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Pencina KM, Travison TG, Cunningham GR, Lincoff AM, Nissen SE, Khera M, Miller MG, Flevaris P, Li X, Wannemuehler K, Bhasin S. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism. J Clin Endocrinol Metab 2024; 109:569-580. [PMID: 37589949 DOI: 10.1210/clinem/dgad484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023]
Abstract
CONTEXT Few long-term randomized trials have evaluated the efficacy of testosterone replacement therapy (TRT) in improving sexual function and hypogonadal symptoms in men with hypogonadism and whether effects are sustained beyond 12 months. OBJECTIVE The Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy ResponSE in hypogonadal men (TRAVERSE) study evaluated the effect of TRT on major adverse cardiovascular events in middle-aged and older men with hypogonadism. The Sexual Function Study, nested within the parent trial, determined testosterone's efficacy in improving sexual activity, hypogonadal symptoms, libido, and erectile function among men reporting low libido. METHODS Among 5204 men, 45-80 years, with 2 testosterone concentrations <300 ng/dL, hypogonadal symptoms, and cardiovascular disease (CVD) or increased CVD risk enrolled in the TRAVERSE trial, 1161 with low libido were enrolled in the Sexual Function Study (587 randomized to receive 1.62% testosterone gel and 574 to placebo gel for the duration of their participation in the study). Primary outcome was change from baseline in sexual activity score. Secondary outcomes included hypogonadal symptoms, erectile function, and sexual desire. RESULTS TRT was associated with significantly greater improvement in sexual activity than placebo (estimated mean [95% CI] between-group difference 0.49 [0.19,0.79] and 0.47 [0.11, 0.83] acts per day at 6 and 12 months, respectively; omnibus test P = .011); treatment effect was maintained at 24 months. TRT improved hypogonadal symptoms and sexual desire, but not erectile function, compared with placebo. CONCLUSION In middle-aged and older men with hypogonadism and low libido, TRT for 2 years improved sexual activity, hypogonadal symptoms, and sexual desire, but not erectile function.
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Affiliation(s)
- Karol M Pencina
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas G Travison
- Marcus Institute for Aging Research, Hebrew Senior Life, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02131, USA
| | - Glenn R Cunningham
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - A Michael Lincoff
- Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Steven E Nissen
- Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mohit Khera
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | - Xue Li
- AbbVie Inc., North Chicago, IL 60044, USA
| | - Kathleen Wannemuehler
- Department of Biostatistics and Medical Informatics, Statistical Data Analysis Center, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Wang C, Ramasamy A, Verduzco-Gutierrez M, Brode WM, Melamed E. Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants. Virol J 2023; 20:124. [PMID: 37328773 PMCID: PMC10276420 DOI: 10.1186/s12985-023-02061-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 06/18/2023] Open
Abstract
SARS-CoV-2 infection leading to Coronavirus Disease 2019 (COVID-19) has caused more than 762 million infections worldwide, with 10-30% of patients suffering from post-acute sequelae of SARS-CoV-2 infections (PASC). Initially thought to primarily affect the respiratory system, it is now known that SARS-CoV-2 infection and PASC can cause dysfunction in multiple organs, both during the acute and chronic stages of infection. There are also multiple risk factors that may predispose patients to worse outcomes from acute SARS-CoV-2 infection and contribute to PASC, including genetics, sex differences, age, reactivation of chronic viruses such as Epstein Barr Virus (EBV), gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients' diet, alcohol use, smoking, exercise, and sleep patterns. In addition, there are important social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients' access to health services and disease outcomes from acute COVID-19 and PASC. Here, we review risk factors in acute SARS-CoV-2 infection and PASC and highlight social determinants of health and their impact on patients affected with acute and chronic sequelae of COVID-19.
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Affiliation(s)
- Chumeng Wang
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Akshara Ramasamy
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Monica Verduzco-Gutierrez
- Department of Physical Medicine and Rehabilitation, University of Texas at San Antonio, San Antonio, TX, USA
| | - W Michael Brode
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
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Abstract
Compared to women, increasing male age is not accompanied by such marked changes in reproductive function but changes certainly do happen. These include alterations to the hypothalamo-pituitary-testicular axis, with resultant implications for testosterone production and bioavailability as well as spermatogenesis. There is a decline in sexual function as men age, with a dramatic increase in the prevalence of erectile dysfunction after the age of 40, which is a marker for both clinically evident as well as covert coronary artery disease. Despite a quantitative decline in spermatogenesis and reduced fecundability, the male potential for fertility persists throughout adult life, however there are also increasingly recognised alterations in sperm quality and function with significant implications for offspring health. These changes are relevant to both natural and medically assisted conception.
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Affiliation(s)
- Sarah Martins da Silva
- Reproductive Medicine Research Group, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY, Dundee, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK.
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Kaufman JM. Diagnosis of hypogonadism in ageing men. Rev Endocr Metab Disord 2022; 23:1139-1150. [PMID: 36355322 DOI: 10.1007/s11154-022-09763-4] [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: 10/10/2022] [Indexed: 11/11/2022]
Abstract
To make the diagnosis of hypogonadism in an ageing man, in absence of rare organic cause often referred to as functional or late onset hypogonadism (LOH), he should present with a clinical syndrome suggestive of androgen deficiency and have consistently low serum testosterone (T) levels. This does not differ from the diagnosis of any other form of hypogonadism. Particular to LOH diagnostic are uncertainties surrounding this entity: signs and symptoms of androgen deficiency (including sexual symptoms) are nonspecific in older men; clinical significance of only moderately low T levels is uncertain; comorbidity plays a substantial role with potential for reversibility; the place of T therapy in these men is debatable. This context demands for a pragmatic, but appropriately conservative approach to diagnosis. Evaluation should be stepwise with clinical evaluation, if suggestive for androgen deficiency, followed by measurement of a fasting morning serum T, if unequivocally low to be confirmed in a separate morning sample by a second low T or, if initial T borderline low or in presence of factors known to affect SHBG, by a low calculated free T level. All other (free) T results make hypogonadism an unlikely cause of the patient's symptoms. In the absence of consensus cut-off levels for total and free T in the published clinical guidelines for diagnosis of hypogonadism, it seems appropriate in the context of LOH to use stringent criteria indicating a convincingly low serum T. The approach to the diagnosis of LOH is not fundamentally different from that of other forms of hypogonadism but should put extra weight on prioritizing the shunning of overdiagnosis above the risk of underdiagnosis.
