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Zhang M, Wang Z, Liu W, Wang M, Wu H, An R. Association between the recommended volume of leisure-time physical activity and erectile dysfunction: A cross-sectional analysis of the national health and nutrition examination survey, 2001-2004. Heliyon 2024; 10:e32884. [PMID: 38975136 PMCID: PMC11226895 DOI: 10.1016/j.heliyon.2024.e32884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Physical activity-related interventions alleviate the severity of erectile dysfunction (ED), but it is unknown whether the recommended volume of physical activity (PA) or a higher level of physical activity reduces the likelihood of ED in adult males. We aimed to evaluate the association between the recommended volume of PA and ED among US male adults. Design A nationally representative cross-sectional survey. Setting National Health and Nutrition Examination Survey 2001-2004. Participants A total of 2509 men aged ≥20 years were enrolled. Primary and secondary outcome measures ED and PA were assessed by a standardised self-report questionnaire. Weighted logistic regression analysis and spline fitting were used to assess the relationship between PA volume and the odds of ED. Results Among 2509 US adult males, the mean (standard error) age was 43.7 (0.46) years. A total of 61.1 % of men reached the recommended volume of aerobic PA. Compared with participants not meeting the PA guidelines, individuals who had recommended aerobic activities demonstrated a 34 % reduction in the odds of having ED (OR 0.66, 95 % CI 0.48-0.90; p = 0.011). Notably, according to the restricted cubic spline, we revealed a dose‒response pattern between PA volume and reduced odds of ED, even when exceeding the recommended PA levels. When compared to males with moderate-equivalent PA of less than 150 min/week, the odds of ED in those with moderate-equivalent PA levels of 150-300 min/week and >300 min/week decreased by 22 % and 39 %, respectively. Compared with participants who did not meet the PA guidelines, the multivariable-adjusted ORs (95 % CIs) of ED associated with adequate PA volumes were 0.37 (0.22-0.61) among non-smokers and 0.85 (0.57-1.25) among current smokers (p for interaction = 0.023). Conclusions and Relevance Our findings supported the benefit of meeting the guideline-recommended PA equivalents or higher volumes for ED prevention. However, PA-related benefit might be significantly diminished by smoking.
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Affiliation(s)
- Mingming Zhang
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, China
| | - Zichun Wang
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, China
| | - Wanpeng Liu
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, China
| | - Minglei Wang
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, China
| | - Huaying Wu
- Department of Reproductive, The First Affiliated Hospital of Harbin Medical University, China
| | - Ruihua An
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, China
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Pan R, Wang J, Chang WW, Song J, Yi W, Zhao F, Zhang Y, Fang J, Du P, Cheng J, Li T, Su H, Shi X. Association of PM 2.5 Components with Acceleration of Aging: Moderating Role of Sex Hormones. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:3772-3782. [PMID: 36811885 DOI: 10.1021/acs.est.2c09005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Fine particulate matter (PM2.5) has been linked to aging risk, and a lack of knowledge about the relationships between PM2.5 components and aging risk impeded the development of healthy aging. Participants were recruited through a multicenter cross-sectional study in the Beijing-Tianjin-Hebei region in China. Middle-age and older males and menopausal women completed the collection of basic information, blood samples, and clinical examinations. The biological age was estimated by Klemera-Doubal method (KDM) algorithms based on clinical biomarkers. Multiple linear regression models were applied to quantify the associations and interactions while controlling for confounders, and a restricted cubic spline function estimated the corresponding dose-response curves of the relationships. Overall, KDM-biological age acceleration was associated with PM2.5 component exposure over the preceding year in both males and females, with calcium [females: 0.795 (95% CI: 0.451, 1.138); males: 0.712 (95% CI: 0.389, 1.034)], arsenic [females: 0.770 (95% CI: 0.641, 0.899); males: 0.661 (95% CI: 0.532, 0.791)], and copper [females: 0.401 (95% CI: 0.158, 0.644); males: 0.379 (95% CI: 0.122, 0.636)] having greater estimates of the effect than total PM2.5 mass. Additionally, we observed that the associations of specific PM2.5 components with aging were lower in the higher sex hormone scenario. Maintaining high levels of sex hormones may be a crucial barrier against PM2.5 component-related aging in the middle and older age groups.
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Affiliation(s)
- Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230031, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230031, Anhui, China
| | - Jiaonan Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Wei-Wei Chang
- Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu 241002, Anhui, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230031, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230031, Anhui, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230031, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230031, Anhui, China
| | - Feng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yi Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jianlong Fang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Peng Du
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230031, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230031, Anhui, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230031, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230031, Anhui, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
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Mohammadi M, Allahverdipour H, Ghanbari Moghaddam A, Matlabi H. The Prevalence of Andropause and Its Relationship With Sexual Quality of Life Among Older Iranian Men. Am J Mens Health 2023; 17:15579883231161050. [PMID: 36922911 PMCID: PMC10021096 DOI: 10.1177/15579883231161050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Available evidence indicates insufficient knowledge about the status of andropause and sexual quality of life among Iranian older men. The study aimed to investigate the prevalence of andropause and its relationship with sexual quality among older adults. This descriptive-analytical study was conducted among 576 older people referred to urban health centers in Mashhad, Iran. The eligible samples were selected through the cluster sampling method. To collect data, the male andropause symptoms' self-assessment questionnaire and the sexual quality of life-male were used. Forty-seven of the respondents (n = 271) were diagnosed with a "moderate" level of andropause. A strong negative correlation was identified between the sexual quality of life and the severity of andropause (r = -.366, p < .001). Sexual quality of life and andropause was also affected by age, marital status, health status, and exercise. Thirty-six percent of the changes in the quality of sexual life of older men were influenced by the independent variables (adjusted R2 = .36; R2 = .40; R = .63). The findings indicated that andropause has highly prevailed among the participants. There was a meaningful association between andropause and sexual quality of life among older men. Further studies are recommended to investigate sexual orientation qualitatively and to discover other factors influencing andropause among adult men.
