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Khalil SHA, Dandona P, Osman NA, Assaad RS, Zaitoon BTA, Almas AA, Amin NG. Diabetes surpasses obesity as a risk factor for low serum testosterone level. Diabetol Metab Syndr 2024; 16:143. [PMID: 38943183 PMCID: PMC11212223 DOI: 10.1186/s13098-024-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Male obesity is one of the most associated factors with substandard testosterone levels. However, there is growing evidence linking low testosterone levels to insulin resistance and diabetic complications. We aimed to study the impact of diabetes mellitus on testosterone levels and to assess the correlation of various clinical and biochemical factors with hypogonadism. SUBJECTS AND METHODS This case-control study was conducted on 160 adult males categorized into four equal groups (40 each); Group A: lean men with T2DM, Group B: obese with T2DM, Group C: lean with normal glycemic profile, Group D: obese with normal glycemic profile. Serum total testosterone (TT), SHBG and HbA1c have been measured. Free testosterone (cFT) and HOMA-IR were calculated. RESULTS A significant negative correlation of serum TT and cFTwith BMI (r -0.16, p 0.04/ r -0.26, p < 0.001, respectively) and with waist circumference (WC) (r -0.23, p 0.003 and r -0.3, p < 0.001, respectively). A significant decrease in TT and cFT in the diabetes group versus the non-diabetes one (p < 0.001 for both). TT level was significantly lower in the diabetic lean group than in the non-diabetic lean (p < 0.001), and even significantly lower than in the non-diabetic obese (p < 0.001). TT level in the diabetic obese group was lower than in the non-diabetic obese (p < 0.001). The same for cFT level, lower in the diabetic lean group than in non-diabetic lean (p < 0.001) and lower in the diabetic obese than in the non-diabetic obese (p < 0.001). Concomitant significant reduction in SHBG in the diabetes group (p < 0.001). Linear regression analysis revealed that TT significantly correlated with HOMA-IR. HOMA-IR with WC, age and the duration of diabetes correlated significantly with cFT. In our model, HOMA-IR and HbA1c accounted for approximately 51.3% of TT variability (adjusted R-squared 0.513). CONCLUSIONS The impact of T2DM on serum testosterone levels was more significant than that of obesity. Our study showed a decrease in SHBG together with cFT among the diabetes group. Hypogonadism is significantly correlated to insulin resistance and poor glycemic control, which implies another perspective on the impact of suboptimal glycemic control on the development of hypogonadism.
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Affiliation(s)
- Samir H Assaad Khalil
- Department of Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Paresh Dandona
- Department of Endocrinology, Faculty of Medicine, University of Buffalo and the State University of New York (SUNY), NY, USA
| | - Nermin A Osman
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
- Data Science Institute, Imperial College London, London, UK
| | - Ramy Samir Assaad
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Basma Tayseer Abdalla Zaitoon
- Department of Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amal Abdulaziz Almas
- Department of Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Internal Medicine, University of Nairobi, Nairobi, Kenya
| | - Noha Gaber Amin
- Department of Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Naseem H, Lokman M, Fitzgerald C. Management of congenital hypogonadotropic hypogonadism in females. HUM FERTIL 2023; 26:622-631. [PMID: 34753367 DOI: 10.1080/14647273.2021.1998929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/02/2021] [Indexed: 10/19/2022]
Abstract
This review explores the challenges in the diagnosis of hypogonadotropic hypogonadism, the transition of care from paediatric to adult care and the considerable health implications of this condition. The role gynaecologists and general practitioners have in managing hormone replacement therapy and reproductive potential is also highlighted. The fertility treatment options, which include ovulation induction with gonadotrophins and in-vitro fertilisation, are discussed in detail along with highlighting the fact that anovulation and markers of low ovarian reserve prior to priming treatment may not be reflective of poor reproductive potential. The holistic management of women with hypogonadotropic hypogonadism is still not standardised and evidence for subfertility management is scarce. This review aims to highlight this concern and provide guidance by evaluating current evidence.
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Affiliation(s)
- Hafiza Naseem
- Reproductive Medicine Department, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mariam Lokman
- Reproductive Medicine Department, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Cheryl Fitzgerald
- Reproductive Medicine Department, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Sumińska M, Podgórski R, Fichna P, Mazur A, Fichna M. The Impact of Obesity on the Excretion of Steroid Metabolites in Boys and Girls: A Comparison with Normal-Weight Children. Nutrients 2023; 15:1734. [PMID: 37049573 PMCID: PMC10097123 DOI: 10.3390/nu15071734] [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: 02/23/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Obesity in childhood is associated with several steroid changes, which result from excess body mass. The aim of this study was to evaluate steroid metabolism in children with obesity compared with those with normal weight, especially in relation to sex and puberty progress. We analyzed the clinical data of 191 children, aged between 5 and 18 years, with 115 affected (64 girls and 51 boys) and 76 unaffected (35 girls and 41 boys) by obesity. Routine clinical assessment and pubertal stage evaluation based upon Tanner's scale were performed. In addition, to evaluate the impact of puberty, children with pre-adolescence and advanced puberty were divided into separate subgroups. Then, 24 h urine steroid excretion profiles were analyzed by gas chromatography/mass spectrometry. Significant differences in the excretion of steroid metabolites were found between normal weight children and children with obesity, especially in the prepubertal cohort. In this group, we observed enhanced activity in all the pathways of adrenal steroidogenesis. Raised excretion of mineralocorticoid derivatives such as tetrahydro-11-deoxycorticosterone, tetrahydrocorticosterone, and 5α-tetrahydrocorticosterone supported increased activity of this track. No significant differences were detected in the excreted free forms of cortisol and cortisone, while the excretion of their characteristic tetrahydro-derivatives was different. In pre-adolescent children with obesity, α-cortol and especially α-cortolone appeared to be excreted more abundantly than β-cortol or β-cortolone. Furthermore, in children with obesity, we observed elevated androgen excretion with an enhanced backdoor pathway. As puberty progressed, remarkable reduction in the differences between adolescents with and without obesity was demonstrated.
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Affiliation(s)
- Marta Sumińska
- Department of Pediatric Diabetes, Auxology and Obesity, Institute of Pediatrics, Poznan University of Medical Sciences, 60-572 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Rafał Podgórski
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
- Department of Biochemistry, Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes, Auxology and Obesity, Institute of Pediatrics, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Artur Mazur
- Department of Pediatrics, Childhood Endocrinology and Diabetes, Collegium of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Marta Fichna
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
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Yang Q, Kennicott K, Zhu R, Kim J, Wakefield H, Studener K, Liang Y. Sex hormone influence on female-biased autoimmune diseases hints at puberty as an important factor in pathogenesis. Front Pediatr 2023; 11:1051624. [PMID: 36793337 PMCID: PMC9923181 DOI: 10.3389/fped.2023.1051624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
The majority of autoimmune diseases affect more women than men, suggesting an important role for sex hormones in regulating immune response. Current research supports this idea, highlighting the importance of sex hormones in both immune and metabolic regulation. Puberty is characterized by drastic changes in sex hormone levels and metabolism. These pubertal changes may be what forms the gulf between men and women in sex bias towards autoimmunity. In this review, a current perspective on pubertal immunometabolic changes and their impact on the pathogenesis of a select group of autoimmune diseases is presented. SLE, RA, JIA, SS, and ATD were focused on in this review for their notable sex bias and prevalence. Due to both the scarcity of pubertal autoimmune data and the differences in mechanism or age-of-onset in juvenile analogues often beginning prior to pubertal changes, data on the connection between the specific adult autoimmune diseases and puberty often relies on sex hormone influence in pathogenesis and established sex differences in immunity that begin during puberty.
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Affiliation(s)
- Qianfan Yang
- School of Medicine and Public Health, Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, United
| | - Kameron Kennicott
- Departments of Physiology and Pharmacology and Toxicology, Michigan State University, East Lansing, MI, United States
| | - Runqi Zhu
- Departments of Physiology and Pharmacology and Toxicology, Michigan State University, East Lansing, MI, United States
| | - Jooyong Kim
- School of Medicine and Public Health, Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, United
| | - Hunter Wakefield
- School of Medicine and Public Health, Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, United
| | - Katelyn Studener
- School of Medicine and Public Health, Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, United
| | - Yun Liang
- Departments of Physiology and Pharmacology and Toxicology, Michigan State University, East Lansing, MI, United States
- Correspondence: Yun Liang
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Culbert KM, Milá Roa A, Stevens K, Sisk CL, Burt SA, Klump KL. Pubertal emergence of testosterone effects on depressive symptoms in boys. JCPP ADVANCES 2022; 2. [DOI: 10.1002/jcv2.12088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kristen M. Culbert
- Department of Psychology Michigan State University East Lansing Michigan USA
| | - Antonio Milá Roa
- Department of Psychology University of Nevada Las Vegas Nevada USA
| | - Kimberly Stevens
- Department of Psychology University of Nevada Las Vegas Nevada USA
| | - Cheryl L. Sisk
- Neuroscience Program Michigan State University East Lansing Michigan USA
| | - S. Alexandra Burt
- Department of Psychology Michigan State University East Lansing Michigan USA
| | - Kelly L. Klump
- Department of Psychology Michigan State University East Lansing Michigan USA
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Cargnelutti F, Di Nisio A, Pallotti F, Spaziani M, Tarsitano MG, Paoli D, Foresta C. Risk factors on testicular function in adolescents. J Endocrinol Invest 2022; 45:1625-1639. [PMID: 35286610 PMCID: PMC9360118 DOI: 10.1007/s40618-022-01769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Adolescence represents an important window for gonadal development. The aim of this review is to carry out a critical excursus of the most recent literature on endogenous and exogenous risk factors related to testicular function, focusing the research on adolescence period. METHODS A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the impact on adolescence of varicocele, cryptorchidism, cancer, diabetes, lifestyle factors, endocrine disruptors, obesity and sexually transmitted diseases. We focused on human studies that evaluated a possible impact of these factors on puberty timing and their effects on andrological health. RESULTS Evidence collected seems to suggest that andrological health in adolescence may be impaired by several factors, as varicocele, cryptorchidism, and childhood cancer. Despite an early diagnosis and treatment, many adolescents might still have symptoms and sign of a testicular dysfunction in their adult life and at the current time it is not possible to predict which of them will experience andrological problems. Lifestyle factors might have a role in these discrepancies. Most studies point out towards a correlation between obesity, insulin resistance, alcohol, smoking, use of illegal drugs and testicular function in pubertal boys. Also, endocrine disruptors and sexually transmitted diseases might contribute to impair reproductive health, but more studies in adolescents are needed. CONCLUSION According to currently available evidence, there is an emerging global adverse trend of high-risk and unhealthy behaviors in male adolescents. A significant proportion of young men with unsuspected and undiagnosed andrological disorders engage in behaviors that could impair testicular development and function, with an increased risk for later male infertility and/or hypogonadism during the adult life. Therefore, adolescence should be considered a key time for intervention and prevention of later andrological diseases.
