Testosterone Concentrations in Hair of Hypogonadal Men With and Without Testosterone Replacement Therapy

Steroid hormones in hair reveal sexual maturity and competition in wild house mice (Mus musculus domesticus)

Endocrine data from wild populations provide important insight into social systems. However, obtaining samples for traditional methods involves capture and restraint of animals, and/or pain, which can influence the animal’s stress level, and thereby undesirable release of hormones. Here, we measured corticosterone, testosterone and progesterone in the hair of 482 wild-derived house mice that experienced sexual competition while living under semi-natural conditions. We tested whether sex, age, weight and indicators of sexual maturity, reproduction and social conflicts predict hormone concentrations measured in hair (sampling at endpoint). We show that body weight, sex and age significantly predict cumulative testosterone and progesterone levels, allowing the differentiation between subadults and adults in both sexes. Corticosterone was only slightly elevated in older males compared to older females and increased with the level of visible injuries or scars. Testosterone in males positively correlated with body weight, age, testes size, and sperm number. Progesterone in females significantly increased with age, body weight, and the number of embryos implanted throughout life, but not with the number of litters when controlled for age and weight. Our results highlight the biological validity of hair steroid measurements and provide important insight into reproductive competition in wild house mice.

Assay validation of hair androgens across the menstrual cycle

INTRODUCTION

Saliva is a common noninvasive biofluid for measuring stress and sex hormones, yet one pressing limitation is that salivary hormones fluctuate momentarily, daily, and (for girls) across the menstrual cycle. Hair steroid assays are thought to provide a cumulative index which collapses across hormonal variability, potentially eliminating the confound of daily and menstrual cyclicity and thereby reflecting individual differences in average hormone levels. Here we seek to validate a hair bioassay methodology and test whether hair androgens accurately measure long-term, stable androgen levels in emerging adult women across two menstrual cycles.

METHODS

Hair samples were collected at the end of each menstrual cycle for two cycles, and saliva samples were collected in the morning once per week across two menstrual cycles (N = 11 women). Hair samples were segmented by 1 cm for the first 4 cm to reflect the hormone levels of the past four serial months. Hair samples were assayed using commercially-available enzyme-immuno-assays for testosterone and DHEA.

RESULTS

Hair androgen concentrations were significantly correlated with averaged saliva hormone levels (DHEA: r = .75, p < .05; Testosterone: r = .67, p < .05). With respect to hair hormone stability, there were significant correlations for almost all the pairs of two 1 cm hair segments collected in two months that corresponded to the same time period. Hair androgens in one segment were significantly correlated with those in next segment. Regarding salivary androgen stability, the intra-class correlation across the weekly saliva samples indicated that for DHEA 59% of the total variance was within person and 41% was between person; and for testosterone 91% of the total variance was between person, and only 9% within person.

DISCUSSION

Results suggest that a one-time measure of hair provides a valid and reliable estimate of average steroid levels across two months. Moreover, whereas saliva measures of androgen levels capture week-to-week fluctuations in steroids, hair samples provide information on individual differences in average exposure to steroids, across long periods of time, such as months. Results are encouraging that hair DHEA and testosterone reflects the cumulative hormonal concentration and can be used as a stable hormonal index. Results also indicate that it is feasible to collect the first 3-4 centimeters of hair for studies of stable hormone levels.

Measurement of cortisol, dehydroepiandrosterone, and testosterone in the hair of children: Preliminary results and promising indications

Hormone analysis is a valuable tool for understanding how physiology and behavior interact. Cortisol in hair has recently been examined as a measure of longer-term hormone output. The aim of this study was to investigate the relationships between other androgens in hair and anthropometric measures. In a child sample (n = 114, mean age: 8.5 years, 66 females) levels of cortisol, dehydroepiandrosterone (DHEA) and testosterone were assayed in the 0-3 cm section proximal to scalp. The 3-6 cm segment within a subsample of female participants (n = 35) was examined and compared. Results showed that testosterone strongly correlated with DHEA, and moderately correlated with cortisol (0-3 cm only). Higher hormone concentrations were present in the 3-6 cm segment. Finally, there was a weak positive association between DHEA and height. The replication of previously identified associations between androgens, particularly testosterone-DHEA, and with developmental measures suggests hair may offer a valid method of hormone measurement for DHEA and testosterone.

Testosterone-like immunoreactivity in hair measured in minute sample amounts - a competitive radioimmunoassay with an adequate limit of detection

The concentrations of testosterone deposited in hair during hair growth may provide a retrospective reflection of the concentrations of bioactive testosterone in plasma. The objective of this study was to develop a radioimmunoassay with a sufficiently low limit of detection to measure the testosterone-like immunoreactivity in smaller hair samples (5 mg) than used in earlier studies, and to compare three different extraction procedures. The competitive radioimmunoassay consisted of a polyclonal antiserum (immunogen testosterone-7α-BSA) and a radioligand synthesised from testosterone-3-CMO-histamine. The within-assay and total coefficients of variation in the working range was 3% and 4.5%, respectively. The limit of detection was 0.87 pg/mL, which is equivalent to 0.12 pg/mg testosterone in 5 mg of hair. The concentration of testosterone-like immunoreactivity in hair samples was 1.23 (SD 0.47) pg/mg in women and 2.67 (SD 0.58) pg/mg in men (pulverised hair). Significantly improved precision was found when pulverised hair was used compared to non-pulverised hair. Our data indicate that pulverisation of the hair prior to hormone extraction is crucial. Detection limits fit for the intended purpose are achievable with 5 mg samples of hair.

