9. [DOI: 10.1016/j.pbb.2014.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 01/23/2023]
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Spoletini I, Vitale C, Pelliccia F, Fossati C, Rosano GMC. Androgens and cardiovascular disease in postmenopausal women: a systematic review. Climacteric 2014; 17:625-34. [DOI: 10.3109/13697137.2014.887669] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Positive association between testosterone, blood pressure, and hypertension in women. J Hypertens 2013; 31:1106-13. [DOI: 10.1097/hjh.0b013e3283603eb1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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34
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Gangula PR, Dong YL, Al-Hendy A, Richard-Davis G, Montgomery-Rice V, Haddad G, Millis R, Nicholas SB, Moseberry D. Protective cardiovascular and renal actions of vitamin D and estrogen. Front Biosci (Schol Ed) 2013; 5:134-48. [PMID: 23277041 PMCID: PMC3673780 DOI: 10.2741/s362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Both basic science and clinical studies support the concept that vitamin D deficiency is involved in the pathogenesis of cardiovascular and renal diseases through its association with diabetes, obesity, and hypertension. Understanding the underlying mechanisms may provide a rationale for advocating adequate intake of vitamin D and calcium in all populations, thereby preventing many chronic diseases. This review explores the effect of vitamin D deficiency in the development of cardiovascular and renal diseases, and the role of vitamin D supplementation on cardiovascular outcomes. In addition, it highlights the importance of vitamin D intake for the prevention of adverse long-term health consequences, and in ways to facilitate the management of cardiovascular disease. This is particularly true for African American and postmenopausal women, who are at added risk for cardiovascular disease. We suggest that the negative cardiovascular effects of low vitamin D in postmenopausal women could be improved by a combined treatment of vitamin D and sex steroids acting through endothelium-dependent and/or -independent mechanisms, resulting in the generation of nitric oxide and calcitonin gene-related peptide (CGRP).
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Affiliation(s)
- Pandu R Gangula
- Departments of Physiology, Meharry Medical College, Nashville, TN 37208, USA.
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35
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Abstract
Testosterone is increasingly used as part of postmenopausal HRT regimens. Unfortunately, few androgenic preparations designed specifically for use in women have been approved by regulatory authorities. Ongoing concerns exist surrounding the potential long-term effects of testosterone therapy. Here, we review the most recent data on postmenopausal testosterone therapy, focusing particularly on the effects of testosterone on breast, endometrium and cardiovascular health.
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Affiliation(s)
- Kate Maclaran
- West London Menopause & PMS Centre, Department of Gynaecology, Queen Charlotte's & Chelsea Hospital, Du Cane Road, London W12 0HS, UK
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Michalakis K, Coppack SW. Primary ovarian insufficiency: Relation to changes in body composition and adiposity. Maturitas 2012; 71:320-5. [DOI: 10.1016/j.maturitas.2011.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 12/21/2011] [Accepted: 12/24/2011] [Indexed: 11/27/2022]
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Davis SR, Braunstein GD. Efficacy and Safety of Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women. J Sex Med 2012; 9:1134-48. [DOI: 10.1111/j.1743-6109.2011.02634.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hadji P, Kauka A, Bauer T, Tams J, Hasenburg A, Kieback DG. Effects of exemestane and tamoxifen on hormone levels within the Tamoxifen Exemestane Adjuvant Multicentre (TEAM) trial: results of a German substudy. Climacteric 2012; 15:460-6. [PMID: 22321061 DOI: 10.3109/13697137.2011.647839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to compare the effects of exemestane and tamoxifen on hormone levels in postmenopausal patients with hormone receptor-positive breast cancer within a Germany substudy of the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial. METHODS Within the TEAM trial, patients were randomized to receive adjuvant treatment with exemestane for 5 years or tamoxifen for 2.5-3 years followed by exemestane for 2-2.5 years. Serum levels of testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH) and parathyroid hormone (PTH)-intact were measured at screening and after 3, 6 and 12 months of treatment. RESULTS Data on hormone levels were available from 63 patients in the tamoxifen arm and 68 patients in the exemestane arm. Treatment with exemestane resulted in decreases from baseline in SHBG and PTH-intact levels, and increases from baseline in testosterone, DHEAS and FSH levels. Tamoxifen treatment resulted in increases from baseline in SHBG and PTH-intact, whereas levels of testosterone and FSH decreased and DHEAS levels did not change. At all time points assessed, the absolute change from baseline was significantly different between tamoxifen and exemestane for testosterone, SHBG, FSH and PTH-intact (all p < 0.0001). CONCLUSIONS Exemestane and tamoxifen had statistically significantly different effects on hormone levels, including testosterone, SHBG, FSH and PTH-intact.