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Affiliation(s)
- F Cargnelutti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A Di Nisio
- Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Spaziani
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M G Tarsitano
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - C Foresta
- Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy
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Mancini M, Pecori Giraldi F, Andreassi A, Mantellassi G, Salvioni M, Berra CC, Manfrini R, Banderali G, Folli F. Obesity Is Strongly Associated With Low Testosterone and Reduced Penis Growth During Development. J Clin Endocrinol Metab 2021; 106:3151-3159. [PMID: 34283215 DOI: 10.1210/clinem/dgab535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Growth of male genitalia represents an important marker of sexual development. Testicle size is the primary measure and little is known regards penile length changes during puberty. OBJECTIVE This work aims to assess penis growth and testosterone levels in obese vs normal-weight children and adolescents, to evaluate a possible influence of obesity on genital development in boys, and to establish a new method for measuring penis length that allows comparison of normal-weight and overweight boys. METHODS We assessed anthropometric and genital development in 1130 boys from birth to age 20 years. Testosterone levels were also measured. A new method for penile length measurement was employed to minimize errors when comparing obese and nonobese children. Penis length was measured with a gentle, painless, straight positioning on a centimetric ruler without stretching, which is doable from the first years of life until the end of adolescence. RESULTS Penis length and testosterone are strongly related in children during puberty. Penile length growth is significantly decreased (by about 10%) in obese boys when compared to normal-weight boys, with concomitantly reduced testosterone levels, across puberal phases. CONCLUSION Childhood obesity represents an important determinant of lower testosterone level and reduced penis development. A new method should be employed to improve penis measurement in normal-weight and overweight/obese boys. The possible significance of these observations for adult genital development and reproductive potential will require large longitudinal studies.
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Affiliation(s)
- Mario Mancini
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan 20142, Italy
| | | | - Alice Andreassi
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan 20142, Italy
| | - Gianna Mantellassi
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan 20142, Italy
| | - Michela Salvioni
- Pediatric and Adolescent Andrological Unit, Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan 20142, Italy
| | - Cesare C Berra
- Department of Endocrine and Metabolic Diseases, IRCCS MultiMedica, Milan 20142, Italy
| | - Roberto Manfrini
- Departmental Unit of Diabetes, Endocrinology and Metabolism, San Paolo Hospital, ASST Santi Paolo e Carlo; Department of Health Science, Università degli Studi di Milano, Milan 20142, Italy
| | - Giuseppe Banderali
- Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan 20142, Italy
| | - Franco Folli
- Departmental Unit of Diabetes, Endocrinology and Metabolism, San Paolo Hospital, ASST Santi Paolo e Carlo; Department of Health Science, Università degli Studi di Milano, Milan 20142, Italy
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Parker MN, Tanofsky-Kraff M, Crosby RD, Byrne ME, LeMay-Russell S, Swanson TN, Ramirez E, Shank LM, Djan KG, Kwarteng EA, Faulkner LM, Yang SB, Zenno A, Chivukula KK, Engel SG, Brady SM, Yanovski SZ, Yanovski JA. Food cravings and loss-of-control eating in youth: Associations with gonadal hormone concentrations. Int J Eat Disord 2021; 54:1426-1437. [PMID: 33942921 PMCID: PMC8355041 DOI: 10.1002/eat.23530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Among youth with overweight, food cravings (FC) are associated with loss-of-control (LOC)-eating, but the impact of sex-associated biological characteristics on this relationship is unknown. We examined whether sex and gonadal hormone concentrations moderated the relationships between FC and LOC-eating severity among healthy boys and girls across the weight strata in natural and laboratory environments. METHOD Using ecological momentary assessment (EMA), FC, and LOC-eating severity were reported 3-5 times a day for 2 weeks. In the laboratory, participants reported FC, consumed lunch from a buffet test meal designed to simulate LOC-eating, and rated LOC-eating severity during the meal. RESULTS Eighty-seven youth (13.0 ± 2.7 years, 58.6% female, 32.2% with overweight/obesity) participated. EMA measured general and momentary FC were positively associated with LOC-eating severity (ps < .01), with no differences by sex (ps = .21-.93). Estradiol and progesterone significantly moderated the relationships between FC and LOC-eating such that general FC and LOC-eating severity were only positively associated among girls with greater (vs. lower) estradiol (p = .01), and momentary FC and LOC-eating severity were only positively associated among girls with greater (vs. lower) progesterone (p = .01). Boys' testosterone did not significantly moderate the associations between FC and LOC-eating severity (ps = .36-.97). At the test meal, pre-meal FC were positively related to LOC-eating severity (p < .01), without sex or hormonal moderation (ps = .20-.64). DISCUSSION FC were related to LOC-eating severity in boys and girls. In the natural environment, gonadal hormones moderated this relationship in girls, but not boys. The mechanisms through which gonadal hormones might affect the relationship between FC and LOC-eating warrant investigation.
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Affiliation(s)
- Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA,Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Ross D. Crosby
- Sanford Center for Biobehavioral Research, 120 Eighth St. South, Box, 2010, Fargo, North Dakota, 58122, USA,University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Meghan E. Byrne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Sarah LeMay-Russell
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Taylor N. Swanson
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA,Metis Foundation, 300 Convent St #1330, San Antonio, TX, 78205, USA
| | - Eliana Ramirez
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Lisa M. Shank
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA,Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,Metis Foundation, 300 Convent St #1330, San Antonio, TX, 78205, USA
| | - Kweku G. Djan
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Esther A. Kwarteng
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Loie M. Faulkner
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Shanna B. Yang
- Nutrition Department, Clinical Research Center, NIH, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Anna Zenno
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - K. Karthik Chivukula
- Clinical Endocrinology Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, USA
| | - Scott G. Engel
- Sanford Center for Biobehavioral Research, 120 Eighth St. South, Box, 2010, Fargo, North Dakota, 58122, USA,University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Sheila M. Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
| | - Susan Z. Yanovski
- Office of Obesity Research, Division of Digestive Diseases and Nutrition, NIDDK, NIH, Bethesda, MD, 20892, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA
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Sex and Gender Differences in Lung Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1304:227-258. [PMID: 34019273 DOI: 10.1007/978-3-030-68748-9_14] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sex differences in the anatomy and physiology of the respiratory system have been widely reported. These intrinsic sex differences have also been shown to modulate the pathophysiology, incidence, morbidity, and mortality of several lung diseases across the life span. In this chapter, we describe the epidemiology of sex differences in respiratory diseases including neonatal lung disease (respiratory distress syndrome, bronchopulmonary dysplasia) and pediatric and adult disease (including asthma, cystic fibrosis, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, lung cancer, lymphangioleiomyomatosis, obstructive sleep apnea, pulmonary arterial hypertension, and respiratory viral infections such as respiratory syncytial virus, influenza, and SARS-CoV-2). We also discuss the current state of research on the mechanisms underlying the observed sex differences in lung disease susceptibility and severity and the importance of considering both sex and gender variables in research studies' design and analysis.
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Li N, Huang C, Lan B, Lin D, Wang C, You L, Li L, Li F, Xiao H, Yan L, Lao G, Sun K. Association of gonadal hormones and sex hormone binding globulin with risk of diabetes: A cohort study in middle-aged and elderly Chinese males. Int J Clin Pract 2021; 75:e14008. [PMID: 33400357 DOI: 10.1111/ijcp.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022] Open
Abstract
AIM Late-onset hypogonadism in men is related to the development of diabetes. The association of gonadal hormones, sex hormone binding globulin with diabetes has been studied in various studies. However, there is no cohort study on the relationship between gonadal hormone, sex hormone binding globulin and diabetes in Chinese. We aimed to provide an insight into the possible association in middle-aged and elderly Chinese males. METHODS We included a population sample of 673 subjects aged 40 years or older. Total testosterone (TT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH) and luteinising hormone (LH) were detected. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated to estimate insulin sensitivity. Diabetes was diagnosed according to the 2010 American Diabetes Association criteria. RESULTS With an average follow-up time of 3.2 ± 0.5 years, 9.8% of participants had developed diabetes. The prevalence of diabetes was decreased according to increasing SHBG quartiles (Q1:13.1%, Q2: 12.0%, Q3: 11.2%, Q4: 3.0%, P for trend < .0001) and TT (Q1:16.0%, Q2: 7.9%, Q3: 9.0%, Q4: 6.4%, P for trend < .0001). The ORs of diabetes for increasing SHBG quartiles were 4.52 (95% CI 1.40-14.57), 4.32 (95% CI 1.33-14.06), 3.89 (95% CI 1.21-12.50) and 1.00 (reference) respectively. But the odds of prevalent diabetes were not increased in different quartiles of TT, FSH and LH. In subgroup analyses, the relationship between SHBG and risk of incident diabetes was significantly increased in the population aged over 60, without insulin resistance and with eGFR < 90 mL/min per 1.73 m2 . CONCLUSIONS Compared with gonadal hormones, a lower level of SHBG is independently associated with the risk of diabetes in middle-aged and elderly Chinese males.
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Affiliation(s)
- Na Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chulin Huang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Biyun Lan
- Department of Endocrinology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Diaozhu Lin
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chengzhi Wang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lingling Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fangping Li
- Department of Endocrinology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Huisheng Xiao
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guojuan Lao
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kan Sun
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Gregoric N, Groselj U, Bratina N, Debeljak M, Zerjav Tansek M, Suput Omladic J, Kovac J, Battelino T, Kotnik P, Avbelj Stefanija M. Two Cases With an Early Presented Proopiomelanocortin Deficiency-A Long-Term Follow-Up and Systematic Literature Review. Front Endocrinol (Lausanne) 2021; 12:689387. [PMID: 34177811 PMCID: PMC8220084 DOI: 10.3389/fendo.2021.689387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 02/03/2023] Open
Abstract
Proopiomelanocortin (POMC) deficiency is an extremely rare inherited autosomal recessive disorder characterized by severe obesity, adrenal insufficiency, skin hypopigmentation, and red hair. It is caused by pathogenic variants in the POMC gene that codes the proopiomelanocortin polypeptide which is cleaved to several peptides; the most notable ones are adrenocorticotropic hormone (ACTH), alpha- and beta-melanocyte-stimulating hormones (α-MSH and β-MSH); the latter two are crucial in melanogenesis and the energy balance by regulating feeding behavior and energy homeostasis through melanocortin receptor 4 (MC4R). The lack of its regulation leads to polyphagia and early onset severe obesity. A novel MC4R agonist, setmelanotide, has shown promising results regarding weight loss in patients with POMC deficiency. A systematic review on previously published clinical and genetic characteristics of patients with POMC deficiency and additional data obtained from two unrelated patients in our care was performed. A 25-year-old male patient, partly previously reported, was remarkable for childhood developed type 1 diabetes (T1D), transient growth hormone deficiency, and delayed puberty. The second case is a girl with an unusual presentation with central hypothyroidism and normal pigmentation of skin and hair. Of all evaluated cases, only 50% of patients had characteristic red hair, fair skin, and eye phenotype. Central hypothyroidism was reported in 36% of patients; furthermore, scarce adolescent data indicate possible growth axis dysbalance and central hypogonadism. T1D was unexpectedly prevalent in POMC deficiency, reported in 14% of patients, which could be an underestimation. POMC deficiency reveals to be a syndrome with several endocrinological abnormalities, some of which may become apparent with time. Apart from timely diagnosis, careful clinical follow-up of patients through childhood and adolescence for possible additional disease manifestations is warranted.
