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Coskun G, Sencar L, Tuli A, Dundar Yenilmez E, Polat S. The effect of Vitamin D on testosterone and uncarboxylated osteocalcin levels in aged male rats. Ultrastruct Pathol 2022; 46:368-376. [PMID: 35675386 DOI: 10.1080/01913123.2022.2083280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is a well-established complex interaction between vitamin D metabolism and bone and gonad functions. In this study, we aimed to investigate the potential effects of vitamin D therapy on testosterone and osteocalcin (OC) levels in aged male rats. Forty-five adult male rats were divided into three groups in this study. Unlike the control group, the two experimental groups received 50 IU/kg/day and 100 IU/kg/day of vitamin D3 (cholecalciferol), respectively, for a 4-week period using the gavage method. Testicular tissue and blood samples from rats were collected under general anesthesia at the end of the 4-week period. Testicular tissue samples were examined using light and electron microscopy. Additionally, serum testosterone and OC levels were measured in blood samples. The 50 IU/kg dose of cholecalciferol increased testosterone and OC levels, which were lower than normal due to aging, and regulated the organization of the seminiferous tubule epithelium and interstitium more effectively than the 100 IU/kg dose of cholecalciferol. Male fertility functions and bone health, which degrade due to aging, were increased due to the use of exogenous vitamin D, although the higher dose was not associated with more effective results.
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Affiliation(s)
- Gulfidan Coskun
- Department of Histology and Embryology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Leman Sencar
- Department of Histology and Embryology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Abdullah Tuli
- Department of Biochemistry, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ebru Dundar Yenilmez
- Department of Biochemistry, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Sait Polat
- Department of Histology and Embryology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Zouhal H, Jayavel A, Parasuraman K, Hayes LD, Tourny C, Rhibi F, Laher I, Abderrahman AB, Hackney AC. Effects of Exercise Training on Anabolic and Catabolic Hormones with Advanced Age: A Systematic Review. Sports Med 2021; 52:1353-1368. [PMID: 34936049 PMCID: PMC9124654 DOI: 10.1007/s40279-021-01612-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/19/2022]
Abstract
Background Ageing is accompanied by decreases in physical capacity and physiological regulatory mechanisms including altered hormonal regulation compared with age-matched sedentary people. The potential benefits of exercise in restoring such altered hormone production and secretion compared to age-matched physically inactive individuals who are ageing remains unclear. Objectives The aim of this systematic review was to summarise the findings of exercise training in modulating levels of ostensibly anabolic and catabolic hormones in adults aged > 40 years. Methods We searched the following electronic databases (to July 2021) without a period limit: Cochrane Library, PubMed, Science Direct, Scopus, SPORTDiscus and Web of Science. Additionally, a manual search for published studies in Google Scholar was conducted for analysis of the ‘grey literature’ (information produced outside of traditional commercial or academic publishing and distribution channels). The initial search used the terms ‘ageing’ OR ‘advanced age’ OR ‘old people’ OR ‘older’ OR elderly’ AND ‘anabolic hormones’ OR ‘catabolic hormones’ OR ‘steroid hormones’ OR ‘sex hormones’ OR ‘testosterone’ OR ‘cortisol’ OR ‘insulin’ OR ‘insulin-like growth factor-1’ OR ‘IGF-1’ OR ‘sex hormone-binding globulin’ OR ‘SHBG’ OR ‘growth hormone’ OR ‘hGH’ OR ‘dehydroepiandrosterone’ OR ‘DHEA’ OR ‘dehydroepiandrosterone sulfate (DHEA-S)’ AND ‘exercise training’ OR ‘endurance training’ OR ‘resistance training’ OR ‘ strength training’ OR ‘weight-lifting’ OR ‘high-intensity interval training’ OR ‘high-intensity interval exercise’ OR ‘high-intensity intermittent training’ OR ‘high-intensity intermittent exercise’ OR ‘interval aerobic training’ OR ‘interval aerobic exercise’ OR ‘intermittent aerobic training’ OR ‘intermittent aerobic exercise’ OR ‘high-intensity training’ OR ‘high-intensity exercise’ OR ‘sprint interval training’ OR ‘sprint interval exercise’ OR ‘combined exercise training’ OR ‘anaerobic training’. Only eligible full texts in English or French were considered for analysis. Results Our search identified 484 records, which led to 33 studies for inclusion in the analysis. Different