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Novaes LF, Flores JM, Benfante N, Schofield E, Katz DJ, Nelson CJ, Mulhall JP. Analysis of diurnal variation in serum testosterone levels in men with symptoms of testosterone deficiency. J Sex Med 2024; 21:408-413. [PMID: 38481019 DOI: 10.1093/jsxmed/qdae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Testosterone (T) plays a crucial role in various physiological functions in men, and understanding the variations in T levels during the day is essential for diagnosing and treating testosterone deficiency (TD). AIM We sought to evaluate the reduction in serum total T (TT) levels throughout the day in men with symptoms of testosterone deficiency and to determine the variables having an impact on the extent of this decline. METHODS The study population consisted of a group of men who within 3 months of each other had all undergone both early morning and afternoon TT level measurements. We did not include patients with a history of a prior orchiectomy, testosterone levels below 100 ng/dL or above 1000 ng/dL, a history of androgen deprivation therapy, or patients on T therapy. Statistical analyses were conducted using descriptive statistics, t-tests, chi-square tests, and correlation calculations. Liquid chromatography-tandem mass spectrometry was used to measure TT, and a change in TT levels greater than 100 ng/dL was considered significant. Using multivariable and univariable analysis, we attempted to define predictors of a decrease in afternoon TT levels. OUTCOMES The majority of men showed no significant difference in T levels between morning and afternoon. RESULTS In total, 506 men with a median age of 65 years were analyzed. The most common comorbidities were hypertension and hyperlipidemia. Levels of TT were measured in the morning and afternoon, and no significant differences in mean T levels based on the time of the test were found. Age was not significantly associated with T levels. CLINICAL IMPLICATIONS There was a weak negative correlation between age and the difference between morning and afternoon T levels, with younger men showing more significant variations in T levels. The most considerable differences in T levels were observed in men younger than 30 years. There were no predictors of the magnitude of the T decrease in the afternoon. STRENGTHS AND LIMITATIONS Strengths of the study include the number of subjects and the use of liquid chromatography-tandem mass spectrometry for T measurement. Limitations include failure to measure morning and afternoon T levels on the same day, the retrospective nature of the study, and a smaller sample size of patients younger than 30 years. CONCLUSION In this study we found no strong link between age and daily T fluctuation, but we observed a decrease in the magnitude of variation with aging. The group experiencing the most significant decline in daily T had higher morning and consistently normal afternoon T levels.
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Affiliation(s)
- Luis F Novaes
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Jose M Flores
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Nicole Benfante
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, United States
| | - Darren J Katz
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Chris J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, United States
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
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Lee S, Kim J, Kong H, Kim YS. Ameliorative effects of elderberry (Sambucus nigra L.) extract and extract-derived monosaccharide-amino acid on H2O2-induced decrease in testosterone-deficiency syndrome in a TM3 Leydig cell. PLoS One 2024; 19:e0302403. [PMID: 38662754 PMCID: PMC11045058 DOI: 10.1371/journal.pone.0302403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
With aging, men develop testosterone-deficiency syndrome (TDS). The development is closely associated with age-related mitochondrial dysfunction of Leydig cell and oxidative stress-induced reactive oxygen species (ROS). Testosterone-replacement therapy (TRT) is used to improve the symptoms of TDS. However, due to its various side effects, research on functional ingredients derived from natural products that do not have side effects is urgently needed. In this study, using the mitochondrial dysfunction TM3 (mouse Leydig) cells, in which testosterone biosynthesis is reduced by H2O2, we evaluated the effects of elderberry extract and monosaccharide-amino acid (fructose-leucine; FL) on mRNA and protein levels related to steroidogenesis-related enzymes steroidogenic acute regulatory protein (StAR), cytochrome P450 11A1(CYP11A1, cytochrome P450 17A1(CYP17A1), cytochrome P450 19A1(CYP19A1, aromatase), 3β-hydroxysteroid dehydrogenase (3β-HSD), and 17β-hydroxysteroid dehydrogenase(17β-HSD). We analyzed elderberry extract and extract-derived FL for changes in ROS scavenging activity and testosterone secretion. Elderberry extract and FL significantly reduced H2O2-induced intracellular ROS levels, improved testosterone secretion, and increased the mRNA and protein expression levels of steroidogenesis-related enzymes (StAR, 3b-HSD, 17b-HSD, CYP11A1, CYp17A1). However, the conversion of testosterone to estradiol was inhibited by elderberry extract and extract-derived FL, which reduced the mRNA and protein expression of CYP19A1. In conclusion, elderberry extract and FL are predicted to have value as novel functional ingredients that may contribute to the prevention of TDS by ameliorating reduced steroidogenesis.
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Affiliation(s)
- Sujung Lee
- Gochang Food & Industry Institute, Gochang, Korea
- Department of Food Science & Technology Jeonbuk National University, Jeonju, Korea
| | | | - Hyunseok Kong
- College of Animal Biotechnology and Resource, Sahmyook University, Seoul, Korea
- PADAM Natural Material Research Institute, Sahmyook University, Seoul, Korea
| | - Yong-Suk Kim
- Department of Food Science & Technology Jeonbuk National University, Jeonju, Korea
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3
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Li S, Wang Z, Yu J, Zhang C, Ye J, Liu H, Jiang Y, He Z, Wang Y. Intramuscularly injected long-acting testosterone-cholesterol prodrug suspension with three different particle sizes: extended in vitro release and enhanced in vivo safety. Drug Deliv Transl Res 2024; 14:1093-1105. [PMID: 37932630 DOI: 10.1007/s13346-023-01460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
The testosterone undecanoate oil solution is the most widely used injection of testosterone for long-acting effects on the market, whereas the formulation carries the potential risk of causing pulmonary vascular embolism, inflammation, and pain at the injection site. Therefore, a sustained-released long-acting injection of testosterone with strong security is urgently exploited. Herein, a poorly water-soluble testosterone-cholesterol prodrug (TST-Chol) was synthesized by esterification. The water solubility of TST-Chol was decreased by 644 folds in comparison to that of testosterone (TST). Moreover, suspensions of TST and TST-Chol were prepared and analyzed in vitro, utilizing three distinct particle sizes: small-sized nanocrystals (SNCs) measuring 300 nm, medium-sized microcrystals (MMCs) measuring 12 μm, and large-sized microcrystals (LMCs) measuring 20 μm. The findings from the in vitro release study indicated that the sustained release of the drug was significantly influenced by the solubility and particle sizes of the suspension. Notably, the suspensions with low water solubility and larger particle sizes exhibited a more desirable sustained-release effect in vitro. Furthermore, the study on pharmacokinetics exhibited that TST-Chol SNCs produced a sustained TST plasma concentration in vivo for up to 40 days and no obvious pathological changes in lung tissue were found. Our study indicated that solubility and particle sizes of suspensions had made a difference in pharmacokinetics and provided a valuable reference for the advancement of long-acting injections.