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Affiliation(s)
- Nadan Gregoric
- Department for Endocrinology, Diabetes and Metabolic Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Urh Groselj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Natasa Bratina
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marusa Debeljak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute for Special Laboratory Diagnostics, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mojca Zerjav Tansek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jasna Suput Omladic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Kovac
- Clinical Institute for Special Laboratory Diagnostics, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Primoz Kotnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Magdalena Avbelj Stefanija
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- *Correspondence: Magdalena Avbelj Stefanija,
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de Dios O, Herrero L, Vales-Villamarín C, Mahíllo-Fernández I, Soriano-Guillén L, Garcés C. Sex steroid hormones, leptin, and high-sensitivity C-reactive protein levels in adolescents. Andrology 2020; 9:829-836. [PMID: 33326704 DOI: 10.1111/andr.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association of sex hormones with C-reactive protein (CRP) levels has been reported. However, this association remains unexplored in children in whom important anthropometric and hormonal changes are taking place. OBJECTIVES To analyze the association between high-sensitivity CRP (hs-CRP) and testosterone, estradiol and sex hormone-binding globulin (SHBG) levels in a population-based sample of adolescents, and to evaluate the influence of leptin levels on this association. MATERIALS AND METHODS The sample population of this cross-sectional study was comprised of 338 male and 385 female adolescents, aged 12-16 years. Information on anthropometric variables, hormone, leptin, and hs-CRP levels was available. RESULTS In male adolescents in our study, higher age is significantly associated with higher testosterone levels and with lower leptin and SHBG concentrations across the range of age studied. No significant changes in leptin and SHBG levels by age are observed in females. In males, leptin correlates negatively with testosterone levels (-0.263, p < 0.001), showing a stronger correlation after adjusting by body mass index (BMI) (-0.424, p < 0.001). A significant correlation between hs-CRP and testosterone levels is observed in males after adjusting by BMI, but the correlation disappears after adjusting by leptin. No association between testosterone and hs-CRP was observed in females. The negative association between hs-CRP levels and SHBG remains significant after adjusting by leptin in both sexes but disappears in males after adjusting by BMI. CONCLUSION The negative association between hs-CRP and testosterone concentrations observed in 12- to 16-year-old males seems to be related to leptin levels which are closely negatively related to testosterone levels in males independently of BMI.
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Affiliation(s)
- Olaya de Dios
- Lipid Research Laboratory, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Leticia Herrero
- Lipid Research Laboratory, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | | | | | | | - Carmen Garcés
- Lipid Research Laboratory, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
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Biobaku F, Hanna A, Matthews G, Dhindsa S, Dandona P. Narcolepsy, depression, and severe flushing in an obese man. Clin Case Rep 2020; 8:1824-1826. [PMID: 32983505 PMCID: PMC7495789 DOI: 10.1002/ccr3.2873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 11/07/2022] Open
Abstract
Hypogonadism as a cause of depression, daytime sleepiness, and flushing is often missed in young males. Our case report highlights the importance of screening for hypogonadotropic hypogonadism and its treatment in symptomatic men with severe obesity, especially if they have depression, excessive sleepiness, and narcolepsy.
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Affiliation(s)
- Fatimo Biobaku
- Division of Endocrinology, Diabetes and MetabolismState University of New York at BuffaloBuffaloNew York
| | - Adel Hanna
- Division of Endocrinology, Diabetes and MetabolismState University of New York at BuffaloBuffaloNew York
| | - George Matthews
- Division of CardiologyState University of New York at BuffaloBuffaloNew York
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and MetabolismSaint Louis UniversitySaint LouisMissouri
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and MetabolismState University of New York at BuffaloBuffaloNew York
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14
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Biobaku F, Ghanim H, Monte SV, Caruana JA, Dandona P. Bariatric Surgery: Remission of Inflammation, Cardiometabolic Benefits, and Common Adverse Effects. J Endocr Soc 2020; 4:bvaa049. [PMID: 32775937 PMCID: PMC7402590 DOI: 10.1210/jendso/bvaa049] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Obesity is associated with increased mortality as a result of several comorbidities which occur in tandem with the obese state. Chronic inflammation is well documented in obesity, and evidence from numerous studies support the notion that the increased inflammation in individuals with obesity accentuates the comorbidities seen in this condition. The remission of comorbidities such as metabolic, cardiovascular, and neurological complications occurs following bariatric procedures. Bariatric surgery significantly reduces mortality and results in remarkable weight loss and reversal in several obesity-related comorbidities. There is indisputable evidence that the resolution of inflammation that occurs after bariatric surgery mitigates some of these comorbidities. With the increasing use of bariatric surgery for the treatment of severe obesity, it is pivotal to elucidate the underlying mechanisms responsible for the notable improvements seen after the procedure. This review summarizes underlying mechanisms responsible for the remission of obesity-related abnormalities and discusses the common adverse effects of bariatric surgery. Well-stratified, large-scale studies are still needed for a proper evaluation of these underlying mechanisms.
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Affiliation(s)
- Fatimo Biobaku
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, New York
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, New York
| | - Scott V Monte
- Synergy Bariatrics (Erie County Medical Center), Williamsville, NY
| | - Joseph A Caruana
- Synergy Bariatrics (Erie County Medical Center), Williamsville, NY
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, New York
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Pérez-Segura P, de Dios O, Herrero L, Vales-Villamarín C, Aragón-Gómez I, Gavela-Pérez T, Garcés C, Soriano-Guillén L. Children with type 1 diabetes have elevated high-sensitivity C-reactive protein compared with a control group. BMJ Open Diabetes Res Care 2020; 8:8/1/e001424. [PMID: 32690576 PMCID: PMC7371029 DOI: 10.1136/bmjdrc-2020-001424] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Our objective was to compare high-sensitivity C-reactive protein (hsCRP) levels in children with type 1 diabetes, healthy controls, and children with obesity. Additionally, we aimed to analyze the association between hsCRP levels and glycemic control measured by glycohemoglobin A (HbA1c) and anthropometric and biochemical variables. RESEARCH DESIGN AND METHODS We conducted a non-randomized descriptive study of children with type 1 diabetes matched for sex and age with a control group and group with obesity. We recorded anthropometric parameters and studied variables related to diabetes, blood pressure, lipid profile, and HbA1c. hsCRP was measured by ELISA. RESULTS We included 49 children with type 1 diabetes, 46 controls, and 40 children with obesity. hsCRP levels were significantly higher in the group with type 1 diabetes compared with controls and nearly significantly lower than in the group comprising children with obesity. We found no correlation between hsCRP and HbA1c and characteristics of type 1 diabetes with the exception of albumin to creatinine ratio. Statistically significant association was found between hsCRP and body mass index (BMI) and waist circumference Z-score. CONCLUSIONS The higher hsCRP levels observed in children with type 1 diabetes compared with a control group with a similar BMI suggest a basal inflammatory state that could increase cardiovascular risk. The main factors related to hsCRP are BMI and waist circumference, so obesity prevention should be a priority when performing follow-up in children with type 1 diabetes.
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Affiliation(s)
- Pilar Pérez-Segura
- Pediatrics, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
- Pediatrics, Universidad Autonoma de Madrid Facultad de Medicina, Madrid, Spain
| | - Olaya de Dios
- Lipid Research Laboratory, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
| | - Leticia Herrero
- Lipid Research Laboratory, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
| | - Claudia Vales-Villamarín
- Lipid Research Laboratory, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
| | - Isabel Aragón-Gómez
- Pediatrics, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
| | - Teresa Gavela-Pérez
- Pediatrics, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
- Pediatrics, Universidad Autonoma de Madrid Facultad de Medicina, Madrid, Spain
| | - Carmen Garcés
- Lipid Research Laboratory, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
| | - Leandro Soriano-Guillén
- Pediatrics, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Madrid, Spain
- Pediatrics, Universidad Autonoma de Madrid Facultad de Medicina, Madrid, Spain
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Abstract
This article contains a systematic review of the main developments that have occurred in the area of male hypogonadism between the publication of the Endocrine Society Guidelines of 2010 and 2018 and after 2018.
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Affiliation(s)
- Marco Marcelli
- Department of Medicine, Division of Endocrinology, Baylor College of Medicine, Houson, Texas, USA .,Section of Endocrinology, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Sanjay Navin Mediwala
- Department of Medicine, Division of Endocrinology, Baylor College of Medicine, Houson, Texas, USA.,Section of Endocrinology, Michael E DeBakey VA Medical Center, Houston, Texas, USA
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Differential effects of 11 years of long-term injectable testosterone undecanoate therapy on anthropometric and metabolic parameters in hypogonadal men with normal weight, overweight and obesity in comparison with untreated controls: real-world data from a controlled registry study. Int J Obes (Lond) 2020; 44:1264-1278. [PMID: 32060355 PMCID: PMC7260126 DOI: 10.1038/s41366-019-0517-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/18/2019] [Accepted: 12/11/2019] [Indexed: 01/08/2023]
Abstract
Background and significance Obesity is a chronic disease, warranting long-term medical intervention. We evaluated effects of testosterone (T) therapy (Th) in men with T deficiency with normal weight, overweight and obesity on anthropometric and metabolic parameters, compared with untreated men. Methods Hypogonadal men (n = 823) with total T ≤ 12.1 nmol/L (age: 60.6 ± 7.0 years) participated in an ongoing registry study. Among these men 474 (57.6%) were obese, 286 (34.8%) overweight and 63 (7.7%) had normal weight. T undecanoate injections were administered to 428 men and 395 remained untreated. Anthropometric and metabolic parameters were measured at least twice a year and changes adjusted for confounding factors to account for baseline differences between groups. Results Long-term TTh in hypogonadal men, irrespective of weight at baseline, produced improvements in body weight, waist circumference (WC) and body mass index (BMI). Furthermore, TTh decreased fasting blood glucose and HbA1c and improved lipid profiles. Gradual decreases in blood pressure (systolic and diastolic) and pulse pressure occurred in men treated with T in each group. Marked reductions in mortality and major cardiovascular events were recorded in men receiving TTh. Conclusions Our findings demonstrate that TTh produces reductions in weight, WC, and BMI. There were 77 (19.5%) deaths in the untreated groups and 23 (5.4%) in the T-groups. Based on these findings we suggest that long-term TTh in overweight and obese hypogonadal men produces progressive and sustained clinically meaningful weight loss and that TTh may contribute to reductions in mortality and incident major adverse cardiovascular events.
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Zhu L, Zhou J, Pan Y, Lv J, Liu Y, Yu S, Zhang Y. Glucagon-like peptide-1 receptor expression and its functions are regulated by androgen. Biomed Pharmacother 2019; 120:109555. [DOI: 10.1016/j.biopha.2019.109555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/27/2022] Open
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A cross-sectional survey of adrenal steroid hormones among overweight/obese boys according to puberty stage. BMC Pediatr 2019; 19:414. [PMID: 31690265 PMCID: PMC6833276 DOI: 10.1186/s12887-019-1755-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is associated with many chronic diseases including cortisol rhythm disorder and low testosterone. Furthermore, studies on obese children are quite limited and no concordance results have been obtained, especially for boys in puberty. Moreover, the sample sizes of previous studies were small, and were not representative. METHODS We conducted a cross-sectional survey including 1148 boys aged 6-14 years, they were divided into overweight/obesity (OW/OB) group and normal weight (NW) group. Puberty status was assessed according to Tanner scale and testicular volume. Serum levels of pregnenolone, 17-OH progesterone, corticosterone, dehydroepiandrosterone (DHEA), and androstenedione were detected by LC-MS. Serum free testosterone and sex hormone-binding globulin (SHBG) levels were measured by chemiluminescence immunoassay. RESULTS The 17-OH progesterone, DHEA, androstenedione and free testosterone levels of OW/OB boys at prepubertal stage or at the age 6 = < 10 years group were higher than those of the NW boys (all the P values were < 0.01). Furthermore, androstenedione and free testosterone levels were lower in OW/OB boys at late puberty, and the trend continued at the post pubertal stage for FT (P < 0.01-0.05). DHEA, androstenedione, and FT levels persisted to be higher at the 10~ < 12 years in OW/OB boys but not for 17-OH progesterone. FT level was lower in the OW/OB group at the 12~ < 15 years group. The SHBG levels in the OW/OB boys were lower than those in the NW ones at the 6~12 years group, and prepubertal to early pubertal stage. CONCLUSIONS Premature adrenarche is more likely in OW/OB boys. More attention should be given to the lower androgen levels of OW/OB boys at late pubertal and post pubertal stages.