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
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Abstract
Sexual symptoms are the most specific determinants of low testosterone (T) observed during adulthood. In this narrative review, we summarize the most important evidence supporting the positive relationships between endogenous T levels and sexual activity in the adult male, by using preclinical and clinical observations. In addition, we also report an update of our previous meta-analysis evaluating the effects of T treatment (TRT) on sexual functioning in subjects with T deficiency. Available data indicate that TRT of symptomatic hypogonadal men can improve several aspects of sexual life, including erection. However, the effect is rather modest and lower in subjects with associated metabolic conditions. The specific observed effects are similar to those derived from lifestyle intervention. Since TRT might result in body composition improvement, it is reasonable to suppose that an initial treatment with T can improve the willingness of hypogonadal subjects to perform physical exercise and to adhere to a healthier behavior. Similar data were derived from animal models. However, it should be important to recognize that lifestyle modifications should be the first step to promote weigh reduction. TRT can be combined with lifestyle interventions only in symptomatic hypogonadal subjects especially in the presence of comorbid metabolic conditions.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
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Mima M, Huang JB, Andriole GL, Freedland SJ, Ohlander SJ, Moreira DM. The Impact of Smoking on Sexual Function. BJU Int 2022; 130:186-192. [PMID: 35166438 DOI: 10.1111/bju.15711] [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: 10/24/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Smoking is a well-established risk factor for sexual dysfunction. However, the impact of smoking cessation on sexual function is unclear. We hypothesize that there is an improvement in sexual function following smoking cessation. To evaluate this hypothesis, we analyzed the association between cigarette smoking and smoking cessation with sexual function among participants of the Reduction by Dutasteride in Prostate Cancer Events (REDUCE) study. MATERIALS AND METHODS We analyzed baseline data of 6,754 men, ages 50-75 years-old divided into: lifelong nonsmokers, former smokers and current smokers. We examined total testosterone (TT, normal range ≥10 nmol/L) and sexual function variables: self-reported sexual activity, low libido and erectile dysfunction. Differences between current vs nonsmokers and former vs current smokers were analyzed using chi-square test, linear and logistic regressions. RESULTS A total of 3,069 (45.4%) men were nonsmokers, 2,673 (39.6%) former smokers, and 1,012 (15%) current smokers. Current smokers were significantly younger than former and nonsmokers (mean age 61.6, 63.2, 62.7 years), leaner (mean body-mass index 27.0, 27.7, 27.2 kg/m2 ), and had less hypertension (32.4%, 41.6%, 36.8%, respectively, all P < 0.01). In uni- and multivariable analysis, current smokers had higher mean TT compared to nonsmokers (485.4, 451.2 nmol/L, P < 0.001), higher prevalence of low libido (25.6%, 21.0%, P=0.002) and erectile dysfunction (31.6%, 26.0%, respectively, P < 0.001) with comparable sexual activity (81.7%, 82.8%, respectively, P=0.420). In multivariable analysis, former smoker had statistically significant less prevalence of low libido (OR: 0.8, P=0.013) and erectile dysfunction (OR: 0.8, P=0.006) compared to current smokers. CONCLUSION Cigarette smoking was associated with worse sexual health compared to nonsmoker, while former smokers had better erectile function and libido than current smokers. Smoking cessation may improve male sexual health and counselling on smoking cessation may be considered at the time of sexual health evaluations.
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Affiliation(s)
- Mahmoud Mima
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason B Huang
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel J Ohlander
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Özer M, Toulabi SP, Fisher AD, T'Sjoen G, Buncamper ME, Monstrey S, Bizic MR, Djordjevic M, Falcone M, Christopher NA, Simon D, Capitán L, Motmans J. ESSM Position Statement "Sexual Wellbeing After Gender Affirming Surgery". Sex Med 2021; 10:100471. [PMID: 34971864 PMCID: PMC8847816 DOI: 10.1016/j.esxm.2021.100471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Much has been published on the surgical and functional results following Gender Affirming Surgery (‘GAS’) in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking. Aim To review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine. Methods The Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS. Main Outcomes Measure The task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasure- are provided for each statement separately. Results The present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing. Conclusion The available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Özer M, Toulabi SP, Fisher AD, et al. ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”. Sex Med 2022;10:100471.
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Affiliation(s)
- Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Sahaand Poor Toulabi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology, Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Department of Plastic, Reconstructive and Hand Surgery, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Marta R Bizic
- Department of Pediatric Urology, University of Belgrade, Belgrade, Serbia
| | | | - Marco Falcone
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Nim A Christopher
- Department of Urology, St Peter's Andrology Centre and The Institute of Urology, London, UK
| | - Daniel Simon
- Facialteam Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Luis Capitán
- Facialteam Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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Taniguchi H, Shimada S, Kinoshita H. Testosterone Therapy for Late-Onset Hypogonadism Improves Erectile Function: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:539-552. [PMID: 34856556 DOI: 10.1159/000520135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) of testosterone therapy (TTh) for late-onset hypogonadism are systematically reviewed and a meta-analysis to assess the efficacy of TTh in improving erectile function is performed. METHODS The PubMed, Cochrane Library, and Web of Science databases were searched to identify RCTs published from 2007. RCTs that assessed erectile function using the erectile function domain of the International Index of Erectile Function (IIEF-EFD) were included in the meta-analysis. RESULTS The systematic review included 18 RCTs and the meta-analysis included 6 studies that enrolled a total of 1,458 patients. The overall meta-analysis revealed that the IIEF-EFD score was significantly improved in the TTh group compared with the placebo group (mean difference 1.86; 95% confidence interval 1.01-2.72; p < 0.0001). Compared with patients receiving placebo, there was a significant improvement in the IIEF-EFD of patients who received TTh using testosterone gel, those who received TTh for over 30 weeks, and those without diabetes mellitus or metabolic syndrome. CONCLUSION TTh achieved a significant improvement in the IIEF-EFD score of hypogonadal men compared with placebo, especially in those who received testosterone gel, were treated for over 30 weeks, and had no comorbidities.
