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Haider SH, Irfan A, Sheikh SM, Abid MT, Naz T, Abbas M, Raza A. Evaluating the impact of testosterone replacement therapy on carotid atherosclerosis: a systematic review and meta-analysis. Future Sci OA 2024; 10:2365125. [PMID: 39183456 DOI: 10.1080/20565623.2024.2365125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 06/04/2024] [Indexed: 08/27/2024] Open
Abstract
Aim: This meta-analysis investigates the association between testosterone replacement therapy [TRT] and carotid artery atherosclerosis. Methods: 3 databases were searched for studies up to June 2023 per the PRISMA guidelines. The eligibility criteria comprised RCTs and observational studies involving hypogonadal males receiving exogenous testosterone, in which CIMT was assessed. CAA was the primary outcome, whereas secondary outcomes included HDL, LDL, CRP, total cholesterol and total testosterone. The statistical analysis was performed using Review Manager. Results: Statistical analysis revealed no association between TRT and assessed outcomes. There was a significant increase in total testosterone levels, depicting indirect anti-atherosclerotic effects of TRT. Conclusion: Meta-analysis shows no relation between TRT and CIMT or other markers, allowing its safe usage for hypogonadal males.
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Affiliation(s)
- Syed Hamza Haider
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
| | - Areeka Irfan
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
| | - Samir Mustafa Sheikh
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
| | - Muhammad Taha Abid
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
| | - Turba Naz
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
| | - Mudassir Abbas
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
| | - Alishba Raza
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, V246+X8C, Mission Rd, Nanakwara, 74200, Karachi, Pakistan
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De Silva NL, Papanikolaou N, Grossmann M, Antonio L, Quinton R, Anawalt BD, Jayasena CN. Male hypogonadism: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00199-2. [PMID: 39159641 DOI: 10.1016/s2213-8587(24)00199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 08/21/2024]
Abstract
Organic male hypogonadism due to irreversible hypothalamic-pituitary-testicular (HPT) pathology is easily diagnosed and treated with testosterone-replacement therapy. However, controversy surrounds the global practice of prescribing testosterone to symptomatic men with low testosterone and non-gonadal factors reducing health status, such as obesity, type 2 diabetes, and ageing (ie, functional hypogonadism), but without identifiable HPT axis pathology. Health optimisation remains the gold-standard management strategy. Nevertheless, in the last decade large clinical trials and an individual patient data meta-analysis of smaller clinical trials confirmed that testosterone therapy induces modest, yet statistically significant, improvements in sexual function without increasing short-term to medium-term cardiovascular or prostate cancer risks in men with functional hypogonadism. Although testosterone improves bone mineral density and insulin sensitivity in these men, trials from the last decade suggest insufficient evidence to determine the safety and effectiveness of use of this hormone for the prevention of fractures or type 2 diabetes. This Review discusses the pathogenesis and diagnosis of male hypogonadism and appraises the evidence underpinning the management of this condition.
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Affiliation(s)
- Nipun Lakshitha De Silva
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Nikoleta Papanikolaou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Leen Antonio
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Richard Quinton
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Northern Regional Gender Dysphoria Service, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Bradley David Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Channa N Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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Mei Y, Ji N, Zhang B, Xia W, Feng X, Xu R, Xue D. Association between life's essential 8 and testosterone deficiency in US men: findings from national health and nutrition examination survey (NHANES) 2011-2016. Front Endocrinol (Lausanne) 2024; 15:1395576. [PMID: 38978622 PMCID: PMC11228159 DOI: 10.3389/fendo.2024.1395576] [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: 03/04/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Background Testosterone deficiency (TD) is closely associated with cardiovascular diseases (CVD). We intended to explore the association of Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health, with the prevalence of TD among US male adults. Methods The population-based cross-sectional study selected male adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. According to the American Heart Association definitions, the LE8 score was measured on a scale of 0-100, and divided into health behavior and health factor scores, simultaneously. Furthermore, these scores were categorized into low (0-49), moderate (50-79), and high (80-100) classifications. TD is defined as a total testosterone level below 300ng/dL. Correlations were investigated by weighted multivariable logistic regression, and the robustness of the results were verified by subgroup analysis. Results A total of 4971 male adults with an average age of 47.46 ± 0.41 years were eligible for the final analyses, of whom 1372 were determined to have TD. The weighted mean LE8 score of the study population was 68.11 ± 0.41. After fully adjusting potential confounders, higher LE8 scores were significantly associated with low risk of TD (odd ratio [OR] for each 10-point increase, 0.79; 95% CI, 0.71-0.88) in a linear dose-response relationship. Similar patterns were also identified in the association of health factor scores with TD (OR for each 10-point increase, 0.74; 95% CI, 0.66-0.83). These results persisted when LE8 and health factor scores was categorized into low, moderate, and high groups. The inversed association of LE8 classifications and TD remained statistically significant among older, obese, and men without CVD. Conclusions LE8 and its health factor subscales scores were negatively associated with the presence of TD in linear fashions. Promoting adherence to optimal cardiovascular health levels may be advantageous to alleviate the burden of TD.
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Affiliation(s)
- Yangyang Mei
- Department of Urology, Jiangyin People’s Hospital of Jiangsu Province, Jiangyin, Jiangsu, China
| | - Nuo Ji
- Department of Urology, The Third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Bo Zhang
- Department of Urology, The Third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Wei Xia
- Department of Urology, The Third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, China
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Arcand MA, Poulin D, Testa EJ, Lemme NJ. Testosterone: A Review for Orthopaedic Surgeons. JBJS Rev 2024; 12:01874474-202406000-00005. [PMID: 38889232 DOI: 10.2106/jbjs.rvw.24.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
» Testosterone replacement treatment (TRT) and anabolic androgenic steroid (AAS) use is common and possibly increasing.» Diagnosing and treating hypogonadism in men is controversial.» Hypogonadism and the use of AASs seem to have a detrimental effect on the musculoskeletal system. The current literature on TRT and the musculoskeletal system shows an increased risk of tendon injury.» There may be a role for testosterone supplementation in the postoperative period.
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Affiliation(s)
- Michel A Arcand
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
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Krishnan S, Aldana-Bitar J, Golub I, Ichikawa K, Shabir A, Bagheri M, Hamidi H, Benzing T, Kianoush S, Budoff MJ. Testosterone therapy and the risk of cardiovascular disease in older, hypogonadal men. Prog Cardiovasc Dis 2024; 84:14-18. [PMID: 38423237 DOI: 10.1016/j.pcad.2024.02.015] [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: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the context of aging, obesity, and endogenous sex hormones on CV disease (CVD) risk to support informed clinical decision-making. Observational studies have variably linked low endogenous testosterone with increased CVD risk, while randomized controlled trials (RCTs) demonstrate that TT yields cardiometabolic benefits without increasing short-term CV risk. The TRAVERSE trial, as the first RCT powered to assess CVD events, did not show increased major adverse cardiac events (MACE) incidence; however, its limitations - specifically the maintenance of testosterone at low-normal levels, a high participant discontinuation rate, and short follow-up - warrant a careful interpretation of its results. Furthermore, findings from the TTrials cardiovascular sub-study, which showed an increase in non-calcified plaque, indicate the need for ongoing research into the long-term CV impact of TT. The decision to initiate TT should consider the current evidence gaps, particularly for older men with known CVD. The CV effects of maintaining physiological testosterone levels through exogenous means remain to be fully explored. Until more definitive evidence is available, clinical practice should prioritize individualized care and informed discussions on the potential CV implications of TT.
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Affiliation(s)
- Srikanth Krishnan
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502.
| | - Jairo Aldana-Bitar
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Ilana Golub
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502; David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Keishi Ichikawa
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Ayesha Shabir
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Marziyeh Bagheri
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Hossein Hamidi
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Travis Benzing
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Sina Kianoush
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502
| | - Matthew J Budoff
- The Lundquist Institute at Harbor-UCLA, 1124 W Carson St, Torrance, CA 90502.
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Tabberer M, Williamson N, Tatlock S, Gater A, Grimes R, Akinseye C, Neil D, Mahon-Smith A, Nelsen L. Qualitative interviews of patients with COPD and muscle weakness enrolled in a clinical trial evaluating a new anabolic treatment: patient perspectives of disease experience, trial participation and outcome assessments. J Patient Rep Outcomes 2024; 8:45. [PMID: 38641716 PMCID: PMC11031513 DOI: 10.1186/s41687-024-00712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and muscle weakness can cause impaired physical function, significantly impacting patients' health-related quality of life (HRQoL). Loss of muscle strength is usually assessed through clinical and performance outcome (PerfO) assessments, which consists of tasks performed in a standardized manner, providing evidence of a patient's functional ability. However, evidence documenting the patient experience of COPD and muscle weakness is limited. METHODS This two-stage qualitative study used semi-structured interviews in patients aged 45-80 years with COPD (post-bronchodilator forced expiratory volume in 1s [FEV1]/forced vital capacity ratio < 0.70, and FEV1% predicted of 30-80%) and muscle weakness. In Stage 1, 30-minute concept elicitation interviews were conducted with participants recruited across three US sites to explore impacts on physical functioning and activities of daily living. In Stage 2, interviews were performed with participants exiting a Phase IIa trial investigating the efficacy of a selective androgen receptor modulator (GSK2881078) on leg strength, whereby PerfOs were used to evaluate strength and physical functioning endpoints. These participants completed either 60-minute in-depth (n = 32) or 15-minute confirmatory (n = 35) interviews exploring trial experience, completion of outcome measures, disease experience and treatment satisfaction. RESULTS In Stage 1 (n = 20), most participants described their muscles as weak (83.3%). Difficulties with walking (100%) and lifting heavy objects (90%) were reported. In Stage 2, 60-minute interviews, all participants (n = 32) reported a positive trial experience. Most participants reported that the home exercise program was easy to fit into daily life (77.8%), the PROactive daily diary was easy to complete (100%) and wearable sensors were easy to use (65.6%). However, technical issues were reported (71%), and few participants (19.4%) found physical assessments easy to complete. Improvements in muscle strength and functional limitations were reported by most participants. The shorter 15-minute confirmatory interviews (n = 35) supported the in-depth interview results. CONCLUSION The qualitative interviews generated in-depth evidence of key concepts relevant to patients with COPD and muscle weakness and support the assessments of patient strength and physical function as outcome measures in this population in future studies. TRIAL NUMBER GSK Stage 1: 206869; Stage 2: 200182, NCT03359473; Registered December 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03359473 .