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Affiliation(s)
- Shuo Li
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China
| | - Zhaomeng Wang
- Department of Oncology, Innovative Cancer Drug Research and Engineering Center of Liaoning Province, Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Jiang Yu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China
| | - Chuang Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China
| | - Jianying Ye
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China
| | - Hengzhi Liu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China
| | - Yiguo Jiang
- Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, 215153, China.
| | - Zhonggui He
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China.
| | - Yongjun Wang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China.
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4
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Yeo JK, Koo HS, Yu J, Park MG. Effects of Testosterone Treatment on Quality of Life in Patients With Chronic Kidney Disease. Am J Mens Health 2021; 14:1557988320917258. [PMID: 32448046 PMCID: PMC7249586 DOI: 10.1177/1557988320917258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Testosterone deficiency (TD) is common and impairs quality of life (QoL) in
patients with chronic kidney disease (CKD). However, there are no studies about
whether testosterone replacement therapy (TRT) can improve QoL in patients with
CKD. Therefore, we investigated the effect of TRT on the QoL of patients with
CKD and confirmed the safety of TRT. Twenty-five male patients with stages
III–IV CKD whose serum testosterone levels were <350 ng/dl (TD) were enrolled
and treated with testosterone gel for 3 months (group II). Age-matched controls
with stages III–IV CKD and TD (group I) were recommended to exercise for the
same period. Before and after the treatment, the BMI and handgrip strength were
checked, serological tests were performed, and questionnaires were administered
in both groups. Compared to baseline, there was no significant difference in
serum testosterone levels, scores of the 36-Item Short Form Health Survey
(SF-36), Aging Males’ Symptoms Scale (AMS), and International Prostate Symptom
Score (IPSS), and grip strength in group I after 3 months. In group II, a
significant increase in testosterone, hemoglobin (Hb), and hematocrit (Hct) was
observed, and grip strength significantly increased after TRT. Significant
improvement in scores of SF-36, AMS, and IPSS was also confirmed after TRT in
group II. There was a significant difference in testosterone, Hb, Hct, grip
strength, and scores of SF-36, AMS, and IPSS between the two groups after 3
months. The patients in group II showed positive results and continued with TRT.
Therefore, we conclude that TRT safely improves the QoL and TD symptoms in
patients with moderate-to-severe CKD.
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Affiliation(s)
- Jeong Kyun Yeo
- Department of Urology, Inje University, Seoul Paik Hospital, Seoul, Korea
| | - Ho Seok Koo
- Department of Nephrology, Inje University, Seoul Paik Hospital, Seoul, Korea
| | - Jihyeong Yu
- Department of Urology, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Min Gu Park
- Department of Urology, Inje University, Seoul Paik Hospital, Seoul, Korea
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Erenpreiss J, Fodina V, Pozarska R, Zubkova K, Dudorova A, Pozarskis A. Prevalence of testosterone deficiency among aging men with and without morbidities. Aging Male 2020; 23:901-905. [PMID: 31156000 DOI: 10.1080/13685538.2019.1621832] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In this cross-sectional study 1852 men aged 40-70 years attending primary health care were invited to fill out the aging male symptoms (AMS) scale. Out of these, 1222 men were found positive for the AMS and agreed to provide blood samples for the general blood test, lipid profile, glucose levels, and assessment of both total and free testosterone (T) levels. Men were screened for the following morbidities and syndromes: dyslipidemia, arterial hypertension, obesity, type II diabetes, metabolic syndrome, and chronic obstructive pulmonary disease (COPD). Testosterone deficiency was diagnosed if total T ≤ 3.46 ng/mL or free T ≤ 72 pg/mL. Among all 1222 men with positive AMS, decreased blood testosterone levels were detected in 669 men (55%). A total of 402 men were found healthy and 820 men were detected with different morbidities. Out of 669 men with testosterone deficiency, only 2.8% had no co-morbidities and 97.2% were men with co-morbidities. Testosterone levels were found significantly higher among healthy men (median 4.7 ng/mL) as compared to the men with morbidities (median 2.55 ng/mL, p<.001), adjusted for age. Testosterone deficiency was detected in significantly lower proportion of 402 men without co-morbidities as compared to the 820 men with co-morbidities: in 19 men (4.7) and in 650 men (79.3%, p<.05), respectively.
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Affiliation(s)
- Juris Erenpreiss
- Andrology Laboratory, Riga Stradins University, Riga, Latvia
- Department of Andrology, Clinic "IVF-Riga", Riga, Latvia
| | - Violeta Fodina
- Department of Gynecology and Reproduction, Clinic "IVF-Riga", Riga, Latvia
| | - Rita Pozarska
- Andrology Laboratory, Riga Stradins University, Riga, Latvia
| | - Ksenija Zubkova
- Andrology Laboratory, Riga Stradins University, Riga, Latvia
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Zhang X, Zhong Y, Saad F, Haider K, Haider A, Xu X. Clinically occult prostate cancer cases may distort the effect of testosterone replacement therapy on risk of PCa. World J Urol 2019; 37:2091-2097. [PMID: 30659301 DOI: 10.1007/s00345-018-02621-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/29/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although prostate cancer (PCa) screening is conducted before testosterone replacement therapy (TRT), clinically occult PCa cases may exist. METHODS To evaluate whether the possible inclusion of occult PCa cases distorts the effect of TRT on risk of PCa, we followed 776 hypogonadal males (TRT = 400, non-TRT = 376) from a urology center in Germany from 2004 to 2016, with a mean follow-up period of 7 years. We assumed occult cases might take 1-2 years (latency period) to become clinically detectable after receiving TRT. We selected several latency periods (12/18/24 months) and compared the risk of PCa in the TRT and non-TRT group over the latency period, from the end of latency period till the end of follow-up, and over the whole follow-up time. RESULTS Overall, 26 PCa cases occurred in the non-TRT group vs 9 cases in the TRT group. Within 18 months of follow-up, 9 cases occurred in the TRT group vs 0 cases in the non-TRT group; from the end of 18 months till the end of follow-up, 26 cases occurred in the non-TRT group vs 0 cases in the TRT group. The adjusted table showed seemingly adverse effects of TRT on PCa development within 18 months (p = 0.0301) and beneficial effects from the end of 18 months till the end of follow-up (p = 0.0069). Similar patterns were observed for 12 or 24 months as the latency period. CONCLUSIONS TRT may make occult PCa cases detectable within early phase of treatment and present a beneficial effect in the long run. Future longitudinal studies are needed to confirm findings from our exploratory analyses.
