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Slowikowska-Hilczer J, Walczak-Jedrzejowska R, Adamczewska D, Byczkiewicz P, Marchlewska K, Katarzynska J, Gebicki J. A New Approach to the Assessment of Erectile Dysfunction Based on Vasomotion Monitored by the Flow-Mediated Skin Fluorescence (FMSF) Technique-A Preliminary Study. J Clin Med 2024; 13:3210. [PMID: 38892921 PMCID: PMC11173337 DOI: 10.3390/jcm13113210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/29/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Erectile dysfunction (ED) most often has vascular etiology and usually is the earliest symptom of vascular dysfunction. The aim of this study was to evaluate vascular dysfunction with the use of the Flow-Mediated Skin Fluorescence (FMSF) technique in men with and without ED. Methods: Included were 39 men (median age 53) with ED and 40 men (median age 41.5) without ED. Medical interview, physical examination, and anthropometrical measurements were performed for all participants. The serum total testosterone, LH, and SHBG determinations were performed in patients with ED, and the Free Testosterone Index (FTI) was calculated. The FMSF technique was used to measure the microcirculatory oscillations at the baseline and to determine the flowmotion (FM) and vasomotion (VM) parameters. The Normoxia Oscillatory Index (NOI) was calculated, which represents the contribution of the endothelial (ENDO) and neurogenic (NEURO) oscillations relative to all oscillations detected at low-frequency intervals (<0.15 Hz): NOI = (ENDO + NEURO)/(ENDO + NEURO + VM). Results: In men with ED were found significantly lower FM and VM parameters, but the NOI was significantly higher in comparison to men without ED. VM and FM correlated significantly positively with erectile function, orgasmic function, and general sexual satisfaction in the whole group and the FTI in the ED group. The thresholds of 53.5 FM (AUC = 0.7) and 8.4 VM (AUC = 0.7) were predictive values for discriminating men with ED. Conclusions: It was shown that the FMSF diagnostic technique may be helpful in the early diagnosis of microcirculation dysfunction due to impaired vasomotion caused by decreased testosterone activity.
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Affiliation(s)
- Jolanta Slowikowska-Hilczer
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Renata Walczak-Jedrzejowska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Daria Adamczewska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Piotr Byczkiewicz
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | - Katarzyna Marchlewska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (R.W.-J.); (D.A.); (P.B.); (K.M.)
| | | | - Jerzy Gebicki
- Angionica Ltd., 90-924 Lodz, Poland; (J.K.); (J.G.)
- Institute of Applied Radiation Chemistry, Lodz University of Technology, 90-924 Lodz, Poland
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Lee H, Hwang EC, Oh CK, Lee S, Yu HS, Lim JS, Kim HW, Walsh T, Kim MH, Jung JH, Dahm P. Testosterone replacement in men with sexual dysfunction. Cochrane Database Syst Rev 2024; 1:CD013071. [PMID: 38224135 PMCID: PMC10788910 DOI: 10.1002/14651858.cd013071.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Clinical practice guidelines recommend testosterone replacement therapy (TRT) for men with sexual dysfunction and testosterone deficiency. However, TRT is commonly promoted in men without testosterone deficiency and existing trials often do not clearly report participants' testosterone levels or testosterone-related symptoms. This review assesses the potential benefits and harms of TRT in men presenting with complaints of sexual dysfunction. OBJECTIVES To assess the effects of testosterone replacement therapy compared to placebo or other medical treatments in men with sexual dysfunction. SEARCH METHODS We performed a comprehensive search of CENTRAL (the Cochrane Library), MEDLINE, EMBASE, and the trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform, with no restrictions on language of publication or publication status, up to 29 August 2023. SELECTION CRITERIA We included randomized controlled trials (RCTs) in men (40 years or over) with sexual dysfunction. We excluded men with primary or secondary hypogonadism. We compared testosterone or testosterone with phosphodiesterase-5 inhibitors (PDEI5I) to placebo or PDE5I alone. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, assessed the risk of bias, extracted data, and rated the certainty of evidence (CoE) according to GRADE using a minimally contextualized approach. We performed statistical analyses using a random-effects model and interpreted them according to standard Cochrane methodology. Predefined primary outcomes were self-reported erectile dysfunction assessed by a validated instrument, sexual quality of life assessed by a validated instrument, and cardiovascular mortality. Secondary outcomes were treatment withdrawal due to adverse events, prostate-related events, and lower urinary tract symptoms (LUTS). We distinguished between short-term (up to 12 months) and long-term (> 12 months) outcomes. MAIN RESULTS We identified 43 studies with 11,419 randomized participants across three comparisons: testosterone versus placebo, testosterone versus PDE5I, and testosterone with PDE5I versus PDE5I alone. This abstract focuses on the most relevant comparison of testosterone versus placebo. Testosterone versus placebo (up to 12 months) Based on a predefined sensitivity analysis of studies at low risk of bias, and an analysis combing data from the similar International Index of Erectile Function (IIEF-EF) and IIEF-5 instruments, TRT likely results in little to no difference in erectile function assessed with the IIEF-EF (mean difference (MD) 2.37, 95% confidence interval (CI) 1.67 to 3.08; I² = 0%; 6 RCTs, 2016 participants; moderate CoE) on a scale from 6 to 30 with larger values reflecting better erectile function. We assumed a minimal clinically important difference (MCID) of greater than or equal to 4. TRT likely results in little to no change in sexual quality of life assessed with the Aging Males' Symptoms scale (MD -2.31, 95% CI -3.63 to -1.00; I² = 0%; 5 RCTs, 1030 participants; moderate CoE) on a scale from 17 to 85 with larger values reflecting worse sexual quality of life. We assumed a MCID of greater than or equal to 10. TRT also likely results in little to no difference in cardiovascular mortality (risk ratio (RR) 0.83, 95% CI 0.21 to 3.26; I² = 0%; 10 RCTs, 3525 participants; moderate CoE). Based on two cardiovascular deaths in the placebo group and an assumed MCID of 3%, this would correspond to no additional deaths per 1000 men (95% CI 1 fewer to 4 more). TRT also likely results in little to no difference in treatment withdrawal due to adverse events, prostate-related events, or LUTS. Testosterone versus placebo (later than 12 months) We are very uncertain about the longer-term effects of TRT on erectile dysfunction assessed with the IIEF-EF (MD 4.20, 95% CI -2.03 to 10.43; 1 study, 42 participants; very low CoE). We did not find studies reporting on sexual quality of life or cardiovascular mortality. We are very uncertain about the effect of testosterone on treatment withdrawal due to adverse events. We found no studies reporting on prostate-related events or LUTS. AUTHORS' CONCLUSIONS In the short term, TRT probably has little to no effect on erectile function, sexual quality of life, or cardiovascular mortality compared to a placebo. It likely results in little to no difference in treatment withdrawals due to adverse events, prostate-related events, or LUTS. In the long term, we are very uncertain about the effects of TRT on erectile function when compared to placebo; we did not find data on its effects on sexual quality of life or cardiovascular mortality. The certainty of evidence ranged from moderate (signaling that we are confident that the reported effect size is likely to be close to the true effect) to very low (indicating that the true effect is likely to be substantially different). The findings of this review should help to inform future guidelines and clinical decision-making at the point of care.