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Affiliation(s)
| | | | | | - Adam Gater
- PCO, Adelphi Values Ltd, Bollington, Cheshire, UK
| | | | | | - David Neil
- GSK R&D, 1250 S Collegeville Road, 19426, Collegeville, PA, USA
| | | | - Linda Nelsen
- GSK R&D, 1250 S Collegeville Road, 19426, Collegeville, PA, USA.
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Cannarella R, Gusmano C, Leanza C, Garofalo V, Crafa A, Barbagallo F, Condorelli RA, Vignera SL, Calogero AE. Testosterone replacement therapy and vascular thromboembolic events: a systematic review and meta-analysis. Asian J Androl 2024; 26:144-154. [PMID: 37921515 PMCID: PMC10919420 DOI: 10.4103/aja202352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/15/2023] [Indexed: 11/04/2023] Open
Abstract
To evaluate the relationship between testosterone replacement therapy (TRT) and arterial and/or venous thrombosis in patients with pre-treatment total testosterone (TT) <12 nmol l -1 , we performed a meta-analysis following the Population Intervention Comparison Outcome model. Population: men with TT <12 nmol l -1 or clear mention of hypogonadism in the inclusion criteria of patients; intervention: TRT; comparison: placebo or no therapy; outcomes: arterial thrombotic events (stroke, myocardial infarction [MI], upper limbs, and lower limbs), VTE (deep vein thrombosis [DVT], portal vein thrombosis, splenic thrombosis, and pulmonary embolism), and mortality. A total of 2423 abstracts were assessed for eligibility. Twenty-four studies, including 14 randomized controlled trials (RCTs), were finally included, with a total of 4027 and 310 288 hypotestosteronemic male patients, from RCTs and from observational studies, respectively. Based on RCT-derived data, TRT did not influence the risk of arterial thrombosis (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 0.47-3.43, P = 0.64), stroke (OR = 1.34, 95% CI: 0.09-18.97, P = 0.83), MI (OR = 0.51, 95% CI: 0.11-2.31, P = 0.39), VTE (OR = 1.42, 95% CI: 0.22-9.03, P = 0.71), pulmonary embolism (OR = 1.38, 95% CI: 0.27-7.04, P = 0.70), and mortality (OR = 0.70, 95% CI: 0.20-2.38, P = 0.56). Meanwhile, when only observational studies are considered, a significant reduction in the risk of developing arterial thrombotic events, MI, venous thromboembolism, and mortality was observed. The risk for DVT remains uncertain, due to the paucity of RCT-based data. TRT in men with TT <12 nmol l -1 is safe from the risk of adverse cardiovascular events. Further studies specifically assessing the risk of DVT in men on TRT are needed.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Carmelo Gusmano
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Claudia Leanza
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Vincenzo Garofalo
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
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Kusters CDJ, Paul KC, Lu AT, Ferruci L, Ritz BR, Binder AM, Horvath S. Higher testosterone and testosterone/estradiol ratio in men are associated with decreased Pheno-/GrimAge and DNA-methylation based PAI1. GeroScience 2024; 46:1053-1069. [PMID: 37369886 PMCID: PMC10828310 DOI: 10.1007/s11357-023-00832-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Sex hormones are hypothesized to drive sex-specific health disparities. Here, we study the association between sex steroid hormones and DNA methylation-based (DNAm) biomarkers of age and mortality risk including Pheno Age Acceleration (AA), Grim AA, and DNAm-based estimators of Plasminogen Activator Inhibitor 1 (PAI1), and leptin concentrations. We pooled data from three population-based cohorts, the Framingham Heart Study Offspring Cohort, the Baltimore Longitudinal Study of Aging, and the InCHIANTI Study, including 1,062 postmenopausal women without hormone therapy and 1,612 men of European descent. Sex-stratified analyses using a linear mixed regression were performed, with a Benjamini-Hochberg (BH) adjustment for multiple testing. Sex Hormone Binding Globulin (SHBG) was associated with a decrease in DNAm PAI1 among men (per 1 standard deviation (SD): -478 pg/mL; 95%CI: -614 to -343; P:1e-11; BH-P: 1e-10), and women (-434 pg/mL; 95%CI: -589 to -279; P:1e-7; BH-P:2e-6). The testosterone/estradiol (TE) ratio was associated with a decrease in Pheno AA (-0.41 years; 95%CI: -0.70 to -0.12; P:0.01; BH-P: 0.04), and DNAm PAI1 (-351 pg/mL; 95%CI: -486 to -217; P:4e-7; BH-P:3e-6) among men. In men, testosterone was associated with a decrease in DNAm PAI1 (-481 pg/mL; 95%CI: -613 to -349; P:2e-12; BH-P:6e-11). SHBG was associated with lower DNAm PAI1 among men and women. Higher testosterone and testosterone/estradiol ratio were associated with lower DNAm PAI and a younger epigenetic age in men. A decrease in DNAm PAI1 is associated with lower mortality and morbidity risk indicating a potential protective effect of testosterone on lifespan and conceivably cardiovascular health via DNAm PAI1.
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Affiliation(s)
- Cynthia D J Kusters
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
- Department of Epidemiology, Fielding School of Public Health at UCLA, Box 708822, 650 Charles E. Young Drive South, CA, 90095-7088, Los Angeles, USA.
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ake T Lu
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
- Altos Labs, San Diego, USA
| | - Luigi Ferruci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute On Aging, National Institutes of Health, Baltimore, USA
| | - Beate R Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Environmental Health, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alexandra M Binder
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
- Altos Labs, San Diego, USA
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Chrysavgis L, Adamantou M, Angelousi A, Cholongitas E. The association of testosterone with sarcopenia and frailty in chronic liver disease. Eur J Clin Invest 2024; 54:e14108. [PMID: 37837304 DOI: 10.1111/eci.14108] [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: 06/19/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Testosterone is an important anabolic hormone responsible for maintaining body composition and muscle mass and circulates mostly albumin-bound, or sex hormone binding globulin (SHBG)-bound or free in the plasma. Of these fractions, the latter is bioactive and exerts the androgenic effects on male population. Liver cirrhosis, the advanced stage of any chronic liver disease characterized by permanent distortions to the hepatic architecture, disrupts the hypothalamic-pituitary-gonadal axis, leading to diminished levels of free testosterone and hypogonadism. METHODS We retrieved the PubMed database to provide a synopsis of testosterone's physiology and action and summarize the effect of sarcopenia in pre-cirrhotic and cirrhotic patients. Moreover, we scoped to provide insight into the relationship of testosterone levels with sarcopenia, frailty and survival in cirrhotic and non-cirrhotic population as well as to discuss the efficacy of exogenous testosterone supplementation on the anthropometric parameters and survival of those patients. RESULTS Low testosterone levels have been associated with sarcopenia, reduced body lean mass, decreased bone mineral density and frailty, thus leading to increased morbidity and mortality especially among cirrhotic patients. Furthermore, exogenous testosterone administration significantly ameliorated body composition on patients with chronic hepatic disease, without significant adverse effects. However, the current literature does not suggest any significant effect on survival of those patients. Moreover, the long-term safety of testosterone use remains an open question. CONCLUSION Low serum testosterone is strongly correlated with sarcopenia, frailty, higher rate of hepatic decompensation and mortality. Nonetheless, exogenous supplementation of testosterone did not ameliorate the liver-related outcomes and complications.
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Affiliation(s)
- Lampros Chrysavgis
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Magdalini Adamantou
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Anna Angelousi
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
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10
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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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Handelsman DJ, Grossmann M, Yeap BB, Stuckey BGA, Shankara-Narayana N, Conway AJ, Inder WJ, McLachlan RI, Allan C, Jenkins AJ, Jesudason D, Bracken K, Wittert GA. Long-term Outcomes of Testosterone Treatment in Men: A T4DM Postrandomization Observational Follow-up Study. J Clin Endocrinol Metab 2023; 109:e25-e31. [PMID: 37623257 DOI: 10.1210/clinem/dgad485] [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: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT The T4DM study randomized 1007 men with impaired glucose tolerance or newly diagnosed diabetes to testosterone undecanoate (TU, 1000 mg) or matching placebo (P) injections every 12 weeks for 24 months with a lifestyle program with testosterone (T) treatment reducing diabetes diagnosis by 40%. BACKGROUND The long-term effects on new diagnosis of diabetes, cardiovascular and prostate disease, sleep apnea, weight maintenance trajectory and androgen dependence were not yet described. METHODS A follow-up email survey after a median of 5.1 years since last injection obtained 599 (59%) completed surveys (316 T, 283 P), with participants in the follow-up survey compared with nonparticipants in 23 anthropometric and demographic variables. RESULTS Randomization to was TU associated with stronger belief in study benefits during (64% vs 49%, P < .001) but not after the study (44% vs 40%, P = .07); there is high interest in future studies. At T4DM entry, 25% had sleep apnea with a new diagnosis more frequent on TU (3.0% vs 0.4%, P = .03) during, but not after, the study. Poststudy, resuming prescribed T treatment was more frequent among TU-treated men (6% vs 2.8%, P = .03). Five years after cessation of TU treatment there was no difference in self-reported rates of new diagnosis of diabetes, and prostate or cardiovascular disease, nor change in weight maintenance or weight loss behaviors. CONCLUSION We conclude that randomized T treatment for 24 months in men with impaired glucose tolerance or new diabetes but without pathological hypogonadism was associated with higher levels of self-reported benefits and diagnosis of sleep apnea during, but not after, the study as well as more frequent prescribed poststudy T treatment consistent with androgen dependence in some men receiving prolonged injectable TU.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Mathis Grossmann
- Department of Medicine Austin Health, The University of Melbourne and Department of Endocrinology, Austin Health, Heidelberg, VIC 3084, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA 6150, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Nandini Shankara-Narayana
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, and PA-Southside Clinical Unit, Medical School, the University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Alicia J Jenkins
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Karen Bracken
- Kolling Institute, University of Sydney, Sydney, NSW 2064, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA 506, Australia
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12
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Kanakis GA, Pofi R, Goulis DG, Isidori AM, Armeni E, Erel CT, Fistonić I, Hillard T, Hirschberg AL, Meczekalski B, Mendoza N, Mueck AO, Simoncini T, Stute P, van Dijken D, Rees M, Lambrinoudaki I. EMAS position statement: Testosterone replacement therapy in older men. Maturitas 2023; 178:107854. [PMID: 37845136 DOI: 10.1016/j.maturitas.2023.107854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable. AIM To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12 months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone.