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The Complex Relationship Between Erectile Dysfunction and Hypogonadism in Diabetes Mellitus. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Nokoff N, Thurston J, Hilkin A, Pyle L, Zeitler PS, Nadeau KJ, Santoro N, Kelsey MM. Sex Differences in Effects of Obesity on Reproductive Hormones and Glucose Metabolism in Early Puberty. J Clin Endocrinol Metab 2019; 104:4390-4397. [PMID: 30985874 PMCID: PMC6736047 DOI: 10.1210/jc.2018-02747] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/09/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Obesity is known to impact reproductive function in adults, but little is known about its effects on reproductive hormones during puberty. OBJECTIVE To assess sex differences in effects of obesity on reproductive hormones and their relation to insulin sensitivity and secretion. DESIGN Cross-sectional study including anthropometrics, serum and urine reproductive hormone concentrations, and intravenous glucose tolerance testing (IVGTT) to assess acute insulin response to glucose (AIRg), and insulin sensitivity (Si). SETTING Outpatient academic clinical research center. PATIENTS Girls (52%) and boys (48%) who were normal weight (NW; n = 51, BMI-Z score = -0.11 ± 0.77, age = 11.5 ± 1.7 years) and obese (n = 53, BMI-Z score = 2.22 ± 0.33, age = 10.9 ± 1.5 years), Tanner stage 2 to 3. RESULTS Boys with obesity had lower total testosterone (P < 0.0001) and higher concentrations of the urinary estradiol metabolite, E1c, (P = 0.046) than boys with NW. Girls with obesity had higher free androgen index (FAI; P = 0.03) than NW girls. Both boys and girls with obesity had lower sex hormone-binding globulin (SHBG; P < 0.0001) than NW. AIRg was inversely related to SHBG in boys (R = 0.6, P < 0.0001) and girls (R = 0.53, P = 0.0001). Si correlated with higher SHBG in boys (R2 = 0.67, P < 0.0001) and girls (R = 0.5, P = 0.0003), higher total testosterone for boys (R = 0.39, P = 0.01), and lower FAI for girls (R = -0.2, P = 0.04). CONCLUSION Youth with obesity have lower SHBG than youth with NW, but obesity has differential effects on reproductive hormones in girls versus boys, which are apparent early in puberty. Ongoing longitudinal studies will evaluate the impact of obesity on reproductive hormones in girls and boys as puberty progresses.
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Affiliation(s)
- Natalie Nokoff
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica Thurston
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Allison Hilkin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Philip S Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Kristen J Nadeau
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Carrageta DF, Oliveira PF, Alves MG, Monteiro MP. Obesity and male hypogonadism: Tales of a vicious cycle. Obes Rev 2019; 20:1148-1158. [PMID: 31035310 DOI: 10.1111/obr.12863] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
Obesity prevalence, particularly in children and young adults, is perilously increasing worldwide foreseeing serious negative health impacts in the future to come. Obesity is linked to impaired male gonadal function and is currently a major cause of hypogonadism. Besides signs and symptoms directly derived from decreased circulating testosterone levels, males with obesity also present poor fertility outcomes, further evidencing the parallelism between obesity and male reproductive function. In addition, males with androgen deficiency also exhibit increased fat accumulation and reduced muscle and mineral bone mass. Thus, compelling evidence highlights a vicious cycle where male hypogonadism can lead to increased adiposity, while obesity can be a cause for male hypogonadism. On the opposite direction, sustained weight loss can attain amelioration of male gonadal function. In this scenario, a thorough evaluation of gonadal function in men with obesity is crucial to dissect the causes from the consequences in order to target clinical interventions towards maximized improvement of reproductive health. This review will address the causes and consequences of the bidirectional relationship between obesity and hypogonadism, highlighting the implicit male reproductive repercussions.
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Affiliation(s)
- David F Carrageta
- Department of Microscopy, Laboratory of Cell Biology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Pedro F Oliveira
- Department of Microscopy, Laboratory of Cell Biology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marco G Alves
- Department of Microscopy, Laboratory of Cell Biology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Mariana P Monteiro
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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23
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Schwartz A, Hunschede S, Lacombe RJS, Chatterjee D, Sánchez-Hernández D, Kubant R, Bazinet RP, Hamilton JK, Anderson GH. Acute decrease in plasma testosterone and appetite after either glucose or protein beverages in adolescent males. Clin Endocrinol (Oxf) 2019; 91:295-303. [PMID: 31055857 DOI: 10.1111/cen.14005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chronic testosterone blood concentrations associate with food intake (FI), but acute effects of testosterone on appetite and effect of protein and glucose consumption on testosterone response have had little examination. METHODS In a randomized, crossover study, twenty-three adolescent (12-18 years old) males were given beverages containing either: (a) whey protein (1 g/kg body weight), (b) glucose (1 g/kg body weight) or (c) a calorie-free control (C). Plasma testosterone, luteinizing hormone (LH), GLP-1 (active), ghrelin (acylated), glucose, insulin and subjective appetite were measured prior (0) and at 20, 35 and 65 minutes after the consumption of the beverage. FI at an ad libitum pizza meal was assessed at 85 minutes. RESULTS Testosterone decreased acutely to 20 minutes after both protein and glucose with the decrease continuing after protein but not glucose to 65 minutes (P = 0.0382). LH was also decreased by both protein and glucose, but glucose had no effect at 20 minutes in contrast to protein (P < 0.001). Plasma testosterone concentration correlated positively with LH (r = 0.58762, P < 0.0001) and negatively with GLP-1 (r = -0.50656, P = 0.0003). No associations with appetite, ghrelin or glycaemic markers were found. Food intake was not affected by treatments. CONCLUSION Protein or glucose ingestion results in acute decreases in both plasma testosterone and LH in adolescent males. The physiological significance of this response remains to be determined as no support for testosterone's role in acute regulation of food intake was found.
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Affiliation(s)
- Alexander Schwartz
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sascha Hunschede
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russel John Scott Lacombe
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diptendu Chatterjee
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diana Sánchez-Hernández
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ruslan Kubant
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Paul Bazinet
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill K Hamilton
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Harvey Anderson
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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24
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Rangel-Huerta OD, Pastor-Villaescusa B, Gil A. Are we close to defining a metabolomic signature of human obesity? A systematic review of metabolomics studies. Metabolomics 2019; 15:93. [PMID: 31197497 PMCID: PMC6565659 DOI: 10.1007/s11306-019-1553-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/01/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Obesity is a disorder characterized by a disproportionate increase in body weight in relation to height, mainly due to the accumulation of fat, and is considered a pandemic of the present century by many international health institutions. It is associated with several non-communicable chronic diseases, namely, metabolic syndrome, type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and cancer. Metabolomics is a useful tool to evaluate changes in metabolites due to being overweight and obesity at the body fluid and cellular levels and to ascertain metabolic changes in metabolically unhealthy overweight and obese individuals (MUHO) compared to metabolically healthy individuals (MHO). OBJECTIVES We aimed to conduct a systematic review (SR) of human studies focused on identifying metabolomic signatures in obese individuals and obesity-related metabolic alterations, such as inflammation or oxidative stress. METHODS We reviewed the literature to identify studies investigating the metabolomics profile of human obesity and that were published up to May 7th, 2019 in SCOPUS and PubMed through an SR. The quality of reporting was evaluated using an adapted of QUADOMICS. RESULTS Thirty-three articles were included and classified according to four types of approaches. (i) studying the metabolic signature of obesity, (ii) studying the differential responses of obese and non-obese subjects to dietary challenges (iii) studies that used metabolomics to predict weight loss and aimed to assess the effects of weight loss interventions on the metabolomics profiles of overweight or obese human subjects (iv) articles that studied the effects of specific dietary patterns or dietary compounds on obesity-related metabolic alterations in humans. CONCLUSION The present SR provides state-of-the-art information about the use of metabolomics as an approach to understanding the dynamics of metabolic processes involved in human obesity and emphasizes metabolic signatures related to obesity phenotypes.
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Affiliation(s)
- Oscar Daniel Rangel-Huerta
- Faculty of Medicine, Department of Nutrition, University of Oslo, Oslo, Norway
- Norwegian Veterinary Institute, Oslo, Norway
| | - Belén Pastor-Villaescusa
- LMU - Ludwig-Maximilians-Universität München, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Centre for Environmental Health, Neuherberg, Germany
| | - Angel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix, Centre for Biomedical Research, University of Granada", Granada, Spain.
- Instituto de Investigación Biosanitaria ibs-Granada, Granada, Spain.
- Physiopathology of Obesity and Nutrition Networking Biomedical Research Centre (CIBEROBN), Madrid, Spain.
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25
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Obesity and Hypogonadism-A Narrative Review Highlighting the Need for High-Quality Data in Adolescents. CHILDREN-BASEL 2019; 6:children6050063. [PMID: 31052376 PMCID: PMC6560454 DOI: 10.3390/children6050063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 12/30/2022]
Abstract
The prevalence of obesity continues to rise in adult and pediatric populations throughout the world. Obesity has a direct impact on all organ systems, including the reproductive system. This review summarizes current knowledge about the effects of obesity on the male reproductive system across age, highlighting the need for more data in children and adolescents. Male hypogonadism is commonly seen in patients with obesity and affects the onset, duration, and progression of puberty. Different pathophysiologic mechanisms include increased peripheral conversion of testosterone to estrone and increased inflammation due to increased fat, both of which lead to suppression of the hypothalamic-pituitary-gonadotropin (HPG) axis and delayed development of secondary sexual characteristics in adolescent males. Evaluation of the HPG axis in obesity includes a thorough history to exclude other causes of hypogonadism and syndromic associations. Evaluation should also include investigating the complications of low testosterone, including increased visceral fat, decreased bone density, cardiovascular disease risk, and impaired mood and cognition, among others. The mainstay of treatment is weight reduction, but medications such as testosterone and clomiphene citrate used in adults, remain scarcely used in adolescents. Male hypogonadism associated with obesity is common and providers who care for adolescents and young adults with obesity should be aware of its impact and management.
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26
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Ayman Abd-Elrahman MN, Fouad AA, Salah HE. The relationship between the level of serum-free testosterone and depression in obese adolescent men in Sharkia Governorate. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_63_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Chin VL, Willliams KM, Donnelley T, Censani M, Conroy R, Lerner S, Oberfield SE, McMahon DJ, Zitsman J, Fennoy I. Long-term follow-up of gonadal dysfunction in morbidly obese adolescent boys after bariatric surgery. J Pediatr Endocrinol Metab 2018; 31:1191-1197. [PMID: 30352040 PMCID: PMC6419513 DOI: 10.1515/jpem-2018-0261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/25/2018] [Indexed: 01/23/2023]
Abstract
Background Elevated body mass index (BMI) is associated with hypogonadism in men but this is not well described in adolescents. The aim is to evaluate gonadal dysfunction and the effects of weight loss after gastric banding in obese adolescent boys. Methods Thirty-seven of 54 boys (age 16.2±1.2 years, mean BMI 48.2 kg/m2) enrolled at the Center for Adolescent Bariatric Surgery at Columbia University Medical Center had low total testosterone for Tanner 5 <350 ng/dL. Sixteen had long-term hormonal data for analysis at baseline (T0), 1 year (T1) and 2 years (T2) post-surgery. T-tests, chi-squared (χ2) tests, correlation and linear mixed models were performed. Results At T0, the hypogonadal group had higher systolic blood pressure (SBP) (75th vs. 57th percentile, p=0.02), fasting insulin (19 vs. 9 μIU/mL, p=0.0008) and homeostatic index of insulin resistance (HOMA-IR) (4.2 vs. 1.9, p=0.009) compared to control group. Total testosterone was negatively correlated with fasting insulin and HOMA-IR. In the long-term analysis, BMI, weight, waist circumference (WC), and % excess weight decreased at T1 and T2 compared to T0. Mean total testosterone at T0, T1 and T2 were 268, 304 and 368 ng/dL, respectively (p=0.07). There was a statistically significant negative correlation between BMI and testosterone after 2 years (r=-0.81, p=0.003). Conclusions Low testosterone levels but unaltered gonadotropins are common in this group and associated with insulin resistance. While a significant increase in testosterone was not found over time, the negative relationship between BMI and testosterone persisted, suggesting there may be an optimal threshold for testosterone production with respect to BMI. Long-term studies are needed.