exercise training programs were used with nine studies using endurance training programs, ten studies examining the effects of high-intensity interval training, and 14 studies investigating the effects of resistance training. Most training programs lasted ≥ 2 weeks. Studies, regardless of the design, duration or intensity of exercise training, reported increases in testosterone, sex hormone-binding globulin (SHBG), insulin-like growth factor-1 (IGF-1), human growth hormone (hGH) or dehydroepiandrosterone (DHEA) (effect size: 0.19 < d < 3.37, small to very large) in both older males and females. However, there was no consensus on the effects of exercise on changes in cortisol and insulin in older adults. Conclusion In conclusion, findings from this systematic review suggest that exercise training increases basal levels of testosterone, IGF-1, SHBG, hGH and DHEA in both male and females over 40 years of age. The increases in blood levels of these hormones were independent of the mode, duration and intensity of the training programs. However, the effects of long-term exercise training on cortisol and insulin levels in elderly people are less clear.
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Affiliation(s)
- Hassane Zouhal
- M2S, Laboratoire Mouvement, Sport, Santé, EA 1274, Université Rennes, 35000, Rennes, France.
- Institut International des Sciences du Sport (2I2S), 35850, Irodouer, France.
| | - Ayyappan Jayavel
- SRM College of Physiotherapy, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, TN, 603203, India
| | - Kamalanathan Parasuraman
- SRM College of Physiotherapy, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, TN, 603203, India
| | - Lawrence D Hayes
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, Glasgow, G72 0LH, UK
| | | | - Fatma Rhibi
- M2S, Laboratoire Mouvement, Sport, Santé, EA 1274, Université Rennes, 35000, Rennes, France
| | - Ismail Laher
- Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada
| | | | - Anthony C Hackney
- Department of Exercise and Sport Science, Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
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Hayes LD, Elliott BT. Short-Term Exercise Training Inconsistently Influences Basal Testosterone in Older Men: A Systematic Review and Meta-Analysis. Front Physiol 2019; 9:1878. [PMID: 30692929 PMCID: PMC6339914 DOI: 10.3389/fphys.2018.01878] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background: The age-associated decrease in testosterone is one mechanism suggested to accelerate the aging process in males. Therefore, approaches to increase endogenous testosterone may be of benefit. The aim of this paper was to undertake a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis concerning the effect of exercise on total (TT), bioavailable (bio-T), free (free-T), and salivary (sal-T) testosterone in older males. Methods: Databases were searched up to and including 20th February 2018 for the terms "testosterone AND exercise AND aging AND males," "testosterone AND exercise AND old AND males," "testosterone AND training AND aging AND males," and "testosterone AND training AND old AND males". From 1259 originally identified titles, 22 studies (randomized controlled trials; RCTs; n = 9, and uncontrolled trials; UCTs; n = 13) were included which had a training component, participants ≥60 years of age, and salivary or serum testosterone as an outcome measure. Meta-analyses were conducted on change to testosterone following training using standardized difference in means (SDM) and random effects models. Results: The overall SDM for endurance training, resistance training, and interval training was 0.398 (95% CI = 0.034-0.761; P = 0.010), -0.003 (95% CI = -0.330-0.324; P = 0.986), and 0.283 (95% CI = 0.030-0.535; P = 0.028), respectively. Resistance training exhibited a qualitative effect of hormone fraction whereby free-T resulted in the greatest SDM (0.253; 95% CI = -0.043-0.549; P = 0.094), followed by TT (0.028; 95% CI = -0.204-0.260; P = 0.813), and resistance training negatively influenced bio-T (-0.373; 95% CI = -0.789-0.042; P = 0.078). Due to the small number of studies, subgroup analysis was not possible for endurance training and interval training studies. Conclusions: Data from the present investigation suggests that resistance training does not significantly influence basal testosterone in older men. Magnitude of effect was influenced by hormone fraction, even within the same investigation. Aerobic training and interval training did result in small, significant increases in basal testosterone. The magnitude of effect is small but the existing data are encouraging and may be an avenue for further research.