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Affiliation(s)
- George A Kanakis
- Department of Endocrinology & IVF Unit, Athens Naval and Veteran Affairs Hospital, Athens, Greece.
| | - Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece; Royal Free Hospital, London, UK
| | - C Tamer Erel
- İstanbul-Cerrahpaşa University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ivan Fistonić
- Faculty for Health Studies, University of Rijeka, Rijeka, Croatia
| | - Timothy Hillard
- Department of Obstetrics & Gynaecology, University Hospitals Dorset, Poole, UK
| | - Angelica-Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Spain
| | - Alfred O Mueck
- Department of Women's Health, University Hospital Tuebingen, Germany; Beijing OB/GYN Hospital, Capital Medical University, China
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Dorenda van Dijken
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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13
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Siltari A, Murtola TJ, Kausz J, Talala K, Taari K, Tammela TL, Auvinen A. Testosterone replacement therapy is not associated with increased prostate cancer incidence, prostate cancer-specific, or cardiovascular disease-specific mortality in Finnish men. Acta Oncol 2023; 62:1898-1904. [PMID: 37971326 DOI: 10.1080/0284186x.2023.2278189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Concerns have been expressed over the safety of testosterone replacement therapy (TRT) in men with late-onset hypogonadism (LOH). Previous studies have shown controversial results regarding the association of TRT with the risk of cardiovascular events or prostate cancer (PCa) incidence, aggressiveness, and mortality. This study explores the overall risk of PCa and risk by tumor grade and stage, as well as mortality from PCa and cardiovascular disease (CVD), among men treated with TRT compared to men without LOH and TRT use. MATERIALS AND METHODS The study included 78,615 men of age 55-67 years at baseline from the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC). Follow-up started at randomization and ended at death, emigration, or a common closing date January 1st, 2017. Cox proportional hazards regression model with time-dependent variables and adjustment for age, trial arm, use of other medications, and Charlson comorbidity index was used. Comprehensive information on TRT purchases during 1995-2015 was obtained from the Finnish National Prescription Database. PCa cases were identified from the Finnish Cancer Registry and causes of death obtained from Statistics Finland. RESULTS Over the course of 18 years of follow-up, 2919 men were on TRT, and 285 PCa cases were diagnosed among them. TRT users did not exhibit a higher incidence or mortality rate of PCa compared to non-users. On the contrary, men using TRT had lower PCa mortality than non-users (HR = 0.52; 95% CI 0.3-0.91). Additionally, TRT users had slightly lower CVD and all-cause mortality compared to non-users (HR = 0.87; 95% CI 0.75-1.01 and HR = 0.93; 95% CI 0.87-1.0, respectively). No time- or dose-dependency of TRT use was evident in any of the analyses. CONCLUSION Men using TRT were not associated to increased risk for PCa and did not experience increased PCa- or CVD-specific mortality compared to non-users. Further studies considering blood testosterone levels are warranted.
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Affiliation(s)
- Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Faculty of Medicine, Pharmacology, University of Helsinki, Helsinki, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Josefina Kausz
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teuvo Lj Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Tampere University, Faculty of Social Sciences, Tampere, Finland
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Lopez DS, Mulla JS, El Haddad D, Tahashilder MI, Polychronopolou E, Baillargeon J, Kuo YF, Gilani S, Khalife WI. Testosterone Replacement Therapy in Relation With Cardiovascular Disease in Cisgender Women and Transgender People. J Clin Endocrinol Metab 2023; 108:e1515-e1523. [PMID: 37392459 PMCID: PMC10655536 DOI: 10.1210/clinem/dgad388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
AIMS This study aimed to investigate the association of testosterone replacement therapy (TTh) with risk of cardiovascular disease (CVD), and CVD-specific outcomes, in cisgender women and transgender population, and to determine whether this association varies by menopausal status. METHODS In 25 796 cisgender women and 1580 transgender people (≥30 years old) who were enrolled in the Optum's deidentified Clinformatics Data Mart Database (2007-2021), we identified 6288 pre- and postmenopausal cisgender women and 262 transgender people diagnosed with incident composite of CVD (coronary artery disease [CAD], congestive heart failure, stroke, and myocardial infarction). Prediagnostic prescription of TTh was ascertained for this analysis. Multivariable adjusted Cox proportional hazards models were used to examine the independent association of TTh with incident CVD. RESULTS We found a 24% increased risk of CVD (hazard ratio [HR] = 1.24; 95% CI, 1.15-1.34), 26% risk of CAD (HR = 1.26; 95% CI, 1.14-1.39), and a 29% risk of stroke (HR = 1.29; 95% CI, 1.14-1.45) after comparing cisgender women who used TTh with nonusers. Stratification by age group showed similar effects of TTh on CVD, CAD, and stroke. Among transgender people, TTh did not increase the risk of composite CVD, including by age stratification. CONCLUSION Use of TTh increased the risk of CVD, CAD, and stroke among cisgender women but not among transgender people. TTh is becoming more widely accepted in women, and it is the main medical treatment for transgender males. Therefore, use of TTh should be further investigated for the prevention of CVD.
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Affiliation(s)
- David S Lopez
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Juwairia S Mulla
- Division of Cardiology, Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Danielle El Haddad
- Division of Cardiology, Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Md Ibrahim Tahashilder
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Efstathia Polychronopolou
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Jacques Baillargeon
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Yong-Fang Kuo
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Syed Gilani
- Division of Cardiology, Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
| | - Wissam I Khalife
- Division of Cardiology, Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0553, USA
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15
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Trumble BC, Negrey J, Koebele SV, Thompson RC, Samuel Wann L, Allam AH, Beheim B, Linda Sutherland M, Sutherland JD, Eid Rodriguez D, Michalik DE, Rowan CJ, Lombardi GP, Garcia AR, Cummings DK, Seabright E, Alami S, Kraft TS, Hooper P, Buetow K, Irimia A, Gatz M, Stieglitz J, Gurven MD, Kaplan H, Thomas GS. Testosterone is positively associated with coronary artery calcium in a low cardiovascular disease risk population. Evol Med Public Health 2023; 11:472-484. [PMID: 38145005 PMCID: PMC10746324 DOI: 10.1093/emph/eoad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/11/2023] [Indexed: 12/26/2023] Open
Abstract
Background In industrialized populations, low male testosterone is associated with higher rates of cardiovascular mortality. However, coronary risk factors like obesity impact both testosterone and cardiovascular outcomes. Here, we assess the role of endogenous testosterone on coronary artery calcium in an active subsistence population with relatively low testosterone levels, low cardiovascular risk and low coronary artery calcium scores. Methodology In this cross-sectional community-based study, 719 Tsimane forager-horticulturalists in the Bolivian Amazon aged 40+ years underwent computed tomography (49.8% male, mean age 57.6 years). Results Coronary artery calcium levels were low; 84.5% had no coronary artery calcium. Zero-inflated negative binomial models found testosterone was positively associated with coronary artery calcium for the full sample (Incidence Rate Ratio [IRR] = 1.477, 95% Confidence Interval [CI] 1.001-2.170, P = 0.031), and in a male-only subset (IRR = 1.532, 95% CI 0.993-2.360, P = 0.053). Testosterone was also positively associated with clinically relevant coronary atherosclerosis (calcium >100 Agatston units) in the full sample (Odds Ratio [OR] = 1.984, 95% CI 1.202-3.275, P = 0.007) and when limited to male-only sample (OR = 2.032, 95% CI 1.118-4.816, P = 0.024). Individuals with coronary artery calcium >100 had 20% higher levels of testosterone than those with calcium <100 (t = -3.201, P = 0.007). Conclusions and Implications Among Tsimane, testosterone is positively associated with coronary artery calcium despite generally low normal testosterone levels, minimal atherosclerosis and rare cardiovascular disease (CVD) events. Associations between low testosterone and CVD events in industrialized populations are likely confounded by obesity and other lifestyle factors.
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Affiliation(s)
- Benjamin C Trumble
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Jacob Negrey
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Stephanie V Koebele
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Randall C Thompson
- Saint Luke’s Mid America Heart Institute, Department of Cardiology, Kansas City, MO, USA
| | - L Samuel Wann
- University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Adel H Allam
- Al Azhar University, School of Medicine, Cairo, Egypt
| | - Bret Beheim
- Max Planck Institute for Evolutionary Anthropology, Department of Human Behavior, Ecology and Culture, Leipzig, Germany
| | | | | | | | - David E Michalik
- University of California Irvine, School of Medicine, Irvine, CA, USA
- Miller Women’s and Children’s Hospital Long Beach, CA, USA
| | | | - Guido P Lombardi
- Universidad Peruana Cayetano Heredia, Laboratorio de Paleopatología, Lima, Peru
| | - Angela R Garcia
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | | | - Edmond Seabright
- Mohammed VI Polytechnic University, School of Collective Intelligence, Ben Guerir, Morocco
| | - Sarah Alami
- Mohammed VI Polytechnic University, School of Collective Intelligence, Ben Guerir, Morocco
| | - Thomas S Kraft
- University of Utah, Anthropology Department, Salt Lake City, UT, USA
| | - Paul Hooper
- Chapman University, Economic Science Institute, Orange, CA, USA
| | - Kenneth Buetow
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Tempe, AZ, USA
| | - Andrei Irimia
- University of Southern California, Psychology Department, Los Angeles, CA, USA
| | - Margaret Gatz
- University of Southern California, Psychology Department, Los Angeles, CA, USA
| | - Jonathan Stieglitz
- Toulouse Scool of Economics, Institute for Advanced Study Toulouse, Toulouse, France
| | - Michael D Gurven
- University of California Santa Barbara, Department of Anthropology, Santa Barbara, CA, USA
| | - Hillard Kaplan
- Chapman University, Economic Science Institute, Orange, CA, USA
| | - Gregory S Thomas
- MemorialCare Health System, Fountain Valley, CA, USA
- University of California Irvine, Division of Cardiology, Orange, CA, USA
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16
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Blackwell K, Blackwell M, Blackwell T. Testosterone Replacement Therapy and Cardiovascular Disease: Balancing Safety and Risks in Hypogonadal Men. Curr Cardiol Rep 2023; 25:1157-1163. [PMID: 37733143 DOI: 10.1007/s11886-023-01935-1] [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] [Accepted: 08/03/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW: The purpose of this review is to analyze the link between testosterone replacement therapy (TRT) and adverse cardiovascular (CV) events. RECENT FINDINGS: A few published studies suggest a link between TRT and CV events. These studies contained flaws, and many other studies reveal a reduction in CV events. Hypogonadism is associated with increased mortality in men with CVD. TRT in hypogonadal men can improve many CVD risk factors, reduce QT interval prolongation, lead to better outcomes in heart failure patients, and slow the progression of atherosclerosis. The use of TRT to achieve physiologic testosterone concentrations in men does not pose a threat to CV health and has demonstrated a cardioprotective effect.