Stress-related and basic determinants of hair cortisol in humans: A meta-analysis

The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol levels, which is increasingly used in psychoneuroendocrinological research. Here, we conduct a first comprehensive meta-analysis of HCC research based on aggregated data from a total of 124 (sub)samples (66 independent studies; total N=10,289). We seek to answer two central questions: (i) Which covariates and basic features of HCC need to be considered in future research? (ii) What are the main determinants of HCC in terms of chronic stress exposure and mental health? Concerning basic characteristics, our findings identify several covariates to be considered (age, sex, hair washing frequency, hair treatment, oral contraceptive use), confirm a decline of HCC from the first to the second proximal 3cm hair segment, and show positive associations between HCC and short-term salivary cortisol measures. Regarding chronic stress, we show that stress-exposed groups on a whole exhibit 22% increased HCC. This long-term cortisol hypersecretion emerges particularly when stress is still ongoing at the time of study (+43% HCC) but is not present in conditions of past/absent stress (-9% HCC, n.s.). We also report evidence for 17%-reduced HCC in anxiety disorders, such as PTSD. Interestingly, no consistent associations with mood disorders and self-reports of perceived stress, depressiveness or social support are found. However, our findings reveal positive associations of HCC with stress-related anthropometric (body mass index, waist-to-hip ratio) and hemodynamic measures (systolic blood pressure). These meta-analytic results are discussed in the light of their practical implications and important areas for future inquiry are outlined.

Metabolic profiling of cholesterol and sex steroid hormones to monitor urological diseases

Cholesterol and sex steroid hormones including androgens and estrogens play a critical role in the development and progression of urological diseases such as prostate cancer. This disease remains the most commonly diagnosed malignant tumor in men and is the leading cause of death from different cancers. Attempts to understand the role of cholesterol and steroid metabolism in urological diseases have been ongoing for many years, but despite this, our mechanistic and translational understanding remains elusive. In order to further evaluate the problem, we have taken an interest in metabolomics; a discipline dedicated to the systematic study of biologically active metabolites in cells, tissues, hair and biofluids. Recently, we provided evidence that a quantitative measurement of cholesterol and sex steroid metabolites can be successfully achieved using hair of human and mouse models. The overall goal of this short review article is to introduce current metabolomic technologies for the quantitative biomarker assay development and also to provide new insight into understanding the underlying mechanisms that trigger the pathological condition. Furthermore, this review will place a particular emphasis on how to prepare biospecimens (e.g., hair fiber), quantify molecular profiles and assess their clinical significance in various urological diseases.

Cortisol and testosterone in hair as biological markers of systolic heart failure

BACKGROUND

Congestive heart failure (CHF) is associated with increased stress and alterations in metabolism, favoring catabolism over anabolism. Hormonal profiles of patients with heart failure have been assessed using serum and saliva as matrices, which are only point measurements and do not provide long-term information. Scalp hair is a novel matrix that allows for measurement of hormones over a period of several months.

PATIENTS AND METHODS

We aimed to evaluate whether levels of cortisol and testosterone and their ratio (C/T) in hair correlate with severity of heart failure. We conducted a prospective study in ambulatory male patients with a left ventricular ejection fraction (LVEF)≤40%. Hormone levels were measured using immunoassays in the proximal 2 cm of hair (representing approximately two months of systemic hormone exposure). Primary endpoints included the correlation of hair cortisol, testosterone, and C/T levels with the New York Heart Association (NYHA) class, LVEF, exercise capacity and NT-proBNP.

RESULTS

The 44 CHF patients had a median hair level (range) of cortisol of 207 (117.7-1277.3)ng/g. Hair cortisol levels correlated positively with NYHA class (r=0.48, p=0.001) and negatively with treadmill stress test performance, (r=-0.37, p<0.05). The hair testosterone was 5.17 (2.39-24.64)ng/g and the C/T ratio was 39.89 (12.98-173.73). No associations were found between hair testosterone and C/T ratio and heart failure severity; however, the C/T ratio was higher in patients who required a CHF-related hospitalization than in patients who did not require this in the year following the inclusion in the study.

CONCLUSIONS

Hair cortisol levels correlate with heart failure severity as assessed by the NYHA class and exercise capacity, while hair testosterone and C/T levels do not correlate with heart failure severity.