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Affiliation(s)
- Lawrence D Hayes
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria, Lancaster, United Kingdom
| | - Bradley T Elliott
- Translational Physiology Research Group, School of Life Sciences, University of Westminster, London, United Kingdom
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Abstract
Many patients with prostate cancer for whom androgen deprivation therapy (ADT) is indicated are young and desire to remain sexually active. In such patients, the side effects of androgen therapy on sexual function can be a source of serious reduction in overall quality of life. Providing the appropriate treatment options in this patient population is therefore essential. Nevertheless, treating such patients is challenging and an understanding of the underlying mechanisms of sexual physiology and pathophysiology is crucial to optimal patient care. In this paper, we reviewed what was known regarding the effects of ADT on sexual function in animal models and we also provided a detailed review on the effects of ADT on sexual health in humans and its treatment.
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Surampudi PN, Wang C, Swerdloff R. Hypogonadism in the aging male diagnosis, potential benefits, and risks of testosterone replacement therapy. Int J Endocrinol 2012; 2012:625434. [PMID: 22505891 PMCID: PMC3312212 DOI: 10.1155/2012/625434] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/04/2011] [Accepted: 12/07/2011] [Indexed: 01/26/2023] Open
Abstract
Hypogonadism in older men is a syndrome characterized by low serum testosterone levels and clinical symptoms often seen in hypogonadal men of younger age. These symptoms include decreased libido, erectile dysfunction, decreased vitality, decreased muscle mass, increased adiposity, depressed mood, osteopenia, and osteoporosis. Hypogonadism is a common disorder in aging men with a significant percentage of men over 60 years of age having serum testosterone levels below the lower limits of young male adults. There are a variety of testosterone formulations available for treatment of hypogonadism. Data from many small studies indicate that testosterone therapy offers several potential benefits to older hypogonadal men. A large multicenter NIH supported double blind, placebo controlled study is ongoing, and this study should greatly enhance the information available on efficacy and side effects of treatment. While safety data is available across many age groups, there are still unresolved concerns associated with testosterone therapy. We have reviewed the diagnostic methods as well as benefits and risks of testosterone replacement therapy for hypogonadism in aging men.
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Affiliation(s)
- Prasanth N. Surampudi
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA 90509, USA
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA 90509, USA
- *Ronald Swerdloff:
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Alterations in Hormone Levels After Adjuvant Chemoradiation in Male Rectal Cancer Patients. Int J Radiat Oncol Biol Phys 2009; 74:1186-90. [DOI: 10.1016/j.ijrobp.2008.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 09/22/2008] [Indexed: 11/21/2022]
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Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag 2009; 5:427-48. [PMID: 19707253 PMCID: PMC2701485 DOI: 10.2147/tcrm.s3025] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Indexed: 12/13/2022] Open
Abstract
Increased longevity and population aging will increase the number of men with late onset hypogonadism. It is a common condition, but often underdiagnosed and undertreated. The indication of testosterone-replacement therapy (TRT) treatment requires the presence of low testosterone level, and symptoms and signs of hypogonadism. Although controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men, reports indicate that TRT may produce a wide range of benefits for men with hypogonadism that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. The purpose of this review is to discuss what is known and not known regarding the benefits and risks of TRT.