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Affiliation(s)
- Kelli Blackwell
- UTMB 301 University Blvd, Rebecca Sealy Bldg 5.138, Galveston, TX, 77554, USA
| | - Michele Blackwell
- UTMB 301 University Blvd, Rebecca Sealy Bldg 5.138, Galveston, TX, 77554, USA
| | - Thomas Blackwell
- UTMB 301 University Blvd, Rebecca Sealy Bldg 5.138, Galveston, TX, 77554, USA.
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17
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Traish AM. Major cardiovascular disease risk in men with testosterone deficiency (hypogonadism): appraisal of short, medium and long-term testosterone therapy - a narrative review. Sex Med Rev 2023; 11:384-394. [PMID: 37587664 DOI: 10.1093/sxmrev/qead031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Low testosterone (T) levels are associated with obesity, metabolic syndrome, type 2 diabetes mellitus and altered lipid profiles, thus contributing to increased cardiovascular disease risk. Hence T deficiency has a detrimental effect on men's vascular health, quality of life and increased mortality. OBJECTIVES This review aims to present summary of data in the contemporary clinical literature pertaining to the benefits of T therapy in clinical studies with varying durations on vascular health in men with T deficiency. METHODS A Medline search using PubMed and EMBASE was performed using the following key words: "testosterone deficiency," "testosterone therapy," major cardiovascular adverse events", "cardiovascular disease". Relevant studies were extracted, evaluated, and analyzed. We evaluated findings from clinical trials, observational studies and systematic reviews and meta-analyses to develop a comprehensive account of the critical role of T in maintaining vascular health. RESULTS Considerable evidence beginning with studies published in 1940s concomitant with findings from the utmost recent clinical studies suggests a clinical value of T therapy in maintaining vascular health and reducing cardiovascular mortality. The current scientific and clinical evidence demonstrates strong relationship between low circulating T levels and risk of cardiovascular disease and T therapy is deemed safe in men with hypogonadism when given in the physiological range with no apparent harm. CONCLUSION What emerges from the current clinical literature is that, irrespective of the length of study durations, testosterone therapy provides significant health benefits and reduces risk of cardiovascular disease. More important is that data from many observational and registry studies, demonstrated that longer durations of testosterone therapy were associated with greater health benefits and reduced cardiovascular risk. T therapy in men with T deficiency reduces the incidence of major adverse cardiovascular events attributed to improving overall metabolic function.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Biochemistry & Department of Urology, Boston University School of Medicine, Boston, MA 02118, United States
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Peters SAE, Woodward M. A roadmap for sex- and gender-disaggregated health research. BMC Med 2023; 21:354. [PMID: 37704983 PMCID: PMC10500779 DOI: 10.1186/s12916-023-03060-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Sex and gender are fundamental aspects of health and wellbeing. Yet many research studies fail to consider sex or gender differences, and even when they do this is often limited to merely cataloguing such differences in the makeup of study populations. The evidence on sex and gender differences is thus incomplete in most areas of medicine. This article presents a roadmap for the systematic conduct of sex- and gender-disaggregated health research. We distinguish three phases: the exploration of sex and gender differences in disease risk, presentation, diagnosis, treatment, and outcomes; explaining any found differences by revealing the underlying mechanisms; and translation of the implications of such differences to policy and practice. For each phase, we provide critical methodological considerations and practical examples are provided, taken primarily from the field of cardiovascular disease. We also discuss key overarching themes and terminology that are at the essence of any study evaluating the relevance of sex and gender in health. Here, we limit ourselves to binary sex and gender in order to produce a coherent, succinct narrative. Further disaggregation by sex and gender separately and which recognises intersex, non-binary, and gender-diverse identities, as well as other aspects of intersectionality, can build on this basic minimum level of disaggregation. We envision that uptake of this roadmap, together with wider policy and educational activities, will aid researchers to systematically explore and explain relevant sex and gender differences in health and will aid educators, clinicians, and policymakers to translate the outcomes of research in the most effective and meaningful way, for the benefit of all.
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Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK.
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Mark Woodward
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Buratto J, Kirk B, Phu S, Vogrin S, Duque G. Safety and Efficacy of Testosterone Therapy on Musculoskeletal Health and Clinical Outcomes in Men: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Endocr Pract 2023; 29:727-734. [PMID: 37164187 DOI: 10.1016/j.eprac.2023.04.013] [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: 03/16/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Age-related declines in muscle and bone, alongside a shift toward greater adiposity, contribute to falls and fracture risk. Testosterone is osteogenic, myogenic, and catabolic to fat. As such, we examined the effects of testosterone therapy on musculoskeletal health and clinical outcomes in men. METHODS Electronic databases (Medline, Embase, Web of Science, Central) were systematically searched for randomized controlled trials (RCTs) reporting on the effects of testosterone therapy versus placebo on any primary outcome (bone density, muscle mass, fat mass, muscle strength/physical performance) or secondary outcome (falls, fractures, disability, adverse events) in men (≥18 years). A random effects meta-regression examined the effects of testosterone on prespecified outcomes. RESULTS One thousand seven hundred twenty-eight men across 16 RCTs were included (mean age: 77.1 ± 7.6 years). Baseline mean serum testosterone ranged from 7.5 ± 0.3 to 18.9 ± 1.2 nmol/L. Compared to placebo, 6 months of testosterone therapy increased hip bone density and total lean mass, but effects for handgrip and total fat mass did not reach statistical significance. No significant effects of testosterone therapy on musculoskeletal outcomes were evident at 12 months. The limited number of RCTs reporting on adverse events/clinical outcomes, and the low incidence of these events across RCTs, prohibited statistical comparisons. CONCLUSION After 6 months, testosterone effectively increases hip bone density and total lean mass in men, but its effects are unclear for lumbar spine bone density and handgrip strength. Further, RCTs are needed to clarify the safety and efficacy of testosterone on musculoskeletal health and clinical outcomes.
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Affiliation(s)
- Jared Buratto
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Steven Phu
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sara Vogrin
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Gustavo Duque
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
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Lau L, Wiebe N, Ramesh S, Ahmed S, Klarenbach SW, Carrero JJ, Stenvinkel P, Thorand B, Senior P, Tonelli M, Bello A. Prospective Study of Associations Between Testosterone, Mortality, and Health Outcomes Among Adults Undergoing Hemodialysis. Kidney Int Rep 2023; 8:1875-1878. [PMID: 37705912 PMCID: PMC10496014 DOI: 10.1016/j.ekir.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Lina Lau
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians Universität (LMU), München, Germany
- International Helmholtz Research School for Diabetes, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sharanya Ramesh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia Ahmed
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott W. Klarenbach
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians Universität (LMU), München, Germany
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden
| | - Peter Stenvinkel
- Renal unit, Department of Clinical Sciences and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site München-Neuherberg, Neuherberg, Germany
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aminu Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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21
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Green DJ, Chasland LC, Naylor LH, Yeap BB. New Horizons: Testosterone or Exercise for Cardiometabolic Health in Older Men. J Clin Endocrinol Metab 2023; 108:2141-2153. [PMID: 36964918 PMCID: PMC10438896 DOI: 10.1210/clinem/dgad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
Middle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.
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Affiliation(s)
- Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
| | - Lauren C Chasland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, 6150, Australia
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, 6150, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia, Perth, WA, 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, 6150, Australia
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Jeon S, Lee YS, Oh SR, Jeong J, Lee DH, So KH, Hwang NS. Recent advances in endocrine organoids for therapeutic application. Adv Drug Deliv Rev 2023; 199:114959. [PMID: 37301512 DOI: 10.1016/j.addr.2023.114959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
The endocrine system, consisting of the hypothalamus, pituitary, endocrine glands, and hormones, plays a critical role in hormone metabolic interactions. The complexity of the endocrine system is a significant obstacle to understanding and treating endocrine disorders. Notably, advances in endocrine organoid generation allow a deeper understanding of the endocrine system by providing better comprehension of molecular mechanisms of pathogenesis. Here, we highlight recent advances in endocrine organoids for a wide range of therapeutic applications, from cell transplantation therapy to drug toxicity screening, combined with development in stem cell differentiation and gene editing technologies. In particular, we provide insights into the transplantation of endocrine organoids to reverse endocrine dysfunctions and progress in developing strategies for better engraftments. We also discuss the gap between preclinical and clinical research. Finally, we provide future perspectives for research on endocrine organoids for the development of more effective treatments for endocrine disorders.
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Affiliation(s)
- Suwan Jeon
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea
| | - Young-Sun Lee
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seh Ri Oh
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jinseong Jeong
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dong-Hyun Lee
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyoung-Ha So
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea; Bio-MAX/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul 08826, Republic of Korea.
| | - Nathaniel S Hwang
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea; Bio-MAX/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul 08826, Republic of Korea; Institute of Engineering Research, Seoul National University, Seoul, 08826, Republic of Korea.
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Schooling CM, Au Yeung SL, Kwok MK, Leung GM. Breastfeeding and ApoB in late adolescence: a Hong Kong birth cohort study. Eur J Pediatr 2023; 182:3733-3741. [PMID: 37289232 DOI: 10.1007/s00431-023-05033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
Breastfeeding is widely promoted. Experimental evidence concerning long-term benefits is limited. Observational studies are open to bias from confounding by socio-economic position. We assessed the association of breastfeeding with late adolescent lipid sub-fractions, particularly apolipoprotein B (ApoB) and non-high-density lipoprotein cholesterol (non-HDL-c), overall and by sex. We took advantage of a setting where breastfeeding has little association with higher socio-economic position and where several results from randomized controlled trials of breastfeeding promotion have been replicated. We used the population-representative "Children of 1997" birth cohort comprising 88% of births in Hong Kong in April and May 1997. Associations of breastfeeding in the first 3 months of life (never, mixed, exclusive) with lipid sub-fractions were obtained using linear regression adjusted for potential confounders including parental socio-economic position, maternal place of birth, type of delivery, gestational age, and birth weight. Differences by sex were assessed. Multiple imputation and inverse probability weighting were used to recover the original sample. Of the 3462 participants included, mean age was 17.6 years and 48.8% were girls. Mean ApoB was 0.74 g/L (standard deviation 0.15). Exclusive versus never breastfeeding was associated with lower ApoB (-0.027 g/L, 95% confidence interval (CI)-0.046 to-0.007, p = 0.007) and lower non-HDL-c (-0.143 mmol/L, 95% CI-0.237 to-0.048) with similar estimates by sex. CONCLUSION Breastfeeding may provide some population-level lifelong protection against cardiovascular disease. This study supports policies promoting breastfeeding as a modifiable exposure that contributes to a healthy start in life as an investment for lifelong cardiovascular disease prevention. WHAT IS KNOWN • Apolipoprotein B (ApoB) is a recognized risk factor for cardiovascular disease, but whether breastfeeding affects ApoB in later life overall and by sex is unknown. WHAT IS NEW • Exclusive breastfeeding in the first 3 months of life was associated with lower ApoB in late adolescence, with similar estimates for both sexes. • The inverse association of breastfeeding with ApoB suggests that breastfeeding could reduce cardiovascular disease and overall mortality over the lifespan.