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Affiliation(s)
- Hunju Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Cheol Kyu Oh
- Department of Urology, Heaundae Paik Hospital, Inje University, Busan, Korea, South
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Ho Song Yu
- Department of Urology, Chonnam National University, Gwangju, Korea, South
| | - Jung Soo Lim
- Division of Endocrinology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Hong Wook Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea, South
| | - Thomas Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Jae Hung Jung
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Ikehata Y, Hachiya T, Kobayashi T, Ide H, Horie S. Body composition and testosterone in men: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1277393. [PMID: 38089610 PMCID: PMC10711270 DOI: 10.3389/fendo.2023.1277393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background Testosterone is an essential sex hormone that plays a vital role in the overall health and development of males. It is well known that obesity decreases testosterone levels, but it is difficult to determine the causal relationship between body composition and testosterone. Methods To investigate potential causal associations between body composition and testosterone levels by a first time application of Mendelian randomization methods. Exposure variables in men included body composition (fat mass, fat-free mass, and body mass index). In addition to whole body fat and fat-free mass, we examined fat and fat-free mass for each body part (e.g., trunk, left arm, right arm, left leg and right leg) as exposures. Instrumental variables were defined using genome-wide association study data from the UK Biobank. Outcome variables in men included testosterone levels (total testosterone [TT], bioavailable testosterone [BT], and sex hormone-binding globulin [SHBG]). A one-sample Mendelian randomization analysis of inverse-variance weighted and weighted median was performed. Results The number of genetic instruments for the 13 exposure traits related to body composition ranged from 156 to 540. Genetically predicted whole body fat mass was negatively associated with TT (β=-0.24, P=5.2×10-33), BT (β=-0.18, P=5.8×10-20) and SHBG (β=-0.06, P=8.0×10-9). Genetically predicted whole body fat-free mass was negatively associated with BT (β=-0.04, P=2.1×10-4), but not with TT and SHBG, after multiple testing corrections. When comparing the causal effect on testosterone levels, there was a consistent trend that the effect of fat mass was more potent than that of fat-free mass. There were no differences between body parts. Conclusion These results show that reducing fat mass may increase testosterone levels.
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Affiliation(s)
- Yoshihiro Ikehata
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Tsuyoshi Hachiya
- Department of Urology, Advanced informatics for genetic diseases, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Takuro Kobayashi
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Department of Urology, Advanced informatics for genetic diseases, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Corona DG, Vena W, Pizzocaro A, Rastrelli G, Sparano C, Sforza A, Vignozzi L, Maggi M. Metabolic syndrome and erectile dysfunction: a systematic review and meta-analysis study. J Endocrinol Invest 2023; 46:2195-2211. [PMID: 37515706 DOI: 10.1007/s40618-023-02136-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The clinical significance of metabolic syndrome (MetS) versus its single components in erectile dysfunction (ED) is conflicting. Thus, the purpose is to analyze the available evidence on the relationship between MetS-along with its components-and ED. METHODS All prospective and retrospective observational studies reporting information on ED and MetS were included. In addition, we here reanalyzed preclinical and clinical data obtained from a previously published animal model of MetS and from a consecutive series of more than 2697 men (mean age: 52.7 ± 12), respectively. RESULTS Data derived from this meta-analysis showed that MetS was associated with an up to fourfold increased risk of ED when either unadjusted or adjusted data were considered. Meta-regression analysis, performed using unadjusted statistics, showed that the MetS-related risk of ED was closely associated with all the MetS components. These associations were confirmed when unadjusted analyses from clinical models were considered. However, fully adjusted data showed that MetS-associated ED was more often due to morbidities included (or not) in the algorithm than to the MetS diagnostic category itself. MetS is also associated with low testosterone, but its contribution to MetS-associated ED-as derived from preclinical and clinical models-although independent, is marginal. CONCLUSIONS The results of our analysis suggest that MetS is a useless diagnostic category for studying ED. However, treating the individual MetS components is important, because they play a pivotal role in determining ED.
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Affiliation(s)
- D G Corona
- Endocrinology Unit, Azienda AUSL Bologna, Largo Nigrisoli 2, 40133, Bologna, Italy.
| | - W Vena
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - C Sparano
- Endocrinology Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - A Sforza
- Endocrinology Unit, Azienda AUSL Bologna, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Cao S, Hu X, Shao Y, Wang Y, Tang Y, Ren S, Li X. Relationship between weight-adjusted-waist index and erectile dysfunction in the United State: results from NHANES 2001-2004. Front Endocrinol (Lausanne) 2023; 14:1128076. [PMID: 37181040 PMCID: PMC10167952 DOI: 10.3389/fendo.2023.1128076] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Objective The purpose of this study is to examine the association between a novel adiposity parameter, the weight-adjusted-waist index (WWI), and erectile dysfunction (ED). Methods According to National Health and Nutrition Examination Survey (NHANES) 2001-2004, a total of 3884 participants were categorized as ED and non-ED individuals. WWI was calculated as waist circumference (WC, cm) divided by the square root of weight (kg). Weighted univariable and multivariable logistic regression models were conducted to assess the correlation between WWI and ED. Smooth curve fitting was utilized to examine the linear association. The receiver operating characteristic (ROC) curve and DeLong et al.'s test were applied to compare the area under curve (AUC) value and predictive power among WWI, body mass index (BMI), and WC for ED. Results WWI was positively related to ED with the full adjustment [odds ratio (OR)=1.75, 95% confidence interval (95% CI): 1.32-2.32, p=0.002]. After converting WWI to a categorical variable by quartiles (Q1-Q4), compared to Q1 the highest WWI quartile was linked to an obviously increased likelihood of ED (OR=2.78, 95% CI: 1.39-5.59. p=0.010). Subgroup analysis revealed the stability of the independent positive relationship between WWI and ED. It was shown that WWI had a stronger prediction for ED (AUC=0.745) than BMI (AUC=0.528) and WC (AUC=0.609). Sensitivity analysis was performed to verify the significantly positive connection between WWI and stricter ED (OR=2.00, 95% CI: 1.36-2.94, p=0.003). Conclusion An elevated WWI was related to higher risks of ED in the United State adults, and a stronger predictive power of WWI for ED was observed than BMI and WC.
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Affiliation(s)
- Shangqi Cao
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Xu Hu
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yanxiang Shao
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yaohui Wang
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yaxiong Tang
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xiang Li
- Institute of Urology, Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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Cayetano-Alcaraz AA, Tharakan T, Chen R, Sofikitis N, Minhas S. The management of erectile dysfunction in men with diabetes mellitus unresponsive to phosphodiesterase type 5 inhibitors. Andrology 2023; 11:257-269. [PMID: 35929992 DOI: 10.1111/andr.13257] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Erectile dysfunction is associated with diabetes mellitus with an estimated prevalence of 52.5% in the diabetic population. The first-line therapy for erectile dysfunction is phosphodiesterase type 5 inhibitors, but data suggest that diabetic men may be less responsive than non-diabetic men. Thus, other treatments, including intracavernosal injections, intraurethral prostaglandin, vacuum erection devices and penile prosthetic surgery, should be considered in management of diabetic men with erectile dysfunction refractory to phosphodiesterase type 5 inhibitors. Furthermore, combination therapy of phosphodiesterase type 5 inhibitors and other oral treatments such as arginine or l-carnitine may have synergistic effects resulting in better outcomes. In addition, there are novel therapies such as low-intensity shockwave therapy and stem-cell therapy, which may also be effective in targeted treatment modalities. Furthermore, studies suggest that erectile dysfunction can be improved by targeting concurrent comorbidities or metabolic diseases such as depression, hypertension, hypogonadism, and dyslipidaemia. We present an evidence-based narrative review focusing on the management of erectile dysfunction in diabetic men who have not responded to phosphodiesterase type 5 inhibitors. CONCLUSIONS Both clinicians and patients should be aware of the different management options in diabetic patients who have not responded to phosphodiesterase type 5 inhibitors.