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Affiliation(s)
- Mojtaba Mohammadi
- Department of Geriatric Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Aging Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Hamid Allahverdipour
- Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghanbari Moghaddam
- Research Center for Nursing and Midwifery Care, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Matlabi
- Department of Geriatric Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Integrative Medicine in Aging, Tabriz University of Medical Sciences, Tabriz, Iran
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4
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Kang WH, Mohamad Sithik MN, Khoo JK, Ooi YG, Lim QH, Lim LL. Gaps in the management of diabetes in Asia: A need for improved awareness and strategies in men's sexual health. J Diabetes Investig 2022; 13:1945-1957. [PMID: 36151988 DOI: 10.1111/jdi.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
Sexual dysfunction, which is defined as 'difficulty during any stage of the sexual encounter that prevents or impairs the individual or couple from enjoying sexual activity', is globally prevalent in males with prediabetes and diabetes. It is an early harbinger of cardiovascular diseases and has a profound impact on one's physical, mental, and social health. Among patients with either prediabetes or diabetes, the most common male sexual dysfunctions are hypogonadism, erectile dysfunction, and premature ejaculation. In Asia, although sexual health is an important factor of men's health, it is rarely discussed freely in real-life practice. Addressing sexual health in Asian males has always been challenging with multiple barriers at the levels of patients and health care providers. Therefore, the assessment and management of sexual dysfunction in routine clinical practice should involve a holistic approach with effective patient-provider communication. In this review, we discuss the epidemiology, pathophysiology, and the management of hypogonadism, erectile dysfunction, and premature ejaculation among males with either prediabetes or diabetes (type 1 and type 2), as well as the evidence gaps across Asia.
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Affiliation(s)
- Waye-Hann Kang
- Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Selangor, Malaysia
| | | | - Jun-Kit Khoo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ying-Guat Ooi
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Quan-Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Asia Diabetes Foundation, Hong Kong SAR, China
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5
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Tsampoukas G, Pang KH, Papatsoris A, Moussa M, Miah S. Testosterone Replacement Therapy in the Aged Male: Monitoring Patients’ Quality of Life Utilizing Scoring Systems. Int J Gen Med 2022; 15:7123-7130. [PMID: 36105846 PMCID: PMC9464626 DOI: 10.2147/ijgm.s253183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Hypogonadism has been associated with significant deterioration of well-being. In the aging male, late-onset hypogonadism affects sexual life, mental health, levels of energy, lower urinary tract symptoms and, therefore, quality of life may be found significantly deteriorated. Testosterone replacement or supplementation therapy has been found efficient to reverse the adverse effects of hypogonadism and improve quality of life. Scales and questionnaires assessing the general health, urinary symptoms, sexual health, and cognition can provide a thorough assessment of the clinical syndrome, optimize treatment, assist the follow-up, and facilitate referrals to other specialties depending on the chief complaint. A systematic assessment might combine several tools, but the optimal ones and the exact usage is unknown. In this narrative review, we are flipping through the literature presenting the available tools per domain for the assessment of quality of life in men on testosterone replacement therapy and we discuss the optimal usage.
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Affiliation(s)
- Georgios Tsampoukas
- Department of Urology, The Great Western Hospital, Swindon, UK
- U-merge Scientific Office, Athens, Greece
- Correspondence: Georgios Tsampoukas, Department of Urology, The Great Western Hospital, Swindon, UK, Email
| | - Karl H Pang
- Institute of Andrology, University College London Hospital, London, UK
| | - Athanasios Papatsoris
- U-merge Scientific Office, Athens, Greece
- Department of Urology, Sismanoglio University Hospital of Athens, Athens, Greece
| | - Mohamad Moussa
- Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Saiful Miah
- Department of Urology, Wycombe Hospital, Buckinghamshire NHS Trust, High Wycombe, UK
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6
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Cirakoglu A, Yuce A, Benli E, Kasko Arici Y, Dugeroglu H, Ogreden E. Is erectile dysfunction an early clinical symptom of chronic kidney disease? Aging Male 2021; 24:24-28. [PMID: 34096824 DOI: 10.1080/13685538.2021.1936483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Erectile dysfunction (ED) is the persistent inability to attain and/or maintain erection sufficient for satisfactory sexual performance. Chronic kidney disease (CKD) is a problem with increasing incidence every day which disrupts quality of life significantly. We aimed to research whether ED is a warning symptom for the early stages of CKD or not. MATERIALS AND METHODS The records of 639 patients attending Ordu University due to ED were retrospectively investigated. According to International Index of Erectile Function (IIEF) scores and degree of ED, patients were compared in terms of GFR values. RESULTS In 92.8% of patients, serum creatinine values were within normal limits (<1 mg/dL), while 30.5% of patients were observed to have GFR below 80. While stage 2 CKD was identified in 1% of the control group, this rate was calculated as 8% in the group with severe ED. In stage 1 and stage 2 CKD, IIEF scores were identified to be low by clear degree. CONCLUSIONS Results confirm that it was identified that the incidence of stage 1 and stage 2 CKD was higher among patients attending with ED compared to the control group. Just as ED may be an early clinical marker of coronary artery disease, it may be early warning symptom for CKD.
