Mobility and Biomechanical Functions in the Aging Male: Testosterone and the Locomotive Syndrome

Testosterone Replacement Therapy in the Aged Male: Monitoring Patients’ Quality of Life Utilizing Scoring Systems

Hypogonadism has been associated with significant deterioration of well-being. In the aging male, late-onset hypogonadism affects sexual life, mental health, levels of energy, lower urinary tract symptoms and, therefore, quality of life may be found significantly deteriorated. Testosterone replacement or supplementation therapy has been found efficient to reverse the adverse effects of hypogonadism and improve quality of life. Scales and questionnaires assessing the general health, urinary symptoms, sexual health, and cognition can provide a thorough assessment of the clinical syndrome, optimize treatment, assist the follow-up, and facilitate referrals to other specialties depending on the chief complaint. A systematic assessment might combine several tools, but the optimal ones and the exact usage is unknown. In this narrative review, we are flipping through the literature presenting the available tools per domain for the assessment of quality of life in men on testosterone replacement therapy and we discuss the optimal usage.

Site-Specific Muscle Loss in the Abdomen and Anterior Thigh in Elderly Males with Locomotive Syndrome

Although locomotive syndrome (LS) is a condition of reduced mobility, little information is available regarding the loss of site-specific skeletal muscle mass. The aim of the present study is to examine site-specific muscle loss in elderly males with LS. A total of 100 men ranging in age from 65 to 74 years were divided into two groups (LS and non-LS) using LS risk tests including the stand-up test, two-step test, and the 25-question geriatric locomotive function scale Muscle thickness (MTH) at eight sites-anterior and posterior thigh (AT and PT, respectively), anterior and posterior lower leg (AL and PL, respectively), rectus abdominis (RA), anterior and posterior upper arm (AU and PU, respectively), and anterior forearm (AF)-was evaluated using B-mode ultrasound. Furthermore, the 30-s chair stand test (CS-30), 10-m walking time, zig-zag walking time, and sit-up test were assessed as physical functions. There were no significant differences in age and body mass index between the LS and non-LS groups. The percentage of skeletal muscle was lower in the LS group than in the non-LS group. Although there were no differences in the MTH of AU, PU, AF, PT, Al and PL, site-specific muscle loss was observed at RA and AT in the LS group. CS-30, 10-m walking time, zig-zag walking time, and sit-up test in the LS group were all worse than those in the non-LS group. The MTHs of RA and AT were both correlated to those physical functions. In conclusion, the LS group had site-specific muscle loss and worse physical functions. This study suggests that site-specific changes may be associated with age-related physical functions. These results may suggest what the essential characteristics of LS are.

Impact of Habitual Exercise on Locomotive Function of Middle-aged and Elderly Volunteers: A Longitudinal Study

OBJECTIVES

This longitudinal study aimed to evaluate the effect of acquisition of an exercise habit on locomotive dysfunction (LD).

METHODS

The subjects were 121 male and 196 female volunteers aged more than 50 years who attended health checkups in Toei, central Japan, in 2012 and 2014. We divided the subjects into three groups: an acquiring exercise group (Ac-Ex) composed of those who acquired an exercise habit between 2012 and 2014, a non-exercise group (Non-Ex) who did not acquire an exercise habit, and an exercise group (Ex) who already had an exercise habit in 2012. We compared the 25-question Geriatric Locomotive Function Scale (GLFS-25) score among the three groups.

RESULTS

In men in the Ac-Ex group, the GLFS-25 score improved significantly between 2012 and 2014 (P=0.046), and sub-analysis of the GLFS-25 responses showed that fundamental and instrumental activities of daily living (ADL) improved significantly. In women in the Ac-Ex group, the prevalence of radiologically diagnosed knee osteoarthritis was significantly higher (P=0.027) than that for the other two groups, and there was no significant improvement in GLFS-25 score over the 2-year period.

CONCLUSIONS

The acquisition of an exercise habit had a positive effect on the locomotive function in men. Orthopedic surgeons must enlighten people on the need for a continuous exercise habit.

Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility

Introduction: Low testosterone and its symptoms is a condition affecting many males with severe repercussions on health. Testosterone affects metabolism, bones, joints, and ligaments, the cardiovascular system, liver, sexual functions, muscle mass, and the nervous system. Nowadays, due to recent research showing the benefits of testosterone replacement therapy, this treatment is gaining in popularity among aging men. However, testosterone replacement can increase the risk of infertility. Areas covered: Human chorionic gonadotropin (HCG) is used in the treatment of male infertility due to its luteinizing hormone (LH)-like action triggering testosterone and sperm production. Due to these positive effects on testosterone production, HCG has also been used to treat secondary hypogonadism. In this review, based on a literature review for the years 1977-2020 via Google Scholar, we summarize the current research on HCG as treatment for patients suffering from low testosterone and provide an overview of the pros and contras for HCG therapy as compared to testosterone replacement therapy for the treatment of secondary hypogonadism. Expert opinion: The testosterone and sperm production triggering effects of HCG without the side effects on fertility seen in testosterone replacement therapy make HCG therapy a prime candidate for patients suffering from secondary hypogonadism.