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Affiliation(s)
| | - Tharu Tharakan
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Runzhi Chen
- Faculty of Medicine, Imperial College London, London, UK
| | - Nikolaos Sofikitis
- Department of Urology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Suks Minhas
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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A Proposal of a New Nomogram to Predict the Need for Testosterone ReplACEment (TRACE): A Simple Tool for Everyday Clinical Practice. J Pers Med 2022; 12:jpm12101654. [PMID: 36294793 PMCID: PMC9605352 DOI: 10.3390/jpm12101654] [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: 09/01/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
International guidelines suggest to use testosterone therapy (TTh) in hypogonadal men presenting symptoms of testosterone deficiency (TD), even if there is no fixed threshold level of T at which TTh should be started. We aimed to develop and validate a nomogram named TRACE (Testosterone ReplACEment) for predicting the need of TTh in patients with "low-normal" total testosterone levels. The following nomogram variables were used: serum T level; serum LH level; BMI; state of nocturnal erections; metabolic comorbidities; and IPSS total score. The nomogram has been tested by calculating concordance probabilities, as well as assaying the calibration of predicted probability of clinical testosterone deficiency and need for TTh, together with the clinical outcome of the TTh. A cohort of 141 patients was used for the development of the nomogram, while a cohort of 123 patients attending another institution was used to externally validate and calibrate it. Sixty-four patients (45.3%) received TTh. Among them, sixty patients (93.7%) reported a significant clinical improvement after TTh. The nomogram had a concordance index of 0.83 [area under the ROC curve 0.81 (95% CI 0.71-0.83)]. In conclusion, the TRACE nomogram accurately predicted the probability of clinical impairment related to TD, and resulted in a simple and reliable method to use to select hypogonadal patients with not clearly pathological testosterone values who will benefit from TTh.
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Kataoka T, Fukamoto A, Hotta Y, Sanagawa A, Maeda Y, Furukawa-Hibi Y, Kimura K. Effect of High Testosterone Levels on Endothelial Function in Aorta and Erectile Function in Rats. Sex Med 2022; 10:100550. [PMID: 35939869 PMCID: PMC9537240 DOI: 10.1016/j.esxm.2022.100550] [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: 01/27/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Testosterone is an important hormone for the physical and mental health of men; however testosterone administration has also been suggested to adversely affect the cardiovascular system. AIM To investigate the effects of excessive testosterone administration on vascular endothelial and erectile function in rats. METHODS A total of seventy-five 12-week-old rats were divided into the following groups: Sham, castrated (Cast), castrated with subcutaneous administration of 100 mg/kg/month testosterone (Cast + T1), and castrated with subcutaneous administration of 100 mg/kg/week testosterone (Cast + T4). To observe the changes in testosterone level after the administration, rats were further divided into the following groups: control; T(6.25), wherein the rats were subcutaneously injected with 6.25 mg/kg testosterone; T(25) per week, wherein the rats were subcutaneously injected with 25 mg/kg testosterone per week; and T(100), wherein the rats were subcutaneously injected with 100 mg/kg testosterone per week. The relaxation responses of aorta were measured in these rats using standardized methods, and their erectile function was also evaluated. Statistical analysis of the obtained data was performed using two-way analysis of variance (ANOVA), Tukey-Kramer's multiple comparison test, or Student's t-test. OUTCOMES At the end of the study period, endothelial function was evaluated through measurement of isometric tension, while erectile function was assessed using intracavernosal pressure (ICP), mean arterial pressure (MAP), and the expression of endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), sirtuin 1 (Sirt1) and vascular endothelial growth factor A. RESULTS The ICP/MAP ratio in the Cast group (0.42 ± 0.04) was significantly lower than that in the Sham group (0.79 ± 0.07). The ICP/MAP ratio in the Cast + T1 group (0.73 ± 0.06) was significantly higher than that in the Cast group (P < .01) and that of the Cast + T4 (0.38 ± 0.01) group was unchanged (P > .05). The T(25) and T(100) groups exhibited significantly lower responses to ACh than the control group at 4 weeks (P < .01). Meanwhile, the ICP/MAP ratios in the T(25) group (0.44 ± 0.07) and T(100) group (0.47 ± 0.03) were significantly lower than that in the control group (0.67 ± 0.05) at stimulation frequencies of 16 Hz (P < .05). The expression of androgen receptor, Sirt1, and eNOS were significantly lower while that of iNOS was higher in the T(25) group compared with the control group (P < .05). CLINICAL TRANSLATION The results based on this animal model indicate that extremely high testosterone levels may affect endothelial and erectile function. STRENGTHS AND LIMITATIONS We found that high-dose testosterone administration decreased endothelial function in aorta and erectile function in rats. A major limitation of this study is that the blood concentration may not be representative of that in humans, and further research is needed. CONCLUSION The findings suggest that high doses of testosterone may cause endothelial dysfunction in the aorta and erectile dysfunction in rats and that the blood concentration should be monitored after testosterone administration. Kataoka T, Fukamoto A, Hotta Y, et al. Effect of High Testosterone Levels on Endothelial Function in Aorta and Erectile Function in Rats. Sex Med 2022;XX:XXXXXX.
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Affiliation(s)
- Tomoya Kataoka
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan; Department of Pharmacology, Kataoka's lab, Graduate School of Pharmaceutical Sciences, Chiba Institute of Science, Chiba, Japan.
| | - Ayako Fukamoto
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Yuji Hotta
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Akimasa Sanagawa
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Yasuhiro Maeda
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Yoko Furukawa-Hibi
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan; Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazunori Kimura
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan; Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan.
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Yuan C, Jian Z, Gao X, Jin X, Wang M, Xiang L, Li H, Wang K. Type 2 diabetes mellitus increases risk of erectile dysfunction independent of obesity and dyslipidemia: A Mendelian randomization study. Andrology 2021; 10:518-524. [PMID: 34842357 DOI: 10.1111/andr.13132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 11/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The causal effects of individual risk factors of metabolic syndrome on erectile dysfunction (ED) are still unclear. OBJECTIVES To evaluate the causal effect of risk factors of metabolic syndrome on ED through Mendelian randomization (MR). MATERIALS AND METHODS Data for risk factors were obtained from multiple databases with 173,082-757,601 individuals, and that for ED were collected from a genome-wide association study including 223,805 Europeans. We performed univariate MR analysis using inverse-variance weighted, MR-Egger, weighted-median, weighted mode methods and multivariable MR analysis to evaluate the total and direct causal effects. RESULTS The univariable MR supported that type 2 diabetes mellitus (odds ratios [OR] = 1.14, 95% confidence intervals [CI]: 1.08-1.21, p < 0.001) and body mass index (BMI) (OR = 1.27, 95% CI: 1.12-1.44, p < 0.001) were associated with ED. After excluding the SNPs associated with BMI and other risk factors, the results of multivariable MR for T2D (OR = 1.15, 95% CI: 1.05-1.25, p = 0.001) remained consistent. However, the results of multivariable MR provided limited evidence for the causality between BMI and ED (OR = 1.06, 95% CI: 0.88-1.29, p = 0.532). For systolic blood pressure and lipid components (low-density lipoprotein, high-density lipoprotein and triglycerides), both univariable and multivariable MR failed to offer sufficient evidence to confirm their causal effect on ED. CONCLUSION T2D showed a direct causal effect on ED independent of obesity and dyslipidemia.