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Affiliation(s)
- Abdullah Cirakoglu
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ahmet Yuce
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Erdal Benli
- Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Yeliz Kasko Arici
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Harun Dugeroglu
- Department of Internal Medicine, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ercan Ogreden
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
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7
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Wei D, Li S, Liu X, Zhang L, Liu P, Fan K, Nie L, Wang L, Liu X, Hou J, Huo W, Yu S, Li L, Jing T, Li X, Li W, Guo Y, Wang C, Mao Z. Long-term exposure to particulate matter and residential greenness in relation to androgen and progesterone levels among rural Chinese adults. ENVIRONMENT INTERNATIONAL 2021; 153:106483. [PMID: 33962270 DOI: 10.1016/j.envint.2021.106483] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Population-based studies on the associations of long-term exposure to particulate matter (PM) with androgen and progesterone are still scant. Residential greenness is benefits health by promoting physical activity, reducing air pollution, and improving mental health, but it remains unclear whether it is related to androgen and progesterone levels among humans. AIMS This study aimed to explore the individual and interactive effects of PM and residential greenness on serum testosterone and progesterone levels among rural Chinese adults. METHODS A total of 6017 subjects were recruited from the baseline of the Henan Rural Cohort Study in 2016. Serum testosterone and progesterone were measured with liquid chromatography-tandem mass spectrometry. Particulate matters (PM) (PM1, PM2.5, and PM10) were assessed by machine learning algorithms. Residential greenness was assessed using the normalized difference vegetation index (NDVI) within 500-m, 1000-m, and 3000-m buffers around participants' residences. The effects of air pollutants and residential greenness and their interaction on serum testosterone and progesterone levels were assessed using linear mixed-effects models with township as a random intercept. RESULTS After adjusting for potential confounding factors, a 1 μg/m3 increase in PM2.5 or PM10 was associated with a 0.037 or 0.030 ng/ml increase in serum testosterone, respectively, in females and with a 0.111 or 0.182 ng/ml decrease in serum progesterone, respectively, in males. A 1 μg/m3 increase in PM1, PM2.5 or PM10 was associated with a 0.222, 0.306, or 0.295 ng/ml decrease in serum progesterone, respectively, among females. Moreover, a 0.1-unit increase in NDVI was associated with a 0.310 ng/ml increase in serum testosterone and a 0.170 ng/ml increased in serum progesterone in males, as well as with a 0.143 ng/ml increase in serum progesterone in females. Interaction effects of PM and residential greenness on serum testosterone and progesterone levels were observed, indicating that the effects of residential greenness on serum testosterone and progesterone were modified by high levels of PM. In addition, physical activity significantly mediated 2.92% of the estimated association between greenness and testosterone levels. CONCLUSIONS Our study suggested that long-term exposure to PM was positively associated with serum testosterone in males but negatively associated with progesterone levels in both genderssin. In addition, positive associations of residential greenness with serum testosterone and progesterone levels were observed, but they were modified by high levels of PM. Furthermore, the estimated effects of residential greenness on testosterone levels were partly mediated by physical activity.
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Affiliation(s)
- Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xue Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Pengling Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Keliang Fan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Luting Nie
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Lulu Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Songcheng Yu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Tao Jing
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xing Li
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenjie Li
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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Goldstein I, Goren A, Li VW, Maculaitis MC, Tang WY, Hassan TA. The association of erectile dysfunction with productivity and absenteeism in eight countries globally. Int J Clin Pract 2019; 73:e13384. [PMID: 31389146 DOI: 10.1111/ijcp.13384] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/27/2019] [Accepted: 06/16/2019] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate the association of erectile dysfunction (ED) with work productivity loss, activity impairment and health-related quality of life (HRQoL) across Brazil, China, France, Germany, Italy, Spain, the UK and the US. METHODS This cross-sectional observational study used data from adult men (40-70 years old; N = 52 697) from the 2015 and 2016 National Health and Wellness Surveys. ED assessment was based on self-reported difficulty in achieving or maintaining an erection in the past 6 months. Impairment to work and non-work activities and HRQoL were assessed for each country and compared against the US. Multivariable models tested interactions between ED status and country for each outcome. RESULTS Overall ED prevalence was reported as 49.7%, with Italy reporting the highest rate (54.7%). Men with ED reported significantly higher absenteeism (7.1% vs 3.2%), presenteeism (22.5% vs 10.1%), overall work productivity impairment (24.8% vs 11.2%), activity impairment (28.6% vs 14.5%) and significantly lower Mental Component Summary scores (MCS; 46.7 vs 51.2), Physical Component Summary scores (PCS; 48.3 vs 53.0), and health state utilities (SF-6D: 0.693 vs 0.778; all, P < 0.001) than men with no ED. After adjusting for covariates, compared with the US, the association of ED status with overall work productivity impairment was greatest in the UK (26% higher; P < 0.05), and with MCS, PCS and SF-6D scores was greatest in China (-2.67, -1.58, and -0.043 points, respectively; all, P < 0.001). Greater ED severity was significantly associated with higher impairment to work and non-work activities and lower HRQoL, with China reporting the highest burden, compared with the US (most P < 0.05). CONCLUSION ED poses a significant burden with respect to work productivity and HRQoL, with greater severity associated with worse outcomes. Better management and earlier detection may help reduce this burden, especially in countries reporting a strong association between ED and poor economic and health outcomes.
