Marked Testosterone Deficiency‐Related Symptoms May be Associated to Higher Metabolic Risk in Men with Low Testosterone Levels

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

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

Isolation and identification of nucleosides/nucleotides raising testosterone and NO levels of mice serum from Chinese chive (Allium tuberosum) leaves

Our previous study found that Chinese chive could significantly (p < 0.01) raise testosterone and nitric oxide (NO) levels in mice serum. However, the specific functional components of this traditional remedy are still unknown. In order to isolate and identify the active constituents from Chinese chive for enhancing testosterone and NO levels, the Chinese chive leaves were extracted by petroleum ether, ethyl acetate, n-butanol and water respectively. Results indicated that the n-butanol extract had a significant effect on NO and testosterone blood levels. Subsequently, n-butanol extract was further isolated by D101 macroporous adsorption and eluted with 50% ethanol and then isolated by Sephadex LH-20 and preparative high-performance liquid chromatography to obtain nucleosides. The fraction eluted with 70% ethanol was further isolated by RP-18 and pre-HPLC to obtain nucleotides. Four novel compounds were identified, and their effects on testosterone and NO levels of male mice were evaluated. Results showed that nucleotides, especially the adenosine in Chinese chive leaves, increased serum testosterone and NO levels in male mice, which had not been reported before. This finding might bring into perspective the treatment strategy for those doctors who treat hormone deficiencies, and might be suitable for using in functional food.

Impact of Testosterone Deficiency and Testosterone Therapy on Lower Urinary Tract Symptoms in Men with Metabolic Syndrome

Lower urinary tract function is modulated by neural, vascular and urethral and bladder structural elements. The pathophysiological mechanisms of lower urinary tract symptoms (LUTS) encompass prostate enlargement, alterations in urethra histological structure bladder fibrosis and alterations in pelvic neuronal and vascular networks, The complex pathophysiological relationship between testosterone (T) deficiency (TD) and the constellations LUTS, and metabolic dysfunction manifested in the metabolic syndrome (Met S) remains poorly understood. TD has emerged as one the potential targets by which Met S may contribute to the onset and development as well as worsening of LUTS. Because it has been recognized that treatment of men with Met S with T therapy ameliorates Met S components, it is postulated that T therapy may represent a therapeutic target in improving LUTS. Furthermore, the effect of TD on the prostate remains unclear, and often debatable. It is believed that T exclusively promotes prostate growth, however recent evidence has strongly contradicted this belief. The true relationship between benign prostatic hyperplasia, TD, and LUTS remains elusive and further research will be required to clarify the role of T in both benign prostatic hypertrophy (BPH) and LUTS as a whole. Although there is conflicting evidence about the benefits of T therapy in men with BPH and LUTS, the current body of literature supports the safety of using this therapy in men with enlarged prostate. As the population afflicted with obesity epidemic continues to age, the number of men suffering from Met S and LUTS together is expected to increase.

The impact of age, BMI and sex hormone on aging males' symptoms and the international index of erectile function scores

OBJECTIVE

To analyze the impact of age, BMI and sex hormone on aging males' symptoms (AMS) and the 5-item version of the international index of erectile function (IIEF-5) scores in middle-aged and elderly Chinese men.

METHODS

A population-based cross-sectional study was conducted in Jiashan County. A total of 969 men, aged between 40 and 80 years old, were admitted. Physical examination and the sex hormones were measured, and AMS and IIEF-5 scores were assessed.

RESULTS

The oneway ANOVA analysis indicated older age groups had higher AMS total-scores, somatic and sexual sub-scores, and lower IIEF5 scores (all p < .01). Pairwise correlation (r_pairwise) analyses showed the significant associations between AMS and age or sex hormone (cFT, Bio-T, SHBG, and LH) levels, and similar for IIEF5. However, when age was adjusted, the correlation coefficients (r_partial) weakened, and correlation significance disappeared, except LH (for AMS: r_partial = 0.096, p = .009; for IIEF-5: r_partial =  -0.140, p = .001). Multiple linear regressions confirmed the influence of increased age and LH on the AMS and IIEF5 scores.

CONCLUSION

CFT, Bio-T and SHBG failed to yield any additional predicting information when age was adjusted. To improve the male reproductive health, future research should pay more attention on aging-related comorbidities and how to improve general wellness.

The influence of comorbidities on the aging males' symptoms scale in patients with erectile dysfunction

OBJECTIVES

To investigate if certain common age-related comorbidities are related with a positive aging males' symptoms (AMS) test outcome.

METHODS

This was a multicentric, transversal, observational study carried out in a male population with erectile dysfunction. Comorbidities and testosterone levels were registered. The relationship between comorbidities, testosterone levels, and the AMS test outcomes was studied using the global score and the sub-scale score components.

RESULTS

The study included 1112 patients. In the multivariate analysis the global score strongly correlated with TT < 12 nmol/L (odds ratio [OR] = 3.17; p < 0.05), psychiatric disorders (OR = 2.73), dyslipidemia (OR = 2.07) and diabetes mellitus (OR = 1.64); the somatic sub-component was related to obesity (OR = 8.62), dyslipidemia (OR = 2.2) and TT < 12 nmol/L (OR = 2.09); the psychogenic sub-component correlated with psychiatric disorders (OR = 3.73), stress (OR = 2.42), dyslipidemia (OR = 1.78) and TT < 12 nmol/L (OR = 1.77); and the sexual sub-component was associated with high blood pressure (OR = 2.94).