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Affiliation(s)
- Chi Yuan
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China.,West China Biomedical Big Data Center, Sichuan University, Chengdu, P.R. China
| | - Xiaoshuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Menghua Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Liyuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, P.R. China
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Effect of Late Androgen Replacement Therapy on Erectile Function Through Structural Changes in Castrated Rats. Sex Med 2021; 9:100348. [PMID: 34186306 PMCID: PMC8360922 DOI: 10.1016/j.esxm.2021.100348] [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: 12/28/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background Because androgen replacement therapy (ART) is not performed immediately after the onset of androgen deficiency, the treatment is considered to be late. Aim To investigate the effects of late ART, starting 4 weeks after castration of rats, on erectile function and structural changes in the corpus cavernosum. Methods Rats were subjected to ART for 4 (Late-ART [4w]) or 8 (Late-ART [8w]) weeks. In either case, rats were assigned to the following groups: castrated (Cast), castrated with subcutaneous administration of testosterone (3 mg/kg/day; Cast+T), and sham (Sham). Cast + T rats received daily subcutaneous doses of testosterone starting 4 weeks after castration for 4 or 8 weeks whereas Sham and Cast rats received only the vehicle. Outcomes Erectile function was assessed by evaluating intracavernosal pressure (ICP) and mean arterial pressure (MAP) after electrical stimulation of the cavernous nerve, corporal veno-occlusive function using dynamic infusion cavernosometry, and histology using Masson's trichrome staining. Results No increase in the ICP was observed in Cast+T rats in the Late-ART (4w) group (0.47 ± 0.02, P > .05), whereas, in Cast+T rats in the Late-ART (8w) group, there was a significant increase in the ICP/MAP ratio (0.60 ± 0.02, P < .05), drop rate, and smooth muscle/collagen ratio. Clinical Translation The present study provides scientific evidence for the effect of late ART on erectile function. Strengths and Limitations This study provides insights into the influence of late ART on erectile function through improvements in the structure of corpus cavernosum. The major limitation of this study is the difference in the time required for healing between the humans and rats, which might have a bearing on the translational relevenace of the results. Conclusions Late ART could improve erectile function. However, as improvement requires a considerable time period, it is necessary to persist with therapy patiently for optimal results. Kataoka T, Hotta Y, Yamamoto Y, et al. Effect of Late Androgen Replacement Therapy on Erectile Function Through Structural Changes in Castrated Rats. Sex Med 2021;XX:XX–XXX.
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Muniroh M, Nindita Y, Karlowee V, Purwoko Y, Rahmah ND, Widyowati R, Suryono S. Effect of Garcinia mangostana pericarp extract on glial NF-κB levels and expression of serum inflammation markers in an obese-type 2 diabetes mellitus animal model. Biomed Rep 2021; 15:63. [PMID: 34113445 PMCID: PMC8188163 DOI: 10.3892/br.2021.1439] [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: 02/24/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is an age-related disease associated with cerebral inflammation and Alzheimer's disease. Garcinia mangostana pericarp (GMP) possesses antihyperglycemic, antidiabetic and anti-inflammatory effects. The aim of the present study was to evaluate the effect of GMP extract on cerebral inflammation in Wistar rats with T2DM by examining the expression levels of glial nuclear factor-κB (NF-κB), interleukin (IL)-6, tumor necrosis factor-α (TNF-α) and superoxide dismutase (SOD). A total of 36 8-10-week-old male Wistar rats were randomly divided into six groups and provided a standard diet (normal control; C1), high-fat diet (HFD) with 200 g/kg GMP extract BW/day (GMP control; C2), HFD with streptozotocin-nicotinamide (diabetic control; C3), and HFD with 100 (M1), 200 (M2) or 400 g/kg body weight (BW)/day (M3) GMP extract for Wistar rats with diabetes. GMP extract was administered for 8 weeks after induction of T2DM was confirmed. Glial NF-κB activity was assessed by immunohistochemical staining, and by measuring IL-6 levels, TNF-α levels and SOD activity in the serum using ELISA. BW significantly increased following HFD treatment. After 7 weeks, the BW remained significantly higher compared with the normal control and GMP extract-treated groups, but decreased continuously in the T2DM groups. Glial NF-κB immunoreaction in the hippocampal region was significantly higher in the diabetic Wistar rats compared with the normal control Wistar rats, and 200 g/kg BW/day GMP significantly reduced its activity. The T2DM Wistar rats showed significantly higher expression levels of serum IL-6 and TNF-α and lower activity of SOD compared with the normal control Wistar rats. Meanwhile, rats in GMP groups M1, M2 and M3 exhibited significant reductions in the levels of IL-6 and TNF-α expression, and increases in SOD activity. GMP extract treatment effectively reduced hippocampal NF-κB, IL-6 and TNF-α levels and increased antioxidant SOD activity. These results suggest that GMP extract prevents cerebral inflammation in T2DM Wistar rats.
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Affiliation(s)
- Muflihatul Muniroh
- Department of Physiology, Faculty of Medicine Diponegoro University, Semarang, Java 50275, Indonesia
| | - Yora Nindita
- Department of Pharmacology and Therapeutics, Faculty of Medicine Diponegoro University, Semarang, Java 50275, Indonesia
| | - Vega Karlowee
- Department of Anatomical Pathology, Faculty of Medicine Diponegoro University, Semarang, Java 50275, Indonesia
| | - Yosef Purwoko
- Department of Physiology, Faculty of Medicine Diponegoro University, Semarang, Java 50275, Indonesia.,Department of Internal Medicine, Faculty of Medicine Diponegoro University, Semarang, Java 50275, Indonesia
| | - Nadya Diena Rahmah
- Department of Nutrition Science, Faculty of Medicine Diponegoro University, Semarang, Java 50275, Indonesia
| | - Retno Widyowati
- Department of Pharmaceutical Science, Faculty of Pharmacy Airlangga University, Surabaya, East Java 60115, Indonesia
| | - Suryono Suryono
- Department of Physics, Faculty of Science and Mathematics Diponegoro University, Semarang, Java 50275, Indonesia
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12
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Bolat MS, Ozbek ML, Şahin B, Yılmaz M, Kocamanoglu F, Buyukalpelli R, Sunter AT, Asci R. Impact of high visceral adiposity index associated with metabolic syndrome on erectile function in sexually active men: Results of a cross-sectional study. Int J Clin Pract 2021; 75:e14111. [PMID: 33621419 DOI: 10.1111/ijcp.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 01/29/2023] Open
Abstract
AIMS Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on visceral adiposity index (VAI). METHODS Participants who met MeTS criteria (Group 1, n = 96) and did not meet MeTS criteria (Group 2, n = 189) were included in this cross-sectional study. The MeTS diagnosis was made in the presence of at least 3 of the following criteria: fasting serum glucose level higher than 100 mg/dL, HDL cholesterol level below 40 mg/dL, triglyceride level higher than 150 mg/dL, waist circumference higher than 102 cm and blood pressure higher than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(Waist Circumference/39.68) + (1.88 × body mass index)] × triglyceride/1.03 × 1.31/HDL formula. RESULTS Mean age, smoking volume, testosterone (T) and testosterone/estradiol (T/E2 ) ratios of the groups were similar (P > .05). The mean VAI was two-fold higher in patients in Group 1 (P < .001) and erectile function score was lower in Group 1 than Group 2 (P = .001). Other sexual function scores were similar (P > .05). The METS was associated with an increased risk of ED (P = .001). Logistic regression analysis showed that each integer increase in the VAI was associated with a 1.4-fold increased risk of ED (P < .001). Higher T values were associated with a better erectile function (P = .03). For the VAI = 4.33, receiver-operating characteristic analysis showed a sensitivity of 89.6% and specificity of 57.7%. CONCLUSION Compared with non-MeTS, the presence of MeTS has emerged as a risk factor for patients with ED with high VAI levels while the other sexual functions are preserved. Management of ED patients with MeTS should cover a comprehensive metabolic and endocrinological evaluation in addition to andrological work up.