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Affiliation(s)
- Vivian L Chin
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Kristen M Willliams
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Tegan Donnelley
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Marisa Censani
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Rushika Conroy
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Shulamit Lerner
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Sharon E Oberfield
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Donald J McMahon
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey Zitsman
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ilene Fennoy
- Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
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28
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Laakso S, Viljakainen H, Lipsanen-Nyman M, Turpeinen U, Ivaska KK, Anand-Ivell R, Ivell R, Mäkitie O. Testicular Function and Bone in Young Men with Severe Childhood-Onset Obesity. Horm Res Paediatr 2018; 89:442-449. [PMID: 29961074 DOI: 10.1159/000489818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies suggest increased risk for hypoandrogenism and fractures in men with obesity. We aimed to describe the effects of severe childhood-onset obesity on the cross talk between metabolic state, testes, and skeleton at late puberty. METHODS A cohort of adolescent and young adult males with severe childhood-onset obesity (n = 21, mean age 18.5 years) and an age-matched control group were assessed for testicular hormones and X-ray absorptiometry-derived bone mass. RESULTS Current median body mass indexes for the obese and control subjects were 37.4 and 22.9. Severe early-onset obesity manifested with lower free testosterone (median [interquartile range] 244 [194-332] vs. 403 [293-463] pmol/L, p = 0.002). Lower insulin-like 3 (1.02 [0.82-1.23] vs. 1.22 [1.01-1.46] ng/mL, p = 0.045) and lower ratio of testosterone to luteinizing hormone (2.81 [1.96-3.98] vs. 4.10 [3.03-5.83] nmol/IU, p = 0.008) suggested disrupted Leydig cell function. The degree of current obesity inversely correlated with free testosterone (τ = -0.516, p = 0.003), which in turn correlated positively with bone area at all measurement sites in males with childhood-onset obesity. CONCLUSIONS Severe childhood-onset obesity is associated with impaired Leydig cell function in young men and lower free testosterone may contribute to impaired skeletal characteristics.
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Affiliation(s)
- Saila Laakso
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heli Viljakainen
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Biomedicum, Helsinki, Finland
| | - Marita Lipsanen-Nyman
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Kaisa K Ivaska
- Department of Cell Biology and Anatomy, University of Turku, Turku, Finland
| | | | - Richard Ivell
- School of Biosciences, University of Nottingham, Nottingham, United Kingdom
| | - Outi Mäkitie
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Biomedicum, Helsinki, Finland.,Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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29
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Hecht M, Veigure R, Couchman L, S Barker CI, Standing JF, Takkis K, Evard H, Johnston A, Herodes K, Leito I, Kipper K. Utilization of data below the analytical limit of quantitation in pharmacokinetic analysis and modeling: promoting interdisciplinary debate. Bioanalysis 2018; 10:1229-1248. [PMID: 30033744 DOI: 10.4155/bio-2018-0078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traditionally, bioanalytical laboratories do not report actual concentrations for samples with results below the LOQ (BLQ) in pharmacokinetic studies. BLQ values are outside the method calibration range established during validation and no data are available to support the reliability of these values. However, ignoring BLQ data can contribute to bias and imprecision in model-based pharmacokinetic analyses. From this perspective, routine use of BLQ data would be advantageous. We would like to initiate an interdisciplinary debate on this important topic by summarizing the current concepts and use of BLQ data by regulators, pharmacometricians and bioanalysts. Through introducing the limit of detection and evaluating its variability, BLQ data could be released and utilized appropriately for pharmacokinetic research.
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Affiliation(s)
- Max Hecht
- Chair of Analytical Chemistry, Institute of Chemistry, University of Tartu, 14a Ravila Street, 50411 Tartu, Estonia
- Analytical Services International, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Rūta Veigure
- Chair of Analytical Chemistry, Institute of Chemistry, University of Tartu, 14a Ravila Street, 50411 Tartu, Estonia
| | - Lewis Couchman
- Analytical Services International, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Charlotte I S Barker
- Paediatric Infectious Diseases Research Group, Institute for Infection & Immunity, St George's University of London, London, SW17 0RE, UK
- Inflammation, Infection & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Paediatric Infectious Diseases Unit, St George's University Hospitals NHS Foundation Trust, London, SW17 0RE, UK
| | - Joseph F Standing
- Paediatric Infectious Diseases Research Group, Institute for Infection & Immunity, St George's University of London, London, SW17 0RE, UK
- Inflammation, Infection & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Kalev Takkis
- Analytical Services International, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Hanno Evard
- Chair of Analytical Chemistry, Institute of Chemistry, University of Tartu, 14a Ravila Street, 50411 Tartu, Estonia
| | - Atholl Johnston
- Analytical Services International, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
- Clinical Pharmacology, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Koit Herodes
- Chair of Analytical Chemistry, Institute of Chemistry, University of Tartu, 14a Ravila Street, 50411 Tartu, Estonia
| | - Ivo Leito
- Chair of Analytical Chemistry, Institute of Chemistry, University of Tartu, 14a Ravila Street, 50411 Tartu, Estonia
| | - Karin Kipper
- Chair of Analytical Chemistry, Institute of Chemistry, University of Tartu, 14a Ravila Street, 50411 Tartu, Estonia
- Analytical Services International, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
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30
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Dhindsa S, Ghanim H, Batra M, Dandona P. Hypogonadotropic Hypogonadism in Men With Diabesity. Diabetes Care 2018; 41:1516-1525. [PMID: 29934480 PMCID: PMC6014549 DOI: 10.2337/dc17-2510] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/02/2018] [Indexed: 02/03/2023]
Abstract
One-third of men with obesity or type 2 diabetes have subnormal free testosterone concentrations. The lower free testosterone concentrations are observed in obese men at all ages, including adolescents at completion of puberty. The gonadotropin concentrations in these males are inappropriately normal; thus, these patients have hypogonadotropic hypogonadism (HH). The causative mechanism of diabesity-induced HH is yet to be defined but is likely multifactorial. Decreased insulin and leptin signaling in the central nervous system are probably significant contributors. Contrary to popular belief, estrogen concentrations are lower in men with HH. Men with diabesity and HH have more fat mass and are more insulin resistant than eugonadal men. In addition, they have a high prevalence of anemia and higher mortality rates than eugonadal men. Testosterone replacement therapy results in a loss of fat mass, gain in lean mass, and increase in insulin sensitivity in men with diabesity and HH. This is accompanied by an increase in insulin-signaling genes in adipose tissue and a reduction in inflammatory mediators that interfere with insulin signaling. There is also an improvement in sexual symptoms, anemia, LDL cholesterol, and lipoprotein (a). However, testosterone therapy does not consistently affect HbA1c in men with diabetes. The effect of testosterone replacement on cardiovascular events or mortality in men with diabesity is not known and remains to be studied in prospective trials.
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Affiliation(s)
- Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health, Buffalo, NY.,Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, St. Louis, MO
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health, Buffalo, NY
| | - Manav Batra
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health, Buffalo, NY
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health, Buffalo, NY
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31
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Abstract
OBJECTIVE The decrease in testosterone levels that occurs with aging has become an important clinical issue both due to the growth of the geriatric population and patient interest in testosterone therapy. The decision to assess for testosterone deficiency and the ability to determine whether the benefits exceed the risks require a comprehensive evaluation of the aging patient. This article is part of a series of papers focused on the endocrinology of aging. This review addresses common issues needed for clinical decision making, including how to interpret test results, differential diagnosis, potential impact of testosterone treatment on insulin resistance and cardiovascular disease, and options for therapy. METHODS Papers reviewed were identified through literature searches conducted on PubMed. RESULTS Assessment of testosterone levels in the geriatric male requires an understanding of the limitations of the assay that is used, the symptoms associated with low testosterone, the impact of comorbid conditions on levels, and risks of therapy. Successful treatment requires setting realistic expectations of the benefits of replacement therapy. CONCLUSION While the prevalence of low testosterone concentrations is increased with aging, the common comorbidities such as obesity and diabetes may contribute to changes in testosterone levels. Clinical trial evidence shows modest benefit for treatment of low testosterone in the presence of symptoms. Assessment of the geriatric male should include evaluation of their testosterone level in the context of their functional status and comorbidities. ABBREVIATIONS CDC = Centers for Disease Control and Prevention; CI = confidence interval; CVD = cardiovascular disease; DXA = dual-energy X-ray absorptiometry; EMAS = European Male Aging Study; FDA = U.S. Food and Drug Administration; FHS = Framingham Heart Study; HDL = high-density lipoprotein; HOMA-IR = homeostasis model assessment of insulin resistance; LH = luteinizing hormone; OR = odds ratio; PSA = prostate-specific antigen; SHBG = sex hormone-binding globulin; T2DM = type 2 diabetes mellitus; vBMD = volumetric bone mineral density.
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32
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Ghanim H, Dhindsa S, Abuaysheh S, Batra M, Kuhadiya ND, Makdissi A, Chaudhuri A, Dandona P. Diminished androgen and estrogen receptors and aromatase levels in hypogonadal diabetic men: reversal with testosterone. Eur J Endocrinol 2018; 178:277-283. [PMID: 29339527 DOI: 10.1530/eje-17-0673] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/15/2018] [Indexed: 01/19/2023]
Abstract
AIMS One-third of males with type 2 diabetes (T2DM) have hypogonadism, characterized by low total and free testosterone concentrations. We hypothesized that this condition is associated with a compensatory increase in the expression of androgen receptors (AR) and that testosterone replacement reverses these changes. We also measured estrogen receptor and aromatase expression. MATERIALS AND METHODS This is a randomized double-blind placebo-controlled trial. Thirty-two hypogonadal and 32 eugonadal men with T2DM were recruited. Hypogonadal men were randomized to receive intramuscular testosterone or saline every 2 weeks for 22 weeks. We measured AR, ERα and aromatase expression in peripheral blood mononuclear cells (MNC), adipose tissue and skeletal muscle in hypogonadal and eugonadal males with T2DM at baseline and after 22 weeks of treatment in those with hypogonadism. RESULTS The mRNA expression of AR, ERα (ESR1) and aromatase in adipose tissue from hypogonadal men was significantly lower as compared to eugonadal men, and it increased significantly to levels comparable to those in eugonadal patients with T2DM following testosterone treatment. AR mRNA expression was also significantly lower in MNC from hypogonadal patients compared to eugonadal T2DM patients. Testosterone administration in hypogonadal patients also restored AR mRNA and nuclear extract protein levels from MNC to that in eugonadal patients. In the skeletal muscle, AR mRNA and protein expression are lower in men with hypogonadism. Testosterone treatment restored AR expression levels to that comparable to levels in eugonadal men. CONCLUSIONS We conclude that, contrary to our hypothesis, the expression of AR, ERα and aromatase is significantly diminished in hypogonadal men as compared to eugonadal men with type 2 diabetes. Following testosterone replacement, there is a reversal of these deficits.