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Affiliation(s)
- C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
- CUNY School of Public Health, 55 West 125Th St, 10027, New York, NY, USA
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
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Kusters CDJ, Paul KC, Lu AT, Ferrucci L, Ritz BR, Binder AM, Horvath S. Higher testosterone and testosterone/estradiol ratio in men are associated with better epigenetic estimators of mortality risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.16.23285997. [PMID: 36865294 PMCID: PMC9980235 DOI: 10.1101/2023.02.16.23285997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Introduction Sex hormones are hypothesized to drive sex-specific health disparities. Here, we study the association between sex steroid hormones and DNA methylation-based (DNAm) biomarkers of age and mortality risk including Pheno Age Acceleration (AA), Grim AA, and DNAm-based estimators of Plasminogen Activator Inhibitor 1 (PAI1), and leptin concentrations. Methods We pooled data from three population-based cohorts, the Framingham Heart Study Offspring Cohort (FHS), the Baltimore Longitudinal Study of Aging (BLSA), and the InCHIANTI Study, including 1,062 postmenopausal women without hormone therapy and 1,612 men of European descent. Sex hormone concentrations were standardized with mean 0 and standard deviation of 1, for each study and sex separately. Sex-stratified analyses using a linear mixed regression were performed, with a Benjamini-Hochberg (BH) adjustment for multiple testing. Sensitivity analysis was performed excluding the previously used training-set for the development of Pheno and Grim age. Results Sex Hormone Binding Globulin (SHBG) is associated with a decrease in DNAm PAI1 among men (per 1 standard deviation (SD): -478 pg/mL; 95%CI: -614 to -343; P:1e-11; BH-P: 1e-10), and women (-434 pg/mL; 95%CI: -589 to -279; P:1e-7; BH-P:2e-6). The testosterone/estradiol (TE) ratio was associated with a decrease in Pheno AA (-0.41 years; 95%CI: -0.70 to -0.12; P:0.01; BH-P: 0.04), and DNAm PAI1 (-351 pg/mL; 95%CI: -486 to -217; P:4e-7; BH-P:3e-6) among men. In men, 1 SD increase in total testosterone was associated with a decrease in DNAm PAI1 (-481 pg/mL; 95%CI: -613 to -349; P:2e-12; BH-P:6e-11). Conclusion SHBG was associated with lower DNAm PAI1 among men and women. Higher testosterone and testosterone/estradiol ratio were associated with lower DNAm PAI and a younger epigenetic age in men. A decrease in DNAm PAI1 is associated with lower mortality and morbidity risk indicating a potential protective effect of testosterone on lifespan and conceivably cardiovascular health via DNAm PAI1.
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Affiliation(s)
- Cynthia DJ Kusters
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ake T Lu
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
- Altos Labs, San Diego, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Beate R Ritz
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Environmental Health, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alexandra M Binder
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
- Altos Labs, San Diego, USA
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
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Cappola AR, Auchus RJ, El-Hajj Fuleihan G, Handelsman DJ, Kalyani RR, McClung M, Stuenkel CA, Thorner MO, Verbalis JG. Hormones and Aging: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1835-1874. [PMID: 37326526 DOI: 10.1210/clinem/dgad225] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Multiple changes occur across various endocrine systems as an individual ages. The understanding of the factors that cause age-related changes and how they should be managed clinically is evolving. This statement reviews the current state of research in the growth hormone, adrenal, ovarian, testicular, and thyroid axes, as well as in osteoporosis, vitamin D deficiency, type 2 diabetes, and water metabolism, with a specific focus on older individuals. Each section describes the natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, key points, and scientific gaps. The goal of this statement is to inform future research that refines prevention and treatment strategies in age-associated endocrine conditions, with the goal of improving the health of older individuals.
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Affiliation(s)
- Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
- Endocrinology and Metabolism Section, Medical Service, LTC Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI 48015, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology, Department of Internal Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Andrology Department, Concord Repatriation General Hospital, Sydney 2139, Australia
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael McClung
- Oregon Osteoporosis Center, Portland, OR 97213, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Cynthia A Stuenkel
- Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, CA 92093, USA
| | - Michael O Thorner
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20057, USA
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Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, Cunningham GR, Granger CB, Khera M, Thompson IM, Wang Q, Wolski K, Davey D, Kalahasti V, Khan N, Miller MG, Snabes MC, Chan A, Dubcenco E, Li X, Yi T, Huang B, Pencina KM, Travison TG, Nissen SE. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med 2023; 389:107-117. [PMID: 37326322 DOI: 10.1056/nejmoa2215025] [Citation(s) in RCA: 88] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND The cardiovascular safety of testosterone-replacement therapy in middle-aged and older men with hypogonadism has not been determined. METHODS In a multicenter, randomized, double-blind, placebo-controlled, noninferiority trial, we enrolled 5246 men 45 to 80 years of age who had preexisting or a high risk of cardiovascular disease and who reported symptoms of hypogonadism and had two fasting testosterone levels of less than 300 ng per deciliter. Patients were randomly assigned to receive daily transdermal 1.62% testosterone gel (dose adjusted to maintain testosterone levels between 350 and 750 ng per deciliter) or placebo gel. The primary cardiovascular safety end point was the first occurrence of any component of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, assessed in a time-to-event analysis. A secondary cardiovascular end point was the first occurrence of any component of the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization, assessed in a time-to-event analysis. Noninferiority required an upper limit of less than 1.5 for the 95% confidence interval of the hazard ratio among patients receiving at least one dose of testosterone or placebo. RESULTS The mean (±SD) duration of treatment was 21.7±14.1 months, and the mean follow-up was 33.0±12.1 months. A primary cardiovascular end-point event occurred in 182 patients (7.0%) in the testosterone group and in 190 patients (7.3%) in the placebo group (hazard ratio, 0.96; 95% confidence interval, 0.78 to 1.17; P<0.001 for noninferiority). Similar findings were observed in sensitivity analyses in which data on events were censored at various times after discontinuation of testosterone or placebo. The incidence of secondary end-point events or of each of the events of the composite primary cardiovascular end point appeared to be similar in the two groups. A higher incidence of atrial fibrillation, of acute kidney injury, and of pulmonary embolism was observed in the testosterone group. CONCLUSIONS In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events. (Funded by AbbVie and others; TRAVERSE ClinicalTrials.gov number, NCT03518034.).
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Affiliation(s)
- A Michael Lincoff
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Shalender Bhasin
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Panagiotis Flevaris
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Lisa M Mitchell
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Shehzad Basaria
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - William E Boden
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Glenn R Cunningham
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Christopher B Granger
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Mohit Khera
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Ian M Thompson
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Qiuqing Wang
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Kathy Wolski
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Deborah Davey
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Vidyasagar Kalahasti
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Nader Khan
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Michael G Miller
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Michael C Snabes
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Anna Chan
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Elena Dubcenco
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Xue Li
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Tingting Yi
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Bidan Huang
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Karol M Pencina
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Thomas G Travison
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Steven E Nissen
- From the Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., L.M.M., Q.W., K.W., D.D., V.K., S.E.N.); the Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School (S. Bhasin, S. Basaria, K.M.P.), Veterans Affairs Boston Healthcare System and Massachusetts Veterans Epidemiology, Research, and Information Center, Boston University School of Medicine (W.E.B.), and Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School (T.G.T.) - all in Boston; AbbVie, North Chicago, IL (P.F., N.K., M.G.M., M.C.S., A.C., E.D., X.L., T.Y., B.H.); Baylor College of Medicine, Houston (G.R.C., M.K.), and CHRISTUS Santa Rosa Health System and the University of Texas Health Science Center, San Antonio (I.M.T.) - all in Texas; and Duke Clinical Research Institute, Durham, NC (C.B.G.)
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Zhao H, Li JM, Li ZR, Zhang Q, Zhong MK, Yan MM, Qiu XY. Major adverse cardiovascular events associated with testosterone treatment: a pharmacovigilance study of the FAERS database. Front Pharmacol 2023; 14:1182113. [PMID: 37502210 PMCID: PMC10370495 DOI: 10.3389/fphar.2023.1182113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Background and purpose: Testosterone is an essential sex hormone in maintaining masculine characteristics, which is prescribed for male hypogonadism as testosterone replacement treatment (TRT). Herein, we investigated long-standing controversies about the association between TRT and major adverse cardiovascular events (MACEs), based on real world adverse event (AE) reports, registered in the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: Publicly available FAERS data from 1 January 2004 to 31 December 2022 were retrieved from the Food and Drug Administration (FDA) website. The data mining protocol including the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) was applied to analyze overreporting caused by risk factors and MACEs, including TRT, morbidities, and ages. The ROR and the BCPNN were also applied to investigate the annually developing trend of pharmacovigilance (PV) signals in the real world, retrospectively. Results: A total of 3,057 cases referring to MACEs, with a median age of 57 years old (yo), were identified from 28,921 cases of testosterone users. MACEs related to PV signals have emerged since 2014, including cardiac death, non-fatal myocardial infarction, and non-fatal stroke. Myocardial infarction (MI) (ROR: 9.46; IC025: 3.08), acute myocardial infarction (AMI) (ROR: 16.20; IC025: 3.72), ischemic cardiomyopathy (ROR: 11.63; IC025: 2.20), and cardiomyopathy (ROR: 5.98; IC025: 1.96) were the most significant signals generated, and weaker signals included cardiac failure acute (ROR: 4.01; IC025: 0.71), cardiac arrest (ROR: 1.88; IC025: 0.56), and ventricular fibrillation (VF) (ROR: 2.38; IC025: 0.38). The time-to-onset (TTO) of MACEs was calculated with a median of 246 days for AMI. Conclusion: For myocardial infarction and cardiomyopathy, TRT statistically tended to increase the risk of MACEs, while for cardiac arrhythmia, cardiac failure, and stroke, TRT demonstrated beneficial effects among the population with morbidities, such as testosterone deficiency (TD), diabetes mellitus (DM), and hypertension. MACEs were rare but led to serious outcomes including significant increase in death and disability. Since 2018, and before 2014, reports referring to TRT associated with MACEs were relatively scarce, which indicated that there might be a considerable number of cases that went unrecorded, due to neglection. Health workers and testosterone users might pay more attention to testosterone-induced MACEs.