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Affiliation(s)
- Irwin Goldstein
- Director of Sexual Medicine, Alvarado Hospital, San Diego, California
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, New York, New York
| | - Vicky W Li
- Health Outcomes Practice, Kantar Health, New York, New York
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9
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Coward RM, Stetter C, Kunselman A, Trussell JC, Lindgren MC, Alvero RR, Casson P, Christman GM, Coutifaris C, Diamond MP, Hansen KR, Krawetz SA, Legro RS, Robinson RD, Smith JF, Steiner AZ, Wild RA, Zhang H, Santoro N. Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility. J Urol 2019; 202:379-384. [PMID: 30835629 PMCID: PMC6686175 DOI: 10.1097/ju.0000000000000205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction. MATERIALS AND METHODS This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity. RESULTS A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77). CONCLUSIONS In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.
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Affiliation(s)
- R. Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
- UNC Fertility, Raleigh, NC
| | - Christy Stetter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - JC Trussell
- Department of Urology, Upstate University Hospital, Syracuse, NY
| | - Mark C. Lindgren
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ruben R. Alvero
- Department of Obstetrics and Gynecology, Warren Alpert School of Medicine at Brown University, Providence, RI
| | - Peter Casson
- Northeastern Reproductive Medicine, Colchester, VT
| | | | - Christos Coutifaris
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Karl R. Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephen A. Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
| | - Richard S. Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA
| | - Randal D. Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James F. Smith
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Anne Z. Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Robert A. Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
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Mark R, Huri HZ, Razack AHA. Demographic, clinical and lifestyle predictors for severity of erectile dysfunction and biomarkers level in Malaysian patients. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000317552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Hasniza Zaman Huri
- University of Malaya, Malaysia; University Malaya Medical Centre, Malaysia
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11
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12
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Rabijewski M, Papierska L, Maksym R, Tomasiuk R, Kajdy A, Siekierski BP. The Relationship Between Health-Related Quality of Life and Anabolic Hormone Levels in Middle-Aged and Elderly Men With Prediabetes: A Cross-Sectional Study. Am J Mens Health 2018; 12:1593-1603. [PMID: 29882445 PMCID: PMC6142157 DOI: 10.1177/1557988318777926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to compare health-related quality of life (HRQoL) between men with prediabetes (PD) and a control group as well as to investigate the relationship between HRQoL and anabolic hormones. The analysis was carried out in 176 middle-aged (40–59 years) and elderly (60 80 years) men with PD, and 184 control peers. PD was defined according the American Diabetes Association and HRQoL was assessed by the SF-36 questionnaire. Total testosterone (TT), calculated free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor 1 (IGF-1) were measured. Analysis of the standardized physical and mental component summary scores (SF-36p and SF-36m) revealed that patients with PD had lower SF-36p and SF-36m than control group (p < .02 and p < .001). Middle-aged men with PD had lower SF-36p and SF-36m than control peers, whereas elderly men with PD had lower only SF-36p. In men with PD negative correlations between glycated hemoglobin (HbA1c) and SF-35m score (r = −0.3768; p = .02) and between HbA1c and SF-36p score (r = −0.3453; p = .01) were reported. In middle-aged prediabetic men, SF-36p was associated with high free testosterone and low HbA1c while SF-36m with high TT and high DHEAS. In elderly patients with PD, SF-36p was associated with high TT, high IGF-1, and low HbA1c, while SF-36m correlated with high free testosterone and high DHEAS. In conclusion, PD in men is associated with decreased HRQoL in comparison with healthy men, and generally better quality of life is associated with higher testosterone, higher free testosterone, higher DHEAS, and lower HbA1c.
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Affiliation(s)
- Michał Rabijewski
- 1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Lucyna Papierska
- 2 Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Radosław Maksym
- 1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ryszard Tomasiuk
- 3 Department of Laboratory Diagnostics, Mazovian Bródno Hospital, Warsaw, Poland
| | - Anna Kajdy
- 1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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Costa MR, Ponciano VC, Costa TR, Gomes CP, de Oliveira EC. Stage effect of chronic kidney disease in erectile function. Int Braz J Urol 2018; 44:132-140. [PMID: 29064656 PMCID: PMC5815543 DOI: 10.1590/s1677-5538.ibju.2017.0228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/29/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. Materials and Methods This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Results Two hundred and forty five patients with chronic kidney disease in conservative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. Conclusions The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages) worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression.
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Gender-specific associations between quality of life and leukocyte telomere length. Maturitas 2018; 107:68-70. [DOI: 10.1016/j.maturitas.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 11/20/2022]
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Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2017; 6:86-105. [PMID: 29128268 DOI: 10.1016/j.sxmr.2017.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Testosterone (T) deficiency (TD; hypogonadism) has deleterious effects on men's health; negatively affects glycometabolic and cardiometabolic functions, body composition, and bone mineral density; contributes to anemia and sexual dysfunction; and lowers quality of life. T therapy (TTh) has been used for the past 8 decades to treat TD, with positive effects on signs and symptoms of TD. AIM To summarize the health benefits of TTh in men with TD. METHODS A comprehensive literature search was carried out using PubMed, articles relevant to TTh were accessed and evaluated, and a comprehensive summary was synthesized. MAIN OUTCOME MEASURES Improvements in signs and symptoms of TD reported in observational studies, registries, clinical trials, and meta-analyses were reviewed and summarized. RESULTS A large body of evidence provides significant valuable information pertaining to the therapeutic value of TTh in men with TD. TTh in men with TD provides real health benefits for bone mineral density, anemia, sexual function, glycometabolic and cardiometabolic function, and improvements in body composition, anthropometric parameters, and quality of life. CONCLUSION TTh in the physiologic range for men with TD is a safe and effective therapeutic modality and imparts great benefits on men's health and quality of life. Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2018;6:86-105.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boson, MA, USA.