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Affiliation(s)
| | | | - Bekir Şahin
- Department of Internal Medicine, Samsun Gazi State Hospital, Samsun, Turkey
| | - Merve Yılmaz
- Department of Endocrinology, Samsun Gazi State Hospital, Samsun, Turkey
| | | | | | | | - Ramazan Asci
- Department of Urology, Ondokuz Mayis University, Samsun, Turkey
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13
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Van Poppel H, Abrahamsson P. Considerations for the use of gonadotropin‐releasing hormone agonists and antagonists in patients with prostate cancer. Int J Urol 2020; 27:830-837. [DOI: 10.1111/iju.14303] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022]
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14
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Lee JY, Lee SR, Lee SY. Prevalence of Asymptomatic Coronary Artery Stenosis Based on Coronary Computed Tomography Angiography in Adults with Erectile Dysfunction: A Cross-Sectional Study. Med Princ Pract 2020; 29:565-571. [PMID: 32450555 PMCID: PMC7768134 DOI: 10.1159/000508876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of asymptomatic coronary artery stenosis (CAS) using coronary computed tomography angiography (CCTA) in Korean men with erectile dysfunction (ED). SUBJECTS AND METHODS A cross-sectional study was conducted on 108 men who underwent CCTA at a health promotion center in Pusan National University Yangsan Hospital. Each subject who was evaluated for ED using the International Index of Erectile Dysfunction (IIEF) questionnaire did not have a past history or symptoms of coronary artery disease (CAD). We assessed the association between ED and CCTA-based CAS. RESULTS The overall prevalence of ED was 57.4%; furthermore, age (p = 0.001) and fasting blood glucose (p =0.035) were the metabolic risk factors that were most significantly associated with the presence of ED. The overall frequency of CAS was 31.5%, and ED (p = 0.022), age (p < 0.001), fasting blood glucose (p = 0.021), and total cholesterol/high-density lipoprotein cholesterol (p = 0.029) were significantly associated with the presence of CAS. The prevalence of CAS was 40.3 and 19.6% in the ED and non-ED groups, respectively. Men with ED were 2.778 times more likely to present with CAS than those without ED (OR 2.778, 95% CI 1.143-6.749, p = 0.024); however multivariate logistic regression analysis, while controlling for age, total cholesterol/high-density lipoprotein cholesterol, and fasting blood glucose, suggested the absence of a significant association between ED and CCTA-based CAS. CONCLUSION This study shows that CCTA-based CAS is a common phenomenon in men who have ED. Furthermore, ED patients without cardiac symptoms need to be investigated for the possibility of hidden CAD.
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Affiliation(s)
- Ju Young Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sae Rom Lee
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sang Yeoup Lee
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea,
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Republic of Korea,
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15
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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16
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Jiang Y, Ye J, Zhao M, Tan A, Zhang H, Gao Y, Lu Z, Wu C, Hu Y, Wang Q, Yang X, Mo Z. Cross-sectional and longitudinal associations between serum testosterone concentrations and hypertension: Results from the Fangchenggang Area Male Health and Examination Survey in China. Clin Chim Acta 2018; 487:90-95. [PMID: 30138621 DOI: 10.1016/j.cca.2018.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 07/09/2018] [Accepted: 08/14/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Low testosterone concentrations have been suggested as a risk factor for hypertension, but their contribution to the development of hypertension is not well studied. We carried out a cohort study based on the results of an earlier cross-sectional investigation. We established the association between testosterone concentrations and hypertension. METHOD Data on 2427 healthy male subjects, aged from 17 to 88 y, were collected for the cross-sectional study. A representative sample of 853 individuals who did not suffer from hypertension at baseline was followed up for 4 y. Differences between the tertiles groups of sex hormones were analyzed, relative risks (RR) were estimated using binary logistic regression model. RESULTS In the cross-sectional analysis, the serum total testosterone (TT), free testosterone (FT), and bioavailable testosterone (BT) concentrations of the hypertensive population were lower than those of the non-hypertensive population. Binary logistic regression analysis showed that TT, BT, and FT were inversely associated with hypertension. Moreover, decreasing odds ratio (OR) was observed from the lowest tertile group to the highest tertile group. After multivariate adjustment, the correlation between FT, BT, and hypertension was attenuated. Statistically significant differences remained only in the middle tertile group of TT and in the highest tertile group of TT, FT, and BT. In the longitudinal analysis, the 4-y incidence of hypertension was higher in participants with lower TT than in those with higher TT. Subjects in the middle and highest tertile groups of TT had an RR of 0.35 (0.22-0.57) and 0.30 (0.18-0.50), respectively (P for trend <0.001). After further adjustments, these associations still remained statistically significant. CONCLUSIONS Serum TT, FT, and BT concentrations were inversely associated with blood pressure in man, and TT independent of age and body mass index (BMI) influences the development of hypertension. Furthermore, TT can be employed as a risk marker for hypertension in the identification of high-risk individuals.
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Affiliation(s)
- Yonghua Jiang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Guangxi Key Laboratory of Genomic and Personalized Medicine, Nanning, Guangxi 530021, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi 530021, China
| | - Juan Ye
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Medical Insurance Section, The Second Affiliated Hospital of Guangxi Medical University, China
| | - Mukun Zhao
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Aihua Tan
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Chemotherapy, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Haiying Zhang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yong Gao
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Zheng Lu
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Chunlei Wu
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Urology, First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan Province, China
| | - Yanling Hu
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Guangxi Key Laboratory of Genomic and Personalized Medicine, Nanning, Guangxi 530021, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi 530021, China
| | - Qiuyan Wang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Guangxi Key Laboratory of Genomic and Personalized Medicine, Nanning, Guangxi 530021, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi 530021, China
| | - Xiaobo Yang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; Guangxi Key Laboratory of Genomic and Personalized Medicine, Nanning, Guangxi 530021, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi 530021, China; Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
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Jung JH, Kim HW, Narayan V, Reddy B, Walsh T, Yu HS, Lim JS, Kim MH, Dahm P. Testosterone supplementation in men with sexual dysfunction. Hippokratia 2018. [DOI: 10.1002/14651858.cd013071] [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]
Affiliation(s)
- Jae Hung Jung
- Yonsei University Wonju College of Medicine; Department of Urology; 20 Ilsan-ro Wonju Gangwon Korea, South 26426
| | - Hong Wook Kim
- Konyang University College of Medicine,; Department of Urology; Gasuwon-dong, Seo-gu Daejeon Korea, South 302-718
| | - Vikram Narayan
- University of Minnesota; Department of Urology; Minneapolis Minnesota USA
| | - Balaji Reddy
- Massachusetts General Hospital; Department of Urology; 55 Fruit Street Boston USA MA 02114
| | - Thomas Walsh
- National Cancer Institute; Immunocompromised Host Section, Pediatric Oncology Branch; CRC 1-5750 10 Center Drive Bethesda MD USA 20892
| | - Ho Song Yu
- Chonnam National University; Department of Urology; 42 Jebong-ro, Dong-gu Gwangju Chonnam Korea, South 61469
| | - Jung Soo Lim
- Yonsei University Wonju College of Medicine; Division of Endocrinology, Department of Internal Medicine; 20 Ilsan-ro Wonju Gangwon Korea, South 26426
| | - Myung Ha Kim
- Yonsei University Wonju College of Medicine; Yonsei Wonju Medical Library; Wonju Korea, South
| | - Philipp Dahm
- University of Minnesota; Department of Urology; Minneapolis Minnesota USA
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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Arver S, Stief C, de la Rosette J, Jones TH, Neijber A, Carrara D. A new 2% testosterone gel formulation: a comparison with currently available topical preparations. Andrology 2018; 6:396-407. [PMID: 29600542 DOI: 10.1111/andr.12487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/19/2018] [Accepted: 03/01/2018] [Indexed: 12/22/2022]
Abstract
Testosterone gel formulations have become a popular testosterone replacement therapy in patients with hypogonadism since their advent in the year 2000. The gel formulations restore testosterone levels to mid-normal physiological levels (14-17.5 nmol/L) as early as within 24 h, and help alleviate the signs and symptoms of testosterone deficiency, thereby leading to an improved quality of life. Although testosterone gels have a favourable efficacy and safety profile as compared to injectable and patch formulations, risk of secondary exposure poses a challenge. Approved testosterone topical formulations include Tostrex® (Tostran® , Fortesta® ), Androgel® (Testogel® ), Testim® and Axiron® (solution), which have a favourable efficacy profile and positively impacted patient-reported outcome(s). Besides, Testavan, which is a 2% testosterone gel, is under registration in Europe and already approved in Australia in May 2017. Testavan uses a novel hydroalcoholic and highly viscous topical formulation. This product comes with a metered dose dispenser and a cap applicator that allows a hands-free application for precise dispensing and application. The present article provides a comprehensive review of pharmacokinetic, tolerability and safety profile of the testosterone gels available in the market along with the new 2% testosterone gel, Testavan.