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Affiliation(s)
- Xiao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, MS 1266, 212 Adriance Lab Road, College Station, TX, 77843-1266, USA
| | - Yan Zhong
- Department of Statistics, Texas A&M University, College Station, USA
| | - Farid Saad
- Global Medical Affairs Andrology, Bayer AG, Berlin, Germany
- Research Department, Gulf Medical University, Ajman, UAE
| | - Karim Haider
- Private Urology Practice, 27570, Bremerhaven, Germany
| | - Ahmad Haider
- Private Urology Practice, 27570, Bremerhaven, Germany
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, MS 1266, 212 Adriance Lab Road, College Station, TX, 77843-1266, USA.
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7
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Neuzillet Y, Thuret R, Kleinclauss F, Timsit MO. [Andrologic consequences of chronic renal failure: State of the art for the yearly scientific report of the French National Association of Urology]. Prog Urol 2016; 26:1088-1093. [PMID: 27647650 DOI: 10.1016/j.purol.2016.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the state of the art of current knowledge regarding gonadal consequences of end-stage chronic kidney disease (CKD) and renal transplantation. MATERIAL AND METHOD A systematic review of the literature search was performed from the databases Medline (NLM, Pubmed) and Embase, focused on the following keywords: "chronic kidney disease"; "chronic renal failure"; "hypogonadism"; "kidney transplantation"; "testicular dysfunction"; "testosterone". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 383 articles. After reading titles and abstracts, 51 were included in the text, based on their relevance. RESULTS The prevalence of hypogonadism in CKD is reported between 24 % and 66 %, and decreases partially after renal transplantation. This is a hypogonadotropic hypogonadism whose pathophysiology is multifactorial, involving mainly a primitive testicular deficit, a hypothalamic-pituitary dysregulation, and an hyperprolactinemia. The consequences of this hypogonadism are not only sexual but also contribute to anemia, sarcopenia, atherosclerosis, and potentially in the progression of CKD. Hypogonadism is an independent risk factor for mortality in CKD patients. CONCLUSIONS CKD is frequently associated with an hypogonadism whose correction is validated only in the setting of erectile dysfunction treatment. The other benefits of the correction of hypogonadism in the CKD patients, including overall survival, needs to be evaluated.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles, Saint-Quentin-en-Yvelines, France.
| | - R Thuret
- Service d'urologie et de transplantation rénale, hôpital Lapeyronie, Montpellier, France; Université de Montpellier, Montpellier, France
| | - F Kleinclauss
- Service d'urologie et de transplantation rénale, CHRU de Besançon, Besançon, France; Université de Franche-Comté, Besançon, France; Inserm UMR 1098, Besançon, France
| | - M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France; Université Paris-Descartes, Paris, France
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Sansone A, Sansone M, Lenzi A, Romanelli F. Testosterone Replacement Therapy: The Emperor's New Clothes. Rejuvenation Res 2016; 20:9-14. [PMID: 27124096 DOI: 10.1089/rej.2016.1818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The mean age of the world population has steadily increased in the last decades, as a result of increased life expectancy and reduced birth rate. Global aging has led to a greater worldwide cost for healthcare: hormonal alterations contribute to the pathogenesis of several conditions and might cause a significant reduction in the perceived sense of well-being. Menopause is archetypal of hormonal alterations occurring during aging: in males, sex hormones do not decrease abruptly, yet testosterone levels decrease steadily and continuously during aging, ultimately resulting in late-onset hypogonadism. Treatment of this condition might mitigate most symptoms; however, testosterone replacement therapy (TRT) should be prescribed only in selected patients and it should not be considered as an antiaging treatment. In recent years, different authors have questioned health risks associated with testosterone treatment; while position statements from many scientific societies seem to be reassuring, the Food and Drug Administration has issued a warning in regard to the possible side effects of this therapy. We aim to review recent controversies and discoveries in regard to TRT.
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Affiliation(s)
- Andrea Sansone
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
| | - Massimiliano Sansone
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
| | - Andrea Lenzi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
| | - Francesco Romanelli
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome , Rome, Italy
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9
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Iglesias P, Prado F, Muñoz A, Guerrero MT, Macías MC, Ridruejo E, Tajada P, García-Arévalo C, Díez JJ. Natural course of hypogonadism diagnosed during hospitalization in aged male patients. Endocrine 2015; 48:978-84. [PMID: 25205450 DOI: 10.1007/s12020-014-0417-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/01/2014] [Indexed: 12/24/2022]
Abstract
Our aim was to assess short-term natural course of hypogonadism diagnosed during hospitalization for acute disease in aged male patients after discharge. A group of 43 hypogonadal males, aged 86.7±5.7 year, was studied. Serum concentrations of testosterone (T) and gonadotropins (follicle-stimulating hormone, FSH, and luteinizing hormone, LH) were measured in every patient both at admission and one month after discharge. Mean serum T at entry was 115.4±48.0 ng/dl. Hypogonadism was hyper-, hypo-, and normogonadotropic in 20 (46.5%), 20 (46.5%), and 3 (7.0%) patients, respectively. One month after discharge serum T concentrations increased significantly (230.9±135.6 ng/dl, p<0.001). At this point, more than half of the patients (n=27, 62.8%) showed normal serum T concentrations. Both gonadotropins, FSH (p<0.001), and LH (p=0.04) also increased one month after discharge. Approximately, half of the patients (13, 48.1%) who normalized serum T concentrations also showed normal serum gonadotropin concentrations. Patients who normalized their serum T concentrations one month after discharge showed significantly higher baseline values of T (134.7±33.9 ng/dl) than those who persisted with hypogonadism (n=16, 32.7%; 82.8±51.6 ng/dl, p<0.001). Lastly, serum T was the only independent predictor for achieving eugonadal status (OR 1.030; CI 95%, 1.010-1.050; p<0.001). In conclusion, about 63% of aged patients hospitalized for acute illness with hypogonadism discovered during hospitalization spontaneously normalize their serum T concentrations one month after discharge. Serum gonadotropin concentrations also increased after discharge. Serum T levels at admission was an independent predictor for the normalization of serum T concentrations.