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Affiliation(s)
| | - Saad Alkaade
- Internal Medicine, Saint Louis University Health Sciences Center, St. Louis, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine
- GRECC, VA Medical Center, St. Louis, Missouri, USA
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Hsieh FI, Hwang TS, Hsieh YC, Lo HC, Su CT, Hsu HS, Chiou HY, Chen CJ. Risk of erectile dysfunction induced by arsenic exposure through well water consumption in Taiwan. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:532-6. [PMID: 18414639 PMCID: PMC2291004 DOI: 10.1289/ehp.10930] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 01/15/2008] [Indexed: 05/20/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) has a profound impact on the quality of life of many men. Many risk factors are associated with ED, such as aging, sex hormone levels, hypertension, cardiovascular diseases, and diabetes mellitus. Arsenic exposure could damage peripheral vessels and increase the risk of cardiovascular disease. However, the relationship between arsenic exposure and ED has seldom been evaluated. OBJECTIVES In this study we aimed to investigate whether exposure to arsenic enhances the risk of ED. METHODS We recruited 177 males >or= 50 years of age through health examinations conducted in three hospitals in Taiwan. We used a questionnaire (International Index of Erectile Function-5) to measure the level of erectile function. Sex hormones, including total testosterone and sex hormone-binding globulin, were determined by radioimmunoassay. We used another standardized questionnaire to collect background and behavioral information (e.g., cigarette smoking; alcohol, tea, or coffee drinking; and physical activity). RESULTS The prevalence of ED was greater in the arsenic-endemic area (83.3%) than in the non-arsenic-endemic area (66.7%). Subjects with arsenic exposure > 50 ppb had a significantly higher risk of developing ED than those with exposure <or= 50 ppb, after adjusting for age, cigarette smoking, diabetes mellitus, hypertension, and cardiovascular disease [odds ratio (OR) = 3.4]. Results also showed that the risk of developing severe ED was drastically enhanced by arsenic exposure (OR = 7.5), after adjusting for free testosterone and traditional risk factors of ED. CONCLUSIONS Results suggested that chronic arsenic exposure has a negative impact on erectile function.
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Affiliation(s)
- Fang-I Hsieh
- School of Public Health and
- Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan
| | - Ti-Sheng Hwang
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | | - Chien-Tien Su
- School of Public Health and
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Shing Hsu
- Department of Urology, Lotung Poh-Ai Hospital, Lotung, Taiwan
| | - Hung-Yi Chiou
- School of Public Health and
- Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan
- Address correspondence to H.-Y. Chiou, School of Public Health, Topnotch Stroke Research Center, Taipei Medical University, No. 250, Wu-Hsing St., Taipei 110, Taiwan. Telephone: 886-2-23779188. Fax: 886-2-23779189. E-mail:
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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9
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Martínez-Jabaloyas JM, Queipo-Zaragozá A, Pastor-Hernández F, Gil-Salom M, Chuan-Nuez P. Testosterone levels in men with erectile dysfunction. BJU Int 2006; 97:1278-83. [PMID: 16686726 DOI: 10.1111/j.1464-410x.2006.06154.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the frequency of hypogonadism in men with erectile dysfunction (ED) and to assess which factors are related with low testosterone levels. PATIENTS AND METHODS In all, 165 men with ED were assessed; the evaluation included: hormonal profiles, serum total and free testosterone (using Vermeulen's formula) levels, and self-reported questionnaires on erectile function and desire domains of the International Index of Erectile Function. The frequency of hypogonadism was established using total and free testosterone levels as diagnostic criteria. The factors that might influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression was used to determine which factors can predict free testosterone levels below normal limits (biochemical hypogonadism). RESULTS Using the total testosterone levels, 4.8% of the men were hypogonadal, whereas when using the free testosterone levels, 17.6% were hypogonadal. In the univariate analyses, not smoking and hypertension were associated with lower total and free testosterone levels. Ageing, absence of nocturnal erections and a lower erectile function score were only associated with lower free testosterone serum levels. There was no association between total and free testosterone levels and desire. In the multivariate analysis, only total testosterone levels were related to hypertension, while free testosterone levels were related to age and nocturnal erections. For biochemical hypogonadism, simple logistic regression analysis selected age, erectile function score and aetiological diagnosis of ED as predictors. In the multivariate analysis only the erectile function score had significant independent prognostic value. CONCLUSIONS The frequency of hypogonadism is higher when free testosterone levels are used for diagnosis. The total and free testosterone levels were not related to the level of sexual desire in men with ED. The free testosterone levels could be related to the quality and frequency of nocturnal erections, and when ED is more severe, it is more probable that free testosterone levels are below the 'normal' limit.