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Affiliation(s)
- S Arver
- Karolinska Institute, Stockholm, Sweden
| | - C Stief
- Department of Urology, Ludwig-Maximilians-Universität München, München, Germany
| | - J de la Rosette
- AMC University Hospital, Amsterdam-Zuidoost, The Netherlands
| | - T H Jones
- Robert Hague Centre for Diabetes and Endocrinology, Barnsley and Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - A Neijber
- International Pharma Science Center, Ferring Pharmaceuticals, Copenhagen, Denmark
| | - D Carrara
- Ferring Galenisches Labor AG, Allschwil, Switzerland
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Spencer J, Mahon J, Daugherty M, Chang-Kit L, Blakely S, McCullough A, Byler T, Nikolavsky D. Hypoandrogenism is Prevalent in Males With Urethral Stricture Disease and is Associated with Longer Strictures. Urology 2018; 114:218-223. [PMID: 29378279 DOI: 10.1016/j.urology.2017.10.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the association of hypoandrogenism (HA) with urethral stricture disease in a series of patients undergoing urethroplasty at 2 institutions. HA has recently been associated with increased urethral atrophy in artificial sphincter failures and decreased androgen receptors and periurethral vascularity. HA might be an etiologic factor in urethral stricture disease. METHODS We reviewed the charts in 202 men with anterior urethral strictures between 2011 and 2017. We excluded patients with radiation-induced stricture, previous prostatectomy, previous urethroplasty, pelvic fracture-related strictures, or those on testosterone replacement. We defined HA by a total testosterone of less than 300 ng/dL. We used as age-matched cohort from a national database (National Health and Nutrition Examination Survey), as a reference. Stricture characteristics, such as length, location, and etiology were compared in HA and eugonadal groups. RESULTS Of 202 men with anterior urethral strictures, we excluded 45. Of the remaining 157 patients, 115 (73%) had preoperative testosterone measurements. Overall, hypoandrogenism (HA) was found in 65 of 115 (57%) men in the urethral stricture group compared with 28% of age-matched men in the national database. Mean stricture length in HA and eugonadal men was 7.2 cm and 4.8 cm, respectively (P = .02). CONCLUSION HA may be more prevalent and associated with increased disease severity in men with anterior urethral strictures. The relationship between HA and stricture formation and its potential impact on therapeutic outcomes merit further prospective investigation.
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Affiliation(s)
- Jeffrey Spencer
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | - Joseph Mahon
- Department of Urology, Albany Medical Center, Albany, NY
| | - Michael Daugherty
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | | | - Stephen Blakely
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | | | - Timothy Byler
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
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Nakashima A, Ohkido I, Yokoyama K, Mafune A, Urashima M, Yokoo T. Associations Between Low Serum Testosterone and All-Cause Mortality and Infection-Related Hospitalization in Male Hemodialysis Patients: A Prospective Cohort Study. Kidney Int Rep 2017; 2:1160-1168. [PMID: 29270524 PMCID: PMC5733882 DOI: 10.1016/j.ekir.2017.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 01/07/2023] Open
Abstract
Introduction Infectious diseases are the second highest cause of death in patients on dialysis. In addition, testosterone deficiency or hypogonadism is prevalent in dialysis patients. However, to our knowledge, no studies have investigated the association between testosterone levels and infectious events. We aimed to evaluate whether serum testosterone levels are associated with infection-related hospitalization in male hemodialysis patients in a prospective cohort study. Methods We divided the study population into 3 groups based on serum testosterone levels. Associations between testosterone levels and clinical outcomes of infection-related hospitalization, all-cause mortality, and cardiovascular disease (CVD) events were analyzed using the Cox proportional hazard model. Results Nine hundred two male patients were enrolled and followed up for a median of 24.7 months. Their mean ± SD age was 63.4 ± 11.8 years, and their median (interquartile range) of total testosterone was 11.7 nmol/l (7.9–14.9 nmol/l). During follow-up, 123 participants died. Infection-related hospitalization and CVD events occurred in 116 and 151 patients, respectively. Infection-related hospitalization was more frequent in the lower testosterone tertile than in the higher testosterone tertile (hazard ratio [HR]: 2.12; 95% confidence interval [CI]: 1.18–3.79; P = 0.01) in adjusted models. Moreover, all-cause mortality was significantly greater in the lower testosterone tertile than in the higher testosterone tertile in adjusted analysis (HR: 2.26; 95% CI: 1.21–4.23; P = 0.01). In contrast, there were no significant differences in CVD events by testosterone level. Discussion Low levels of testosterone may be associated with higher rates of infection-related hospitalization and all-cause mortality in male hemodialysis patients.
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Affiliation(s)
- Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.,Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Aki Mafune
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.,Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
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Sanchez E, Pastuszak AW, Khera M. Erectile dysfunction, metabolic syndrome, and cardiovascular risks: facts and controversies. Transl Androl Urol 2017; 6:28-36. [PMID: 28217448 PMCID: PMC5313297 DOI: 10.21037/tau.2016.10.01] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Erectile dysfunction (ED) is the most common male sexual dysfunction, and shares many risk factors with systemic conditions including cardiovascular disease (CVD) and the metabolic syndrome (MetS). ED is considered to be an independent risk factor for CVD and can be a harbinger of future cardiovascular events. Given this relationship, each encounter for ED should be viewed by healthcare providers as an opportunity to screen for CVD and other comorbid conditions, including the MetS, that can significantly affect a man's overall health. While universally accepted screening guidelines are lacking, expert panels do recommend an approach to risk stratification in men with ED. In this review, we discuss the current state of understanding of the relationship between ED, the MetS, and CV risk, and how this impacts the approach to the patient presenting with ED.
