The role of testosterone measurement in the investigation of androgen disorders

Association between male sex hormones and tramadol abuse

Background

Tramadol dependence is prevalent across Egypt. The allegation that it can improve sexual function is the main reason for its popularity among young men. This study aims to determine the serum level of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in tramadol abusers.

Results

Serum testosterone (5.18 ± 1.95) and LH (7.79 ± 1.63) of abusers showed highly significant lower levels than control subjects, while FSH showed no significant difference between abusers and controls. There was no significant difference of hormonal levels in subjects according to the duration of abuse and dose of tramadol.

Conclusions

The results indicate that tramadol abuse causes a pronounced lowering of testosterone and LH levels that is not correlated to the duration of abuse and dose of tramadol.

Effects of sublethal Abamectin exposure on some hormonal profiles and testicular histopathology in male albino rats and the possible ameliorative role of Eruca sativa

The ameliorative role of Eruca sativa on some hormonal profile and testicular histopathology in male albino rats exposed to a sublethal dose of 1 mg/kg body weight (b.wt). Abamectin (Crater 3.37% EC) was evaluated. Eighteen male albino rats were divided into three groups: control group, Abamectin-treated group, and Abamectin + E. sativa-treated group. Rats of the second group were orally administrated 1 mg/kg b.wt. of Abamectin, the third group received a mixture of sublethal oral dose of Abamectin (1 mg/kg b.wt.) and E. sativa suspension (5 g/kg b.wt.) every 48 h for 28 days. At the end of the study, blood samples were collected from all groups to measure some hormonal parameters; also, rats were dissected and tissue sections from the testes were prepared and stained with hematoxylin and eosin for examination under light microscope. The results of the present study revealed a disturbance in the hormonal parameters and some testicular histopathological changes. In addition, administration of E. sativa might have a promising effect against Abamectin toxicity-induced disorders of thyroid hormones and impaired testicular functions, which were correlated with histopathological changes in the testes of male rats.

Effects of marjoram volatile oil and grape seed extract on ethanol toxicity in male rats

Natural dietary antioxidants are extensively studied for their ability to protect cells from miscellaneous damages. Marjoram volatile oil (Origanum majorana L., Lamiaceae) and grape seed extract (Vitis vinifera L., Vitaceae) are potent antioxidants. Effects of administration of marjoram volatile oil or grape seed extract on oral administration of ethanol, simultaneously, daily for 10 weeks were studied through determining epididymal spermatozoal analysis, serum testosterone level, weight and histopathological examination of testis, liver and brain. Glutathione level and lipid peroxidation content as malondialdehyde in the testis, liver and brain were measured. The repeated intake of a great amount of ethanol (10 ml/kg body weight, 25% v/v) was followed by fertility disturbances with low sperm count, impaired sperm motility and decrease in serum testosterone level. Moreover, ethanol toxicity induced significant alterations in the histological structures of the testis, liver and brain. The results revealed a significant increase in lipid peroxidation and decrease in the level of glutathione in the testis, liver and brain in the ethanol-treated group. However, co-administration of the extracts of protective plants resulted in minimizing the hazard effects of ethanol toxicity on male fertility, liver and brain tissues. It may be concluded that marjoram volatile oil and grape seed extract are useful herbal remedies, especially for controlling oxidative damages.