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Affiliation(s)
- José M Martínez-Jabaloyas
- Servicio de Urología and Laboratorio de Bioquímica Clínica, Hospital Clínico Universitario de Valencia, Spain.
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Nakazawa R, Baba K, Nakano M, Katabami T, Saito N, Takahashi T, Iwamoto T. Hormone profiles after intramuscular injection of testosterone enanthate in patients with hypogonadism. Endocr J 2006; 53:305-10. [PMID: 16710076 DOI: 10.1507/endocrj.k05-069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To examine hormone levels after androgen replacement therapy (ART) in Japanese male patients with hypogonadism, nine Japanese male patients with hypogonadism (serum total testosterone (tT) or free testosterone (fT) levels of < or = 2.7 ng/mL or < or = 10 pg/mL, respectively; average age, 59 years) were enrolled. They were treated with 125 mg of testosterone enanthate by single intramuscular injection. Blood samples were collected on the morning of the day of treatment, pre-ART, as well as on days 1 to 7 and day 14 after administration. Serum levels of tT, fT, estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) were determined. On day 1 after administration, the mean serum levels of tT and fT were 7.62 ng/mL and 23.22 pg/mL, respectively. Serum levels of tT and fT on day 14 after administration were lower than their pre-ART values. One patient exhibited abnormally high serum tT and fT levels of 19.6 ng/mL and 44.4 pg/mL, respectively. Serum levels of LH and FSH began to decrease gradually on day 5 after administration. Serum levels of SHBG did not change throughout the observation period. Serum levels of E2 increased 1.7 times on day 1 after administration but returned to its pre-ART value by day 14 after administration. The dose of testosterone enanthate for male patients with hypogonadism requiring ART should be determined carefully because some patients exhibited high serum levels of androgen beyond the physiological range and gonadotropin was suppressed in all treated patients.
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Affiliation(s)
- Ryuto Nakazawa
- Department of Urology, St. Marianna University, Kawasaki, Japan
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Isidori AM, Giannetta E, Gianfrilli D, Greco EA, Bonifacio V, Aversa A, Isidori A, Fabbri A, Lenzi A. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 2005; 63:381-94. [PMID: 16181230 DOI: 10.1111/j.1365-2265.2005.02350.x] [Citation(s) in RCA: 308] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The role of androgen decline in the sexual activity of adult males is controversial. To clarify whether sexual function would benefit from testosterone (T) treatment in men with partially or severely reduced serum T levels, we conducted a systematic review and meta-analysis of placebo-controlled studies published in the past 30 years. The aim of this study was to assess and compare the effects of T on the different domains of sexual life. DATA SOURCE A comprehensive search of all published randomized clinical trials was performed in MEDLINE, the Cochrane Library, EMBASE and Current Contents databases. REVIEW METHODS Guided by prespecified criteria, software-assisted data abstraction and quality assessed by two independent reviewers, a total of 17 randomized placebo-controlled trials were found to be eligible. For each domain of sexual function we calculated the standardized mean difference relative to T and reported the results of pooled estimates of T treatment using the random effect model of meta-analysis. Heterogeneity, reproducibility and consistency of the findings across studies were explored using sensitivity and meta-regression analysis. RESULTS Overall, 656 subjects were evaluated: 284 were randomized to T, 284 to placebo (P) and 88 treated in cross-over. The median study length was 3 months (range 1-36 months). Our meta-analysis showed that in men with an average T level at baseline below 12 nmol/l, T treatment moderately improved the number of nocturnal erections, sexual thoughts and motivation, number of successful intercourses, scores of erectile function and overall sexual satisfaction, whereas T had no effect on erectile function in eugonadal men compared to placebo. Heterogeneity was explored by grouping studies according to the characteristics of the study population. A cut-off value of 10 nmol/l for the mean T of the study population failed to predict the effect of treatment, whereas the presence of risk factors for vasculogenic erectile dysfunction (ED), comorbidities and shorter evaluation periods were associated with greater treatment effects in the studies performed in hypogonadal, but not in eugonadal, men. Meta-regression analysis showed that the effects of T on erectile function, but not libido, were inversely related to the mean baseline T concentration. The meta-analysis of available studies indicates that T treatment might be useful for improving vasculogenic ED in selected subjects with low or low-normal T levels. The evidence for a beneficial effect of T treatment on erectile function should be tempered with the caveats that the effect tends to decline over time, is progressively smaller with increasing baseline T levels, and long-term safety data are not available. The present meta-analysis highlights the need, and pitfalls, for large-scale, long-term, randomized controlled trials to formally investigate the efficacy of T replacement in symptomatic middle-aged and elderly men with reduced T levels and ED.