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Affiliation(s)
- Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, St Louis, Missouri, USA
| | - Sanaa Abuaysheh
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
| | - Manav Batra
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
| | - Nitesh D Kuhadiya
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
| | - Antoine Makdissi
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
| | - Ajay Chaudhuri
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York, USA
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33
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Dhindsa S, Chemitiganti R, Ghanim H, Santiago E, Haider A, Chaar N, Mok M, McKee A, Dandona P. Intranasal Insulin Administration Does Not Affect LH Concentrations in Men with Diabetes. Int J Endocrinol 2018; 2018:6170154. [PMID: 30515210 PMCID: PMC6234437 DOI: 10.1155/2018/6170154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/10/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022] Open
Abstract
A quarter of men with obesity or type 2 diabetes have hypogonadotropic hypogonadism. Animal studies and in vitro data have shown that insulin action and insulin responsiveness in the brain are necessary for the maintenance of the functional integrity of the hypothalamo-hypophyseal-gonadal axis. We conducted a randomized, placebo-controlled trial to evaluate the effect of one dose of intranasal insulin (40 IU of regular insulin) or saline on LH concentrations in 14 men (8 with type 2 diabetes and 6 healthy lean men). Insulin or saline was administered intranasally on two different occasions, at least one week apart. Blood samples were collected to measure LH concentrations every 15 minutes for 5 hours. Study drug was administered intranasally after a 2-hour baseline sampling period. Patients remained fasting throughout the procedure. The primary endpoint of the study was to compare the change in LH concentrations after intranasal insulin as compared to placebo (intranasal saline). Change was defined as the difference between baseline LH concentrations (average of the 9 samples collected in two hours prior to drug administration) and average LH concentrations following drug administration (average of the 12 samples collected in 3 hours). There was no change in LH concentrations following insulin administration as compared to placebo in men with diabetes or in lean men. We conclude that one dose of 40 IU of regular insulin administered intranasally does not change LH concentrations acutely in men.
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Affiliation(s)
- Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA
- Division of Endocrinology, Diabetes and Metabolism, State University of New York, Buffalo and Kaleida Health 462 Grider Street, Buffalo NY-14215, USA
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, 1402 S Grand Blvd, St. Louis MO-63141, USA
| | - Rama Chemitiganti
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York, Buffalo and Kaleida Health 462 Grider Street, Buffalo NY-14215, USA
| | - Evangelina Santiago
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA
| | - Adnan Haider
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA
| | - Natalia Chaar
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA
| | - Mary Mok
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, 800 West 4th Street, Odessa, TX 79763, USA
| | - Alexis McKee
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, 1402 S Grand Blvd, St. Louis MO-63141, USA
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York, Buffalo and Kaleida Health 462 Grider Street, Buffalo NY-14215, USA
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Hietamäki J, Hero M, Holopainen E, Känsäkoski J, Vaaralahti K, Iivonen AP, Miettinen PJ, Raivio T. GnRH receptor gene mutations in adolescents and young adults presenting with signs of partial gonadotropin deficiency. PLoS One 2017; 12:e0188750. [PMID: 29182666 PMCID: PMC5705112 DOI: 10.1371/journal.pone.0188750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/13/2017] [Indexed: 11/20/2022] Open
Abstract
Biallelic, partial loss-of-function mutations in GNRHR cause a wide spectrum of reproductive phenotypes from constitutional delay of growth and puberty to complete congenital hypogonadotropic hypogonadism. We studied the frequency of GNRHR, FGFR1, TAC3, and TACR3 mutations in nine adolescent and young adult females with clinical cues consistent with partial gonadotropin deficiency (stalled puberty, unexplained secondary amenorrhea), and describe phenotypic features and molecular genetic findings of monozygotic twin brothers with stalled puberty. Two girls out of nine (22%, 95%CI 6–55%) carried biallelic mutations in GNRHR. The girl with compound heterozygous c.317A>G p.(Gln106Arg) and c.924_926delCTT p.(Phe309del) GNRHR mutations displayed incomplete puberty and clinical signs of hypoestrogenism. The patient carrying a homozygous c.785G>A p.(Arg262Gln) mutation presented with signs of hypoestrogenism and unexplained secondary amenorrhea. None of the patients exhibited mutations in FGFR1, TAC3, or TACR3. The twin brothers, compound heterozygous for GNRHR mutations c.317A>G p.(Gln106Arg) and c.785G>A p.(Arg262Gln), presented with stalled puberty and were discordant for weight, and the heavier of them had lower testosterone levels. These results suggest that genetic testing of the GNRHR gene should be offered to adolescent females with low-normal gonadotropins and unexplained stalled puberty or menstrual dysfunction. In male patients with partial gonadotropin deficiency, excess adipose tissue may suppress hypothalamic-pituitary-gonadal axis.
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Affiliation(s)
- Johanna Hietamäki
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- * E-mail: (JH); (TR)
| | - Matti Hero
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Holopainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Känsäkoski
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kirsi Vaaralahti
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anna-Pauliina Iivonen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Päivi J. Miettinen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Molecular Neurology, and Biomedicum Stem Cell Center, University of Helsinki, Helsinki, Finland
| | - Taneli Raivio
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- * E-mail: (JH); (TR)
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Dhindsa S, Ghanim H, Batra M, Kuhadiya ND, Abuaysheh S, Green K, Makdissi A, Chaudhuri A, Dandona P. Effect of testosterone on hepcidin, ferroportin, ferritin and iron binding capacity in patients with hypogonadotropic hypogonadism and type 2 diabetes. Clin Endocrinol (Oxf) 2016; 85:772-780. [PMID: 27292585 PMCID: PMC5065401 DOI: 10.1111/cen.13130] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/26/2016] [Accepted: 06/07/2016] [Indexed: 01/23/2023]
Abstract
CONTEXT As the syndrome of hypogonadotropic hypogonadism (HH) is associated with anaemia and the administration of testosterone restores haematocrit to normal, we investigated the potential underlying mechanisms. DESIGN Randomized, double-blind, placebo-controlled trial. METHODS We measured basal serum concentrations of erythropoietin, iron, iron binding capacity, transferrin (saturated and unsaturated), ferritin and hepcidin and the expression of ferroportin and transferrin receptor (TR) in peripheral blood mononuclear cells (MNC) of 94 men with type 2 diabetes. Forty-four men had HH (defined as subnormal free testosterone along with low or normal LH concentrations) while 50 were eugonadal. Men with HH were randomized to testosterone or placebo treatment every 2 weeks for 15 weeks. Blood samples were collected at baseline, 3 and 15 weeks after starting treatment. Twenty men in testosterone group and 14 men in placebo group completed the study. RESULTS Haematocrit levels were lower in men with HH (41·1 ± 3·9% vs 43·8 ± 3·4%, P = 0·001). There were no differences in plasma concentrations of hepcidin, ferritin, erythropoietin, transferrin or iron, or in the expression of ferroportin or TR in MNC among HH and eugonadal men. Haematocrit increased to 45·3 ± 4·5%, hepcidin decreased by 28 ± 7% and erythropoietin increased by 21 ± 7% after testosterone therapy (P < 0·05). There was no significant change in ferritin concentrations, but transferrin concentration increased while transferrin saturation and iron concentrations decreased (P < 0·05). Ferroportin and TR mRNA expression in MNC increased by 70 ± 13% and 43 ± 10%, respectively (P < 0·01), after testosterone therapy. CONCLUSIONS The increase in haematocrit following testosterone therapy is associated with an increase in erythropoietin, the suppression of hepcidin, and an increase in the expression of ferroportin and TR.
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Affiliation(s)
- Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
- Division of Endocrinology, Diabetes and Metabolism, Texas Tech University Health Sciences Center, Odessa, TX, USA
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Manav Batra
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nitesh D Kuhadiya
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sanaa Abuaysheh
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Kelly Green
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Antoine Makdissi
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Ajay Chaudhuri
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Buffalo, NY, USA.
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Cameron JL, Jain R, Rais M, White AE, Beer TM, Kievit P, Winters-Stone K, Messaoudi I, Varlamov O. Perpetuating effects of androgen deficiency on insulin resistance. Int J Obes (Lond) 2016; 40:1856-1863. [PMID: 27534842 PMCID: PMC5140744 DOI: 10.1038/ijo.2016.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/14/2016] [Accepted: 07/23/2016] [Indexed: 12/22/2022]
Abstract
Background/Objectives Androgen deprivation therapy (ADT) is commonly used for treatment of
prostate cancer, but is associated with side effects such as sarcopenia and
insulin resistance. The role of lifestyle factors such as diet and exercise
on insulin sensitivity and body composition in testosterone-deficient males
is poorly understood. The aim of the present study was to examine the
relationships between androgen status, diet, and insulin sensitivity. Subjects/Methods Middle-aged (11–12-yo) intact and orchidectomized male rhesus
macaques were maintained for two months on a standard chow diet, and then
exposed for six months to a Western-style, high-fat/calorie-dense diet (WSD)
followed by four months of caloric restriction (CR). Body composition,
insulin sensitivity, physical activity, serum cytokine levels, and adipose
biopsies were evaluated before and after each dietary intervention. Results Both intact and orchidectomized animals gained similar proportions of
body fat, developed visceral and subcutaneous adipocyte hypertrophy, and
became insulin resistant in response to the WSD. CR reduced body fat in both
groups, but reversed insulin resistance only in intact animals.
Orchidectomized animals displayed progressive sarcopenia, which persisted
after the switch to CR. Androgen deficiency was associated with increased
levels of interleukin-6 and macrophage-derived chemokine (CCL22), both of
which were elevated during CR. Physical activity levels showed a negative
correlation with body fat and insulin sensitivity. Conclusion Androgen deficiency exacerbated the negative metabolic side effects
of the WSD, such that CR alone was not sufficient to improve altered insulin
sensitivity, suggesting that ADT patients will require additional
interventions to reverse insulin resistance and sarcopenia.
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Goodman N, Guay A, Dandona P, Dhindsa S, Faiman C, Cunningham GR. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF TESTOSTERONE AND CARDIOVASCULAR RISK. Endocr Pract 2016; 21:1066-73. [PMID: 26355962 DOI: 10.4158/ep14434.ps] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.
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Potikanond S, Rattanachote P, Pintana H, Suntornsaratoon P, Charoenphandhu N, Chattipakorn N, Chattipakorn S. Obesity does not aggravate osteoporosis or osteoblastic insulin resistance in orchiectomized rats. J Endocrinol 2016; 228:85-95. [PMID: 26675491 DOI: 10.1530/joe-15-0333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 01/03/2023]
Abstract
The present study aimed to test the hypothesis that testosterone deprivation impairs osteoblastic insulin signaling, decreases osteoblast survival, reduces bone density, and that obesity aggravates those deleterious effects in testosterone-deprived rats. Twenty four male Wistar rats underwent either a bilateral orchiectomy (O, n=12) or a sham operation (S, n=12). Then the rats in each group were further divided into two subgroups fed with either a normal diet (ND) or a high-fat diet (HF) for 12 weeks. At the end of the protocol, blood samples were collected to determine metabolic parameters and osteocalcin ratios. The tibiae were collected to determine bone mass using microcomputed tomography and for osteoblast isolation. The results showed that rats fed with HF (sham-operated HF-fed rats (HFS) and ORX HF-fed rats (HFO)) developed peripheral insulin resistance and had decreased trabecular bone density. In ND-fed rats, only the ORX ND-fed rats (NDO) group had decreased trabecular bone density. In addition, osteoblastic insulin resistance, as indicated by a decrease in tyrosine phosphorylation of the insulin receptor and Akt, were observed in all groups except the sham-operated ND-fed rats (NDS) rats. Those groups, again with the exception of the NDS rats, also had decreased osteoblastic survival. No differences in the levels of osteoblastic insulin resistance and osteoblastic survival were found among the NDO, HFS, and HFO groups. These findings suggest that either testosterone deprivation or obesity alone can impair osteoblastic insulin signaling and decrease osteoblastic survival leading to the development of osteoporosis. However, obesity does not aggravate those deleterious effects in the bone of testosterone-deprived rats.