Reproductive and cytogenetic toxicity of metronidazole in male mice

The purpose of this study was to examine the effects of metronidazole (500 mg/kg b.wt. daily by gavage for 14 consecutive days) on male fertility, haematopoiesis and genotoxic affinity. Mature male Swiss mice were treated with metronidazole and divided into 3 groups each with 10 animals, examined after 2 weeks, 1 and 2 months from the onset of drug administration. The results demonstrated that metronidazole significantly (P<0.05) decreased the weight of the testes, epididymides and accessory sexual organs (seminal vesicles and prostates) after one month from the onset of treatment. While accessory sexual organ weights were restored after 2 months from onset of treatment, the decrease in testes and epididymides weights persisted until 2 months later. The deleterious effects of metronidazole on reproductive organ weights might be due to a decrease in testosterone level after 2 weeks, and 1 and 2 months from the onset of treatment. Metronidazole induced a significant decrease in motile sperm and an increase in abnormal sperm after 1 month. The viability of sperm was normal after 2 months. Metronidazole induced anaemia characterized by decreased erythrocyte and leukocytic counts, haemoglobin content and haematocrit %. The ability of oral metronidazole administration to induce genotoxic damage in somatic cells of mice was evaluated using mitotic index, micronuclei and chromosomal aberration. A significant reduction in mitotic activity was observed two weeks from the onset of drug administration, restoration occurred after one month. A significant and persistence increase in the frequency of chromosomal aberration and micronucleus was observed at all periods of the experiment. In conclusion, the results of this study indicate that 1) metronidazole (500 mg/kg by gavage) for 14 days caused a harmful effect on male fertility in mice after one and two months from start of administration, 2) metronidazole induced anaemia after one month from start of administration, 3) metronidazole at this high dose level (3 times the therapeutic dose in mice) has the ability to induce genotoxic effects in somatic cells.

Evaluation of an algorithm for calculation of serum “Bioavailable” testosterone (BAT)

OBJECTIVES

To evaluate a recently published algorithm for calculation of serum "Bioavailable" Testosterone (BAT) using serum Total Testosterone (TT), Sex Steroid Binding Globulin (SSBG) [also commonly known as Sex Hormone Binding Globulin (SHBG)] and albumin concentrations as parameters, in comparison with a locally available "salting-out" BAT method. If satisfactory, this calculation could serve as a substitute for the BAT assay, which would amount to a major cost saving and faster turnaround time.

DESIGN AND METHODS

During a 6-month period, 426 serum samples referred for BAT analysis to the Hospitals In-Common Laboratory of Toronto were also analyzed in-house for TT, SSBG and albumin for computation of comparison calculated BAT results.

RESULTS

A good statistical correlation was obtained, but only after unexpectedly drastic empirical modification of the association constant values: r=0.95, Calculated %BAT=0.971 x Measured %BAT + 0.008. The endocrinologist/andrologist of our team (JB), who was the responsible physician for all patients included in this study, reviewed the tabulated and charted calculated BAT results and verified that they were clinically equivalent.

CONCLUSIONS

Although it is feasible to calculate BAT, the algorithm is not directly portable. Before adopting such a calculation each laboratory should compare it with the locally available BAT method and consider adjusting the calculation to optimize the correlation. Future reassessment may be necessary whenever the SSBG, TT or BAT assay is changed.

Growth hormone, insulin growth factor-1, and igf binding protein-3 axis relationship with bone mineral density among healthy men