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Affiliation(s)
- P Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. de Colmenar km 9.100, 28034, Madrid, Spain,
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Miner MM, Khera M, Bhattacharya RK, Blick G, Kushner H. Baseline Data from the TRiUS Registry: Symptoms and Comorbidities of Testosterone Deficiency. Postgrad Med 2015; 123:17-27. [DOI: 10.3810/pgm.2011.05.2280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Mirmirani P. Age-related hair changes in men: Mechanisms and management of alopecia and graying. Maturitas 2015; 80:58-62. [DOI: 10.1016/j.maturitas.2014.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
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12
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Malon RSP, Sadir S, Balakrishnan M, Córcoles EP. Saliva-based biosensors: noninvasive monitoring tool for clinical diagnostics. BIOMED RESEARCH INTERNATIONAL 2014; 2014:962903. [PMID: 25276835 PMCID: PMC4172994 DOI: 10.1155/2014/962903] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/16/2014] [Accepted: 08/11/2014] [Indexed: 02/08/2023]
Abstract
Saliva is increasingly recognised as an attractive diagnostic fluid. The presence of various disease signalling salivary biomarkers that accurately reflect normal and disease states in humans and the sampling benefits compared to blood sampling are some of the reasons for this recognition. This explains the burgeoning research field in assay developments and technological advancements for the detection of various salivary biomarkers to improve clinical diagnosis, management, and treatment. This paper reviews the significance of salivary biomarkers for clinical diagnosis and therapeutic applications, with focus on the technologies and biosensing platforms that have been reported for screening these biomarkers.
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Affiliation(s)
- Radha S. P. Malon
- Faculty of Biosciences and Medical Engineering (FBME), Universiti Teknologi Malaysia, Building VO1, Block A, Level 5, Room 27, 81310 Skudai, Johor, Malaysia
| | - Sahba Sadir
- Faculty of Mechanical Engineering (FKM), Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - Malarvili Balakrishnan
- Faculty of Biosciences and Medical Engineering (FBME), Universiti Teknologi Malaysia, Building VO1, Block A, Level 5, Room 27, 81310 Skudai, Johor, Malaysia
| | - Emma P. Córcoles
- Faculty of Biosciences and Medical Engineering (FBME), Universiti Teknologi Malaysia, Building VO1, Block A, Level 5, Room 27, 81310 Skudai, Johor, Malaysia
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Kumar R, Jhorawat R, Mathur M, Garsa RK, Kimmatkar PD, Sharma S, Singh A, Beniwal P, Malhotra V. Effect of renal transplantation on multiple hormone levels in patients of chronic kidney disease: A single center study. INDIAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.1016/j.ijt.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
In a manuscript entitled, "Bashful boys and coy girls: A review of gender differences in childhood shyness" Doey et al. (2013) suggest that shyness and its related constructs pose a greater developmental risk for boys compared to girls. They support this claim by citing empirical evidence suggesting that shy and anxiously withdrawn boys are responded to more negatively by important others (i.e., parents, peers, and teachers) and that the relationship between internalizing problems and anxious withdrawal is stronger for boys compared to girls. The principal aim of our commentary is to provide a critical examination of Doey et al.'s conclusions vis-à-vis gender differences in child and adolescent shyness. In this response, we begin by providing important theoretical background regarding shyness and its related constructs. Next, we critically examine the two main arguments the authors use in support of their conclusion through a review of existing empirical and theoretical work as well as the presentation of data from The Friendship Project. These data were analyzed with the specific purpose of providing an empirical test of the hypotheses implicit in Doey et al.'s primary arguments: 1) shy and anxiously withdrawn boys are responded to more negatively than girls and 2) the association between anxious withdrawal and internalizing problems is stronger for boys compared to girls. Our results indicate mixed support for these two claims. Finally, we conclude by suggesting new directions for future researchers interested in clarifying the relationship between gender and both the correlates and outcomes of childhood shyness.
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Affiliation(s)
- Kenneth H. Rubin
- Department of Human Development & Quantitative Methodology, University of Maryland, 3304 Benjamin Building, College Park, MD 20742, USA
| | - Matthew G. Barstead
- Department of Human Development & Quantitative Methodology, University of Maryland, 3304 Benjamin Building, College Park, MD 20742, USA
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Iglesias P, Prado F, Macías MC, Guerrero MT, Muñoz A, Ridruejo E, Tajada P, García-Arévalo C, Díez JJ. Hypogonadism in aged hospitalized male patients: prevalence and clinical outcome. J Endocrinol Invest 2014; 37:135-41. [PMID: 24497212 DOI: 10.1007/s40618-013-0009-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Male hypogonadism is common in the elderly and has been associated with increased risk of mortality. Our objective has been to assess the prevalence of primary and central hypogonadism in elderly male patients admitted to the hospital because of acute illness. We also evaluated the relationships between gonadal dysfunction and in-hospital mortality. PATIENTS AND METHODS 150 patients, aged ≥65 years, admitted during 2010 and 2011 in our geriatric unit, were studied. Serum concentrations total, bioavailable and free testosterone, as well as of follicle-stimulating hormone and luteinizing hormone were quantified in every patient. Hypogonadism was defined by the presence of serum testosterone levels lower than 200 ng/dl. RESULTS Hypogonadism was found in 80 patients (53.3 %). Serum gonadotropin concentrations were elevated in 43.7 % of these patients, whereas 41.3 % of hypogonadic patients showed normal and 15 % low gonadotropin concentrations. Respiratory tract infection and congestive heart failure were the main causes of hospitalization in hypogonadal men, whereas acute cerebrovascular disease was the main reason for admission in eugonadal patients. Of the 13 patients who died during hospitalization, 12 were hypogonadic. Patients who died showed significantly lower serum levels of total, free and bioavailable testosterone than those found in patients who survived. CONCLUSION Our results show that about half of patients admitted for acute illness have hypogonadism, mainly of non-hypergonadotropic type. Gonadal hypofunction is significantly related with in-hospital mortality. A low value of serum testosterone may be a predictor for mortality in elderly male patients.