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Acar D, Cayan S, Bozlu M, Akbay E. Is routine hormonal measurement necessary in initial evaluation of men with erectile dysfunction? ACTA ACUST UNITED AC 2005; 50:247-53. [PMID: 15277002 DOI: 10.1080/01485010490448769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To prospectively compare serum hormone levels and the incidence of hormonal pathologies between men with and without erectile dysfunction, and investigate risk factors that might predict hormonal pathologies in men complaining of erectile dysfunction. The study included 262 men with erectile dysfunction and 53 healthy men with no erectile dysfunction as a control group. All men enrolled in the study were evaluated with a detailed history, physical examination, international index of erectile function (IIEF-5), and serum hormone measurement. Hypotestosteronemia was considered as serum total testosterone value of < 3 ng/mL, and hyperprolactinemia was considered as serum prolactin level of > 18 ng/mL. Serum hormone levels and the incidence of hormonal abnormalities were compared between the two groups. In addition, risk factors for hormonal abnormalities were investigated. There were no significant differences in the mean serum FSH (p = 0.212), LH (p = 0.623), testosterone (p = 0.332) and prolactin values (p = 0.351) between the men with and without erectile dysfunction. Hypotestosteronemia was detected in 29 (11%) of the erectile dysfunction group and in 2 (3.7%) of the control group, revealing no significant difference (p = 0.104). Hyperprolactinemia was detected in 25 (9.5%) of the erectile dysfunction group and in 2 (3.7%) of the control group, revealing no significant difference (p = 0.171). To investigate risk factors that might predict hormonal pathologies, there were no significant differences in the patient age, duration of the sexual dysfunction, smoking history and duration, the presence of chronic disease and the type of erectile dysfunction. Our findings suggest that hormonal measurement should not be routinely performed in the initial evaluation of men presenting with erectile dysfunction, and may be necessary based only on the findings obtained with a careful history and physical examination.
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Affiliation(s)
- D Acar
- Department of Urology, University of Mersin School of Medicine, Turkey
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Hermann RM, Henkel K, Christiansen H, Vorwerk H, Hille A, Hess CF, Schmidberger H. Testicular dose and hormonal changes after radiotherapy of rectal cancer. Radiother Oncol 2005; 75:83-8. [PMID: 15878105 DOI: 10.1016/j.radonc.2004.12.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 11/08/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE To measure the dose received by the testicles during radiotherapy for rectal cancer and to determine the contribution of each field of the pelvic box and the relevance for hormonal status. MATERIALS AND METHODS In 11 patients (mean age 55.2 years) testicular doses were measured with an ionisation chamber between 7 and 10 times during the course of pelvic radiotherapy (50 Gy) for rectal carcinoma. Before and several months after radiotherapy luteinizing hormone, follicle stimulating hormone and total testosterone serum levels were determined. RESULTS The mean cumulative radiation exposure to the testicles was 3.56 Gy (0.7-8.4 Gy; 7.1% of the prescribed dose). Seventy-three percent received more than 2 Gy to the testicles. Fifty-eight percent of the measured dose was contributed by the p.a. field, 30% by the a.p. field and 12% by the lateral fields. Mean LH and FSH levels were significantly increased after therapy (350%/185% of the pre-treatment values), testosterone levels decreased to 78%. No correlation could be found between changes of hormones and doses to the testis, probably due to the low number of evaluated patients. CONCLUSIONS Radiotherapy of rectal carcinoma causes significant damage to the testis, as shown by increased levels of gonadotropins after radiotherapy. Most of the gonadal dose is delivered by the p.a. field, due to the divergence of the p.a. beam towards the testicles. The reduction in testosterone level may be of clinical concern. Patients who will receive radiotherapy for rectal carcinoma must be instructed about a high risk of permanent infertility, and the risk of endocrine failure (hypogonadism). Larger studies are needed to establish the correlation between testicular radiation dose and hormonal changes in this group of patients.