Analysis of cortisol in hair--state of the art and future directions

Changes to long-term secretion of the glucocorticoid cortisol are considered to play a crucial role in mediating the link between chronic stress and the development of numerous immune system related diseases. However, obtaining valid assessments of long-term cortisol levels is difficult due to limitations of previous measurement strategies in blood, saliva or urine. This review discusses evidence on a recent methodological development assumed to provide a considerable advancement in this respect: the analysis of cortisol in hair. Being incorporated into the growing hair, hair cortisol concentrations (HCC) are assumed to provide a retrospective reflection of integrated cortisol secretion over periods of several months. Over the past years, supportive evidence has accumulated regarding several fundamental characteristics of HCC, including its validity as an index of long-term systemic cortisol levels, its reliability across repeated assessments and its relative robustness to a range of potential confounding influences. Based on this groundwork, research has now also commenced to utilise HCC for answering more specific questions regarding the role of long-term cortisol secretion in different stress and health-related conditions. The possibility of extending hair analysis to also capture long-term secretion of other steroid hormones (e.g., androgens or estrogens) provides a further intriguing prospect for future research. Given its unique characteristics, the use of hair analysis holds great promise to significantly enhance current understanding on the role of steroid hormones in psychoimmunological research.

Minireview: Hair cortisol: a novel biomarker of hypothalamic-pituitary-adrenocortical activity

Activity of the hypothalamic-pituitary-adrenocortical (HPA) axis is commonly assessed by measuring glucocorticoids such as cortisol (CORT). For many years, CORT was obtained primarily from blood plasma or urine, whereas later approaches added saliva and feces for noninvasive monitoring of HPA functioning. Despite the value of all these sample matrices for answering many research questions, they remain limited in the temporal range of assessment. Plasma and saliva are point samples that vary as a function of circadian rhythmicity and are susceptible to confounding by environmental disturbances. Even urine and feces generally assess HPA activity over a period of only 24 h or less. We and others have recently developed and validated methods for measuring the concentration of CORT in the body hair of animals (e.g. rhesus monkeys) and scalp hair of humans. CORT is constantly deposited in the growing hair shaft, as a consequence of which such deposition can serve as a biomarker of integrated HPA activity over weeks and months instead of minutes or hours. Since the advent of this methodological advance, hair CORT has already been used as an index of chronic HPA activity and stress in human clinical and nonclinical populations, in a variety of laboratory-housed and wild-living animal species, and in archival specimens that are many decades or even centuries old. Moreover, because human hair is known to grow at an average rate of about 1 cm/month, several studies suggest that CORT levels in hair segments that differ in proximity to the scalp can, under certain conditions, be used as a retrospective calendar of HPA activity during specific time periods preceding sample collection.

Hair cortisol content in patients with adrenal insufficiency on hydrocortisone replacement therapy

OBJECTIVE

Patients with adrenal insufficiency (AI) require life-long replacement therapy with exogenous glucocorticoids. Several studies have shown impaired subjective health status in these patients as well as increased morbidity and mortality risk, which may be caused by glucocorticoid over-replacement. As a measure of long-term cortisol exposure, the usefulness of hair cortisol analysis in patients receiving glucocorticoid replacement therapy was investigated.

PATIENTS AND DESIGN

Hair samples, demographics, medical history and perceived stress scale questionnaires were collected from 93 patients across North America diagnosed with primary or secondary AI. Sixty-two household partners served as a control group. Cortisol was measured in the proximal 2 cm of hair, representing the most recent 2 months of exposure. A modified enzyme immunoassay was used for the measurement of cortisol.

RESULTS

The male patients had significantly higher hair cortisol levels than the male controls (P < 0·05), while there was no significant difference among females. Hair cortisol content correlated significantly with glucocorticoid dose (r = 0·3, P < 0·01). Patients with AI had significantly higher subjective stress scores than control subjects.

CONCLUSIONS

Hair cortisol content correlates with hydrocortisone (HC) dose in patients with AI. Our results suggest that some AI patients may be over-treated and hence may be at risk for the adverse effects of cortisol. Measurement of HC in hair may become a useful monitoring tool for long-term cortisol exposure in patients treated with glucocorticoids.

Gas chromatography/mass spectrometry based hair steroid profiling may reveal pathogenesis in hair follicles of the scalp

A method of steroid profiling, including androgens, progestins, corticoids and sterols, was developed to evaluate the concentrations of steroids as well as the activities of the enzymes responsible for steroidogenesis in hair by gas chromatography/mass spectrometry. The extraction efficiencies of steroids from the hair matrix were improved by ultrasonication for 1 h at 50 °C. The overall recoveries ranged from 71 to 132%, with a limit of quantification for all analytes ranging from 1 to 50 ng/g. The devised method was used to identify the metabolic changes for both male-pattern baldness (MPB) and the drug efficiency of dutasteride, which inhibits 5α-reductase. Increased dihydrotestosterone levels and the dihydrotestosterone/testosterone (DHT/T) ratio, which is responsible for the 5α-reductase activity, were observed in the MPB patients. A dutasteride treatment resulted in decreases in the DHT and 5α-androstanedione concentrations and DHT/T ratio in the hair samples. Hair steroid profiling reflects the sebaceous status in the scalp and may be useful for monitoring the metabolic responses to both the disease and drug actions.