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Affiliation(s)
- Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan,
| | - Seiji Shimada
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Majumdar S, Mukherjee JJ, Ray S, Goswami S, Jude E, Biswas A, Hanumanthu A, John M, Sinha B, Ghoshal S, Kota S, Sharma SK, Jacob JJ. Testosterone replacement therapy in men with type 2 diabetes mellitus and functional hypogonadism -an Integrated Diabetes and Endocrine Academy (IDEA) consensus guideline. Diabetes Metab Syndr 2021; 15:102191. [PMID: 34245961 DOI: 10.1016/j.dsx.2021.102191] [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: 01/25/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Though testosterone replacement therapy in men with organic hypogonadism is established, its role in men with type 2 diabetes mellitus (T2DM) and functional hypogonadism is unclear. METHODS Thirteen experts addressed ten topic-specific questions after an in-depth review of literature, where all relevant issues were critically evaluated. RESULTS Ten recommendations concerning diagnosis and management of men with T2DM and functional hypogonadism have been put forward. CONCLUSION Routine measurement of serum testosterone in all, and inappropriate replacement of testosterone in asymptomatic T2DM men with functional hypogonadism and borderline low serum testosterone values, is not recommended.
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Affiliation(s)
- Sujoy Majumdar
- Peerless Hospital, Kolkata, India; Department of Diabetes and Endocrinology, GD Hospital and Diabetes Institute, Kolkata, India.
| | | | - Subir Ray
- Apollo Gleneagles Hospital, Kolkata, India
| | - Soumik Goswami
- Department of Endocrinology and Diabetes, NRS Medical College and Hospital, Kolkata, India
| | - Edward Jude
- Tameside Hospital NHS Foundation Trust, United Kingdom; Honorary Professor, University of Manchester, United Kingdom; Manchester Metropolitan University, United Kingdom
| | - Ajoy Biswas
- GD Hospital and Diabetes Institute, Kolkata, India
| | - Ajay Hanumanthu
- Department of Endocrinology and Diabetes, NRS Medical College and Hospital, Kolkata, India
| | - Mathew John
- Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | | | | | - Sunil Kota
- Diabetes and Endocare Clinic, Berhampur, Orissa, India
| | | | - Jubbin Jagan Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, India
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Hidayatik N, Purnomo A, Fikri F, Purnama MTE. Amelioration on oxidative stress, testosterone, and cortisol levels after administration of Vitamins C and E in albino rats with chronic variable stress. Vet World 2021; 14:137-143. [PMID: 33642797 PMCID: PMC7896882 DOI: 10.14202/vetworld.2021.137-143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND AIM Stress can cause physiological and biological disorders in the body. On the other hand, antioxidants from vitamins and minerals are effective for stress treatment. Therefore, this study aimed to evaluate the effect of the administration of Vitamins C and E on serum superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPx), testosterone, and cortisol activity in albino rats with chronic variable stress (CVS). MATERIALS AND METHODS Twenty albino rats were randomly assigned into four treatment groups: C was administered normal saline; T1 was administered Vitamins C and E; T2 was only induced CVS; and T3 was induced CVS followed by Vitamins C and E administration. All treatments were applied for 4 weeks, respectively. Furthermore, 5 mL of blood samples were collected intracardially. Body weight data were collected for the initial and final weights. From serum samples, SOD, GPx, and CAT were measured using the enzymol method; MDA was measured using the high-performance liquid chromatography method; and testosterone and cortisol were measured using the enzyme-linked immunosorbent assay method. All variables were analyzed statistically using analysis of variance followed by the Duncan test (p<0.05). RESULTS Our findings showed that the T1 and T3 groups significantly decreased (p<0.001) compared to T2 in the following parameters: SOD, MDA, GPx, and cortisol. Meanwhile, CAT and testosterone levels in the T1 and T3 groups were significantly increased (p<0.001) compared to the T2 group. In addition, the weight gain in T1 and T3 groups was significantly increased (p<0.001) compared to T2 group. CONCLUSION It can be concluded that the administration of Vitamins C and E had a significant effect to alleviate SOD, MDA, GPx, and cortisol and to improve the testosterone level in albino rats with CVS.
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Affiliation(s)
- Nanik Hidayatik
- Department of Veterinary Clinical Pathology and Physiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Agus Purnomo
- Department of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Faisal Fikri
- Department of Veterinary Clinical Pathology and Physiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
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Fisher JS, Rezk A, Nwefo E, Masterson J, Ramasamy R. Sexual Health in the Elderly Population. CURRENT SEXUAL HEALTH REPORTS 2020; 12:381-388. [PMID: 33437223 PMCID: PMC7799439 DOI: 10.1007/s11930-020-00278-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Among the growing elderly population, sexual health remains an important concern for individuals and couples. An understanding of the expected changes with aging and taking care of aging men and women is important for treating sexual dysfunction. Sexual health issues related to aging can be both linked between men and women and independent. The aim of this study is to determine the most important considerations that contribute to sexual satisfaction in men and women in this population. RECENT FINDINGS Many factors contribute to the overall sexual health of men and women. Hypogonadism and erectile dysfunction both warrant thorough evaluation and consideration of treatment to improve sexual satisfaction. Underlying cardiovascular issues may be present in men presenting with these concerns. In addition to hormone replacement and traditional therapy for erectile dysfunction, therapeutic stem cell injection has shown some promise. Menopause, vaginal dryness, and dyspareunia play important roles in sexual satisfaction in women. Vaginal moisturizers, topical estrogen, and MonaLisa Touch laser therapy all may aid in improving these symptoms and ultimately sex lives. Studies have also demonstrated some benefit in populations with arousal disorders, which can be present in the elderly. SUMMARY Male patients often describe issues related to erectile dysfunction and hypogonadism, and issues with sexual drive. The pathophysiology is linked between these conditions and treatment of one component can provide symptom relief on a larger scale. A combination of testosterone therapy, lifestyle modifications, and therapy for erectile dysfunction relates to sexual satisfaction in men. In women, an understanding of the physiological process of menopause and offering therapy when indicated can improve the quality of sexual health and provide satisfaction to both patient and partner. While aging can diminish drive and desire, proper counseling and treatment may significantly benefit some patients. A multimodal approach involving the physician, patient, and partner will optimize care and may improve the quality of life in the elderly. This review outlines some normal changes due to aging and identifies some current treatment options for a population in which sexual health can be often ignored or dismissed. By understanding the available tools, a more comprehensive approach can be taken to achieve satisfaction in couples and individuals alike.