The aim of this study was to investigate serum levels of growth hormone (GH), insulin growth factor-I (IGF-I), and insulin growth factor binding protein-3 (IGFBP-3) in 363 healthy caucasian men with and without decreased bone density, who had never experienced fractures. Mean age was 51+/-8.7 years. Height and weight were measured and BMI was calculated using the formula weight (kg)/height (m(2)). Bone mineral density (BMD) was assessed: in 4 skeletal sites (lumbar spine [LS], femoral neck [FN], Ward's triangle [WT], and trochanter [T]) using dual-energy X-ray absorpsiometry (DEXA). After an overnight fasting, blood samples were taken at 8:00 a.m. Serum concentrations of GH, IGF-I, and IGFBP-3 were measured using the immunofunctional (GH) and IRMA (IGF-I and IGFBP-3) methods. The BMD at the 4 skeletal sites is expressed as mean value+/-SD in g/cm(2) and T score. Forty-four men (11%) had bone mineral density (BMD)<-2.5 SD (T score). Mean GH, IGF-I, and IGFBP-3 levels were 0.2+/-0.1, 186.1+/-177.3, and 4990+/-1460 ng/mL, respectively. There were no significant differences between men with normal BMD and men with reduced BMD concerning GH, IGF-I, and IGFBP-3 measurements. In normal men (319), mean GH, IGF-I, and IGFBP-3 levels were 0.4+/-0.1, 192+/-87, and 4960+/-1530 ng/mL, respectively. In the subgroup with reduced BMD (44), mean GH, IGF-I and IGFBP-3 levels were 0.2+/-0.1, 179+/-72 and 5230+/-1270 ng/mL, respectively. An age-dependent attenuation of GH, IGF-I, and IGFBP-3 levels was also found. No correlation was revealed between BMD and GH in the 4 skeletal sites tested. On the contrary, a positive correlation was established between BMD and IGF-I levels in 3 skeletal sites (LS, FN, T). The same was true between BMD and IGFBP-3 in 2 skeletal sites (LS, FN). In conclusion, 11% of Greek healthy males had decreased bone density. No fractures were demonstrated in any individuals. No significant differences were found between men with normal and reduced BMD, with regards to serum GH, IGF-I, and IGFBP-3, although these levels decreased with age. No correlation was found between BMD and GH levels in the 4 skeletal sites. A positive correlation was found between BMD and IGF-I levels in 3 skeletal sites and IGFBP-3 in 2 skeletal sites.

Structural insights into steroid hormone binding: the crystal structure of a recombinant anti-testosterone Fab fragment in free and testosterone-bound forms

The monoclonal anti-testosterone antibody (3-C(4)F(5)) has a relatively high affinity (3 x 10(8) m(-1)) with an overall good specificity profile. However, the earlier characterized binding properties have shown that both the affinity and specificity of this antibody must be improved if it is intended for use in clinical immunoassays. In this paper, the crystal structures of the recombinant anti-testosterone (3-C(4)F(5)) Fab fragment have been determined in the testosterone-bound and free form at resolutions of 2.60 and 2.72 A, respectively. The high affinity binding of the (3-C(4)F(5)) Fab is mainly determined by shape complementarity between the protein and testosterone. Only one direct hydrogen bond is formed between the hydroxyl group of the testosterone D-ring and the main-chain oxygen of Gly100(J)H. The testosterone is deeply bound in a hydrophobic pocket, and the close shape complementarity is mainly formed by the third complementarity-determining regions (CDR) of the heavy and light chain. Comparison of the bound structure with the free structure indicates conformational changes in the protein upon testosterone binding. The conformational changes of the side chains of two residues Glu95H and Tyr99H in the CDR-H3 are particularly essential for the binding. Interesting similarities in the binding of different steroids were also observed upon comparison of the available structures of anti-steroid antibodies.

Inhibition of steroid sex hormones release in rats by two Ca2+ channel blockers

The calcium channel blockers Diltiazem HCl (2 mg kg-1 day-1, IP) or Cinnarizine (8 mg kg-1 day-1, IP) were given for a period of 30 days to adult male and female albino rats. The effect of each calcium channel blocker on circulating blood levels of steroid sex hormones was investigated by radioimmunoassay in comparison with the normal control level. The data demonstrated that both Diltiazem and Cinnarizine significantly decreased serum normal testosterone levels in males (36% and 52% inhibition respectively) as well as both normal estradiol and progesterone contents in females (58% and 45% inhibition with Diltiazem and 68% and 52% inhibition with Cinnarizine respectively). This study indicates the importance of blood sex hormones-follow up in case of long term Ca2+ channel blockers medication.