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Affiliation(s)
- Hui Zhao
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun-Min Li
- School of Pharmacy, Fudan University, Shanghai, China
| | - Zi-Ran Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Zhang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Kang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Ming Yan
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yan Qiu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
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Testosterone Therapy in Oncologic Patients. CURRENT SEXUAL HEALTH REPORTS 2023. [DOI: 10.1007/s11930-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Low-Intensity Pulsed Ultrasound Alleviates Human Testicular Leydig Cell Senescence In Vitro. Int J Mol Sci 2022; 24:ijms24010418. [PMID: 36613865 PMCID: PMC9820771 DOI: 10.3390/ijms24010418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022] Open
Abstract
Aging has a significant negative impact on human testicular function; steroidogenesis is gradually impaired, and testosterone replacement therapy still has many risks. Low-intensity pulsed ultrasound (LIPUS) has been used as a novel non-invasive treatment for male erectile dysfunction and other fields, and has been shown to increase testosterone levels in animal models. Testosterone is synthesized and secreted by Leydig cells (LCs), and the serum testosterone level decreases after aging due to the LCs senescence. However, the effect of LIPUS on human senescent LCs has not been reported. In this study, human senescent LCs were isolated and stimulated with different energy intensities in vitro, and cell morphology, cell apoptosis, cell proliferation, cell senescence levels, lipid droplet number, testosterone and INSL3 secretion levels were tested and analyzed. Quantitative Polymerase Chain Reaction (QPCR) and Western Blot were performed to compare cell senescence characteristics and the expression profile of key pathways of testosterone secretion, and transcriptome analysis was performed to explore the signaling pathways of LCs alteration after LIPUS stimulation. It was safe and effective to stimulate LCs with the 75 mW/cm2 energy of LIPUS in vitro, which not only improved the senescence phenotype, but also effectively enhanced the secretory function of LCs in vitro, and increased the expression of key pathways of the testosterone synthesis pathway. These results suggest that LIPUS could be used as a novel treatment to human senescent LCs with decreased testosterone secretion levels in vitro.
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Yuan S, Wang L, Sun J, Yu L, Zhou X, Yang J, Zhu Y, Gill D, Burgess S, Denny JC, Larsson SC, Theodoratou E, Li X. Genetically predicted sex hormone levels and health outcomes: phenome-wide Mendelian randomization investigation. Int J Epidemiol 2022; 51:1931-1942. [PMID: 35218343 PMCID: PMC9749729 DOI: 10.1093/ije/dyac036] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/10/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sex hormone-binding globulin (SHBG), testosterone and oestradiol have been associated with many diseases in observational studies; however, the causality of associations remains unestablished. METHODS A phenome-wide Mendelian randomization (MR) association study was performed to explore disease outcomes associated with genetically proxied circulating SHBG, testosterone and oestradiol levels by using updated genetic instruments in 339 197 unrelated White British individuals (54% female) in the UK Biobank. Two-sample MR analyses with data from large genetic studies were conducted to replicate identified associations in phenome-wide MR analyses. Multivariable MR analyses were performed to investigate mediation effects of hormone-related biomarkers in observed associations with diseases. RESULTS Phenome-wide MR analyses examined associations of genetically predicted SHBG, testosterone and oestradiol levels with 1211 disease outcomes, and identified 28 and 13 distinct phenotypes associated with genetically predicted SHBG and testosterone, respectively; 22 out of 28 associations for SHBG and 10 out of 13 associations for testosterone were replicated in two-sample MR analyses. Higher genetically predicted SHBG levels were associated with a reduced risk of hypertension, type 2 diabetes, diabetic complications, coronary atherosclerotic outcomes, gout and benign and malignant neoplasm of uterus, but an increased risk of varicose veins and fracture (mainly in females). Higher genetically predicted testosterone levels were associated with a lower risk of type 2 diabetes, coronary atherosclerotic outcomes, gout and coeliac disease mainly in males, but an increased risk of cholelithiasis in females. CONCLUSIONS These findings suggest that sex hormones may causally affect risk of several health outcomes.
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Affiliation(s)
- Shuai Yuan
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lijuan Wang
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Sun
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Yu
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuan Zhou
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Yang
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yimin Zhu
- Department of Big Data in Health Science, Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Stephen Burgess
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Xue Li
- Corresponding author. School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. E-mail:
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31
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Testosterone replacement therapy and cardiovascular disease. Int J Impot Res 2022; 34:685-690. [PMID: 34999717 DOI: 10.1038/s41443-021-00516-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/23/2023]
Abstract
The use of testosterone therapy has a complex history of apprehension and questions regarding its safety. Despite an eventual consensus that testosterone therapy was safe and effective, several studies relating to cardiovascular risks emerged in the last decade, rekindling skepticism regarding the safety of testosterone therapy. Given the utility of testosterone therapy in treating the symptoms of hypogonadism, it remains crucial to closely examine the safety of testosterone therapy. The present article synthesizes the current evidence regarding cardiovascular risks that may be associated with testosterone therapy, the potential mechanisms regarding testosterone's efficacy, and future directions in evaluating the safety of its use.
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Defeudis G, Maddaloni E, Rossini G, Di Tommaso AM, Mazzilli R, Di Palma P, Pozzilli P, Napoli N. Glycemic Variability in Subjects with Diabetes and Hypogonadism during Testosterone Replacement Treatment: A Pilot Study. J Clin Med 2022; 11:jcm11185333. [PMID: 36142982 PMCID: PMC9505941 DOI: 10.3390/jcm11185333] [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: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This is a proof of concept, as a pilot study, with the aim to evaluate continuous glucose monitoring metrics (CGM) in subjects with type 2 diabetes (T2DM), treated with nutritional therapy and metformin, before and after testosterone replacement therapy (TRT). Methods: In this longitudinal observational study, subjects affected by T2DM and starting TRT for documented ED and hypogonadism were enrolled. All subjects mounted a CGM system during the v0 visit, one week before the beginning of the TRT (week−1), during v2, four weeks after the start of TRT (week 4), and v4 (week 12). CGM was worn for about 144 h after each visit. Results: A total of seven patients, referring to our clinic for erectile dysfunction (ED), were studied (aged 63.3 ± 2.3 years). Mean (± standard deviation) total testosterone level was 2.3 ± 0.6 ng/mL at baseline. After TRT, total testosterone level was 4.6 ± 3.04 ng/mL at week 4 and 3.93 ± 4.67 ng/mL at week 12. No significant differences were observed in TIR, TAR, TBR, estimated HbA1c, AUC below, and AUC above limit during the intervention period. Conclusions: This is the first study evaluating the effects of TRT on daily glucose excursions in subjects with T2DM and hypogonadism. Though we did not find any significant difference in key CGM metrics during the 12 weeks of TRT, this study confirms the glycometabolic safety of the TRT even on the most novel standardized glycemic targets.
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Affiliation(s)
- Giuseppe Defeudis
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
- Correspondence: or
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Rossini
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Alfonso Maria Di Tommaso
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, 00189 Rome, Italy
| | - Paolo Di Palma
- Unit of Urology, Hospital of Frosinone, ASL Frosinone, 03100 Frosinone, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128 Rome, Italy
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Low Testosterone Level and Risk of Adverse Clinical Events among Male Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Cohort Studies. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3630429. [PMID: 36124237 PMCID: PMC9482512 DOI: 10.1155/2022/3630429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
The phenomenon of low testosterone level is extremely common in male patients with chronic kidney diseases (CKDs). This meta-analysis aimed to evaluate whether the low circulating testosterone could independently predict adverse outcomes among male patients with chronic kidney diseases (CKDs). The data till May 2022 were systematically searched from Pubmed, Web of Science, and Embase from inception. Studies meeting the PICOS (population, intervention/exposure, control/comparison, outcomes, and study design) principles were included in this meta-analysis. Study-specific effect estimates were pooled using fixed-effects (I2 > 50%) or random-effects models (I2 < 50%). Ultimately, 9 cohort studies covering 5331 patients with CKDs were involved in this meta-analysis. The results suggested that per 1-standard deviation (SD) decrease in total testosterone independently increased the risk of all-cause mortality by 27% [hazard risk (HR) 1.27, 95% confidence interval (CI) 1.16–1.38], cardiovascular mortality by 100% (HR 2.00, 95% CI 1.39–2.86), cardiovascular events by 20% (HR 1.20, 95% CI 1.04–1.39), and infectious events by 41% (HR 1.41, 95% CI 1.08–1.84). Besides, with per 1-SD decrease in free testosterone, the risk of overall adverse events increased by 66% (HR 1.66, 95% CI 1.34–2.05). Stratified analyses indicated that the negative relationship of the total testosterone with all-cause death risk was independent of factors involving age, race, body mass index, diabetes, hypertension, C-reactive protein, creatinine, and sex hormone binding globulin. In conclusion, it was identified that low endogenous testosterone could serve as an independent predictor of adverse clinical events among male patients with CKDs.
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34
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Fallara G, Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Montorsi F, Salonia A. Cardiovascular Morbidity and Mortality in Men – Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone. J Sex Med 2022; 19:1243-1254. [DOI: 10.1016/j.jsxm.2022.05.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
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35
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The Pre-Testosterone Therapy Checklist. J Sex Med 2022; 19:1214-1217. [DOI: 10.1016/j.jsxm.2022.03.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
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36
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Enina TN, Kuznetsov VA, Soldatova AM. [Testosterone and congestive heart failure]. KARDIOLOGIIA 2022; 62:61-67. [PMID: 35989631 DOI: 10.18087/cardio.2022.7.n1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/11/2020] [Indexed: 06/15/2023]
Abstract
This article summarizes current information about the interrelation between testosterone concentrations and chronic heart failure (CHF). The authors described key publications that address the prevalence of testosterone deficiency in patients with CHF, the effect of endogenous and exogenous testosterone on the cardiovascular system, the relationship between testosterone levels and the severity and prognosis of CHF, and the efficacy of interventional treatments for CHF.