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Affiliation(s)
- John S. Fisher
- Department of Urology, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Andrew Rezk
- Department of Urology, University of Miami, Miami, FL, USA
| | - Elie Nwefo
- Department of Urology, University of Miami, Miami, FL, USA
| | - John Masterson
- Cedars-Sinai Department of Urology, Beverly Hills, CA, USA
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Dias FCR, Gomes MDLM, Melo FCSAD, Menezes TP, Martins AL, Cupertino MDC, Otoni WC, Matta SLPD. Pfaffia glomerata hydroalcoholic extract stimulates penile tissue in adult Swiss mice. JOURNAL OF ETHNOPHARMACOLOGY 2020; 261:113182. [PMID: 32730872 DOI: 10.1016/j.jep.2020.113182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Roots of Pfaffia glomerata are used in traditional medicine as aphrodisiacs and sexual stimulants. AIM OF THE STUDY The aim of this study was to evaluate the action of the hydroalcoholic extract from the roots of Pfaffia glomerata on the Leydig cells, cavernous bodies and other penile constituents, as well as on serum testosterone and 17β-estradiol levels of adult mice. MATERIALS AND METHODS Mature male Swiss mice were divided into 6 groups: control (water), sildenafil citrate, 3 groups receiving daily doses of P. glomerata extract (100, 200 and 400 mg/kg) and one group receiving intermittent doses of P. glomerata (200 mg/kg/3-3d). RESULTS The proportions of blood vessels, lymphatic space and estradiol levels were increased. On the other hand, reduction of testosterone levels due to Leydig cells death was observed. As for penile parameters, volumetric proportions of cavernous bodies, collagen and nitric oxide were increased, while smooth muscle content was decreased. CONCLUSIONS Despite that the long term intake of P. glomerata extract was related to a stimulant action, reduction on Leydig cell viability induced decreased testosterone production.
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Affiliation(s)
- Fernanda Carolina Ribeiro Dias
- Department of General Biology, Federal University of Viçosa, Peter Henry Rolfs Avenue S/n, 36570-900, Viçosa, MG, Brazil; Department of Structural Biology, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, 38025-015, Uberaba, MG, Brazil
| | - Marcos de Lucca Moreira Gomes
- Department of Structural Biology, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, 38025-015, Uberaba, MG, Brazil.
| | | | - Tatiana Prata Menezes
- Department of General Biology, Federal University of Viçosa, Peter Henry Rolfs Avenue S/n, 36570-900, Viçosa, MG, Brazil
| | - Ana Luiza Martins
- Department of General Biology, Federal University of Viçosa, Peter Henry Rolfs Avenue S/n, 36570-900, Viçosa, MG, Brazil
| | - Marli do Carmo Cupertino
- Department of General Biology, Federal University of Viçosa, Peter Henry Rolfs Avenue S/n, 36570-900, Viçosa, MG, Brazil
| | - Wagner Campos Otoni
- Department of Plant Biology, Federal University of Viçosa, Peter Henry Rolfs Avenue S/n, 36570-900, Viçosa, MG, Brazil
| | - Sérgio Luis Pinto da Matta
- Department of General Biology, Federal University of Viçosa, Peter Henry Rolfs Avenue S/n, 36570-900, Viçosa, MG, Brazil
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13
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The Role of Hormones in Male Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Ristori J, Cocchetti C, Castellini G, Pierdominici M, Cipriani A, Testi D, Gavazzi G, Mazzoli F, Mosconi M, Meriggiola MC, Cassioli E, Vignozzi L, Ricca V, Maggi M, Fisher AD. Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data. J Sex Med 2020; 17:142-151. [DOI: 10.1016/j.jsxm.2019.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 12/21/2022]
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15
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Ramli FF, Shuid AN, Pakri Mohamed RM, Tg Abu Bakar Sidik TMI, Naina Mohamed I. Health-Seeking Behavior for Erectile Dysfunction in Methadone Maintenance Treatment Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214249. [PMID: 31683816 PMCID: PMC6862227 DOI: 10.3390/ijerph16214249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
Background: Erectile dysfunction (ED) is commonly associated with methadone usage. However, little data is known regarding the health-seeking behavior for ED in the methadone maintenance treatment (MMT) population. This study aimed to determine the health-seeking behavior of MMT patients with ED who perceived themselves as having ED. We aimed to assess the attitudes and health-seeking behavior, the effectiveness of the treatment and the factors associated with treatment-seeking behavior. Methods: This was an observational questionnaire-based study. Patients were first screened for ED (n = 154) using the International Index of Erectile Function-5 (IIEF-5). Fifty patients with ED were evaluated for health-seeking behavior for ED. Results: More than half of the patients who thought they had ED (78%) believed their sex life was affected. Most patients (48%) did not seek any information regarding ED. Education level (p = 0.017) and marital status (p = 0.008) were predictive factors of health-seeking behavior. Conclusions: The health-seeking rate among MMT patients with ED needs to be improved. Measures to increase awareness of ED in MMT patients should be taken to overcome the barrier to health-seeking behavior. Health practitioners should take action to screen ED in this population to increase the detection rate and offer appropriate management according to the patients’ needs.