Regular aerobic exercise improves sexual function assessed by the Aging Males' Symptoms questionnaire in adult men

The leading cause of aging-induced male-specific disorders such as physical, mental and/or sexual symptoms is testosterone deficiency. Although aerobic exercise is suggested to improves circulating testosterone levels, physical fitness, depressive symptoms, and sexual function, the effect of regular aerobic exercise on aging-induced disorders has not yet been clarified. Here we performed cross-sectional and interventional studies to identify the effect of aerobic exercise on aging-induced disorders assessed by the Aging Males' Symptoms questionnaire (AMS). In study 1, the relationship between aerobic exercise capacity (i.e. peak oxygen consumption) and AMS scores were cross-sectionally examined in 169 adult men. In study 2, the effect of a 12-week regular aerobic exercise on AMS scores was longitudinally investigated in 18 adult men. In study 1, the AMS-total, AMS-somatic, AMS-psychological, and AMS-sexual scores were significantly correlated to aerobic exercise capacity even after considering age and testosterone levels. In study 2, 12-week aerobic exercise training significantly improved AMS-sexual and tended to improve AMS-total scores. Additionally, an increase in vigorous physical activity was correlated to improve in the AMS-sexual score. These results suggest that regular aerobic exercise is an effective strategy to improve aging-induced disorders in men.

Association between metabolic syndrome, hepatic steatosis, and testosterone deficiency: evidences from studies with men and rodents

Testosterone is the predominant androgen in men and the lack of it can be a trigger to the development of the metabolic syndrome. Here we review the relationship between testosterone deficiency, metabolic syndrome, and hepatic steatosis reported by studies with men and rodents. The prevalence of metabolic syndrome and testosterone deficiency is higher among older subjects. Low total and free testosterone levels were positively associated with disturbs on energy metabolism, changes in body fat distribution, and body composition. Studies reported visceral fat accumulation in men with hypogonadism and castrated rats. Despite some contradictions, the association between higher adiposity, low testosterone, and metabolic syndrome was a common point among the studies. Few studies evaluated the hepatic steatosis and found an association with hypogonadism. Most of the studies with rodents combined the castration with a high-fat diet to study metabolic disturbs. The importance of proper levels of testosterone for energy metabolism homeostasis in men was also underlined by studies that investigated the metabolic effects of testosterone replacement therapy and androgen deprivation therapy.

Bone mineral density and vitamin D levels in patients with group a COPD

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) is a chronic, inflammatory airway disease associated with osteoporosis. Reduced bone mineral density (BMD) and impaired bone quality were shown to cause increased bone fragility and fractures in COPD patients. The aim of this study was to evaluate vitamin D levels and BMDs in Group A COPD patients.

METHODS

This case-control study involved 33 males aged 50 or above diagnosed with Group A COPD and 44 age-matched healthy males. Participants' serum vitamin D and other indicators were evaluated as well as lumbar and hip BMD of COPD patients.

RESULTS

Vitamin D levels were significantly lower in COPD patients (15.13 ± 6.02 ng/L) than controls (21.89 ± 4.49 ng/L). Two patients had a history of thoracic vertebral fracture. Lumbar (L1-L4) T scores were normal in 16 patients (48.5%) and indicated osteopenia in 15 (45.5%) and osteoporosis in 2 (6%). Hip femur total T scores were normal in 19 patients (57.6%) and indicated osteopenia in 14 (42.4%).

CONCLUSION

Vitamin D deficiency/insufficiency is prevalent in COPD patients, and BMD decreases in the early period of the disease. Vitamin D and BMD should be evaluated in the early stages to prevent osteoporosis and its complications in COPD patients.

Lipid profile, random blood glucose and carotid arteries thickness in human male subjects with different ages and body mass indexes

OBJECTIVE

This article investigated the effect of age and body mass index of male humans on the carotid arteries intima media thickness (IMT) and the blood concentration of glucose, triglycerides, total cholesterol and HDL cholesterol.

METHODS

Thirty seven normal male human subjects participated in this study. The participants were classified to three groups depending on their age; 20-29 (11), 30-39 (14) and 40-49 (12). Also, the study subjects were divided to three groups according to their body mass index; normal (13), overweight (13) and obese (11). The Anova test was used for the statistical analysis of the obtained results.

RESULTS

The body mass index significantly affected the blood glucose concentration while its effect on all the other parameters was insignificant. The age significantly affected all the studied parameters except the blood glucose, triglycerides and HDL cholesterol. The total cholesterol/HDL ratio was significantly affected by the age and insignificantly by the body mass index.

CONCLUSIONS

The age was more effective on the studied parameters than the body mass index. Worsening of the lipid profile was seen in the overweight participants rather than the obese ones.

Impact of testosterone treatment on circulating irisin in men with late-onset hypogonadism and metabolic syndrome

OBJECTIVES

The beneficial effects of testosterone replacement therapy (TRT) in men with late-onset hypogonadism (LOH) on the body composition and metabolic outcomes are well-established. A potential explanation might lie in the hormones, secreted from skeletal muscles, named "myokines". The aim of this study was to evaluate the effects of TRT on the levels of serum irisin in subjects with LOH.