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Affiliation(s)
- T N Enina
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk
| | - V A Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk
| | - A M Soldatova
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk
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The relationship between serum sex hormone and cardiac echocardiographic findings in healthy men. Sci Rep 2022; 12:12787. [PMID: 35896587 PMCID: PMC9329341 DOI: 10.1038/s41598-022-17101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
Serum sex hormones are known to be associated with cardiovascular disease (CVD), but effects in healthy men on cardiac function have not been well quantified. The authors sought to evaluate an association of sex hormones with cardiac structure and function. Study participants were 857 Korean men without significant cardiovascular diseases participating in the Healthy Twin Study. We estimated the associations of total testosterone (TT) and sex hormone-binding globulin (SHBG) with cardiac structure and function measured by echocardiography using a linear mixed regression model with consideration of random and fixed effects of covariates. The ratio of peak early diastolic velocity of mitral inflow over peak early diastolic mitral annular velocity (E/e') and left atrial volume index (LAVI), functional parameters reflecting left ventricle (LV) filling pressure, were inversely associated with TT even after further cross-adjustment for SHBG level. There was a positive association between LAVI and SHBG, regardless of TT adjustment. These findings suggest that serum testosterone level is positively associated with LV diastolic function independent of SHBG level.
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38
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Fallara G, Pozzi E, Corsini C, Belladelli F, Boeri L, Capogrosso P, Montorsi F, Salonia A. Morbidity and mortality in men: Role of androgens. Best Pract Res Clin Endocrinol Metab 2022; 36:101662. [PMID: 35484028 DOI: 10.1016/j.beem.2022.101662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this narrative review we provide an overview of the current literature on male hypogonadism and related comorbidities, also depicting the role of testosterone therapy (TTh) in the various settings. Male hypogonadism has been associated with major comorbidities such as type 2 diabetes mellitus, obesity and cardiovascular diseases, promoting a vicious cycle that may lead to further hypogonadism. The biological underpinnings of this association are currently under investigations, but clearly emerges the relevance of the hypothalamic-pituitary-gonadal axis. Hypogonadism has also been associated with increased risk of mortality. As such, TTh has the potential to oppose these patterns and improve cardiovascular and metabolic health in hypogonadal men. Clinical and observational data suggest that in males with hypogonadism, TTh, together with lifestyle changes and diabetes medications, may improve glycemia, reduce risk of progression to diabetes and provides positive effects on cardiovascular risk. Conversely, available data does not fully support any increased risk of prostate cancer in men under TTh. Of clinical relevance, a possible harmful role of hypogonadal status in men with COVID-19 eventually emerged.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy.
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
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Wu FCW. Ageing male (part 2): Management of functional hypogonadism in older men, a patient-centric holistic approach. Best Pract Res Clin Endocrinol Metab 2022; 36:101626. [PMID: 35461757 DOI: 10.1016/j.beem.2022.101626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The diagnosis of functional hypogonadism should prompt a thorough assessment and optimization of general health, including lifestyle changes, weight reduction, care of comorbidities and cessation of offending medications, some of which can lead to meaningful gains in endogenous testosterone (T) concentrations. Having excluded or addressed reversible causes and contra-indications, patients with functional hypogonadism can be offered a trial of testosterone replacement therapy (TRT) after full discussion on the anticipated benefits and potential risks. T treatment improves libido but may be less effective for erectile dysfunction (ED). T treatment can also have modest positive effects on insulin resistance, bone strength, some measures of physical strength, and mild depressive symptoms but the clinical significance of these relatively short-term improvements remain uncertain in terms of longer-term patient-important outcomes. Initiation of TRT is a joint decision between patient and clinician since longer-term benefits and risks have not been adequately defined.
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Affiliation(s)
- Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK.
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Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis. THE LANCET. HEALTHY LONGEVITY 2022; 3:e381-e393. [PMID: 35711614 PMCID: PMC9184259 DOI: 10.1016/s2666-7568(22)00096-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Testosterone is the standard treatment for male hypogonadism, but there is uncertainty about its cardiovascular safety due to inconsistent findings. We aimed to provide the most extensive individual participant dataset (IPD) of testosterone trials available, to analyse subtypes of all cardiovascular events observed during treatment, and to investigate the effect of incorporating data from trials that did not provide IPD. Methods We did a systematic review and meta-analysis of randomised controlled trials including IPD. We searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE Epub Ahead of Print, Embase, Science Citation Index, the Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and Database of Abstracts of Review of Effects for literature from 1992 onwards (date of search, Aug 27, 2018). The following inclusion criteria were applied: (1) men aged 18 years and older with a screening testosterone concentration of 12 nmol/L (350 ng/dL) or less; (2) the intervention of interest was treatment with any testosterone formulation, dose frequency, and route of administration, for a minimum duration of 3 months; (3) a comparator of placebo treatment; and (4) studies assessing the pre-specified primary or secondary outcomes of interest. Details of study design, interventions, participants, and outcome measures were extracted from published articles and anonymised IPD was requested from investigators of all identified trials. Primary outcomes were mortality, cardiovascular, and cerebrovascular events at any time during follow-up. The risk of bias was assessed using the Cochrane Risk of Bias tool. We did a one-stage meta-analysis using IPD, and a two-stage meta-analysis integrating IPD with data from studies not providing IPD. The study is registered with PROSPERO, CRD42018111005. Findings 9871 citations were identified through database searches and after exclusion of duplicates and of irrelevant citations, 225 study reports were retrieved for full-text screening. 116 studies were subsequently excluded for not meeting the inclusion criteria in terms of study design and characteristics of intervention, and 35 primary studies (5601 participants, mean age 65 years, [SD 11]) reported in 109 peer-reviewed publications were deemed suitable for inclusion. Of these, 17 studies (49%) provided IPD (3431 participants, mean duration 9·5 months) from nine different countries while 18 did not provide IPD data. Risk of bias was judged to be low in most IPD studies (71%). Fewer deaths occurred with testosterone treatment (six [0·4%] of 1621) than placebo (12 [0·8%] of 1537) without significant differences between groups (odds ratio [OR] 0·46 [95% CI 0·17-1·24]; p=0·13). Cardiovascular risk was similar during testosterone treatment (120 [7·5%] of 1601 events) and placebo treatment (110 [7·2%] of 1519 events; OR 1·07 [95% CI 0·81-1·42]; p=0·62). Frequently occurring cardiovascular events included arrhythmia (52 of 166 vs 47 of 176), coronary heart disease (33 of 166 vs 33 of 176), heart failure (22 of 166 vs 28 of 176), and myocardial infarction (10 of 166 vs 16 of 176). Overall, patient age (interaction 0·97 [99% CI 0·92-1·03]; p=0·17), baseline testosterone (interaction 0·97 [0·82-1·15]; p=0·69), smoking status (interaction 1·68 [0·41-6·88]; p=0.35), or diabetes status (interaction 2·08 [0·89-4·82; p=0·025) were not associated with cardiovascular risk. Interpretation We found no evidence that testosterone increased short-term to medium-term cardiovascular risks in men with hypogonadism, but there is a paucity of data evaluating its long-term safety. Long-term data are needed to fully evaluate the safety of testosterone. Funding National Institute for Health Research Health Technology Assessment Programme.
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Willemars MMA, Nabben M, Verdonschot JAJ, Hoes MF. Evaluation of the Interaction of Sex Hormones and Cardiovascular Function and Health. Curr Heart Fail Rep 2022; 19:200-212. [PMID: 35624387 PMCID: PMC9329157 DOI: 10.1007/s11897-022-00555-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/02/2022]
Abstract
Purpose of Review Sex hormones drive development and function of reproductive organs or the development of secondary sex characteristics but their effects on the cardiovascular system are poorly understood. In this review, we identify the gaps in our understanding of the interaction between sex hormones and the cardiovascular system. Recent Findings Studies are progressively elucidating molecular functions of sex hormones in specific cell types in parallel with the initiation of crucial large randomized controlled trials aimed at improving therapies for cardiovascular diseases (CVDs) associated with aberrant levels of sex hormones. Summary In contrast with historical assumptions, we now understand that men and women show different symptoms and progression of CVDs. Abnormal levels of sex hormones pose an independent risk for CVD, which is apparent in conditions like Klinefelter syndrome, androgen insensitivity syndrome, and menopause. Moreover, sex hormone–based therapies remain understudied and may not be beneficial for cardiovascular health.
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Affiliation(s)
- Myrthe M A Willemars
- Department of Genetics & Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Miranda Nabben
- Department of Genetics & Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands.,Department of Clinical Genetics, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Job A J Verdonschot
- CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands.,Department of Clinical Genetics, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Martijn F Hoes
- CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands. .,Department of Clinical Genetics, Maastricht University Medical Center+, Maastricht, the Netherlands. .,Department of Cardiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
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Barone B, Napolitano L, Abate M, Cirillo L, Reccia P, Passaro F, Turco C, Morra S, Mastrangelo F, Scarpato A, Amicuzi U, Morgera V, Romano L, Calace FP, Pandolfo SD, De Luca L, Aveta A, Sicignano E, Trivellato M, Spena G, D’Alterio C, Fusco GM, Vitale R, Arcaniolo D, Crocetto F. The Role of Testosterone in the Elderly: What Do We Know? Int J Mol Sci 2022; 23:3535. [DOI: doi.org/10.3390/ijms23073535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Testosterone is the most important hormone in male health. Aging is characterized by testosterone deficiency due to decreasing testosterone levels associated with low testicular production, genetic factors, adiposity, and illness. Low testosterone levels in men are associated with sexual dysfunction (low sexual desire, erectile dysfunction), reduced skeletal muscle mass and strength, decreased bone mineral density, increased cardiovascular risk and alterations of the glycometabolic profile. Testosterone replacement therapy (TRT) shows several therapeutic effects while maintaining a good safety profile in hypogonadal men. TRT restores normal levels of serum testosterone in men, increasing libido and energy level and producing beneficial effects on bone density, strength and muscle as well as yielding cardioprotective effects. Nevertheless, TRT could be contraindicated in men with untreated prostate cancer, although poor findings are reported in the literature. In addition, different potential side effects, such as polycythemia, cardiac events and obstructive sleep apnea, should be monitored. The aim of our review is to provide an updated background regarding the pros and cons of TRT, evaluating its role and its clinical applicability in different domains.