Some effects of ochratoxin A, a mycotoxin contaminating feeds and food, on rat testis

In previous toxicokinetic studies, ochratoxin A (OTA) was found in testicles of laboratory animals. Therefore its possible adverse effects on the rat testis have been investigated. Male Wistar rats 300 g +/- 20 g, randomised in groups of 5 animals, were given OTA: 289 micrograms/kg in 0.1 M NaHCO3 every 48 h for 2, 4, 6 and 8 weeks, by gastric intubation. This corresponds to a contamination of 2 ppm/day in the feeds. Controls were given only the vehicle. Some testicular enzymic activities and the stages of association of germinal cells (according to Leblond and Clermont) were determined. Some of these enzymic activities vary with the ochratoxin A poisoning in the homogenate of testicles: alpha-amylase, from 1905 +/- 145 units/g to 3190 +/- 128 units/g, alkaline phosphatase from 259 +/- 20 units/g to 323 +/- 15 units/g, gamma-glutamyltransferase (gamma GT), from 170 +/- 59 units/g to 900 +/- 65 units/g after 8 weeks. In adult rats, the increase of these enzymes, especially gamma GT, may be associated with an impairment of spermatogenesis and an accumulation of premeiotic germinal cells induced by OTA. Concerning the number of association stages of germinal cells, a decrease is observed for stages I and VII whereas stages XII and XIII increase after OTA treatment, indicating also a possible impairment of spermatogenesis. All these changes seem to be due to an earlier modification of the androgen status, the testosterone level in testes being 10.4 +/- 3.6 micrograms/g of protein after 3 weeks OTA treatment instead of 5.3 +/- 1 micrograms/g in control animals.

A clinical evaluation of a direct radioimmunoassay of testosterone

We report the evaluation of a commercial coated tube kit (Medgenix) to the measurement of testosterone in plasma/serum samples. The accuracy, precision, specificity and recovery of the assay and the affinity of antibody for ligand were established. The range of concentrations of testosterone providing satisfactory analyses was 0.48-48 nmol/l, which is appropriate for general clinical use. Results of analysis of male and female samples obtained from the routine hospital laboratory in endocrinologically-defined groups were also reviewed. In all groups of male subjects and in normal females, the kit provided results in close agreement to those of an extraction method. With samples from women with various reproductive disorders, as well as with some samples obtained from external quality controls, the kit showed a small but significant negative bias relative to the results of the extraction method. There was, however, no evidence of bias with samples from a separate group of volunteer women with the polycystic ovary syndrome. No interference due to SHBG was detected. Clinical sensitivities using the kit were equivalent to those obtained using the extraction RIA. There was no evidence of spuriously high results in samples from females which has been a common problem with direct radioimmunoassay of testosterone.

Reduced levels of free testosterone in four Catania-type alloalbuminemic males

We studied total testosterone, sex hormone binding globulin, and free testosterone in four males presenting an electrophoretically slow-moving genetic variant of albumin, the alloalbumin Catania. Free testosterone levels were lower in these cases, found in a year of observation, than those expected for the ages. This finding, which is not related to any disease and constantly not recognized in other males with various genetic variants, should induce consideration of a probable difference of the genetic variant in hormone binding.

Castration may not affect the penile erection ability in terms of peripheral neurocavernous mechanism in dogs

The penile erection ability (PEA) was assessed in 27 dogs with intact orchids (Group I), seven dogs with bilateral orchidectomy for one month (Group II) and four dogs with bilateral orchidectomy for three months (Group III). PEA was indicated by the increase of the intracorporeal pressure (ICP) upon electrical stimulation of the cavernous nerves. PEA was significantly decreased in both orchidectomized groups. However, when reduction in the blood pressure was considered, the difference in PEA between Group I and the orchidectomized group was no longer significant. Before the orchidectomy, plasma testosterone level of 22 adult male dogs varied widely from 105 to 6302 pg./ml. At one or three months after the orchidectomy in 11 dogs, it decreased to a level below 100 pg./ml. There was no significant change in the body weight in the post orchidectomy period. These findings indicate that the castration and/or the resulting low plasma testosterone level does not directly affect PEA through the peripheral neural and cavernosal mechanism.

Diagnostic value of serum testosterone measurement in infancy: two case reports

The diagnostic value of serum testosterone measurement and hCG stimulation during early infancy is highlighted by describing two unrelated cases in whom such investigations aided diagnosis and management. When performed on infants between 2 and 9 weeks of age, these measurements can provide valuable information on the integrity of the hypothalamic-pituitary axis in male infants and can identify the presence of testicular tissues in babies with abnormal or ambiguous genitalia.