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Affiliation(s)
- Edward Sanchez
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Aoun F, Chemaly AK, Albisinni S, Zanaty M, Roumeguere T. In Search for a Common Pathway for Health Issues in Men - the Sign of a Holmesian Deduction. Asian Pac J Cancer Prev 2016; 17:1-13. [DOI: 10.7314/apjcp.2016.17.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Maiorino MI, Bellastella G, Petrizzo M, Della Volpe E, Orlando R, Giugliano D, Esposito K. Circulating endothelial progenitor cells in type 1 diabetic patients with erectile dysfunction. Endocrine 2015; 49:415-21. [PMID: 25411101 DOI: 10.1007/s12020-014-0478-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/07/2014] [Indexed: 12/18/2022]
Abstract
Circulating endothelial progenitor cells (EPCs) are bone marrow-derived stem cells able to migrate to sites of damaged endothelium and differentiate into endothelial cells, thereby contributing to vascular repair. Recent studies demonstrated a reduction of EPCs in patients with diabetes mellitus or erectile dysfunction (ED). The aim of this study was to evaluate the circulating levels of different EPCs phenotypes and their relation with testosterone levels in young type 1 diabetic patients with ED. We studied 118 consecutively type 1 diabetic patients and 60 age-matched healthy controls. Erectile function was assessed by completing the International Index of Erectile Function (IIEF-5) and EPCs levels by flow cytometry. Testosterone concentrations were evaluated in all the study population. We identified 38 diabetic patients with ED (Group 1) and 80 patients without ED (Group 2). CD34+KDR+CD133+ cells were significantly lower in patients in Group 1 as compared with those in Group 2 [median and interquartile range, n/10(6) events, 12 (6-16) vs. 18 (13-22), P < 0.001)]. In all participants in the study, there was a significant correlation between circulating CD34+KDR+CD133+ cells and testosterone levels (r = 0.410, P < 0.001), which was highest in Group 1, intermediate in Group 2, and lowest in Group 3 (controls). There was a significant correlation between IIEF-5 score and both CD34+KDR+ (r = 0.459, P = 0.003) and CD34+KDR+CD133+ (r = 0.316, P = 0.050) cells among patients of Group 1, as well as between testosterone levels and most of the EPCs phenotypes. Finally, multivariate regression analysis identified levels of circulating CD34+KDR+ cells as an independent risk factor for ED (β-coefficient 0.348, P = 0.007). In conclusion, type 1 diabetic patients with ED show reduced levels of CD34+KDR+CD133+ cells, whose number correlates with IIEF. Further studies are needed to fully understand the exact mechanisms by which testosterone regulates vascular homeostasis.
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Affiliation(s)
- Maria Ida Maiorino
- Endocrinology and Metabolic Diseases Unit, Department of Medical, Surgical, Neurological, Metabolic Science and Geriatrics, University Hospital at Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy,
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Chillarón JJ, Fernández-Miró M, Albareda M, Vila L, Colom C, Fontserè S, Pedro-Botet J, Flores-Le Roux JA. Age, insulin requirements, waist circumference, and triglycerides predict hypogonadotropic hypogonadism in patients with type 1 diabetes. J Sex Med 2014; 12:76-82. [PMID: 25394376 DOI: 10.1111/jsm.12748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The prevalence of hypogonadotropic hypogonadism (HH) in patients with type 2 diabetes mellitus is higher than in the general population and leads to detrimental effects on metabolic control, lipid profile, and body composition. Few studies have examined its role in type 1 diabetes mellitus. AIM To determine the prevalence of HH in patients with type 1 diabetes and associated risk factors. MAIN OUTCOME MEASURES Clinical and biochemical parameters were gathered on initial evaluation. An HH score creating different experimental models was devised to calculate the risk of HH for an individual with type 1 diabetes. METHODS Cross-sectional study of 181 male patients with type 1 diabetes consecutively admitted to the Diabetes outpatient clinics of three urban hospitals. All participants were Caucasians aged ≥ 18 years with type 1 diabetes duration of more than 6 months. RESULTS One hundred and eighty-one male patients with a mean age of 44.2 ± 13.2 years and a type 1 diabetes duration of 18.9 ± 12.7 years were included. Fifteen patients had HH, representing a prevalence of 8.3% (95% confidence interval [CI]: 4.3-12.3%). Age (odds ratio [OR] 1.066 [95% CI: 1.002-1.134]), waist circumference (OR 1.112 [95% CI: 1028-1203]), and insulin requirements ([IU/Kg] ×10 [OR 1.486 {95% CI: 1052-2.098}]) were independently associated with the presence of HH. The model that best predicted HH generated this formula: HH-score = (1.060 × age) + (1.084 × waist circumference) + (14.00 × insulin requirements) + triglycerides, where age was expressed in years, waist circumference in cm, insulin requirements in IU/kg/d, and triglycerides in mg/dL. An HH score > 242.4 showed 100% sensitivity and 53.2% specificity for HH diagnosis; positive and negative predictive values were 17.0 % and 100%, respectively. CONCLUSIONS One in 10 men with type 1 diabetes presents HH. This condition is associated with age, waist circumference, and insulin requirements. A simple formula based on clinical parameters can rule out its presence.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Frisbee JC, Goodwill AG, Frisbee SJ, Butcher JT, Brock RW, Olfert IM, DeVallance ER, Chantler PD. Distinct temporal phases of microvascular rarefaction in skeletal muscle of obese Zucker rats. Am J Physiol Heart Circ Physiol 2014; 307:H1714-28. [PMID: 25305181 DOI: 10.1152/ajpheart.00605.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Evolution of metabolic syndrome is associated with a progressive reduction in skeletal muscle microvessel density, known as rarefaction. Although contributing to impairments to mass transport and exchange, the temporal development of rarefaction and the contributing mechanisms that lead to microvessel loss are both unclear and critical areas for investigation. Although previous work suggests that rarefaction severity in obese Zucker rats (OZR) is predicted by the chronic loss of vascular nitric oxide (NO) bioavailability, we have determined that this hides a biphasic development of rarefaction, with both early and late components. Although the total extent of rarefaction was well predicted by the loss in NO bioavailability, the early pulse of rarefaction developed before a loss of NO bioavailability and was associated with altered venular function (increased leukocyte adhesion/rolling), and early elevation in oxidant stress, TNF-α levels, and the vascular production of thromboxane A2 (TxA2). Chronic inhibition of TNF-α blunted the severity of rarefaction and also reduced vascular oxidant stress and TxA2 production. Chronic blockade of the actions of TxA2 also blunted rarefaction, but did not impact oxidant stress or inflammation, suggesting that TxA2 is a downstream outcome of elevated reactive oxygen species and inflammation. If chronic blockade of TxA2 is terminated, microvascular rarefaction in OZR skeletal muscle resumes, but at a reduced rate despite low NO bioavailability. These results suggest that therapeutic interventions against inflammation and TxA2 under conditions where metabolic syndrome severity is moderate or mild may prevent the development of a condition of accelerated microvessel loss with metabolic syndrome.
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Affiliation(s)
- Jefferson C Frisbee
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Adam G Goodwill
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Stephanie J Frisbee
- Department of Health Policy, Management and Leadership, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Joshua T Butcher
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Robert W Brock
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, West Virginia; Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - I Mark Olfert
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, West Virginia; and Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Evan R DeVallance
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, West Virginia; and Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Paul D Chantler
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, West Virginia; and Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
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Traish AM. Adverse health effects of testosterone deficiency (TD) in men. Steroids 2014; 88:106-16. [PMID: 24942084 DOI: 10.1016/j.steroids.2014.05.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/05/2014] [Accepted: 05/21/2014] [Indexed: 12/20/2022]
Abstract
Testosterone and its metabolite, 5α-dihydrotestosterone are critical metabolic and vascular hormones, which regulate a host of biochemical pathways including carbohydrate, lipid and protein metabolism and modulate vascular function. Testosterone deficiency (TD) is a well-recognized medical condition with important health implications. TD is associated with a number of co-morbidities including increased body weight, adiposity and increased waist circumference, insulin resistance (IR) and type 2 diabetes mellitus (T2DM), hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased incidence of mortality. In this review, we summarize the data in the literature on the prevalence of TD and its association with the various co-morbidities and suggest that T therapy is necessary to improve health outcomes in men with TD.