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Affiliation(s)
- Saranyapin Potikanond
- Department of PharmacologyFaculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pinyada Rattanachote
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Hiranya Pintana
- Center of Calcium and Bone Research (COCAB)Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Narattaphol Charoenphandhu
- Cardiac Electrophysiology Unit Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Center of Excellence in Cardiac Electrophysiology ResearchChiang Mai University, Chiang Mai, Thailand
| | - Siriporn Chattipakorn
- Department of Oral Biology and Diagnostic SciencesFaculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Abstract
The association between obesity and sexual dysfunction has been described in many studies. Neurobiological, hormonal, vascular and mental disturbances are the main reasons in male and in female gender. Sexual interest and desire, sexual arousal, orgasm, painful intercourse and premature ejaculation can be involved. Data for prevalence of sexual function disturbances in obese people are scarce and most studies were small. For screening of sexual function we recommend the International Index of Erectile Function (IIEF)-Score, which contains 15 Items for males and the Female Sexual Function Index (FSFI), which contains 19 items for females. Treatment of sexual function disturbances include lifestyle changes with an increase of physical activity, weight control, healthy eating and smoking cessation. Testosterone substitution in cases of real hypogonadism and treatment with PDE-5 inhibitors are well documented treatment options in male individuals. New treatment options for female patients with variable effectiveness are fibanserin, testosterone, bupropione and oxytocin.
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Moser VA, Pike CJ. Obesity and sex interact in the regulation of Alzheimer's disease. Neurosci Biobehav Rev 2015; 67:102-18. [PMID: 26708713 DOI: 10.1016/j.neubiorev.2015.08.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 01/09/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder, for which a number of genetic, environmental, and lifestyle risk factors have been identified. A significant modifiable risk factor is obesity in mid-life. Interestingly, both obesity and AD exhibit sex differences and are regulated by sex steroid hormones. Accumulating evidence suggests interactions between obesity and sex in regulation of AD risk, although the pathways underlying this relationship are unclear. Inflammation and the E4 allele of apolipoprotein E have been identified as independent risk factors for AD and both interact with obesity and sex steroid hormones. We review the individual and cooperative effects of obesity and sex on development of AD and examine the potential contributions of apolipoprotein E, inflammation, and their interactions to this relationship.
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Affiliation(s)
- V Alexandra Moser
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA 90089, USA.
| | - Christian J Pike
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA 90089, USA; Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA.
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Chao KC, Chang CC, Chiou HY, Chang JS. Serum Ferritin Is Inversely Correlated with Testosterone in Boys and Young Male Adolescents: A Cross-Sectional Study in Taiwan. PLoS One 2015; 10:e0144238. [PMID: 26646112 PMCID: PMC4672881 DOI: 10.1371/journal.pone.0144238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The transition from childhood to teenaged years is associated with increased testosterone and a decreased iron status. It is not clear whether higher testosterone levels cause the decreased iron status, and to what extent, obesity-related inflammation influences the iron-testosterone relationship. The aim of the present study was to examine relationships of testosterone, iron status, and anti-/proinflammatory cytokines in relation to nutritional status in boys and young adolescent Taiwanese males. Methods In total, 137 boys aged 7~13 yr were included. Parameters for obesity, the iron status, testosterone, and inflammatory markers were evaluated. Results Overweight and obese (ow/obese) boys had higher mean serum testosterone, interleukin (IL)-1β, and nitric oxide (NO) levels compared to their normal-weight counterparts (all p<0.05). Mean serum ferritin was slightly higher in ow/obese boys compared to normal-weight boys, but this did not reach statistical significance. A multiple linear regression showed that serum ferritin (β = -0.7470, p = 0.003) was inversely correlated with testosterone, while serum IL-10 (β = 0.3475, p = 0.009) was positively associated with testosterone after adjusting for covariates. When normal-weight boys were separately assessed from ow/obesity boys, the association between testosterone and serum ferritin became stronger (β = -0.9628, p<0.0001), but the association between testosterone and IL-10 became non-significant (β = 0.1140, p = 0.4065) after adjusting for covariates. In ow/obese boys, only IL-10 was weakly associated with serum testosterone (β = 0.6444, p = 0.051) after adjusting for age. Conclusions Testosterone and serum ferritin are intrinsically interrelated but this relationship is weaker in ow/obese boys after adjusting for age.
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Affiliation(s)
- Kuo-Ching Chao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Janjua QM, Shahid A, Alam R, Rizwan M, Saeed S, Qazi MH, Arslan M. Evidence of male hypogonadism at an early age as a familial risk of type 2 diabetes. ANNALES D'ENDOCRINOLOGIE 2015; 76:658-63. [PMID: 26639184 DOI: 10.1016/j.ando.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/20/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Previous investigations provide evidence of an association of hypogonadism with type 2 diabetes in men, and low testosterone levels have been regarded a risk factor for the disease. Since a strong genetic predisposition to type 2 diabetes has been demonstrated, here we investigate a possible tendency towards hypogonadism in young male offspring of diabetic parents. MATERIAL AND METHODS The study compares 32 male offspring of diabetic parents with 31 male offspring of nondiabetic parents matched by age. The subjects comprised boys (9-17 years) and young adults (19-25 years). Anthropomorphic measurements were made in all subjects. Fasting blood samples were analyzed for glucose and serum concentrations of testosterone (T), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), insulin and leptin were measured by ELISA. Free testosterone (FT) was calculated using T and SHBG levels. RESULTS Serum T, FT and bioavailable T (BAT) levels in offspring of diabetic parents were significantly lower than those of offspring of nondiabetic parents across all age groups. Mean serum LH levels were also lower in offspring of diabetic parents compared to the controls. Although LH levels in young adults with diabetic parents, tended to be lower than those of age-matched controls but the difference was not statistically significant. Serum insulin and leptin, and insulin resistance measured by HOMA-IR were significantly raised in older offspring of diabetic parents but were within the normal range. CONCLUSION Whereas hypogonadism was the only indicator of a possible predisposition to metabolic dysfunction in peripubertal children of diabetic parents, a significant change in other metabolic markers becomes apparent at a more advanced age.
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Affiliation(s)
- Qasim M Janjua
- Department of Physiology, University College of Medicine and Dentistry, The University of Lahore, Lahore 54600, Pakistan
| | - Adeela Shahid
- Department of Physiology, Shalamar Medical College, Lahore 54000, Pakistan
| | - Rabail Alam
- Centre for Research in Molecular Medicine, The University of Lahore, Lahore 54600, Pakistan
| | - Marvi Rizwan
- SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Sadia Saeed
- Centre for Research in Molecular Medicine, The University of Lahore, Lahore 54600, Pakistan
| | - Mahmood H Qazi
- Centre for Research in Molecular Medicine, The University of Lahore, Lahore 54600, Pakistan
| | - Muhammad Arslan
- Centre for Research in Molecular Medicine, The University of Lahore, Lahore 54600, Pakistan; Department of Biological Sciences, Forman Christian College (A Chartered University), Lahore 54000, Pakistan.
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Bendre SV, Murray PJ, Basaria S. Clomiphene Citrate Effectively Increases Testosterone in Obese, Young, Hypogonadal Men. ACTA ACUST UNITED AC 2015; 4. [PMID: 26844009 DOI: 10.4172/2161-038x.1000155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity has been associated with low testosterone (T) in adult males and in pubertal boys. Therapy for hypogonadism with exogenous T may lead to testicular atrophy and later infertility. Only a few studies have demonstrated that the Selective Estrogen Receptor Modulator (SERM) clomiphene citrate (CC), an estrogen receptor antagonist, increases T in obese hypogonadal men while preventing testicular atrophy. No studies to date using CC have been done in younger obese post-pubertal hypogonadal males. OBJECTIVE To determine whether CC therapy is effective in increasing serum T levels in hypogonadal post-pubertal obese males 18-21 years. MATERIALS AND METHODS A retrospective chart analysis of records in obese men aged 18-21 years was done. Patients with early morning T level <350 ng/dl were given 25 mg CC on alternate days. Out of 18 patients found to have low T, 11 were analyzed. Baseline serum T, LH, FSH, weight and BMI were compared at baseline and after 3 months of CC treatment. RESULTS Baseline T level was 233 ± 66 ng/dl and increased to 581 ± 161 ng/dl (p<0.0001) after 3 months of CC treatment. Baseline LH levels increased from 3.3 ± 1.6 mIU/mL to 5.7 ± 1.7 mIU/mL (p=0.027). Similarly, baseline FSH levels increased from 2.8 ± 1.5 mIU/mL to 6.2 ± 3 mIU/mL after CC treatment (p=0.026). There was no correlation between baseline or post treatment weight or BMI and the T level, LH, or FSH level. CONCLUSION This is the first study reporting on CC therapy in obese, hypogonadal post-pubertal men 18-21 years. The SERM CC increased T in obese post-pubertal hypogonadal men, similar to efficacy of CC in adult hypogonadal men over the age 21 years. Larger randomized controlled studies to study the safety and potential use of CC to improve T in young obese HG men are needed.
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Affiliation(s)
- Sachin V Bendre
- Department of Pediatrics, West Virginia University, Charleston Division, USA
| | - Pamela J Murray
- Department of Pediatrics, West Virginia University, Charleston Division, USA
| | - Shehzad Basaria
- Department of Medicine, Aging and Metabolism, Boston, MA, USA
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Caslin HL, Franco RL, Crabb EB, Huang CJ, Bowen MK, Acevedo EO. The effect of obesity on inflammatory cytokine and leptin production following acute mental stress. Psychophysiology 2015; 53:151-8. [DOI: 10.1111/psyp.12568] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
- H. L. Caslin
- Department of Kinesiology and Health Sciences; College of Humanities and Sciences, Virginia Commonwealth University; Richmond Virginia USA
| | - R. L. Franco
- Department of Kinesiology and Health Sciences; College of Humanities and Sciences, Virginia Commonwealth University; Richmond Virginia USA
| | - E. B. Crabb
- Department of Kinesiology and Health Sciences; College of Humanities and Sciences, Virginia Commonwealth University; Richmond Virginia USA
| | - C. J. Huang
- Department of Exercise Science and Health Promotion; School of Education, Florida Atlantic University; Boca Raton Florida USA
| | - M. K. Bowen
- Department of Kinesiology and Health Sciences; College of Humanities and Sciences, Virginia Commonwealth University; Richmond Virginia USA
| | - E. O. Acevedo
- Department of Kinesiology and Health Sciences; College of Humanities and Sciences, Virginia Commonwealth University; Richmond Virginia USA
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Lokaj-Berisha V, Gacaferri-Lumezi B, Berisha N, Gashi-Hoxha S. A Pilot Study on BMI, Serum Testosterone and Estradiol Levels in Allergic Male Patients. Open Access Maced J Med Sci 2015; 3:595-600. [PMID: 27275293 PMCID: PMC4877893 DOI: 10.3889/oamjms.2015.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The dramatic increase in the prevalence of high body mass index (BMI) increases the prevalence of allergic diseases, both in adults and children and obesity is associated with hypogonadism in adult males. AIM We aimed to evaluate the effect of high body mass index on plasma concentrations of testosterone and estradiol in young pubertal and adult males with allergic diseases. MATERIAL AND METHODS Morning fasting blood samples were obtained form 51 allergic patients and 6 healthy volunteer males between the ages 11-57 years (Mean 26.9, DS ± 11.9 years). Total testosterone, estradiol, FSH and LH concentrations were measured by radioimmunoassay. All participants were subjected to skin prick tests with test kit G aeroallergens, and BMI was calculated according to the body weight divided by the square of height (kg/m(2)). RESULTS Low levels of testosterone and high levels of estradiol were associated with high BMI only in patients with asthma/rhinitis, but not in asthma patients. Allergic dermatitis/urticaria group along with healthy controls were overweight but within normal ranges for total testosterone and estradiol concentrations. Patients with allergic rhinitis were within normal ranges for BMI, total testosterone and estradiol concentrations. CONCLUSION High BMI is not always associated with low levels of testosterone and high levels of estradiol in our patients with allergic diseases, but low levels of testosterone are present in patients with asthma and asthma/rhinitis although not among patients with rhinitis only. Our results should be confirmed in a larger group of participants.