Oestradiol assays: applications and guidelines for the provision of a clinical biochemistry service

This paper reports on the provision of a clinical biochemistry service for serum oestradiol. The pathophysiology and recognised applications of oestradiol assays are discussed and the current availability of assay reagents and methodologies reviewed. Data are presented on the analytical performance of assays for serum oestradiol in the UK External Quality Assessment Scheme (UKEQAS) and general guidance is offered to laboratories providing a diagnostic service for this analyte.

Assays for follicle stimulating hormone and luteinising hormone: guidelines for the provision of a clinical biochemistry service

The measurement of serum follicle stimulating hormone (FSH) and luteinising hormone (LH), together with the appropriate sex steroid, is of great value in the investigation of delayed and precocious puberty, hypogonadism, subfertility, polycystic ovarian disease and hypothalamic-pituitary disorders. Dynamic function testing of the hypothalamic-pituitary-gonadal axis should be restricted to a few defined situations. Sequential LH measurements, either in serum or in urine, may be used to time ovulation during artificial insemination or in vitro fertilisation programmes. No special precautions are necessary when sampling for FSH and LH measurement; serum is preferred to plasma and should be stored frozen before assay. Aliquots of timed urine specimens of known volume should be stored frozen without preservative. Gonadotrophin results should be available within 2-3 weeks; laboratories unable to meet this schedule are advised to send their samples to a Regional Centre for assay. Reagents for the radioimmunoassay of FSH and LH are readily available, and standard techniques have been developed for their use. Laboratories using 'in-house' methods should pay particular attention to the matrix used for preparing standard solutions, the purification of radioligands and the optimisation of the separation system. Low cost matched reagents of proven performance are available in kit form from the Chelsea Hospital for Women; several commercial kits are also available, although few are widely used in the UK. The overall performance of laboratories in the UK External Quality Assessment Scheme (EQAS) for FSH and LH has remained steady for several years. Of the 130 participants, only about 15% in each scheme have 'good' performance (cumulative bias less than 10%, plus cumulative variability of bias less than 10%), whilst a similar proportion have 'unacceptable' performance (cumulative bias greater than 20% and/or cumulative variability of bias greater than 25%). The remaining 70% of laboratories have 'adequate' performance but are at risk of producing results that are clinically misleading. Within any one method group, the performance of FSH and LH assays are closely related. Optimal assay performance depends upon sensible laboratory management to ensure skilled operators, a regular programme of reagent/kit renewal, comprehensive internal and external quality assessment, and attention to detail in all aspects of gonadotrophin assay. The working range of each individual assay should be defined and no absolute result reported from outside this range.(ABSTRACT TRUNCATED AT 400 WORDS)

Salivary androgens in hirsutism: are they of use in routine evaluation?

In the biochemical evaluation of hirsutism, 50% or less of patients have an elevated total serum testosterone. Recent work has suggested that measuring salivary testosterone or a derived serum 'free testosterone index' may be of use in the evaluation of hyperandrogenism. We have measured serum total, derived serum free indices and salivary concentrations of testosterone and 5 alpha-dihydrotestosterone in an unselected group of hirsute patients in order to assess their value in the routine evaluation of hirsutism. The assays were performed using a novel oxidation procedure to overcome the need for chromatographic separation. The 'free testosterone index' gave the best discrimination. Salivary androgen concentrations were comparatively poor and cannot be recommended for routine use.

Testosterone assays: guidelines for the provision of a clinical biochemistry service

Approximately one year after the devolution of testosterone assays from the SAS, the Analytical Methods Working Party of the Association of Clinical Biochemists set up a working party to investigate the performance of the assays, to survey the available methodology and to give guidance on the factors that influence the assay. This document represents a summary of the deliberations of the group and forms one of a series of similar reports.