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García-Cruz E, Gosálbez D, Sallent A, Piqueras M, Leibar-Tamayo A, Romero-Otero J, Castañeda-Argaiz R, Carrión A, Asiain I, Mateu L, Luque P, Alcaraz A. Erectile Dysfunction but Not Hormonal Levels Are Related to Higher Estimated Mortality Risk Using Charlson Comorbidity Index. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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García‐Cruz E, Leibar‐Tamayo A, Romero‐Otero J, Asiaín I, Carrión A, Castañeda R, Mateu L, Luque P, Cardeñosa O, Alcaraz A. Marked Testosterone Deficiency‐Related Symptoms May be Associated to Higher Metabolic Risk in Men with Low Testosterone Levels. J Sex Med 2014; 11:2292-301. [DOI: 10.1111/jsm.12615] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Saad F, Gooren LJ. Late onset hypogonadism of men is not equivalent to the menopause. Maturitas 2014; 79:52-7. [DOI: 10.1016/j.maturitas.2014.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 11/15/2022]
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31
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Cui Y, Zong H, Yan H, Zhang Y. The Effect of Statins on Erectile Dysfunction: A Systematic Review and Meta‐Analysis. J Sex Med 2014; 11:1367-75. [DOI: 10.1111/jsm.12497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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32
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Huang Y, Chen B, Yao F, Chen S, Ouyang B, Deng C, Huang Y. Weaker Masturbatory Erection May Be a Sign of Early Cardiovascular Risk Associated with Erectile Dysfunction in Young Men Without Sexual Intercourse. J Sex Med 2014; 11:1519-26. [DOI: 10.1111/jsm.12460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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San Francisco IF, Rojas PA, DeWolf WC, Morgentaler A. Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance. BJU Int 2014; 114:229-35. [PMID: 24898919 DOI: 10.1111/bju.12682] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether total testosterone and free testosterone levels predict disease reclassification in a cohort of men with prostate cancer (PCa) on active surveillance (AS). PATIENTS AND METHODS Total testosterone and free testosterone concentrations were determined at the time the men began the AS protocol. Statistical analysis was performed using Student's t-test and a chi-squared test to compare groups. Odds ratios (ORs) with 95% confidence intervals (CIs) were obtained using univariate logistic regression. Receiver-operator characteristic curves were generated to determine the investigated testosterone thresholds. Kaplan-Meier curves were used to estimate time to disease reclassification. A Cox proportional hazard regression model was used for multivariate analysis. RESULTS A total of 154 men were included in the AS cohort, of whom 54 (35%) progressed to active treatment. Men who had disease reclassification had significantly lower free testosterone levels than those who were not reclassified (0.75 vs 1.02 ng/dL, P = 0.03). Men with free testosterone levels <0.45 ng/dL had a higher rate of disease reclassification than patients with free testosterone levels ≥0.45 (P = 0.032). Free testosterone levels <0.45 ng/dL were associated with a several-fold increase in the risk of disease reclassification (OR 4.3, 95% CI 1.25-14.73). Multivariate analysis showed that free testosterone and family history of PCa were independent predictors of disease reclassification. CONCLUSIONS Free testosterone levels were lower in men with PCa who had reclassification during AS. Men with moderately severe reductions in free testosterone level are at increased risk of disease reclassification.
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Affiliation(s)
- Ignacio F San Francisco
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Kataoka T, Hotta Y, Maeda Y, Kimura K. Assessment of androgen replacement therapy for erectile function in rats with type 2 diabetes mellitus by examining nitric oxide-related and inflammatory factors. J Sex Med 2014; 11:920-929. [PMID: 24467772 DOI: 10.1111/jsm.12447] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) has become a major public health issue and is considered a risk factor for erectile dysfunction (ED). T2DM is also associated with androgen deficiency. However, there have been few basic studies on androgen replacement therapy (ART) for ED treatment in T2DM animal models, and the mechanism underlying the effect of ART on T2DM-induced ED is unclear. AIM To investigate the effect of ART on ED in T2DM rats by examining inflammatory and nitric oxide (NO)-related factors. METHODS Otsuka Long-Evans Tokushima Fatty (OLETF) rats and their controls, Long-Evans Tokushima Otsuka (LETO) rats, were distributed into three groups: LETO, OLETF, and ART. In the ART group, OLETF rats were treated daily with testosterone (3 mg/kg/day, subcutaneously) from 20 to 25 weeks of age; LETO and OLETF rats received vehicle only. MAIN OUTCOME MEASURES We measured erectile function by using measurements of the ratio between intracavernosal pressure (ICP) and mean arterial pressure (MAP) following electrical stimulation of the cavernous nerve and by evaluating the endothelial function of the corpus cavernosum in an isometric tension study. Expression of endothelial NO synthase (eNOS), inducible NO synthase (iNOS), sirtuin-1 (Sirt1), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) mRNA was detected using polymerase chain reaction. RESULTS The ICP/MAP ratio in the OLETF group was significantly decreased and that in the ART group was significantly improved (P < 0.01). The response to acetylcholine was significantly decreased in the OLETF group and improved in the ART group (P < 0.01). Although expression of eNOS and Sirt1 mRNA was decreased and that of iNOS, IL-6, and TNF-α mRNA was increased in the OLETF group, ART improved mRNA expression. CONCLUSIONS ART suppressed inflammation in rats with T2DM and metabolic disorders and improved their endothelial and erectile functions. ART could be effective for T2DM-induced ED and may be considered a potential ED treatment method.
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Affiliation(s)
- Tomoya Kataoka
- Department of Hospital PharmacyGraduate School of Pharmaceutical SciencesNagoya City UniversityNagoyaJapan
| | - Yuji Hotta
- Department of Hospital PharmacyGraduate School of Pharmaceutical SciencesNagoya City UniversityNagoyaJapan
| | - Yasuhiro Maeda
- Department of Hospital PharmacyGraduate School of Pharmaceutical SciencesNagoya City UniversityNagoyaJapan
| | - Kazunori Kimura
- Department of Hospital PharmacyGraduate School of Pharmaceutical SciencesNagoya City UniversityNagoyaJapan; Department of Clinical PharmacyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan.
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Traish AM, Galoosian A. Androgens modulate endothelial function and endothelial progenitor cells in erectile physiology. Korean J Urol 2013; 54:721-31. [PMID: 24255752 PMCID: PMC3830963 DOI: 10.4111/kju.2013.54.11.721] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/24/2013] [Indexed: 12/21/2022] Open
Abstract
The incidence of erectile dysfunction (ED) increases with age and cardiovascular disease risk factors, such as hypertension, hyperlipidemia, insulin resistance, obesity, and diabetes. These risk factors are thought to contribute to endothelial dysfunction and atherosclerosis, thus contributing to the pathophysiology of ED. The role of the endothelium in regulating erectile physiology is well established. However, the role of androgens in modulating endothelial function and endothelial repair mechanisms subsequent to vascular injury in erectile tissue remains a subject of intensive research. The clinical and preclinical evidence discussed in this review suggests that androgens regulate endothelial function and also play an important role in the development and maturation of endothelial progenitor cells (EPCs), which are thought to play a critical role in repair of endothelial injury in vascular beds. In this review, we discuss the data available on the effects of androgens on endothelial function and EPCs in the repair of vascular injury. Indeed, more research is needed to fully understand the molecular and cellular basis of androgen action in regulating the development, differentiation, maturation, migration, and homing of EPCs to the site of injury. A better understanding of these processes will be critical to the development of new therapeutic approaches to the treatment of vascular ED.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA. ; Department of Urology, Boston University School of Medicine, Boston, MA, USA
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