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Affiliation(s)
- P Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. de Colmenar, Km 9,100, 28034, Madrid, Spain,
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Alidjanov J, Wolf J, Schuppe HC, Weidner W, Diemer T, Linn T, Halefeldt I, Wagenlehner F, Wiltink J, Pilatz A. Validation of the German version of the ‘Hypogonadism Related Symptom Scale’ (HRS) in andrological patients with infertility, HIV infection and metabolic syndrome. Andrologia 2014; 46:1189-97. [DOI: 10.1111/and.12215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 01/20/2023] Open
Affiliation(s)
- J. Alidjanov
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
- Outpatient Department; The Republican Specialized Center of Urology; Tashkent Uzbekistan
| | - J. Wolf
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
| | - H.-C. Schuppe
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
| | - W. Weidner
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
| | - T. Diemer
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
| | - T. Linn
- Clinical Research Unit; 3rd Medical Clinic and Policlinic; Justus Liebig University; Giessen Germany
| | - I. Halefeldt
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
| | - F. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
| | - J. Wiltink
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center of the Johannes Gutenberg University; Mainz Germany
| | - A. Pilatz
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University; Giessen Germany
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Bercea RM, Patacchioli FR, Ghiciuc CM, Cojocaru E, Mihaescu T. Serum testosterone and depressive symptoms in severe OSA patients. Andrologia 2013; 45:345-50. [PMID: 22998358 DOI: 10.1111/and.12022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 02/05/2023] Open
Abstract
Obstructive sleep apnoea (OSA), also characterised by hypoxia-related sleep- fragmentation, has been studied in relation to depression and serum testosterone deficit. In middle-aged men, it has been reported the association between depressive mood and low serum testosterone level; however, no data are available about this association in OSA patients. Therefore, the aim of this study was to investigate in adult obese males, affected by severe OSA, the relationship between serum testosterone concentration and depressive symptoms, in order to identify among all measured parameters (serum testosterone morning concentration, polysomnography parameters, body mass index, Epworth Sleepiness Scale) those predictors for OSA-related depression. Forty patients diagnosed with severe OSA and forty subjects for the control-matched group were enroled in the study. The results indicated that the serum testosterone in OSA group was significantly lower than in controls. In addition, the OSA group presented a level of depression although moderate, yet significantly higher than controls. Furthermore, a statistically significant inverse correlation has been found between serum testosterone level and depressive symptoms. Among all variables, serum testosterone level was shown to be the only independent variable significantly predictor for depression in OSA patients.
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Affiliation(s)
- R M Bercea
- Clinic of Pulmonary Diseases, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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Park M, Koo H, Lee B. Characteristics of Testosterone Deficiency Syndrome in Men With Chronic Kidney Disease and Male Renal Transplant Recipients: A Cross-Sectional Study. Transplant Proc 2013; 45:2970-4. [DOI: 10.1016/j.transproceed.2013.08.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bello AK, Stenvinkel P, Lin M, Hemmelgarn B, Thadhani R, Klarenbach S, Chan C, Zimmerman D, Cembrowski G, Strippoli G, Carrero JJ, Tonelli M. Serum testosterone levels and clinical outcomes in male hemodialysis patients. Am J Kidney Dis 2013; 63:268-75. [PMID: 23896484 DOI: 10.1053/j.ajkd.2013.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 06/13/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies linking low serum testosterone concentration to adverse clinical outcomes in hemodialysis patients have been relatively small. We investigated the role of testosterone in adverse outcomes and quality of life in an incident cohort of male Canadian hemodialysis patients. STUDY DESIGN A prospectively designed multicenter observational study using data from the Canadian Kidney Disease Cohort Study (CKDCS). SETTING & PARTICIPANTS Male patients initiating hemodialysis therapy since February 14, 2005, in 3 Canadian centers serving ethnically diverse populations were studied (N = 623). PREDICTOR Serum testosterone levels using the International Society of Andrology, International Society for the Study of the Aging Male, and European Association of Urology cutoffs (low, <231 ng/dL; borderline, 231-346 ng/dL; normal, >346 ng/dL). OUTCOMES All-cause mortality, fatal and nonfatal cardiovascular (CV) events, and Health Utility Index (HUI)-assessed health-related quality of life. MEASUREMENTS Participants completed a structured interview on demographics and medical history and an HUI questionnaire (version 3). Routine laboratory test results captured into the study database, and serum testosterone measured within 3 months after initiation of the baseline hemodialysis session. RESULTS During a median follow-up of 20 (range, 1-81) months, 166 (27%) died and 98 (20%) had a CV event. Mean serum testosterone level was 234.1 ± 146.1 (SD) ng/dL. Higher serum testosterone levels were associated with significantly decreased unadjusted risk of death (HR per 10-ng/dL increase, 0.58; 95% CI, 0.37-0.90). There was a statistically significant trend for higher all-cause mortality with low serum testosterone levels in adjusted analyses (P < 0.001). Higher levels of log-transformed testosterone were associated with significantly higher HUI scores (P for trend <0.001), and low levels of serum testosterone were associated significantly with lower HUI scores (P for trend <0.001). Although there was a significant trend in the unadjusted risk of CV events among participants with low serum testosterone levels (P < 0.001), the risk was no longer significant after adjustment for age. There was no significant interaction with age and serum testosterone level tested as continuous variables (P = 0.07). LIMITATIONS A short follow-up period and serum testosterone measured on a single occasion. CONCLUSIONS Low serum testosterone concentration may be a modifiable risk factor for adverse outcomes and poor quality of life in male hemodialysis patients. This hypothesis should be tested in randomized controlled trials.
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Affiliation(s)
| | | | - Meng Lin
- University of Alberta, Edmonton, Alberta, Canada
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Elliott JA, Fibuch EE. Endocrine effects of chronic opioid therapy: implications for clinical management. Pain Manag 2013; 3:237-46. [DOI: 10.2217/pmt.13.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Over the past few decades, the use of opioids in the management of chronic pain conditions has greatly increased. As opioid utilization has expanded, so has the recognition of associated hormonal derangements. These hormonal disturbances involve disruption, predominantly of the hypothalamic–pituitary–gonadal axis, and can affect both men and women treated with opioids. The best recognized of these hormonal disorders is opioid-associated androgen deficiency. Opioid-associated androgen deficiency is most likely to occur with prolonged, high-dose opioid therapy and may be associated with the development of other conditions such as depression, osteoporosis and possible hyperalgesia. Once identified, opioid-associated androgen deficiency should be managed with appropriate hormonal replacement therapy and patients should be closely monitored for adequacy of treatment and treatment-associated adverse events.