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Affiliation(s)
- P Hadji
- University Hospital of Giessen and Marburg, Marburg, Germany
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Creatsa M, Armeni E, Stamatelopoulos K, Rizos D, Georgiopoulos G, Kazani M, Alexandrou A, Dendrinos S, Augoulea A, Papamichael C, Lambrinoudaki I. Circulating androgen levels are associated with subclinical atherosclerosis and arterial stiffness in healthy recently menopausal women. Metabolism 2012; 61:193-201. [PMID: 21820132 DOI: 10.1016/j.metabol.2011.06.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 06/03/2011] [Accepted: 06/05/2011] [Indexed: 01/09/2023]
Abstract
Although increasing evidence supports an association between endogenous sex hormones and cardiovascular disease, the results still remain controversial. This study aims to examine the association between endogenous sex hormones and indices of vascular function and structure. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate (DHEAS), and Δ4-androstenedione were measured in 120 healthy postmenopausal women aged 41 to 60 years. Possible associations with surrogate markers of subclinical atherosclerosis, arterial stiffness, and endothelial function were investigated. Indices of arterial structure included carotid and femoral intima-media thickness and atheromatous plaques presence. Indices of arterial function included flow-mediated dilation of the brachial artery, carotid-femoral pulse wave velocity (PWV), and augmentation index. Total testosterone and free androgen index (FAI) were the most important predictors of common carotid artery intima-media thickness (β = 0.376 and β = 0.236, P < .001 and P = .014, respectively). Similarly, FAI was the only significant independent predictor of PWV (β = 0.254, P = .027) after adjusting for age, smoking, body mass index, homeostasis model assessment of insulin resistance, and blood lipids. Free estrogen index showed a positive association with PWV, independently of age, smoking, and body mass index, but not of homeostasis model assessment of insulin resistance and blood lipids. Age-adjusted levels of DHEAS exhibited a significant independent negative association with measures of augmentation index. Follicle-stimulating hormone, luteinizing hormone, estradiol, sex hormone-binding globulin, and Δ4-androstenedione were not associated with any of the vascular parameters independently of traditional cardiovascular risk factors. Higher serum testosterone and FAI are associated with subclinical atherosclerosis in healthy recently menopausal women. This association is independent of traditional cardiovascular risk factors or insulin resistance. On the contrary, serum DHEAS exhibits a negative association with arterial stiffness.