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Affiliation(s)
- Fitri Fareez Ramli
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Ahmad Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Rashidi Mohamed Pakri Mohamed
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Tg Mohd Ikhwan Tg Abu Bakar Sidik
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Isa Naina Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
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16
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Burgio G, Giammusso B, Calogero AE, Mollaioli D, Condorelli RA, Jannini EA, La Vignera S. Evaluation of the Mistakes in Self-Diagnosis of Sexual Dysfunctions in 11,000 Male Outpatients: A Real-Life Study in An Andrology Clinic. J Clin Med 2019; 8:jcm8101679. [PMID: 31615034 PMCID: PMC6832924 DOI: 10.3390/jcm8101679] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose: The aim of this study was to compare the initial request for sexual consultation with the final diagnosis and to evaluate the limits of the active andrological anamnesis concerning unclassified male sexual dysfunction. Methods: In this 12-year observational retrospective study, we collected data from patients referring to an andrological outpatient clinic, evaluating the requests, perceptions, needs, and self-diagnosis at their first visit and comparing them with the final diagnosis reached after a complete clinical, laboratory, and instrumental investigation. Results: A total of 11,200 patients were evaluated. The main request of andrological consultation was erectile dysfunction (ED) (52%), followed by premature ejaculation (PE) (28%), and low sexual desire (11.5%). Among the patients seeking help for ED, about 30% were ultimately found to have a different type of dysfunction and 24% were diagnosed with an “unmet need”, which included issues not present in the current nosography nonetheless affecting sexual and relational life. Among the patients referring for PE, the final diagnosis was lifelong PE for the large majority of them, regardless of whether initially they thought to have an acquired form. Several of those who sought consultation for acquired PE were frequently found to be able to compensate for lifelong PE by a subsequent coitus or were able to induce orgasm in the partner with different modalities. Among the patients referring for low sexual desire, only 57.5% were confirmed to have it; 23% had ED and 18.5% showed a raised threshold of penile sensitivity. Conclusions: The results of this study show that the reason for consultation is frequently misleading and raise the relevance of being aware of the so-called “unmet needs” and to discuss with the patient and the couple to explore the sexual history behind the self-diagnosis. These findings also suggest the need to expand the current taxonomy of male sexual dysfunctions.
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Affiliation(s)
- Giovanni Burgio
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
| | - Bruno Giammusso
- Urology Clinic, Policlinic "Morgagni", 95125 Catania, Italy.
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
| | - Daniele Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
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17
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Kaufman JM, Lapauw B, Mahmoud A, T'Sjoen G, Huhtaniemi IT. Aging and the Male Reproductive System. Endocr Rev 2019; 40:906-972. [PMID: 30888401 DOI: 10.1210/er.2018-00178] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022]
Abstract
This narrative review presents an overview of current knowledge on fertility and reproductive hormone changes in aging men, the factors driving and modulating these changes, their clinical consequences, and the benefits and risks of testosterone (T) therapy. Aging is accompanied by moderate decline of gamete quality and fertility. Population mean levels show a mild total T decline, an SHBG increase, a steeper free T decline, and a moderate LH increase with important contribution of comorbidities (e.g., obesity) to these changes. Sexual symptoms and lower hematocrit are associated with low T and are partly responsive to T therapy. The relationship of serum T with body composition and metabolic health is bidirectional; limited beneficial effects of T therapy on body composition have only marginal effects on metabolic health and physical function. Skeletal changes are associated primarily with estradiol and SHBG. Cognitive decline is not consistently linked to low T and is not improved by T therapy. Although limited evidence links moderate androgen decline with depressive symptoms, T therapy has small beneficial effects on mood, depressive symptoms, and vitality in elderly patients with low T. Suboptimal T (and/or DHT) has been associated with increased risk of stroke, but not of ischemic heart disease, whereas an association with mortality probably reflects that low T is a marker of poor health. Globally, neither severity of clinical consequences attributable to low T nor the nature and magnitude of beneficial treatment effects justify the concept of some broadly applied "T replacement therapy" in older men with low T. Moreover, long-term safety of T therapy is not established.
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ahmed Mahmoud
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ilpo Tapani Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.,Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
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18
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Sim J, Cho B, Park M, Rhee J, In S, Choe S. Monitoring urinary testosterone and epitestosterone levels, and their ratio, in Korean chemical castration subjects using liquid chromatography–tandem mass spectrometry. J Anal Toxicol 2019; 44:192-199. [DOI: 10.1093/jat/bkz002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/16/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
In Europe, chemical castration has been adopted as a treatment for paraphilia since the 1930s. Among the various chemical castration agents, luteinizing hormone-releasing hormone (LHRH) agonists are now used widely because of their effectiveness and safety. In South Korea, a legislation of chemical castration to control the sexual impulses of sexual offenders was enforced in July 2011. Most of these subjects are treated with leuprorelin acetate, an LHRH agonist, for chemical castration. Despite this, there are few studies that address the long-term influence of LHRH agonists on testosterone (T) and epitestosterone (E) levels in chemical castration subjects. In order to analyze the urinary levels of T in chemical castration subjects, whose T levels are extremely low, we developed and validated an analytical method for the detection of both T and E in human urine using a liquid chromatography-tandem mass spectrometry (LC–MS/MS) system. The urine samples were hydrolyzed, extracted, and analyzed by LC–MS/MS with electrospray ionization in the positive-ion mode. The limits of detection were 0.02 ng/mL and the limits of quantitation were 0.05 ng/mL, which provided great sensitivity. The established method was applied to urine samples from chemical castration subjects and healthy male volunteers. The chemical castration subjects showed significantly lower urinary T levels than the control subjects. In addition, the urinary E levels were also lower in the chemical castration subjects; however, the T/E ratios were constant and did not show a notable decrease because of the simultaneous decrease in both urinary T and E. The urinary T levels and T/E ratio did not exceed the doping control criteria for exogenous T ingestion for any subject. This study shows the trend of urinary T and E levels in long-term treated chemical castration subjects by establishing a highly sensitive LC–MS/MS method, that provides useful information for monitoring chemical castration.