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Affiliation(s)
- Jennifer A Elliott
- University of Missouri–Kansas City School of Medicine, 215 W 43rd Street, Kansas City, MO 64111, USA.
| | - Eugene E Fibuch
- University of Missouri–Kansas City School of Medicine, 215 W 43rd Street, Kansas City, MO 64111, USA
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Seisen T, Rouprêt M, Gallais JL, Costa P. Critères cliniques et biologiques pertinents pour poser un diagnostic de déficit androgénique lié à l'âge (DALA). Prog Urol 2012; 22 Suppl 1:S21-6. [DOI: 10.1016/s1166-7087(12)70031-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Behre HM, Christin-Maitre S, Morales AM, Tostain J. Transversal European survey on testosterone deficiency diagnosis. Aging Male 2012; 15:69-77. [PMID: 22380815 DOI: 10.3109/13685538.2012.655704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite being one of the relevant public health threats among ageing men, testosterone deficiency syndrome (TDS) is under-recognized and under-diagnosed. OBJECTIVE To assess current clinical practices of European physicians regarding diagnosis and management of TDS compared with current guidelines. METHODS Postal survey conducted June-November 2008 in France, Germany, Italy and Spain among urologists, endocrinologists and general practitioners to collect information regarding knowledge of TDS. RESULTS Among 801 respondents, the majority of endocrinologists and urologists had received training on TDS, either initially or as part of continuous medical education. TDS was recognized by 86.5% of physicians as a true clinical entity, and estimated the prevalence at 10-15% of the male population; 73.5% considered that symptoms and a low level of testosterone were required for diagnosis. Treatment preferences were quarterly intramuscular injections (26.3% of physicians), percutaneous gels (23.9%), matrix patch (21.2%), semi-monthly injections (15.4%) and oral therapy (13.4%). Adverse effects of testosterone replacement therapy, such as benign prostatic hyperplasia and prostate cancer, were a concern for physicians. CONCLUSIONS TDS management appeared to be close to that recommended in international guidelines. Signs and symptoms of testosterone deficiency were fairly well known, but some diagnostic and treatment variations were observed.
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Affiliation(s)
- Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
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Chiu YW, Chu CL, Chen Y, Jiang JR, Chau YL, Hsu SC, Hsieh ML, Chen CL, Chen CY. Complaint of insomnia as a predictor of aging symptoms in males at a men's health clinic. Aging Male 2012; 15:7-13. [PMID: 22044340 DOI: 10.3109/13685538.2011.605185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Issues of men's health have been greatly researched by scholars in recent decades. At men's health clinics, many patients complain of both insomnia and aging males' symptoms (AMS). These symptoms might be influenced by biological, psychological or even social factors. The aim of this study was to investigate different aspects of the relationship between insomnia and aging symptoms. METHODS This cross-sectional study included 231 males from a men's health clinic. Participants completed a set of general data and screening assessments, including the AMS rating scale, insomnia severity index (ISI), Beck depression inventory-II (BDI-II) and Beck anxiety inventory Chinese version (BAI), to investigate the severity of aging symptoms, insomnia, depression and anxiety. RESULTS The ISI correlated significantly with the AMS scale, both with (partial correlation coefficient = 0.470) and without (r = 0.580) controlled variances of depression and anxiety. Using linear regression, aging symptoms were statistically predicted by the severity of the ISI, and a substantial proportion of the variance was explained (adjusted R(2) = 0.410). When all variables were included, this proportion rose to 55.3% (adjusted R(2) = 0.553). CONCLUSION We suggest that insomnia is a good predictor of aging symptoms across all age groups of men.
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Affiliation(s)
- Yu-Wen Chiu
- Men's Health Center, Chang Gung Memorial Hospital, Linkou, Taiwan
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Strom JO, Ingberg E, Druvefors E, Theodorsson A, Theodorsson E. The female menstrual cycle does not influence testosterone concentrations in male partners. J Negat Results Biomed 2012; 11:1. [PMID: 22214343 PMCID: PMC3269376 DOI: 10.1186/1477-5751-11-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 01/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The time of ovulation has since long been believed to be concealed to male heterosexual partners. Recent studies have, however, called for revision of this notion. For example, male testosterone concentrations have been shown to increase in response to olfactory ovulation cues, which could be biologically relevant by increasing sexual drive and aggressiveness. However, this phenomenon has not previously been investigated in real-life human settings. We therefore thought it of interest to test the hypothesis that males' salivary testosterone concentrations are influenced by phases of their female partners' menstrual cycle; expecting a testosterone peak at ovulation. METHODS Thirty young, healthy, heterosexual couples were recruited. During the course of 30-40 days, the women registered menses and ovulation, while the men registered sexual activity, physical exercise, alcohol intake and illness (confounders), and obtained daily saliva samples for testosterone measurements. All data, including the registered confounders, were subjected to multiple regression analysis. RESULTS In contrast to the hypothesis, the ovulation did not affect the testosterone levels, and the resulting testosterone profile during the menstrual cycle was on the average flat. The specific main hypothesis, that male testosterone levels on the day of ovulation would be higher than day 4 of the cycle, was clearly contradicted by a type II error(β)-analysis (< 14.3% difference in normalized testosterone concentration; β = 0.05). CONCLUSIONS Even though an ovulation-related salivary testosterone peak was observed in individual cases, no significant effect was found on a group level.
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Affiliation(s)
- Jakob O Strom
- Clinical Chemistry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Abstract
INTRODUCTION Androgens regulate a wide array of physiological processes, including male sexual development, bone and muscle growth, and behavior and cognition. Because androgens play a vital role in so many tissues, changes in androgen signaling are associated with a plethora of diseases. How such varied responses are achieved by a single stimulus is not well understood. Androgens act primarily through the androgen receptor (AR), a hormone nuclear receptor that is expressed in a select variety of tissues. METHODS In order to gain a better understanding of how the tissue-selective effects of androgens are achieved, we performed a comparison of microarray data, using previously published datasets and several of our own microarray datasets. These datasets were derived from clinically relevant, AR-expressing tissues dissected from rodents treated with the full androgen dihydrotestosterone (DHT). RESULTS We found that there is a diverse response to DHT, with very little overlap of androgen regulated genes in each tissue. Gene ontology analyses also indicated that, while several tissues regulate similar biological processes in response to DHT, most androgen regulated processes are specific to one or a few tissues. Thus, it appears that the disparate physiological effects mediated by androgens begin with widely varying effects on gene expression in different androgen-sensitive tissues. CONCLUSION The analysis completed in this study will lead to an improved understanding of how androgens mediate diverse, tissue-specific processes and better ways to assess the tissue-selective effects of AR modulators during drug development.