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The Role of Testosterone in the Elderly: What Do We Know? Int J Mol Sci 2022; 23:ijms23073535. [PMID: PMID: 35408895 PMCID: PMC8998588 DOI: 10.3390/ijms23073535] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Abstract
Testosterone is the most important hormone in male health. Aging is characterized by testosterone deficiency due to decreasing testosterone levels associated with low testicular production, genetic factors, adiposity, and illness. Low testosterone levels in men are associated with sexual dysfunction (low sexual desire, erectile dysfunction), reduced skeletal muscle mass and strength, decreased bone mineral density, increased cardiovascular risk and alterations of the glycometabolic profile. Testosterone replacement therapy (TRT) shows several therapeutic effects while maintaining a good safety profile in hypogonadal men. TRT restores normal levels of serum testosterone in men, increasing libido and energy level and producing beneficial effects on bone density, strength and muscle as well as yielding cardioprotective effects. Nevertheless, TRT could be contraindicated in men with untreated prostate cancer, although poor findings are reported in the literature. In addition, different potential side effects, such as polycythemia, cardiac events and obstructive sleep apnea, should be monitored. The aim of our review is to provide an updated background regarding the pros and cons of TRT, evaluating its role and its clinical applicability in different domains.
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Bhasin S, Lincoff AM, Basaria S, Bauer DC, Boden WE, Cunningham GR, Davey D, Dubcenco E, Fukumoto S, Garcia M, Granger CB, Kalahasti V, Khera M, Miller MG, Mitchell LM, O'Leary MP, Pencina KM, Snyder PJ, Thompson IM, Travison TG, Wolski K, Nissen SE. Effects of long-term testosterone treatment on cardiovascular outcomes in men with hypogonadism: Rationale and design of the TRAVERSE study. Am Heart J 2022; 245:41-50. [PMID: 34871580 DOI: 10.1016/j.ahj.2021.11.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Testosterone exerts some effects on the cardiovascular system that could be considered beneficial; some other effects may potentially increase the risk of cardiovascular (CV) events. Neither the long-term efficacy nor safety of testosterone treatment has been studied in an adequately-powered randomized trial. METHODS The Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy ResponSE in hypogonadal men (TRAVERSE) study is a randomized, double-blind, placebo-controlled, parallel group, non-inferiority, multicenter study. Eligible participants are men, 45 to 80 years, with serum testosterone concentration <300 ng/dL and hypogonadal symptoms, who have evidence pre-existing CV disease or increased risk of CV disease. Approximately 6,000 subjects will be randomized to either 1.62% transdermal testosterone gel or a matching placebo gel daily for an anticipated duration of up to 5 years. The primary outcome is CV safety defined by the major adverse CV event composite of nonfatal myocardial infarction, nonfatal stroke, or death due to CV causes. The trial will continue until at least 256 adjudicated major adverse CV event endpoints have occurred to assess whether the 95% (2-sided) upper confidence limit for a hazard ratio of 1.5 can be ruled out. Secondary endpoints include prostate safety defined as the incidence of adjudicated high grade prostate cancer and efficacy in domains of sexual function, bone fractures, depression, anemia, and diabetes. RESULTS As of July 1, 2021, 5,076 subjects had been randomized. CONCLUSIONS The TRAVERSE study will determine the CV safety and long-term efficacy of testosterone treatment in middle-aged and older men with hypogonadism with or at increased risk of CV disease.
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Affiliation(s)
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- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Abstract
All approved testosterone replacement methods, when used according to recommendations, can restore normal serum testosterone concentrations, and relieve symptoms in most hypogonadal men. Selection of the method depends on the patient's preference with advice from the physician. Dose adjustment is possible with most delivery methods but may not be necessary in all hypogonadal men. The use of hepatotoxic androgens must be avoided. Testosterone treatment induces reversible suppression of spermatogenesis; if fertility is desired in the near future, human chronic gonadotropin, selective estrogen receptor modulator, estrogen antagonist, or an aromatase inhibitor that stimulates endogenous testosterone production may be used.
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Affiliation(s)
- Christina Wang
- Division of Endocrinology, Clinical and Translational Science Institute, The Lundquist Institute at Harbor-UCLA Medical Center, Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA.
| | - Ronald S Swerdloff
- Division of Endocrinology, The Lundquist Institute and Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
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Jayasena CN, Anderson RA, Llahana S, Barth JH, MacKenzie F, Wilkes S, Smith N, Sooriakumaran P, Minhas S, Wu FCW, Tomlinson J, Quinton R. Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clin Endocrinol (Oxf) 2022; 96:200-219. [PMID: 34811785 DOI: 10.1111/cen.14633] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Male hypogonadism (MH) is a common endocrine disorder. However, uncertainties and variations in its diagnosis and management exist. There are several current guidelines on testosterone replacement therapy that have been driven predominantly by single disciplines. The Society for Endocrinology commissioned this new guideline to provide all care providers with a multidisciplinary approach to treating patients with MH. This guideline has been compiled using expertise from endocrine (medical and nursing), primary care, clinical biochemistry, urology and reproductive medicine practices. These guidelines also provide a patient perspective to help clinicians best manage MH.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | | | - Sofia Llahana
- School of Health Sciences, City, University of London, London & Department of Endocrinology & Diabetes, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK
| | - Julian H Barth
- Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Finlay MacKenzie
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | | | - Prasanna Sooriakumaran
- Department of Uro-oncology, UCLH NHS Foundation Trust, London & Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Sukhbinder Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jeremy Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK
| | - Richard Quinton
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals NHS Foundation Trust & Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, UK
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Testosterone Use in the Perioperative Setting. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-021-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Haider A, Bengs S, Portmann A, Rossi A, Ahmed H, Etter D, Warnock GI, Mikail N, Grämer M, Meisel A, Gisler L, Jie C, Keller C, Kozerke S, Weber B, Schibli R, Mu L, Kaufmann PA, Regitz-Zagrosek V, Ametamey SM, Gebhard C. Role of sex hormones in modulating myocardial perfusion and coronary flow reserve. Eur J Nucl Med Mol Imaging 2022; 49:2209-2218. [PMID: 35024889 PMCID: PMC9165260 DOI: 10.1007/s00259-022-05675-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/31/2021] [Indexed: 12/02/2022]
Abstract
Background A growing body of evidence highlights sex differences in the diagnostic accuracy of cardiovascular imaging modalities. Nonetheless, the role of sex hormones in modulating myocardial perfusion and coronary flow reserve (CFR) is currently unclear. The aim of our study was to assess the impact of female and male sex hormones on myocardial perfusion and CFR. Methods Rest and stress myocardial perfusion imaging (MPI) was conducted by small animal positron emission tomography (PET) with [18F]flurpiridaz in a total of 56 mice (7–8 months old) including gonadectomized (Gx) and sham-operated males and females, respectively. Myocardial [18F]flurpiridaz uptake (% injected dose per mL, % ID/mL) was used as a surrogate for myocardial perfusion at rest and following intravenous regadenoson injection, as previously reported. Apparent coronary flow reserve (CFRApp) was calculated as the ratio of stress and rest myocardial perfusion. Left ventricular (LV) morphology and function were assessed by cardiac magnetic resonance (CMR) imaging. Results Orchiectomy resulted in a significant decrease of resting myocardial perfusion (Gx vs. sham, 19.4 ± 1.0 vs. 22.2 ± 0.7 % ID/mL, p = 0.034), while myocardial perfusion at stress remained unchanged (Gx vs. sham, 27.5 ± 1.2 vs. 27.3 ± 1.2 % ID/mL, p = 0.896). Accordingly, CFRApp was substantially higher in orchiectomized males (Gx vs. sham, 1.43 ± 0.04 vs. 1.23 ± 0.05, p = 0.004), and low serum testosterone levels were linked to a blunted resting myocardial perfusion (r = 0.438, p = 0.020) as well as an enhanced CFRApp (r = −0.500, p = 0.007). In contrast, oophorectomy did not affect myocardial perfusion in females. Of note, orchiectomized males showed a reduced LV mass, stroke volume, and left ventricular ejection fraction (LVEF) on CMR, while no such effects were observed in oophorectomized females. Conclusion Our experimental data in mice indicate that sex differences in myocardial perfusion are primarily driven by testosterone. Given the diagnostic importance of PET-MPI in clinical routine, further studies are warranted to determine whether testosterone levels affect the interpretation of myocardial perfusion findings in patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05675-2.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Hazem Ahmed
- Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Dominik Etter
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Geoffrey I Warnock
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Muriel Grämer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland
| | - Livio Gisler
- Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Caitlin Jie
- Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Claudia Keller
- Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, CH-8092, Zurich, Switzerland
| | - Bruno Weber
- Institute of Pharmacology and Toxicology, University of Zurich, CH-8057, Zurich, Switzerland
| | - Roger Schibli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Linjing Mu
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.,Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Charité Universitaetsmedizin Berlin, D-10115, Berlin, Germany.,University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Simon M Ametamey
- Institute of Pharmaceutical Sciences, ETH Zurich, CH-8093, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich, CH-8952, Schlieren, Switzerland.
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Trends in testosterone prescription amongst medical specialties: a 5-year CMS data analysis. Int J Impot Res 2022:10.1038/s41443-021-00497-6. [PMID: 34992225 DOI: 10.1038/s41443-021-00497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022]
Abstract
Testosterone Therapy (TTh) trends have changed as a result of clinical research and market forces over the past several years. Understanding the trends or preferences regarding testosterone prescriptions remains unknown. Our objective was to assess both regional and national trends in TTh prescriptions amongst medical specialties within the United States between 2013 and 2017. Publicly available data from the Center for Medicare and Medicaid Services (CMS) Part D Prescriber database with regards to TTh prescriptions across a 5-year span (January 1, 2013-December 31, 2017) were analyzed. TTh therapies were consolidated into four categories: Topical, Oral, Injection and Pellet. Statistical analysis utilizing R 4.0.2 was performed on the resulting data. Trends in prescription modality claim count and cost were plotted over the study period while statistical analysis evaluated associations between TTh modality and medical specialist. We found that Endocrinologists and Urologists prescribed topical testosterone more than all other specialties (60.4% and 53.5%, respectively), while Family and Internal medicine physicians were more likely to prescribe injections (59.82% and 50.69%, respectively). Oral and pellet testosterone were rarely prescribed across all specialties. In conclusion, the wide variation in modalities of testosterone prescriptions illustrates an opportunity for treatment guidelines to be streamlined across all specialists to improve patient outcomes.
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Hematologic Disorders and Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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