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Affiliation(s)
- Juhyun Sim
- National Forensic Service, 26460, 10 Ipchun-ro, Wonju, Gangwon-do, Republic of Korea
| | - Byungsuk Cho
- National Forensic Service, 26460, 10 Ipchun-ro, Wonju, Gangwon-do, Republic of Korea
| | - Meejung Park
- National Forensic Service, 26460, 10 Ipchun-ro, Wonju, Gangwon-do, Republic of Korea
| | - Jongsook Rhee
- National Forensic Service Busan institute, 50612, 50, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Sangwhan In
- National Forensic Service, 26460, 10 Ipchun-ro, Wonju, Gangwon-do, Republic of Korea
| | - Sanggil Choe
- National Forensic Service Seoul institute, 08036, 139, Jiyang-ro, Yangcheon-gu, Seoul, Republic of Korea
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19
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Meissner VH, Schroeter L, Köhn FM, Kron M, Zitzmann M, Arsov C, Imkamp F, Hadaschik B, Gschwend JE, Herkommer K. Factors Associated with Low Sexual Desire in 45-Year-Old Men: Findings from the German Male Sex-Study. J Sex Med 2019; 16:981-991. [DOI: 10.1016/j.jsxm.2019.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
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20
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Montagna G, Balestra S, D'Aurizio F, Romanelli F, Benagli C, Tozzoli R, Risch L, Giovanella L, Imperiali M. Establishing normal values of total testosterone in adult healthy men by the use of four immunometric methods and liquid chromatography-mass spectrometry. Clin Chem Lab Med 2019; 56:1936-1944. [PMID: 29746252 DOI: 10.1515/cclm-2017-1201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The total testosterone (T) cutoffs clinically adopted to define late-onset hypogonadism (LOH) do not consider the differences that exist between different analytical platforms, nor do they consider the body mass index (BMI) or age of the patient. We aimed at providing method, age and BMI-specific normal values for total T in European healthy men. METHODS A total of 351 eugonadal healthy men were recruited, and total T was measured with four automated immunometric assays (IMAs): ARCHITECT i1000SR (Abbott), UniCel DxI800 (Beckman Coulter), Cobas e601 (Roche), IMMULITE 2000 (Siemens) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Reference ranges (RRs) were calculated for each method. RESULTS Passing and Bablok regression analysis and Bland-Altman plot showed an acceptable agreement between Abbott and LC-MS/MS, but a poor one between LC-MS/MS and the other IMAs. Age-specific T concentrations in non-obese (BMI <29.9 kg/m2) men were greater than in all men. The total T normal range, in non-obese men aged 18-39 years, measured with LC-MS/MS was 9.038-41.310 nmol/L. RRs calculated with LC-MS/MS statistically differed from the ones calculated with all individual IMAs, except Abbott and among all IMAs. Statistically significant differences for both upper and lower reference limits between our RRs and the ones provided by the manufacturers were also noticed. CONCLUSIONS We calculated normal ranges in a non-obese cohort of European men, aged 18-39 years, with four commercially available IMAs and LC-MS/MS and found statistically significant differences according to the analytical method used. Method-specific reference values can increase the accuracy of LOH diagnosis and should be standardly used.
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Affiliation(s)
- Giacomo Montagna
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| | - Samuela Balestra
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Francesco Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Cinzia Benagli
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Renato Tozzoli
- Clinical Pathology Service, Regional Hospital, Pordenone, Italy
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland.,Institute of Clinical Chemistry, University of Bern, Bern, Switzerland.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Luca Giovanella
- Clinic for Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Integrated Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland, Phone: +41 91 811 86 72, Fax: +41 91 811 82 50
| | - Mauro Imperiali
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
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21
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Rastrelli G, Guaraldi F, Reismann Y, Sforza A, Isidori AM, Maggi M, Corona G. Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev 2019; 7:464-475. [PMID: 30803919 DOI: 10.1016/j.sxmr.2018.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several data have clearly shown that the endocrine system-and androgens in particular-play a pivotal role in regulating all the steps involved in the male sexual response cycle. Accordingly, testosterone (T) replacement therapy (TRT) represents a cornerstone of pharmacologic management of hypogonadal subjects with erectile dysfunction. AIM The aim of this review is to summarize all the available evidence supporting the role of T in the regulation of male sexual function and to provide a comprehensive summary regarding the sexual outcomes of TRT in patients complaining of sexual dysfunction. METHODS A comprehensive PubMed literature search was performed. MAIN OUTCOME MEASURE Specific analysis of preclinical and clinical evidence on the role of T in regulating male sexual function was performed. In addition, available evidence supporting the role of TRT on several sexual outcomes was separately investigated. RESULTS T represents an important modulator of male sexual response function. However, the role of T in sexual functioning is less evident in epidemiologic studies because other factors, including organic, relational, and intrapsychic determinants, can orchestrate their effect independently from the state of androgens. Nonetheless, it is clear that TRT can ameliorate several aspects of sexual functioning, including libido, erectile function, and overall sexual satisfaction. Conversely, data on the role of TRT in improving orgasmic function are more conflicting. Finally, further controlled studies are needed to investigate the combination of TRT and PDE5 inhibitors. CONCLUSION Positive effects of TRT are observed only in the presence of a hypogonadal status (ie, total T < 12 nmol/L). In addition, TRT alone can be effective in restoring only milder forms of erectile dysfunction, whereas the combined therapy with other drugs is required when more severe vascular damage is present. Rastrelli G, Guaraldi F, Reismann Y, et al. Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev 2019;7:464-475.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Federica Guaraldi
- Pituitary Unit, IRCCS Institute of Neurological Science of Bologna, Bologna, Italy; Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Yacov Reismann
- Amstelland Hospital, Department of Urology, Amsterdam, The Nederland
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy.
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22
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Banihani SA. Effect of Coenzyme Q 10 Supplementation on Testosterone. Biomolecules 2018; 8:biom8040172. [PMID: 30551653 PMCID: PMC6316376 DOI: 10.3390/biom8040172] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 12/19/2022] Open
Abstract
Enhancing testosterone production in males is a continuous research direction for many scientists in the field, due to its role as a principal sex hormone and as a crucial modulator of well-being and general health in humans. Since 1978, there have been more than 30 studies that have connected coenzyme Q10 and testosterone. Such a link is attributable to the vigorous biological role of coenzyme Q10 as a crucial member in the energy production route in humans and animals, which is thought to have a positive influence on testosterone production, and hence on infertility, particularly male infertility. However, this connection has not yet been deliberated. The present work systematically reviews and summarizes the influence of coenzyme Q10 supplementation on testosterone. To accomplish this purpose, the Scopus, PubMed, and Web of Science databases were searched using the keywords “coenzyme Q10” versus “testosterone” for English language papers from November 1978 through October 2018. Relevant articles were also discussed and included to address an integral discussion. In summary, to date the studies conducted on human males reveal insignificant effects of coenzyme Q10 supplementation on testosterone. Similarly, rather than the reproductive toxicity studies, the studies conducted on animals did not show any positive influence of coenzyme Q10 on testosterone. However, coenzyme Q10 supplementation was found to ameliorate the reduction in testosterone induced by chemical reproductive toxicants, mainly by neutralizing the damaging effect of the generated free radicals. However, collectively these findings require further confirmation by additional research studies.
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Affiliation(s)
- Saleem Ali Banihani
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.