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Affiliation(s)
- Violeta Lokaj-Berisha
- Department of Physiology & Immunology, Faculty of Medicine, University of Prishtina, Republic of Kosovo
| | - Besa Gacaferri-Lumezi
- Department of Physiology & Immunology, Faculty of Medicine, University of Prishtina, Republic of Kosovo
| | - Naser Berisha
- Departments of OB & GYNE, University Clinical Centre, Prishtina, Republic of Kosovo
| | - Sanije Gashi-Hoxha
- Departments of OB & GYNE, University Clinical Centre, Prishtina, Republic of Kosovo
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Polari L, Yatkin E, Martínez Chacón MG, Ahotupa M, Smeds A, Strauss L, Zhang F, Poutanen M, Saarinen N, Mäkelä SI. Weight gain and inflammation regulate aromatase expression in male adipose tissue, as evidenced by reporter gene activity. Mol Cell Endocrinol 2015; 412:123-30. [PMID: 26054748 DOI: 10.1016/j.mce.2015.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/11/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
Obesity and white adipose tissue (WAT) inflammation are associated with enhanced aromatization in women, but little is known about the regulation of aromatase (CYP19A1) gene expression in male WAT. We investigated the impact of weight gain and WAT inflammation on the regulation of CYP19A1 in males, by utilizing the hARO-Luc aromatase reporter mouse model containing a >100-kb 5'-region of the human CYP19A1 gene. We show that hARO-Luc reporter activity is enhanced in WAT of mice with increased adiposity and inflammation. Dexamethasone and TNFα, as well as forskolin and phorbol 12-myristate 13-acetate, upregulate hARO-Luc activity, suggesting the involvement of promoters I.4 and I.3/II. Furthermore, we show that diet enriched with antioxidative plant polyphenols attenuates WAT inflammation and hARO-Luc activity in obese males. In conclusion, our data suggest that obesity-associated WAT inflammation leads to increased peripheral CYP19A1 expression in males, and that polyphenol-enriched diet may have the potential to attenuate excessive aromatization in WAT of obese men.
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Affiliation(s)
- L Polari
- Functional Foods Forum, University of Turku, Turku, Finland; Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland
| | - E Yatkin
- Functional Foods Forum, University of Turku, Turku, Finland; Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland
| | - M G Martínez Chacón
- Functional Foods Forum, University of Turku, Turku, Finland; Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland
| | - M Ahotupa
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - A Smeds
- Åbo Akademi University, Process Chemistry Centre, Laboratory of Wood and Paper Chemistry, Turku, Finland
| | - L Strauss
- Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland; Department of Physiology, Institute of Biomedicine, University of Turku, Finland
| | - F Zhang
- Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland; Department of Physiology, Institute of Biomedicine, University of Turku, Finland
| | - M Poutanen
- Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland; Department of Physiology, Institute of Biomedicine, University of Turku, Finland
| | - N Saarinen
- Functional Foods Forum, University of Turku, Turku, Finland; Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland; Department of Physiology, Institute of Biomedicine, University of Turku, Finland
| | - S I Mäkelä
- Functional Foods Forum, University of Turku, Turku, Finland; Turku Center for Disease Modeling, Institute of Biomedicine, University of Turku, Turku, Finland.
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Schwartz A, Patel BP, Vien S, McCrindle BW, Anderson GH, Hamilton J. Acute decrease in serum testosterone after a mixed glucose and protein beverage in obese peripubertal boys. Clin Endocrinol (Oxf) 2015; 83:332-8. [PMID: 25308907 DOI: 10.1111/cen.12630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/24/2014] [Accepted: 10/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Delayed puberty and lower levels of testosterone (T) have been observed in adult obese males and some adolescent males. In adult men, enteral glucose ingestion results in acute lowering of serum testosterone levels; however, this has not been studied in adolescents. We aimed to examine the acute effect of a glucose/protein beverage on serum T concentration changes in obese peripubertal males. A second objective was to determine whether change in T concentration was related to appetite hormone levels. PATIENTS AND METHODS Twenty-three overweight and obese males aged 8-17 in pre-early (Tanner stage 1-2) and mid-late (Tanner stage 3-5) puberty were included in this cross-sectional study at the Clinical investigative unit at the Hospital for Sick Children. Participants consumed a beverage containing glucose and protein, and blood samples measuring pubertal hormones, ghrelin and glucagon-like peptide-1 (GLP-1) were taken over 60 min. RESULTS Across pubertal stages, there was a significant decrease in T levels in adolescent boys (-18·6 ± 3·1%, P < 0·01) with no proportional differences between pre-early and mid-late puberty (P = 0·09). Decrease in T was associated with a decrease in LH (r = 0·52, P = 0·02), and fasting T was inversely correlated with fasting ghrelin (r = -0·51, P = 0·03) with no correlation with GLP-1. CONCLUSIONS Intake of a mixed glucose/protein beverage acutely decreases T levels in overweight and obese peripubertal boys. A potential mechanism for this decrease may be secondary to an acute decrease in LH, but this requires further evaluation.
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Affiliation(s)
- Alexander Schwartz
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Barkha P Patel
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shirley Vien
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian W McCrindle
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - G Harvey Anderson
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill Hamilton
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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48
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Paltoglou G, Fatouros IG, Valsamakis G, Schoina M, Avloniti A, Chatzinikolaou A, Kambas A, Draganidis D, Mantzou A, Papagianni M, Kanaka-Gantenbein C, Chrousos GP, Mastorakos G. Antioxidation improves in puberty in normal weight and obese boys, in positive association with exercise-stimulated growth hormone secretion. Pediatr Res 2015; 78:158-64. [PMID: 25938733 DOI: 10.1038/pr.2015.85] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/23/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Oxidative stress is associated with obesity while the evidence for the role of GH in pro- and antioxidation is inconclusive. This study investigates the relationships between growth hormone (GH), pro- and antioxidation in relation to obesity and puberty before and after an acute bout of exercise. METHODS In this case-control study, 76 healthy normal-weight and obese, prepubertal and pubertal boys underwent a blood sampling before and immediately after an aerobic exercise bout until exhaustion at 70% maximal oxygen consumption. Markers of prooxidation (thiobarbituric acid reactive substances (TBARS) and protein carbonyls (PCs)) and antioxidation (glutathione (GSH), oxidized glutathione disulfide (GSSG), GSH/GSSG ratio, glutathione peroxidase (GPX), catalase, and total antioxidant capacity (TAC)) and hormones (GH, insulin-like growth factor (IGF)-1, IGF-BP-3, luteinizing hormone, follicle-stimulating hormone, and testosterone) were measured. RESULTS Baseline and postexercise TBARS and PCs were greater, while baseline GSH, GSH/GSSG ratio, GPX, and TAC were lower in obese than that in normal-weight participants. In all participants, waist was the best negative and positive predictor for postexercise GPX and TBARS, respectively. Baseline TAC was greater in pubertal than that in pre-pubertal participants. In all participants, baseline GH was the best negative predictor for postexercise PCs. Significant positive linear correlation exists between the exercise-associated GH, and GSSG increases in pubertal normal-weight boys. CONCLUSIONS Higher prooxidation and lower antioxidation were observed in obese boys, while antioxidation improves with puberty and postexercise, paralleling GH accentuated secretion.
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Affiliation(s)
- George Paltoglou
- 1] Endocrine Unit, Aretaieion Hospital, University of Athens Medical School, Athens, Greece [2] First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Ioannis G Fatouros
- School of Physical Education and Sports Sciences, Democritus University of Thrace, Komotini, Greece
| | - George Valsamakis
- First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Schoina
- School of Physical Education and Sports Sciences, Democritus University of Thrace, Komotini, Greece
| | - Alexandra Avloniti
- School of Physical Education and Sports Sciences, Democritus University of Thrace, Komotini, Greece
| | | | - Antonis Kambas
- School of Physical Education and Sports Sciences, Democritus University of Thrace, Komotini, Greece
| | - Dimitris Draganidis
- School of Physical Education and Sports Sciences, Democritus University of Thrace, Komotini, Greece
| | - Aimilia Mantzou
- Endocrine Unit, Evgenidion Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Papagianni
- Pediatric Endocrinology Unit, Third Department of Pediatrics, Hippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens Medical School, Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens Medical School, Athens, Greece
| | - George Mastorakos
- Endocrine Unit, Aretaieion Hospital, University of Athens Medical School, Athens, Greece
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Dwyer AA, Phan-Hug F, Hauschild M, Elowe-Gruau E, Pitteloud N. TRANSITION IN ENDOCRINOLOGY: Hypogonadism in adolescence. Eur J Endocrinol 2015; 173:R15-24. [PMID: 25653257 DOI: 10.1530/eje-14-0947] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/04/2015] [Indexed: 01/15/2023]
Abstract
Puberty is a remarkable developmental process with the activation of the hypothalamic-pituitary-gonadal axis culminating in reproductive capacity. It is accompanied by cognitive, psychological, emotional, and sociocultural changes. There is wide variation in the timing of pubertal onset, and this process is affected by genetic and environmental influences. Disrupted puberty (delayed or absent) leading to hypogonadism may be caused by congenital or acquired etiologies and can have significant impact on both physical and psychosocial well-being. While adolescence is a time of growing autonomy and independence, it is also a time of vulnerability and thus, the impact of hypogonadism can have lasting effects. This review highlights the various forms of hypogonadism in adolescence and the clinical challenges in differentiating normal variants of puberty from pathological states. In addition, hormonal treatment, concerns regarding fertility, emotional support, and effective transition to adult care are discussed.
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Affiliation(s)
- Andrew A Dwyer
- Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland
| | - Franziska Phan-Hug
- Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland
| | - Michael Hauschild
- Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland
| | - Eglantine Elowe-Gruau
- Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland
| | - Nelly Pitteloud
- Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland Center for Endocrinology and Metabolism in Young Adults (CEMjA)EndocrinologyDiabetes and Metabolism ServiceDivision of Pediatric Endocrinology Diabetology and ObesityDepartment of Pediatric Medicine and Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, SwitzerlandDepartment of PhysiologyFaculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 7, 1005 Lausanne, Switzerland
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Abstract
PURPOSE OF REVIEW Data on sex steroid levels and pubertal development in obese adolescent boys are scarce and contrasting. The present review summarizes the most recent results obtained with improved methodology to measure low sex steroid levels in children. RECENT FINDINGS Obese pubertal boys have lower serum sex hormone-binding globulin and consequently lower total testosterone levels compared to normal-weight peers. However, during pubertal development, free testosterone levels in obese adolescents are not different from controls, indicating preserved androgen exposure as is additionally suggested by similar clinical genital staging (Tanner), serum gonadotropins levels, and serum prostate-specific antigen concentrations compared to nonobese adolescents. In pre and early puberty, total testosterone levels is not decreased, notwithstanding low sex hormone-binding globulin, and free testosterone is slightly increased in obese boys. This may result from increased adrenal activity as revealed by elevated serum androstenedione and dehydroepiandrosterone sulfate. In obese adolescent boys, increased aromatization of testosterone to estradiol tends to accelerate skeletal maturation. SUMMARY In obese adolescent boys, free testosterone is a better index than total testosterone levels of androgen status, which is not different from nonobese controls. Increased aromatization of testosterone to estradiol underlies the dissociation between normal clinical sexual maturation and advanced skeletal maturation in the obese adolescent.
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Affiliation(s)
- Sara Vandewalle
- aDepartment of Endocrinology bDepartment of Pediatric Endocrinology, Ghent University Hospital cDepartment of Pediatric Endocrinology, Brussels University Hospital, Belgium
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