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16
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Quality of Life and Sexual Function Benefits of Long-Term Testosterone Treatment: Longitudinal Results From the Registry of Hypogonadism in Men (RHYME). J Sex Med 2017; 14:1104-1115. [PMID: 28781213 DOI: 10.1016/j.jsxm.2017.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/27/2017] [Accepted: 07/01/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The benefits and risks of long-term testosterone administration have been a topic of much scientific and regulatory interest in recent years. AIM To assess long-term quality of life (QOL) and sexual function benefits of testosterone replacement therapy (TRT) prospectively in a diverse, multinational cohort of men with hypogonadism. METHODS A multinational patient registry was used to assess long-term changes associated with TRT in middle-age and older men with hypogonadism. Comprehensive evaluations were conducted at 6, 12, 24, and 36 months after enrollment into the registry. OUTCOMES QOL and sexual function were evaluated by validated measures, including the Aging Males' Symptom (AMS) Scale and the International Index of Erectile Function (IIEF). RESULTS A total of 999 previously untreated men with hypogonadism were enrolled at 25 European centers, 750 of whom received TRT at at least one visit during the period of observation. Patients on TRT reported rapid and sustained improvements in QOL, with fewer sexual, psychological, and somatic symptoms. Modest improvements in QOL and sexual function, including erectile function, also were noted in RHYME patients not on TRT, although treated patients showed consistently greater benefit over time in all symptom domains compared with untreated patients. AMS total scores for patients on TRT were 32.8 (95% confidence interval = 31.3-34.4) compared with 36.6 (95% confidence interval = 34.8-38.5) for untreated patients (P < .001). Small but significant improvements in IIEF scores over time also were noted with TRT. Approximately 25% of treated and untreated men also used phosphodiesterase type 5 inhibitors, with notable differences in the frequency of phosphodiesterase type 5 inhibitor prescription use according to physician specialty and geographic site location. CLINICAL IMPLICATIONS TRT-related benefits in QOL and sexual function are well maintained for up to 36 months after initiation of treatment. STRENGTHS AND LIMITATIONS The major strengths are the large, diverse patient population being treated in multidisciplinary clinical settings. The major limitation is the frequency of switching from one formulation to another. CONCLUSION Overall, we confirmed the broad and sustained benefits of TRT across major QOL dimensions, including sexual, somatic, and psychological health, which were sustained over 36 months in our treatment cohort. Rosen RC, Wu F, Behre H, et al. Quality of Life and Sexual Function Benefits Effects of Long-Term Testosterone Treatment: Longitudinal Results From the Registry of Hypogonadism in Men (RHYME). J Sex Med 2017;14:1104-1115.
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Hackett G, Kirby M, Edwards D, Jones TH, Rees J, Muneer A. UK policy statements on testosterone deficiency. Int J Clin Pract 2017; 71:e12901. [PMID: 28318076 PMCID: PMC5573939 DOI: 10.1111/ijcp.12901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/24/2016] [Accepted: 09/27/2016] [Indexed: 12/20/2022] Open
Abstract
To address widespread media and scientific concerns over the appropriate treatment of TDS with Testosterone Therapy (T Therapy), the Executive Committee of the British Society for Sexual Medicine developed eight consensus statements, based on current scientific evidence to address these controversial issues. These statements were in no-way designed to replace the published evidence-based guidelines on the subject developed by various professional organisations, but to provide specific answers to several current controversial issues. This review examined evidence from Medline, EMBASE and Cochrane searches on HG, T Therapy and cardiovascular safety from May 2005 to May 2015, which revealed 1714 articles, with 52 clinical trials and 32 placebo-controlled randomised controlled trials. The task force developed the following eight key statements.
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Affiliation(s)
| | - Michael Kirby
- Faculty of Health & Human SciencesUniversity of HertfordshireHatfieldUK
- The Prostate CentreLondonUK
| | - David Edwards
- White House SurgeryChipping NortonUK
- British Society for Sexual Medicine (BSSM)StaffordshireUK
| | - T. Hugh Jones
- Barnsley HospitalBarnsleyUK
- University of Sheffield Medical SchoolSheffieldUK
- Royal Hallamshire HospitalSheffieldUK
| | - Jonathan Rees
- Backwell & Nailsea Medical GroupBristolUK
- Primary Care Urology SocietyLondonUK
| | - Asif Muneer
- British Society for Sexual Medicine (BSSM)StaffordshireUK
- Department of Urology and NIHR Biomedical Research Centre University College London HospitalsLondonUK
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Qing XR, Wan CC, Shang XJ, Li HG, Xiong CL, Zhan XX, Mo DS, Cai HC, Zhang HP, Guan HT, Kong XB, Chen YP, Liu TH, Hao BJ, Zong SY. Relative contributions of testosterone deficiency and metabolism syndrome at the risk of reduced quality of life: A cross-sectional study among Chinese mid-aged and elderly men. Andrologia 2016; 49. [PMID: 28026037 DOI: 10.1111/and.12736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/12/2022] Open
Abstract
Testosterone deficiency and metabolism syndrome (MetS) are universal among ageing males, and they have been suggested responsible for poorer quality of life (QoL). We aimed to evaluate the relative contributions of reproductive hormones and components of MetS at the risk of reduced QoL among Chinese mid-aged and elderly men. A cross-sectional study recruited 2,364 males aged 40-79 years, and 2,165 was included for analysis eventually. The Chinese version of ageing male symptoms scale, 36-item Short Form and Beck Depression Inventory were applied to assess QoL. Bivariate correlation analysis and multiple linear regression analysis were used to assess the relative contributions of reproductive hormones and components of MetS at the risk of reduced QoL. Testosterone deficiency and MetS contributed to poorer QoL, of which higher fasting blood glucose made the primary contribution, lower total testosterone mainly contributed to poorer physical functioning.