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23
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Xiao GY, Peng B, Hu Y, Qu D, Lai MQ, Gong Y, Zhao FL, Yi H, Jia Y, Zhou WK, Lei SC, Wang SL, Xia J, Lv DZ, Geng S, Bai RL, Zhong XN. Characteristics influencing high-risk sexual behaviours in elderly men. Int J STD AIDS 2018; 30:353-361. [PMID: 30486763 DOI: 10.1177/0956462418804652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With the objective of investigating the characteristics influencing high-risk sexual behaviours in elderly men (60-74 years of age) in Chongqing, China, a total of 1433 healthy elderly men with sexual intercourse frequencies of one to six times/month who were willing to participate in the questionnaires were studied at four hospitals. We measured serum testosterone levels and performed follow-ups every six months, with a total of 1128 elderly men followed up after two years. We also investigated socio-economic and demographic characteristics (age, education, income, location, marital status and number of marriages), types of sexual partners, age differences with fixed sexual partners, frequency of sexual intercourse, combined basic age-related diseases, sexually transmitted infections (STIs) education, elderly self-care ability and high-risk sexual behaviours (frequency of sexual intercourse and number of sexual partners) using questionnaires. We analysed the influencing factors of high-risk sexual behaviours in elderly men using a univariate analysis, multivariate logistic regression analysis, BP neural network prediction and cluster analysis. Finally, we found that serum total testosterone, age, types of sexual partners, age differences with fixed partners and frequency of sexual intercourse are five factors that influence high-risk sexual behaviours in elderly men.
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Affiliation(s)
- Gui-Yuan Xiao
- 1 Department of Health Statistics, School of Public Health, Chongqing Medical University,Chongqing, China
| | - Bin Peng
- 2 Department of Dermatology, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Ying Hu
- 1 Department of Health Statistics, School of Public Health, Chongqing Medical University,Chongqing, China
| | - Dou Qu
- 1 Department of Health Statistics, School of Public Health, Chongqing Medical University,Chongqing, China
| | - Min-Qing Lai
- 1 Department of Health Statistics, School of Public Health, Chongqing Medical University,Chongqing, China
| | - Yu Gong
- 2 Department of Dermatology, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Feng-Lan Zhao
- 2 Department of Dermatology, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Hong Yi
- 2 Department of Dermatology, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Yu Jia
- 3 Department of Dermatology, The 4th People's Hospital of Chongqing, Chongqing, China
| | - Wei-Kang Zhou
- 4 Department of Dermatology, The People's Hospital of Chongqing, Chongqing, China
| | - Shan-Chuan Lei
- 5 Department of Dermatology, Yong Chuan Hospital at Chongqing Medical University, Chongqing, China
| | - Sha-Li Wang
- 6 Department of Physiology, Basic Department at Chongqing Medical University, Chongqing, China
| | - Jing Xia
- 7 Laboratory Department, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Deng-Zhi Lv
- 8 Department of Community, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Shan Geng
- 9 Department of Geriatrics, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Rong-Li Bai
- 10 Department of Medical Education, The 13th People's Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Xiao-Ni Zhong
- 1 Department of Health Statistics, School of Public Health, Chongqing Medical University,Chongqing, China
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Bandak M, Lauritsen J, Johansen C, Kreiberg M, Skøtt JW, Agerbaek M, Holm NV, Daugaard G. Sexual Function and Quality of Life in a National Cohort of Survivors of Bilateral Testicular Cancer. Eur Urol Focus 2018; 6:711-719. [PMID: 30482585 DOI: 10.1016/j.euf.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/27/2018] [Accepted: 11/15/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sexual function and quality of life remain unexplored among long-term survivors of bilateral testicular cancer (TC). OBJECTIVE To investigate sexual function, fatigue, anxiety, and depression among long-term survivors of bilateral TC (unilateral TC with contralateral germ cell neoplasia in situ [TC+GCNIS] or bilateral TC [BTC]). DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study of 2479 long-term TC survivors, of whom 126 were treated with contralateral radiotherapy for GCNIS, 93 were treated with bilateral orchiectomy for BTC, and 2260 had unilateral TC (reference group). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes were assessed using validated questionnaires at a median time since diagnosis of 17 yr (interquartile range 12-23). Results for survivors of TC+GCNIS and of BTC were compared with those for the reference group. Adjustment was made for age and treatment for disseminated disease. RESULTS AND LIMITATIONS The age-adjusted risk of anxiety was significantly higher among BTC survivors (odds ratio 1.7, 95% confidence interval [CI] 1.1-2.8; p=0.002) than in the reference group. Apart from a higher risk of reduced motivation among survivors of TC+GCNIS (β=0.067, 95% CI 0.0013-0.13; p=0.046) there were no significant differences between the groups. Limitations include the low number of cases with symptoms of depression. CONCLUSIONS Survivors of BTC had a higher risk of anxiety but did not experience impairment of other aspects of quality of life when compared to survivors of unilateral TC. These results are of importance for evidence-based information on late effects for bilateral TC patients. PATIENT SUMMARY We evaluated quality of life and sexual function among long-term survivors of bilateral testicular cancer. Reassuringly, we did not find impaired quality of life apart from a higher risk of anxiety when comparing survivors of bilateral testicular cancer with survivors of unilateral testicular cancer.
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Affiliation(s)
- Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Internal Medicine, Nykøbing Falster Sygehus, Nykøbing Falster, Denmark.
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julie Wang Skøtt
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mads Agerbaek
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels V Holm
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Alabi QK, Olukiran OS, Adefisayo MA, Fadeyi BA. Effects of Treatment with Nauclea latifolia Root Decoction on Sexual Behavior and Reproductive Functions in Male Rabbits. J Diet Suppl 2018; 15:649-664. [PMID: 29087735 DOI: 10.1080/19390211.2017.1380105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Nauclea latifolia is used in traditional medicine for the treatment of male reproductive diseases. Despite its vast uses, its effects on the male reproductive system have not been scientifically proven. This study aimed to investigate the effects of Nauclea latifolia root decoction on sexual behavior and functions in male rabbits. Twenty-four male rabbits were divided into four groups: The first group received daily distilled water orally. The second, third, and fourth groups were orally treated with 100, 200, and 400 mg/kg body weight of Nuclea latifolia root, respectively. Sexual behavior parameters were carried out on weeks 1, 2, and 3 of the study. Testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were measured from the serum, while the testes tissue samples were used for antioxidant and histopathological examinations. Treatment with 200 and 400 mg/kg body weight resulted in significantly (p < .05) increased frequencies of mounting and intromission. In addition, the ejaculation latency was significantly prolonged (p < .05). The latencies of mounting and intromission were significantly decreased (p < .05), whereas ejaculation frequency increased. Serum testosterone, FSH, and LH increased significantly (p < .05) after treatment with Nuclea latifolia. There was an increase in epididymal sperm counts at 200 and 400 mg/kg body weight doses compared to the control. The extract also increased sperm motility and viability and improved testicular oxidative status. Histological examination revealed an increase in germinal layer thickness. The present study suggests that treatment with N. latifolia improves male sexual function and fertility and protects the testes from oxidative damage.