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Affiliation(s)
- Maria Creatsa
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, GR-11528, Athens, Greece
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Dai W, Li Y, Zheng H. Estradiol/Testosterone Imbalance: Impact on Coronary Heart Disease Risk Factors in Postmenopausal Women. Cardiology 2012; 121:249-54. [DOI: 10.1159/000337274] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/06/2012] [Indexed: 11/19/2022]
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Haring R, Travison TG, Bhasin S, Vasan RS, Wallaschofski H, Davda MN, Coviello A, Murabito JM. Relation between sex hormone concentrations, peripheral arterial disease, and change in ankle-brachial index: findings from the Framingham Heart Study. J Clin Endocrinol Metab 2011; 96:3724-32. [PMID: 21937625 PMCID: PMC3232625 DOI: 10.1210/jc.2011-1068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 08/29/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objective was to investigate cross-sectional and longitudinal associations of sex hormone concentrations with ankle-brachial index (ABI) and peripheral arterial disease (PAD). METHODS AND RESULTS We used data from 3034 (1612 women) participants of the Framingham Heart Study. ABI was measured and PAD defined as ABI below 0.90, intermittent claudication, or lower extremity revascularization. Sex hormone concentrations were measured by liquid chromatography-tandem mass spectrometry [total testosterone (T), total estradiol, and estrone], immunofluorometric assay (SHBG), or calculated (free T). Sex-specific multivariable linear and logistic regression models were conducted for each sex hormone separately. Cross-sectional multivariable analyses revealed that men with lower free T and higher estrone (E1) concentrations had a significantly lower ABI [for free T, lowest vs. higher quartiles, β = -0.02, with 95% confidence interval (CI) = -0.04 to -0.001; and for E1, highest vs. lower quartiles, β = -0.02, with 95% CI = -0.04 to -0.002, respectively). Lower total T and SHBG concentrations were also associated with prevalent PAD in age-adjusted [odds ratio (OR) = 2.24, 95% CI = 1.17-4.32; and OR = 2.06; 95% CI = 1.07-3.96, lowest vs. highest quartile, respectively), but not in multivariable logistic regression models. Longitudinal multivariable analyses showed an association of lower SHBG with ABI change (decline ≥ 0.15; n = 69) in men [OR for SHBG quartiles 1, 2, and 3 as compared with quartile 4 were 2.56 (95% CI = 1.01-6.45), 2.28 (95% CI = 0.98-5.32), and 2.93 (95% CI = 1.31-6.52), respectively]. In women, none of the investigated associations yielded statistically significant estimates. CONCLUSION Our investigation of a middle-aged community-based sample suggests that sex hormone concentrations in men but not in women may be associated with PAD and ABI change.
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Affiliation(s)
- Robin Haring
- Preventive Medicine and Epidemiology Section, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Current world literature. Curr Opin Obstet Gynecol 2011; 23:301-5. [PMID: 21734502 DOI: 10.1097/gco.0b013e3283491e27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gannagé-Yared MH, Chedid R, Abs L. Relation between androgens and cardiovascular risk factors in a young population. Clin Endocrinol (Oxf) 2011; 74:720-5. [PMID: 21521259 DOI: 10.1111/j.1365-2265.2011.03987.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The relationship between androgens and blood pressure, insulin resistance, lipid profile, adiponectin and hs-CRP in a young Middle-Eastern population has not been examined previously. We studied this relationship in a randomly selected population of Lebanese students. METHODS Three hundred and sixty-eight subjects (201 men and 167 women) aged 18-30 years were included in the study. Anthropometric and biological parameters [waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol, HDL cholesterol, homeostasis model assessment of insulin resistance (HOMA-IR), total testosterone (TT), dehydroepiandrostenedione sulphate (DHEAS), sex hormone-binding globulin (SHBG), adiponectin (ADP) and hs-CRP] were measured. RESULTS In men, there were inverse associations of both TT and SHBG with body mass index (BMI), WC, HOMA-IR, triglycerides and hs-CRP. After adjustment for major confounders (BMI, WC, age and smoking), associations disappeared except for those between TT and hs-CRP, and for SHBG HOMA-IR, hs-CRP and triglycerides. In women, only SHBG was inversely associated with BMI, WC, HOMA-IR and hs-CRP and positively correlated with adiponectin. Except for the association between SHBG and adiponectin, these correlations disappeared after adjustment for confounders. Although DHEAS appeared to correlate negatively with blood pressure in men, this relationship disappeared after adjustment for confounders, while a relationship between DHEAS and triglycerides in women persisted after such adjustment. In multivariate regression analysis, SHBG was an independent predictor of hs-CRP, triglycerides and HOMA-IR in men and of adiponectin in women. CONCLUSION Our results suggest that SHBG is independently associated with HOMA-IR, adiponectin, hs-CRP and triglycerides. A gender difference in these associations is observed. Further studies are needed to elucidate these findings.