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Affiliation(s)
- X R Qing
- Department of Andrology, Jingling Hospital, School of Medicine, Nanjing University, Nanjing, China.,Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C C Wan
- Clinical laboratory, People's hospital of Jinhu County, Huai'an, China
| | - X J Shang
- Department of Andrology, Jingling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - H G Li
- Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C L Xiong
- Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - X X Zhan
- Center of Reproductive Medicine, Xi'an No. 4 hospital/GuangRen hospital of Xi'an Jiaotong University, Xi'an, China
| | - D S Mo
- Department of Andrology, Jingling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - H C Cai
- Department of Andrology, Jingling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - H P Zhang
- Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - H T Guan
- Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - X B Kong
- Center of Reproductive Medicine, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China
| | - Y P Chen
- Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - T H Liu
- Family Planning Research Institute/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - B J Hao
- Department of Urology, People's hospital of Jinhu County, Huai'an, China
| | - S Y Zong
- Clinical laboratory, People's hospital of Jinhu County, Huai'an, China
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Traish A. Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return? Investig Clin Urol 2016; 57:384-400. [PMID: 27847912 PMCID: PMC5109795 DOI: 10.4111/icu.2016.57.6.384] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
Although testosterone therapy in men with testosterone deficiency was introduced in the early 1940s, utilization of this effective treatment approach in hypogonadal men is met with considerable skepticism and resistance. Indeed, for decades, the fear that testosterone may cause prostate cancer has hampered clinical progress in this field. Nevertheless, even after considerable knowledge was acquired that this fear is unsubstantiated, many in the medical community remain hesitant to utilize this therapeutic approach to treat men with hypogonadism. As the fears concerning prostate cancer have subsided, a new controversy regarding use of testosterone therapy and increase in cardiovascular disease was introduced. Although the new controversy was based on one ill-fated clinical trial, one meta-analysis with studies that utilized unapproved formulation in men with liver cirrhosis, and two retrospective studies with suspect or nonvalidated statistical methodologies and database contaminations, the flames of such controversy were fanned by the lay press and academics alike. In this review we discuss the adverse effect of testosterone deficiency and highlight the numerous proven benefits of testosterone therapy on men's health and debunk the myth that testosterone therapy increases cardiovascular risk. Ultimately, we believe that there is considerable scientific and clinical evidence to suggest that testosterone therapy is safe and effective with restoration of physiological levels in men with testosterone deficiency, irrespective of its etiology.
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Affiliation(s)
- Abdulmaged Traish
- Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, MA, USA
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20
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Yassin AA, Nettleship JE, Salman M, Almehmadi Y. Waist circumference is superior to weight and BMI in predicting sexual symptoms, voiding symptoms and psychosomatic symptoms in men with hypogonadism and erectile dysfunction. Andrologia 2016; 49. [DOI: 10.1111/and.12634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- A. A. Yassin
- Institute of Urology and Andrology; Segeberger Kliniken; Norderstedt Germany
- Dresden International University; Dresden Germany
- Gulf Medical University School of Medicine; Ajman United Arab Emirates
| | | | - M. Salman
- Institute of Urology and Andrology; Segeberger Kliniken; Norderstedt Germany
| | - Y. Almehmadi
- Institute of Urology and Andrology; Segeberger Kliniken; Norderstedt Germany
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21
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Ho CH, Wu CC, Chen KC, Jaw FS, Yu HJ, Liu SP. Erectile dysfunction, loss of libido and low sexual frequency increase the risk of cardiovascular disease in men with low testosterone. Aging Male 2016; 19:96-101. [PMID: 26755067 DOI: 10.3109/13685538.2015.1129400] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Testosterone deficiency increases the cardiovascular disease (CVD) risk. AIM To evaluate the effect of erectile dysfunction (ED), sexual frequency and hypogonadal symptoms on CVD risk. METHODS A total of 395 hypogonadal men aged 45-74 years were surveyed using the Androgen Deficiency in the Aging Male and the International Index of Erectile Function. MAIN OUTCOME MEASURES The 10-year CVD risk was measured with the Framingham Risk Score. Logistic regression was performed to obtain the odds ratios of sexual function and hypogonadal symptoms for a 10-year CVD risk ≥20% (high risk). RESULTS The mean age was 56.1 ± 6.7 years. The mean 10-year CVD risk of the whole cohort was 18.1% ± 11.4%, while 131 subjects (33.2%) were classified as high risk. Logistic regression revealed that ED severity was associated with CVD risk [OR = 2.37 (CI 1.24-4.51) for mild-to-moderate ED, OR = 4.39 (1.78-8.43) for moderate ED and OR = 12.81 (4.65-26.11) for severe ED]. Compared to sexual frequency <1 per month, sexual frequency ≥4 decreased the risk of high CVD risk [OR = 0.35 (0.23-0.780)]. Loss of libido [OR = 2.95 (1.91-4.12)] and less strong erection [OR = 3.87 (CI 2.11-4.95)] increased the risk of high CVD risk. All remained significant after adjustment for age and testosterone. CONCLUSIONS ED, decreased sexual frequency and loss of libido predict a high 10-year CVD risk in hypogonadal men.