CONCLUSION

Although the AMS test is related to low levels of testosterone, it is also of some limited use for diagnosing hypogonadism because it has low specificity and is influenced by pathologies that are frequent during ageing.

Erectile dysfunction, loss of libido and low sexual frequency increase the risk of cardiovascular disease in men with low testosterone

INTRODUCTION

Testosterone deficiency increases the cardiovascular disease (CVD) risk.

AIM

To evaluate the effect of erectile dysfunction (ED), sexual frequency and hypogonadal symptoms on CVD risk.

METHODS

A total of 395 hypogonadal men aged 45-74 years were surveyed using the Androgen Deficiency in the Aging Male and the International Index of Erectile Function.

MAIN OUTCOME MEASURES

The 10-year CVD risk was measured with the Framingham Risk Score. Logistic regression was performed to obtain the odds ratios of sexual function and hypogonadal symptoms for a 10-year CVD risk ≥20% (high risk).

RESULTS

The mean age was 56.1 ± 6.7 years. The mean 10-year CVD risk of the whole cohort was 18.1% ± 11.4%, while 131 subjects (33.2%) were classified as high risk. Logistic regression revealed that ED severity was associated with CVD risk [OR = 2.37 (CI 1.24-4.51) for mild-to-moderate ED, OR = 4.39 (1.78-8.43) for moderate ED and OR = 12.81 (4.65-26.11) for severe ED]. Compared to sexual frequency <1 per month, sexual frequency ≥4 decreased the risk of high CVD risk [OR = 0.35 (0.23-0.780)]. Loss of libido [OR = 2.95 (1.91-4.12)] and less strong erection [OR = 3.87 (CI 2.11-4.95)] increased the risk of high CVD risk. All remained significant after adjustment for age and testosterone.

CONCLUSIONS

ED, decreased sexual frequency and loss of libido predict a high 10-year CVD risk in hypogonadal men.

The complex and multifactorial relationship between testosterone deficiency (TD), obesity and vascular disease

Testosterone deficiency (TD) is a well-established and recognized medical condition that contributes to several co-morbidities, including metabolic syndrome, visceral obesity and cardiovascular disease (CVD). More importantly, obesity is thought to contribute to TD. This complex bidirectional interplay between TD and obesity promotes a vicious cycle, which further contributes to the adverse effects of TD and obesity and may increase the risk of CVD. Testosterone (T) therapy for men with TD has been shown to be safe and effective in ameliorating the components of the metabolic syndrome (Met S) and in contributiong to increased lean body mass and reduced fat mass and therefore contributes to weight loss. We believe that appropriate T therapy in obese men with TD is a novel medical approach to manage obesity in men with TD. Indeed, other measures of lifestyle and behavioral changes can be used to augment but not fully replace this effective therapeutic approach. It should be noted that concerns regarding the safety of T therapy remain widely unsubstantiated and considerable evidence exists supporting the benefits of T therapy. Thus, it is paramount that clinicians managing obese men with TD be made aware of this novel approach to treatment of obesity. In this review, we discuss the relationship between TD and obesity and highlight the contemporary advancement in management of obesity with pharmacological and surgical approaches, as well as utilization of T therapy and how this intervention may evolve as a novel approach to treatment of obesity in men with TD .

The prevalence and the risk factors of testosterone deficiency in newly diagnosed and previously known type 2 diabetic men

INTRODUCTION

While the epidemiology of testosterone deficiency has been well described in men with previously known type 2 diabetes mellitus (T2DM), it was less reported in those with untreated, newly diagnosed T2DM.

AIM

The aim of this study was to investigate the prevalence and the risk factors of testosterone deficiency of men with newly diagnosed T2DM.

METHODS

The cross-sectional study included 105 men (mean age: 61.2 ± 6.8 years) with previously known T2DM and another 81 (57.8 ± 8.8 years) with newly diagnosed T2DM. All received health checkup and sex hormone measurement at our institute in 2009.

MAIN OUTCOME MEASURES

We calculated the prevalence and explored the risk factors of low total (<300 ng/dL) and free (<6 ng/dL) testosterone in men with newly diagnosed and previously known T2DM.

RESULTS

Men with previously known T2DM were older and had higher diastolic pressure and greater fasting glucose. There was no significant difference in total (358.0 [155.0] ng/dL vs. 363.0 [154.0] ng/dL, P=0.68) and free (7.2 [2.5] ng/dL vs. 7.4 [2.4]ng/dL, P=0.84) testosterone and sex-hormone binding globulin (SHBG) (27.3 [22.3]nmol/L vs. 28.7 [14.9]nmol/L, P=0.46). The prevalence of low total and free testosterone was 28.4% and 21.0%, respectively, in men with newly diagnosed T2DM, and was 26.7% and 19.0% in those with previously known T2DM. In men with previously known T2DM, better glycemic control (HbA1c <7%) was associated with a higher level of total testosterone and a lower risk of low total testosterone. Men with newly diagnosed and previously known T2DM shared similar risk factors of low total testosterone, including high HbA1c (≥ 7%), low SHBG (<20 nmol/L), obesity, hyperuricemia, hypertriglycemia, and metabolic syndrome. Elevated prostate-specific antigen was a protective factor of low total testosterone. However, none of these factors was associated with low free testosterone.

CONCLUSIONS

The prevalence and the risk factors of testosterone deficiency are similar between newly diagnosed and previously known type 2 diabetic men.