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Maggio M, Ceda GP, Lauretani F, Bandinelli S, Corsi AM, Giallauria F, Guralnik JM, Zuliani G, Cattabiani C, Parrino S, Ablondi F, Dall'aglio E, Ceresini G, Basaria S, Ferrucci L. SHBG, sex hormones, and inflammatory markers in older women. J Clin Endocrinol Metab 2011; 96:1053-9. [PMID: 21239514 PMCID: PMC3070258 DOI: 10.1210/jc.2010-1902] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In premenopausal and older women, high testosterone and estradiol (E2) and low SHBG levels are associated with insulin resistance and diabetes, conditions characterized by low-grade inflammation. OBJECTIVE The aim of the study was to examine the relationship between SHBG, total testosterone, total E2, and inflammatory markers in older women. DESIGN AND PATIENTS We conducted a retrospective cross-sectional study of 433 women at least 65 yr old from the InCHIANTI Study, Italy, who were not on hormone replacement therapy or recently hospitalized and who had complete data on SHBG, testosterone, E2, C-reactive protein (CRP), IL-6, soluble IL-6 receptor (sIL-6r), and TNF-α. Relationships between sex hormones and inflammatory markers were examined by multivariate linear regression analyses adjusted for age, body mass index, smoking, insulin, physical activity, and chronic disease. RESULTS In fully adjusted analyses, SHBG was negatively associated with CRP (P = 0.007), IL-6 (P = 0.008), and sIL-6r (P = 0.02). In addition, testosterone was positively associated with CRP (P = 0.006), IL-6 (P = 0.001), and TNF-α (P = 0.0002). The negative relationship between testosterone and sIL-6r in an age-adjusted model (P = 0.02) was no longer significant in a fully adjusted model (P = 0.12). E2 was positively associated with CRP (P = 0.002) but not with IL-6 in fully adjusted models. In a final model including E2, testosterone, and SHBG, and all the confounders previously considered, SHBG (0.23 ± 0.08; P = 0.006) and E2 (0.21 ± 0.08; P = 0.007), but not testosterone (P = 0.21), were still significantly associated with CRP. CONCLUSION In late postmenopausal women not on hormone replacement therapy, SHBG and E2 are, respectively, negative and positive, independent and significant correlates of a proinflammatory state.
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Affiliation(s)
- Marcello Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, 43100 Parma, Italy.
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Wylie K, Rees M, Hackett G, Anderson R, Bouloux PM, Cust M, Goldmeier D, Kell P, Terry T, Trinick T, Wu F. Androgens, health and sexuality in women and men. HUM FERTIL 2010; 13:277-97. [DOI: 10.3109/14647273.2010.530966] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Wylie K, Rees M, Hackett G, Anderson R, Bouloux PM, Cust M, Goldmeier D, Kell P, Terry T, Trinick T, Wu F. Androgens, health and sexuality in women and men. Maturitas 2010; 67:275-89. [DOI: 10.1016/j.maturitas.2010.07.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 07/20/2010] [Indexed: 01/23/2023]
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Abstract
Modest benefit has been shown from transdermal testosterone therapy given to postmenopausal women with reduced sexual desire. An increased frequency of satisfying sexual encounters and intensity of sexual desire and response has been shown in medically and psychiatrically healthy women able to have 2-3 satisfying sexual experiences each month before therapy commences. Women more clearly sexually dysfunctional in keeping with currently proposed definitions of sexual disorder have not been studied. Numerous factors are known to influence women's sexual desire with mood and feelings towards the partner showing the most robust associations. How to identify women whose low desire might stem from low testosterone activity remains unknown: neither serum levels of testosterone nor its metabolites correlate with desire or function. Production of androgens in the brain, sensitivity of the androgen receptors, and activity of cofactors are all potentially relevant confounds. The long-term safety of systemic testosterone with or without estrogen is unknown but necessary as women's sexual lives tend to endure as long as there is an active partner.
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Affiliation(s)
- Rosemary Basson
- Correspondence to: Rosemary Basson, MD, FRCP (UK) BC Centre for Sexual Medicine, Vancouver Hospital, 855 West 12th Avenue, Vancouver, British Columbia, Canada V5Z 1M9
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