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Affiliation(s)
- Robert M Hermann
- Department of Radiation Oncology and Radiotherapy, Georg-August-Universität Göttingen, Germany
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Morgentaler A. Testosterone replacement therapy: Benefits, risks, and controversies. CURRENT SEXUAL HEALTH REPORTS 2004. [DOI: 10.1007/s11930-004-0008-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kaweski S. Anti-aging medicine: hormone replacement therapy in men. Plast Reconstr Surg 2004; 113:1506-10. [PMID: 15060372 DOI: 10.1097/01.prs.0000125283.18798.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susan Kaweski
- Craniofacial, Reconstructive, and Cosmetic Institute, San Diego, CA 92123, USA.
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Affiliation(s)
- Ernani Luis Rhoden
- Division of Urology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, USA
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Dueland S, Guren MG, Olsen DR, Poulsen JP, Magne Tveit K. Radiation therapy induced changes in male sex hormone levels in rectal cancer patients. Radiother Oncol 2003; 68:249-53. [PMID: 13129632 DOI: 10.1016/s0167-8140(03)00120-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE To determine the effect of curative radiation therapy (46-50 Gy) on the sex hormone levels in male rectal cancer patients. MATERIALS AND METHODS Twenty-five male rectal cancer patients (mean age 65 years), receiving pelvic radiation therapy (2 Gyx23-25 fractions in 5 weeks) were included. Serum testosterone, FSH and LH were determined before start of treatment, at the 10th and 25th fractions, and 4-6 weeks after completed radiotherapy. The testicular dose was determined by thermoluminescent dosimetry. RESULTS Five weeks of radiation therapy (46-50 Gy) resulted in a 100% increase in serum FSH, a 70% increase in LH, and a 25% reduction in testosterone levels. After treatment, 35% of the patients had serum testosterone levels below lower limit of reference. The mean radiation dose to the testicles was 8.4 Gy. A reduction in testosterone values was observed already after a mean dose of 3.3 Gy (10th fraction). CONCLUSION Radiation therapy (46-50 Gy) for rectal cancer resulted in a significant increase in serum FSH and LH and a significant decrease in testosterone levels, indicating that sex hormone production is sensitive to radiation exposure in patients with a mean age of 65 years.