STUDY DESIGN

A total 40 men with metabolic syndrome (MS) and LOH (measured serum testosterone concentration < 12 nmol/l). TRT with Testosterone Undecanoate (Nebido™) was performed at baseline and at week 6. Irisin serum concentration was determined at baseline and at week 18 by means of ELISA.

RESULTS

Circulating irisin was positively associated with serum testosterone (r = 0.283, p < 0.05). TRT has led to a statistically significant rise in circulating serum irisin levels (7.12 ± 0.76 mcg/ml versus 7.76 ± 0.75 mcg/ml; paired-samples t-test p < 0.001). ROC-analyses determined irisin to be predictive of treatment response (AUC = 0.741, p = 0.014).

CONCLUSIONS

Irisin is positively associated with serum testosterone in a population of men with MS and LOH. TRT in these subjects has led to a significant improvement in associated clinical symptoms as well as to a significant rise in serum irisin levels.

Effect of endothelial dysfunction on the pathogenesis of urolithiasis in patients with metabolic syndrome

OBJECTIVE

The aim of the present prospective clinical study was to investigate the possible effect of endothelial dysfunction in urolithiasis.

METHODS

The study included 92 patients older than 18 years. The patients were divided into 4 groups with 23 patients each as group 1: metabolic sydrome (MetS) (-) stone disease (SD) (-), group 2: MetS (-) SD (+), group 3: MetS (+) SD (-) and group 4: MetS (+) SD (+). C-reactive protein, homocysteine, uric acid, and creatinine levels were evaluated between the groups. Endothelial (dys)function was evaluated based on the brachial artery flow-mediated dilation (FMD) measurement.

RESULTS

The mean age was 41.9 ± 10.2 (range, 18-62) years. Mean FMD value was 15.9 ± 18.2% (range, 24.0-68.5%). A strong significant difference was found between group 1 and 2 (p < .001); group 1 and 3 (p < .001) and group 1 and 4 (p < .001) with regard to FMD.

CONCLUSION

These results suggest that endothelial dysfunction plays an important role in the pathogenesis of urolithiasis in patients with MetS.

Strength training as a supplemental therapy for androgen deficiency of the aging male (ADAM): study protocol for a three-arm clinical trial

INTRODUCTION

Androgen deficiency of the ageing male is a clinical syndrome resulting from the low production of androgens (testosterone levels <6.9 nmol/L) with symptoms including decline in lean mass, muscle strength, increases in body mass and overall fat mass. The aim of the study is to examine the effect of a 12 week strength training intervention on body composition, physical function, muscle cellular and molecular and selected biochemical markers of metabolic health in hypogonadal patients.

METHODS AND ANALYSIS

The study is three-group controlled 12-week experiment to assess the effect of strength training on hypogonadal patients with testosterone replacement therapy and newly diagnosed males without testosterone replacement therapy. Age matched healthy eugonadal males are also engaged in strength training. Lean mass is used to determine sample size indicating, that 22 subjects per group will be sufficient to detect intervention related changes at the power of 0.90. All outcomes are collected before the intervention (pre-intervention assessments) and after the intervention (post-intervention assessments). Clinical outcomes are body composition (lean mass, fat mass and total body mass) measured by dual-energy X-ray absorptiometry, physical functioning assessed by physical tests and psychosocial functioning. The most important haematological and biochemical parameters included are glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, testosterone, luteinizing hormone, follicle-stimulating hormone, sexhormone-binding globulin, insulin and prostate-specific antigen. Muscle cellular and molecular outcomes are muscle fibre size and regulators of muscle fibre size. Muscle cellular outcomes are measured from muscle biopsies obtained from musculus vastus lateralis.

ETHICS AND DISSEMINATION

This trial is approved by Ethics Committee of the University Hospital in Bratislava, Slovakia, (ref. trial number: 127/2017) and all subjects will be fully informed on the rationale, risks and benefits of the study and sign the written informed consent prior to entering the study. Results will be published in peer-reviewed journals and presented in scientific conferences.

TRIAL REGISTRATION NUMBER

NCT03282682.

Sharing Pathological Mechanisms of Insomnia and Osteoporosis, and a New Perspective on Safe Drug Choice

Lack of adequate sleep has become increasingly common in our 24/7 modern society. Reduced sleep has significant health consequences including metabolic and cardiovascular disorders, and mental problems including depression. In addition, although the increase in life expectancy has provided a dream of longevity to humans, the occurrence of osteoporosis is a big obstacle to this dream for both male and female. It is known that insomnia and bone health problems, which are very critical conditions in human life, interestingly, share a lot of pathogenesis in recent decades. Nevertheless, due to another side effects of the synthetic drugs being taken for the treatment of insomnia and osteoporosis, patients have substantial anxiety for the safety of drugs with therapeutic expectation. This review examines the pathogenesis shared by sleep and osteoporosis together and herbal medicine, which has recently been shown to be safe and efficacious in the treatment of both diseases other than synthetic drugs. We suggestions for how to treat osteoporosis. These efforts will be the first step toward enabling patients to have comfortable and safe prescriptions through a wide selection of therapeutic agents in the future.