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Affiliation(s)
- Chen-Hsun Ho
- a Department of Urology , Taipei Medical University-Shuang Ho Hospital , New Taipei City , Taiwan
- b Department of Urology , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Chia-Chang Wu
- a Department of Urology , Taipei Medical University-Shuang Ho Hospital , New Taipei City , Taiwan
- b Department of Urology , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Kuan-Chou Chen
- a Department of Urology , Taipei Medical University-Shuang Ho Hospital , New Taipei City , Taiwan
- b Department of Urology , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Fu-Shan Jaw
- c Institute of Biomedical Engineering, National Taiwan University , Taipei , Taiwan , and
| | - Hong-Jeng Yu
- d Department of Urology , National Taiwan University Hospital and College of Medicine , Taipei , Taiwan
| | - Shih-Ping Liu
- d Department of Urology , National Taiwan University Hospital and College of Medicine , Taipei , Taiwan
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Yassin A, Nettleship JE, Talib RA, Almehmadi Y, Doros G. Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity, voiding function and prostate safety parameters. Aging Male 2016; 19:64-9. [PMID: 26742589 DOI: 10.3109/13685538.2015.1126573] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Whether testosterone replacement therapy (TRT) is a lifelong treatment for men with hypogonadism remains unknown. We investigated long-term TRT and TRT withdrawal on obesity and prostate-related parameters. Two hundred and sixty-two hypogonadal patients (mean age 59.5) received testosterone undecanoate in 12-week intervals for a maximum of 11 years. One hundred and forty-seven men had TRT interrupted for a mean of 16.9 months and resumed thereafter (Group A). The remaining 115 patients were treated continuously (Group B). Prostate volume, prostate-specific antigen (PSA), residual voiding volume, bladder wall thickness, C-reactive protein (CRP), aging male symptoms (AMS), International Index of erectile function - erectile function (IIEF-EF) and International Prostate Symptoms Scores (IPSS) were measured over the study period with anthropometric parameters of obesity, including weight, body mass index (BMI) and waist circumference. Prior to interruption, TRT resulted in improvements in residual voiding volume, bladder wall thickness, CRP, AMS, IIEF-EF, IPSS and obesity parameters while PSA and prostate volume increased. TRT interruption reduced total testosterone to hypogonadal levels in Group A and resulted in worsening of obesity parameters, AMS, IPSS, residual voiding volume and bladder wall thickness, IIEF-EF and PSA while CRP and prostate volume were unchanged until treatment resumed whereby these effects were reversed. TRT interruption results in worsening of symptoms. Hypogonadism may require lifelong TRT.
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Affiliation(s)
- Aksam Yassin
- a Institute of Urology & Andrology , Norderstedt , Germany
- b Department of Preventive Medicine, Men's Health Programme , Dresden International University , Dresden , Germany
- c Department of Urology , School of Medicine, Gulf Medical University , Ajman , UAE
| | | | - Raidh A Talib
- e Department of Urology & Andrology , Hamad Medical Corporation , Doha , Qatar , and
| | | | - Gheorge Doros
- f Boston University School of Public Health , Boston , MA , USA
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Hackett G. An update on the role of testosterone replacement therapy in the management of hypogonadism. Ther Adv Urol 2015; 8:147-60. [PMID: 27034727 DOI: 10.1177/1756287215617648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
While US testosterone prescriptions have tripled in the last decade with lower trends in Europe, debate continues over the risks, benefits and appropriate use of testosterone replacement therapy (TRT). Some authors blame advertising and the availability of more convenient formulations whilst other have pointed out that the routine testing of men with erectile dysfunction (a significant marker of cardiovascular risk) and those with diabetes would inevitably increase the diagnosis of hypogonadism and lead to an increase in totally appropriate prescribing. They commented that this was merely an appropriate correction of previous underdiagnosis and undertreatment by adherence to evidence-based guidelines. Urologists and primary care physicians are the most frequent initiators of TRT, usually for erectile dysfunction. Benefits are clearly established for sexual function, increase in lean muscle mass and strength, mood and cognitive function, with possible reduction in frailty and osteoporosis. There remains no evidence that TRT is associated with increased risk of prostate cancer or symptomatic benign prostatic hyperplasia, yet the decision to initiate and continue therapy is often decided by urologists. The cardiovascular issues associated with TRT have been clarified by recent studies showing clearly that therapy associated with clear rise in testosterone levels are associated with reduced mortality. Studies reporting to show increased risk have been subject to flawed designs with inadequate baseline diagnosis and follow-up testing. Effectively they have compared nontreated patients with undertreated or on-compliant subjects involving a range of different therapy regimens. Recent evidence suggests long acting injections may be associated with decreased cardiovascular risk but the transdermal route may be associated with potentially relatively greater risk because of conversion to dihydrotestosterone by the effect of 5α reductase in skin. The multiple effects of TRT may add up to a considerable benefit to the patient that might be underestimated by the physician primarily concerned with his own specialty. This paper will attempt to identify who should be treated, and how they should be treated safely to achieve best outcomes, based on a comprehensive MEDLINE and EMBASE and Cochrane searches on hypogonadism, TRT and cardiovascular safety from May 2005 to May 2015. This revealed 1714 papers with 52 clinical trials and 32 placebo-controlled randomized, controlled trials.