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Affiliation(s)
- Svein Dueland
- Department of Oncology, Ullevaal University Hospital, Oslo, Norway
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Zakaria L, Anastasiadis AG, Shabsigh R. Common conditions of the aging male: erectile dysfunction, benign prostatic hyperplasia, cardiovascular disease and depression. Int Urol Nephrol 2002; 33:283-92. [PMID: 12092641 DOI: 10.1023/a:1015292603884] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With increasing life expectancy, medical profession will be faced with the task of ensuring that the large, aging population remains healthy and vital despite the face of increasing healthcare costs. Naturally, urology as a specialty is concerned with important geriatric issues. This article will focus specifically on the aging male population and the health problems that most frequently plague them. Four major, non-cancer, disease states have been identified that adversely effect males over the age of 50. These conditions are: erectile dysfunction (ED), benign prostatic hyperplasia (BPH), cardiovascular disease (CVD) and depression. A literature search of PubMed was conducted using the key words ED, BPH, CVD and depression as well as ADAM (Androgen Decline in the Aging Male) and quality of life (QoL). NIH and WHO conference proceedings and publications were also referenced to insure detail and accuracy of data. Information was then organized and correlated in order to provide a detailed description of the key conditions and their interrelatedness. The spectrum of research performed thus far regarding this topic has done little to investigate the effects, causes and correlations between these conditions. Research has been done linking two or three of these conditions; however, there remains to be information discussing the four disease states in terms of their possible cause and effect relationships or the effectiveness of parallel, multi-disciplinary approach to their therapy. This report calls attention to the benefits of viewing and researching the above mentioned conditions as possibly interrelated, as opposed to the traditional view of them as separate, unrelated and independently treatable disease states. ED, BPH, CVD and depression are all common conditions that accompany aging and negatively impact QoL. They almost always develop with age and precipitate considerable morbidity and may even result in mortality. Furthermore, the presentation of one condition may correlate with the development of another. The inter-relation of these conditions, as evident from their underlying similarities, cause-and-effects relationships and therapeutic consequences, should be enough to warrant a multidisciplinary approach to their research. This approach, combined with careful choice of therapy, parallel and singular, will help providers reach their goal to keep patients healthy, and more importantly happy, late into their life, thus realizing the concept of "successful aging".
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Affiliation(s)
- L Zakaria
- Department of Urology, The College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Rhoden EL, Teloken C, Sogari PR, Souto CARYV. The Relationship Of Serum Testosterone To Erectile Function In Normal Aging Men. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65191-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ernani Luis Rhoden
- From the Andrology Division, Department of Urology, Santa Casa Hospital and Fundação Faculdade Federal de Ciências Médicas, Porto Alegre, Brazil
| | - Claudio Teloken
- From the Andrology Division, Department of Urology, Santa Casa Hospital and Fundação Faculdade Federal de Ciências Médicas, Porto Alegre, Brazil
| | - Paulo Roberto Sogari
- From the Andrology Division, Department of Urology, Santa Casa Hospital and Fundação Faculdade Federal de Ciências Médicas, Porto Alegre, Brazil
| | - Carlos ARY Vargas Souto
- From the Andrology Division, Department of Urology, Santa Casa Hospital and Fundação Faculdade Federal de Ciências Médicas, Porto Alegre, Brazil
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Tangredi JF, Buxton IL. Hypertension as a complication of topical testosterone therapy. Ann Pharmacother 2001; 35:1205-7. [PMID: 11675846 DOI: 10.1345/aph.1a020] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To report a patent developing hypertension following the use of testosterone gel. CASE SUMMARY A 65-year-old white man who was placed on topical testosterone therapy to increase libido developed hypertension and increased hematocrit simultaneously. After discontinuation of the testosterone, the hematocrit returned to mid-normal reference range and blood pressure returned to normal; he had been normotensive prior to topical testosterone use. DISCUSSION The popularity of hormone replacement for women for the maintenance of appearance and lifestyle and the prevention of complications such as osteoporosis has been established over several decades, and the complications and risks and benefits of this therapy have been well described. More recently, and particularly with the availability of topical preparations of testosterone, hormone replacement for men is becoming popular with both older male patients and their physicians. We describe a case of hypertension as a complication of the application of topical testosterone and link this adverse effect to the known anabolic effects of testosterone. CONCLUSIONS Clinicians should be cautious in prescribing topical preparations of testosterone for the proper administration by the patient and alert to the development of hypertension in this population at increased risk for cardiovascular events due to their age.
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Affiliation(s)
- J F Tangredi
- Department of Surgery, School of Medicine, University of Nevada, Las Vegas 89557-0046, USA
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22
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Bhugra D. Literature update: A critical review. SEXUAL AND RELATIONSHIP THERAPY 2001. [DOI: 10.1080/14681990123528] [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: 10/27/2022]
Affiliation(s)
- Dinesh Bhugra
- a Senior Lecturer, Institute of Psychiatry , De Crespigny Park, London , SE5 8AF , United Kingdom
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Affiliation(s)
- C F Donatucci
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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