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Affiliation(s)
- Maya Otto-Duessel
- Department of Molecular Pharmacology, Beckman Research Institute, Duarte, CA 91010, USA
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Yilmaz MI, Sonmez A, Qureshi AR, Saglam M, Stenvinkel P, Yaman H, Eyileten T, Caglar K, Oguz Y, Taslipinar A, Vural A, Gok M, Unal HU, Yenicesu M, Carrero JJ. Endogenous testosterone, endothelial dysfunction, and cardiovascular events in men with nondialysis chronic kidney disease. Clin J Am Soc Nephrol 2011; 6:1617-25. [PMID: 21700826 DOI: 10.2215/cjn.10681210] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Deterioration of kidney function impairs testosterone production, with hypogonadism being common in men with chronic kidney disease (CKD). In nonrenal populations, testosterone is suggested to participate in the atherosclerotic process. In male dialysis patients, we showed that low testosterone increases the risk of mortality. We here studied plausible links among testosterone levels, vascular derangements, and cardiovascular events in nondialysis CKD men. DESIGN, SETTING, PARTICIPANTS, & METHODS This was a cross-sectional analysis in which flow-mediated dilation (FMD) was assessed in 239 CKD male patients (stages 1 to 5; mean age 52 ± 12 years), together with routine measurements, serum total and free testosterone, and follow-up for cardiovascular outcomes. RESULTS Total and free testosterone levels decreased in parallel with the reduction of kidney function. Multiple regression analyses showed that total and free testosterone significantly and independently contributed to explain the variance of FMD. After a median follow-up of 31 months (range 8 to 35 months), 22 fatal and 50 nonfatal cardiovascular events occurred. In Cox analysis, the risk of cardiovascular events was reduced by 22% for each nanomole-per-liter increment of total testosterone. This reduced risk persisted after adjustment for age, renal function, diabetes mellitus, previous cardiovascular history, C-reactive protein, albumin, and FMD. The same was true for free testosterone concentrations. CONCLUSIONS The reduction in endogenous testosterone levels observed with progressive CKD was inversely associated with endothelial dysfunction and exacerbated the risk of future cardiovascular events in nondialysis male CKD patients.
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Nakchbandi IA. Commentary on Grey et al. (2011): does methadone maintenance therapy adversely affect bone mass? Addiction 2011; 106:355-6. [PMID: 21208320 DOI: 10.1111/j.1360-0443.2010.03278.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Inaam A Nakchbandi
- University of Heidelberg, Im Neuneheimer Feld 305, 2. OG. R210, Heidelberg 69120, Germany.
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Gungor O, Kircelli F, Carrero JJ, Asci G, Toz H, Tatar E, Hur E, Sever MS, Arinsoy T, Ok E. Endogenous testosterone and mortality in male hemodialysis patients: is it the result of aging? Clin J Am Soc Nephrol 2010; 5:2018-23. [PMID: 20651153 DOI: 10.2215/cjn.03600410] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Low serum testosterone levels in hemodialysis (HD) patients have recently been associated with cardiovascular risk factors and increased mortality. To confirm this observation, we investigated the predictive role of serum total testosterone levels on mortality in a large group of male HD patients from Turkey. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS A total of 420 prevalent male HD patients were sampled in March 2005 and followed up for all-cause mortality. Serum total testosterone levels were measured by ELISA at baseline and studied in relation to mortality and cardiovascular risk profile. RESULTS Mean testosterone level was 8.69 ± 4.10 (0.17 to 27.40) nmol/L. A large proportion of patients (66%) had testosterone deficiency (<10 nmol/L). In univariate analysis, serum testosterone levels were positively correlated with creatinine and inversely correlated with age, body mass index, and lipid parameters. During an average follow-up of 32 months, 104 (24.8%) patients died. The overall survival rate was significantly lower in patients within the low testosterone tertile (<6.8 nmol/L) compared with those within the high tertile (>10.1 nmol/L; 64 versus 81%; P = 0.004). A 1-nmol/L increase in serum testosterone level was associated with a 7% decrease in overall mortality (hazard ratio 0.93; 95% confidence interval 0.89 to 0.98; P = 0.01); however, this association was dependent on age and other risk factors in adjusted Cox regression analyses. CONCLUSIONS Testosterone deficiency is common in male HD patients. Although testosterone levels, per se, predicted mortality in this population, this association was largely dependent on age.
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Affiliation(s)
- Ozkan Gungor
- Ege University School of Medicine, Division of Nephrology, Izmir, Turkey.
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Carrero JJ, Qureshi AR, Nakashima A, Arver S, Parini P, Lindholm B, Bárány P, Heimbürger O, Stenvinkel P. Prevalence and clinical implications of testosterone deficiency in men with end-stage renal disease. Nephrol Dial Transplant 2010; 26:184-90. [PMID: 20624775 DOI: 10.1093/ndt/gfq397] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Abnormally low serum testosterone levels were recently associated with an increased mortality risk in male dialysis patients. However, the prevalence of testosterone deficiency in end-stage renal disease (ESRD) is not well defined. We hereby explore the prevalence and correlates of clinical testosterone deficiency in a large cohort of ESRD male patients. METHODS Two hundred and sixty ESRD men [median age 59 (25th-75th percentile 48-67) years] were included. Testosterone concentration and testosterone deficiency (<10 nmol/L) were studied in relation to clinically evident cardiovascular disease and markers of inflammation at baseline as well as deaths registered during the following 36 months. RESULTS Testosterone deficiency was present in 44% of the patients, while 33% showed testosterone insufficiency (10-14 nmol/L), and only 23% had normal testosterone values (>14 nmol/L). Testosterone was strongly and inversely correlated to inflammatory markers (CRP, IL-6 and fibrinogen), even after correction for age and sex hormone-binding globulin. In a crude spline curve, low testosterone concentrations were associated with worse outcome. A clinical condition of testosterone deficiency was independently associated with cardiovascular co-morbidity [odds ratio (OR) 2.51; 95% confidence interval (CI) 1.32-4.76] and death (OR 2.00; 95% CI 1.01-3.97) in logistic regression analyses. CONCLUSIONS Testosterone deficiency is a common finding among male ESRD patients, and it is independently associated with inflammation, cardiovascular co-morbidity and outcome. Future studies are needed to determine the potential adverse effects of male hypogonadism in ESRD and the possibility of improving risk profile, quality of life, and ultimately outcome with testosterone supplementation in these patients.