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Affiliation(s)
- Geoffrey Hackett
- Consultant in Urology and Sexual Medicine, Heartlands Hospital, Birmingham, UK
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Almehmadi Y, Yassin AA, Nettleship JE, Saad F. Testosterone replacement therapy improves the health-related quality of life of men diagnosed with late-onset hypogonadism. Arab J Urol 2015; 14:31-6. [PMID: 26966591 PMCID: PMC4767784 DOI: 10.1016/j.aju.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/09/2015] [Accepted: 10/24/2015] [Indexed: 01/03/2023] Open
Abstract
Objectives To test the hypothesis that testosterone replacement therapy (TRT) improves the long-term health-related quality of life (HRQoL) of men with late-onset hypogonadism (LOH), as studies have shown that sub-physiological testosterone levels have a negative impact on psychological (e.g. mood, vitality, libido and sexual interest) and physical features (e.g. erectile function and physical strength), all of which contribute to a sense of well-being. Patients and methods In all, 261 patients (mean age 58 years) diagnosed with LOH were treated with long-acting intramuscular testosterone undecanoate (TU) for up to 5 years. Health quality indicators including the International Prostate Symptom Score (IPSS), the five-item version of the International Index of Erectile Function (IIEF-5), the Aging Males’ Symptoms (AMS) scale, and the percentage of patients reporting joint and muscle pain were measured at baseline and at each visit. The means were then plotted over time in parallel with mean total testosterone (TT) levels. Results Both the mean IPSS and AMS scores fell significantly within the first 3 months and the mean IIEF-5 score and TT levels increased within the first 3 months. All four parameters continued to improve over the course of the trial. The percentage of patients reporting both joint and muscle pain decreased during TRT. Conclusions This prospective, observational and longitudinal analysis shows a clear improvement in both psychological and physical characteristics as physiological testosterone levels are reached and maintained contributing to an improvement in the HRQoL in men with diagnosed LOH.
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Affiliation(s)
| | - Aksam A Yassin
- Institute of Urology/Andrology, Norderstedt-Hamburg, Germany; Dresden International University, Dresden, Germany; Gulf Medical University School of Medicine, Ajman, United Arab Emirates
| | - Joanne E Nettleship
- Department of Human Metabolism, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Farid Saad
- Gulf Medical University School of Medicine, Ajman, United Arab Emirates; Global Medical Affairs Men's Healthcare, Bayer Pharma AG, Berlin, Germany
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Almehmadi Y, Yassin DJ, Yassin AA. Erectile dysfunction is a prognostic indicator of comorbidities in men with late onset hypogonadism. Aging Male 2015; 18:186-94. [PMID: 26030350 DOI: 10.3109/13685538.2015.1046044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The role of testosterone deficiency in erectile dysfunction (ED) is increasingly recognized; however, there is a need to clarify the nature of the relationship between ED and late onset hypogonadism (LOH). AIM In this study, we sought to determine the correlators of ED severity amongst men with LOH. METHODS 130 patients diagnosed with LOH fulfilling the criteria of total testosterone ≤3.5 ng/ml (<12 nmol/l) and with an erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1-5) were enrolled for a subsequent trial of Testosterone Undecanoate. Demographic data were recorded at baseline. MAIN OUTCOME MEASURES Subjects completed three standardised questionnaires to assess sexual health including International Prostate Symptom Score (IPSS), Aging Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by ED severity with SHIM scores of 1-7 considered severe ED, 8-11 moderate ED and 12-16 mild to moderate. Serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) were assessed along with plasma fasting glucose and HbA1c. Weight, BMI and waist circumference were also recorded. RESULTS A significant association was observed between severity of ED and mean weight (p = 0.000), waist circumference (p = 0.000), triglycerides (p = 0.009), total cholesterol (p = 0.027), HbA1c (p = 0.000), fasting glucose (p = 0.003) and AMS scores (p = 0.043). No significant differences were seen in testosterone fractions and SHBG levels between ED subgroups. A positive correlation existed between the prevalence of diabetes mellitus (type 1 and type 2) and ED severity in this cohort (p = 0.018). CONCLUSIONS The descriptive data of our cohort show that increased severity of ED within LOH patients correlated with an increased waist circumference, hyperglycemia, hypertriglyceridemia, hyperlipidemia and a history of diabetes mellitus. Severe ED functions as a prognostic indicator of co-morbidities in men with LOH.
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Affiliation(s)
- Yousef Almehmadi
- a Institute of Urology/Andrology , Norderstedt, Hamburg , Germany
| | - Dany-Jan Yassin
- b Department of Urology , Klinikum Braunschweig , Braunschweig , Germany , and
| | - Aksam A Yassin
- a Institute of Urology/Andrology , Norderstedt, Hamburg , Germany
- c Dresden International University , Dresden , Germany
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