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Heyman A, Edwards L, Lavalle JB, Swidan S. Cardiometabolic disease in men: an integrative medicine approach to managing hormonal risk factors. JOURNAL OF MEN'S HEALTH 2010. [DOI: 10.1016/j.jomh.2009.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Clinical observations suggest that testosterone generates unconscious broad-spectrum motivations to act. It has also been suggested that subliminal positive-priming techniques also unconsciously enhances motivation for action. This placebo-controlled study examined the separate and possible joint contributions of these assumed unconscious sources of human motivation. Healthy females were administered 0.5 mg sublingual testosterone or placebo. Next, they were subliminally primed with action concepts that were paired with positive or neutral cues, and indicated their motivation for the respective action. Testosterone and positive priming both increased the motivation for action, but there was no joint contribution. Possibly, testosterone pushed the motivational brain system to a limit allowing no add-on contribution by priming, but our data also agree with neuroimaging evidence showing that the neural (subcortical and cortical) pathways of motivation can be functionally disconnected by testosterone administration.
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Matrix effects on an antigen immobilized format for competitive enzyme immunoassay of salivary testosterone. J Immunol Methods 2009; 349:61-6. [DOI: 10.1016/j.jim.2009.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 11/23/2022]
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Schulman CC, Fusco F, Martin Morales A, Tostain J, Vendeira P, Zitzmann M. Testosterone Deficiency: A Common, Unrecognised Syndrome? ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eursup.2009.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jones JO. Improving selective androgen receptor modulator discovery and preclinical evaluation. Expert Opin Drug Discov 2009; 4:981-93. [DOI: 10.1517/17460440903206957] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Clerico A, Fontana M, Vittorini S, Emdin M. The search for a pathophysiological link between gender, cardiac endocrine function, body mass regulation and cardiac mortality: Proposal for a working hypothesis. Clin Chim Acta 2009; 405:1-7. [DOI: 10.1016/j.cca.2009.03.050] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 11/16/2022]
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:260-77. [PMID: 19390324 DOI: 10.1097/med.0b013e32832c937e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rice D, Brannigan RE, Campbell RK, Fine S, Jack L, Nelson JB, Regan-Klich J. Men's health, low testosterone, and diabetes: individualized treatment and a multidisciplinary approach. DIABETES EDUCATOR 2009; 34 Suppl 5:97S-112S; quiz 113S-4S. [PMID: 19020265 DOI: 10.1177/0145721708327143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Testosterone plays a critical role in male reproductive and metabolic functioning. Serum testosterone levels decrease with age, and low testosterone is associated with a variety of comorbidities, including insulin resistance, type 2 diabetes, obesity, metabolic syndrome, and cardiovascular disease. Men with type 2 diabetes have been shown to have significantly lower testosterone levels than men without diabetes. Several forms of testosterone replacement therapy (eg, oral, injectable, buccal, transdermal preparations) are available for use in the United States. The primary goals of testosterone therapy are to restore physiologic testosterone levels and reduce the symptoms of hypogonadism. Testosterone therapy may be a viable option in some men with diabetes and low testosterone; however, clinicians must be aware of contraindications to therapy (eg, prostate cancer and male breast cancer), implement appropriate monitoring procedures, and ensure that patient expectations are realistic regarding treatment outcome. Data suggest that testosterone therapy may have a positive effect on bones, muscles, erythropoiesis and anemia, libido, mood and cognition, penile erection, cholesterol, fasting blood glucose, glycated hemoglobin, insulin resistance, visceral adiposity, and quality of life. Sexual health may be a window into men's health; thus, more effective communication strategies are needed between clinicians and men with diabetes to ensure that sexual health topics are adequately addressed. Diabetes educators can play a key role in screening for low testosterone, providing relevant information to patients, and increasing clinician awareness of the need to address men's sexual health and implement appropriate strategies. Multidisciplinary care and individualized treatment are needed to optimize outcome.
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Affiliation(s)
- Donna Rice
- The Botsford Center for Lifestyle Management, Novi, Michigan (Ms Rice)
| | - Robert E Brannigan
- Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, Illinois (Dr Brannigan)
| | - R Keith Campbell
- Washington State University College of Pharmacy, Pullman (Mr Campbell)
| | - Shari Fine
- Christ Hospital, Short Hills, New York (Dr Fine)
| | - Leonard Jack
- School of Public Health, Louisiana State University, New Orleans (Dr Jack)
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Veltkamp M, Aarts H, Custers R. Unravelling the motivational yarn: A framework for understanding the instigation of implicitly motivated behaviour resulting from deprivation and positive affect. EUROPEAN REVIEW OF SOCIAL PSYCHOLOGY 2009. [DOI: 10.1080/10463280903388665] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paasch U, Glander HJ, Stolzenburg JU. Andrologische Testosteronersatztherapie. Urologe A 2009; 48:79-86; quiz 87. [DOI: 10.1007/s00120-008-1911-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mitchell JS, Lowe TE. Ultrasensitive detection of testosterone using conjugate linker technology in a nanoparticle-enhanced surface plasmon resonance biosensor. Biosens Bioelectron 2008; 24:2177-83. [PMID: 19117747 DOI: 10.1016/j.bios.2008.11.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/07/2008] [Accepted: 11/20/2008] [Indexed: 11/16/2022]
Abstract
A rationally designed oligoethylene glycol linker conjugate to testosterone was synthesised and covalently immobilized on a surface plasmon resonance (SPR) biosensor surface. The sensing surface was stable for more than 330 binding and regeneration cycles allowing a high degree of re-use. This surface was then used in the development of an ultrasensitive immunobiosensor system for testosterone in buffer utilizing both secondary antibody and gold nanoparticle signal enhancement. The mechanism for the increased sensitivity results from increased binding mass and a gold plasmon coupling effect. The addition of a secondary antibody with an attached gold nanoparticle increased the signal sensitivity of the assay 12.5-fold compared with primary antibody alone. In the enhanced format the assay had limits of detection (LOD) of 3.7 pgml(-1) with standard in running buffer, and 15.4 pgml(-1) in a stripped human saliva matrix. This immunobiosensor system has sufficient sensitivity to measure testosterone across the broad physiologically relevant range in male saliva (29-290 pgml(-1)) in under 13 min allowing monitoring of testosterone in near real-time.
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Affiliation(s)
- John S Mitchell
- Health and Food Group, The Horticulture and Food Research Institute of New Zealand Ltd., East Street Private Bag 3123, Hamilton, New Zealand
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