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Affiliation(s)
- Quadri Kunle Alabi
- a Department of Physiological Sciences, Faculty of Basic Medical Sciences , Obafemi Awolowo University , Ile-Ife , Osun State , Nigeria
| | - Olaoluwa Sesan Olukiran
- a Department of Physiological Sciences, Faculty of Basic Medical Sciences , Obafemi Awolowo University , Ile-Ife , Osun State , Nigeria
| | - Modinat Adebukola Adefisayo
- b Department of Physiology, Faculty of Basic Medical Sciences , University of Medical Sciences , Ondo State , Nigeria
| | - Benson Akinloye Fadeyi
- a Department of Physiological Sciences, Faculty of Basic Medical Sciences , Obafemi Awolowo University , Ile-Ife , Osun State , Nigeria
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Taylor DG, Giuliano F, Hackett G, Hermes-DeSantis E, Kirby MG, Kloner RA, Maguire T, Stecher V, Goggin P. The pharmacist's role in improving the treatment of erectile dysfunction and its underlying causes. Res Social Adm Pharm 2018; 15:591-599. [PMID: 30057329 DOI: 10.1016/j.sapharm.2018.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/07/2023]
Abstract
Erectile dysfunction (ED), which worldwide is likely to affect in excess of 300 million men by 2025, is often either untreated or insufficiently treated. It can be a prelude to other serious illnesses and may be a cause or consequence of depression in affected individuals. Among men younger than 60 years of age, ED can be a robust early-stage indicator of vascular disease and type 2 diabetes. Untreated or inadequately treated ED can also be a sign of poor communication between health professionals and service users of all ages. Improved treatment of ED could cost-effectively prevent premature deaths and avoidable morbidity. The extension of community pharmacy‒based health care would enable more men living with ED to safely access effective medications, along with appropriate diagnostic services and support for beneficial lifestyle changes such as smoking cessation in conveniently accessible settings. The task of introducing improved methods of affordably addressing problems linked to ED exemplifies the strategic challenges now facing health care systems globally. Promoting professionally supported self-care in pharmacies has the potential to meet the needs of aging populations in progressively more effective ways.
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Affiliation(s)
- David G Taylor
- The UCL School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK.
| | - Francois Giuliano
- Neurourology R. Poincaré Hal Garches, Versailles Saint-Quentin University, 104 Boulevard Raymond Poincaré, Garches, 92380, France.
| | - Geoff Hackett
- Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham, B75 7RR, UK.
| | - Evelyn Hermes-DeSantis
- Ernest Mario School of Pharmacy, Rutgers University, 160 Frelinghuysen Road, New Brunswick, NJ, 08854, USA.
| | - Michael G Kirby
- The Prostate Centre, 32 Wimpole St, Marylebone, London W1G 8GT, UK; University of Hertfordshire, Centre for Research in Primary and Community Care, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Robert A Kloner
- Huntington Medical Research Institutes, 686 S Fair Oaks Ave, Pasadena, CA 91105, USA; Division of Cardiovascular Medicine, Dept. of Medicine, Keck School of Medicine at University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
| | - Terry Maguire
- Queens University Belfast, University Road, Belfast, BT7 1NN, UK, Ireland.
| | - Vera Stecher
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA.
| | - Paul Goggin
- Pfizer Ltd, Discovery Park, Ramsgate Rd, Sandwich, CT13 9ND, UK.
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Arnocky S, Carré JM, Bird BM, Moreau BJP, Vaillancourt T, Ortiz T, Marley N. The Facial Width-to-Height Ratio Predicts Sex Drive, Sociosexuality, and Intended Infidelity. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1375-1385. [PMID: 28929303 DOI: 10.1007/s10508-017-1070-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 03/18/2017] [Accepted: 08/29/2017] [Indexed: 05/09/2023]
Abstract
Previous research has linked the facial width-to-height ratio (FWHR) to a host of psychological and behavioral characteristics, primarily in men. In two studies, we examined novel links between FWHR and sex drive. In Study 1, a sample of 145 undergraduate students revealed that FWHR positively predicted sex drive. There were no significant FWHR × sex interactions, suggesting that FWHR is linked to sexuality among both men and women. Study 2 replicated and extended these findings in a sample of 314 students collected from a different Canadian city, which again demonstrated links between the FWHR and sex drive (also in both men and women), as well as sociosexuality and intended infidelity (men only). Internal meta-analytic results confirm the link between FWHR and sex drive among both men and women. These results suggest that FWHR may be an important morphological index of human sexuality.
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Affiliation(s)
- Steven Arnocky
- Department of Psychology, Nipissing University, North Bay, ON, P1B 8L7, Canada.
| | - Justin M Carré
- Department of Psychology, Nipissing University, North Bay, ON, P1B 8L7, Canada
| | - Brian M Bird
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Benjamin J P Moreau
- Medical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Triana Ortiz
- Department of Psychology, Nipissing University, North Bay, ON, P1B 8L7, Canada
| | - Nicole Marley
- Department of Psychology, Nipissing University, North Bay, ON, P1B 8L7, Canada
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28
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Santi D, Spaggiari G, Gilioli L, Potì F, Simoni M, Casarini L. Molecular basis of androgen action on human sexual desire. Mol Cell Endocrinol 2018; 467:31-41. [PMID: 28893567 DOI: 10.1016/j.mce.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 12/14/2022]
Abstract
Reproduction is a fundamental process for the species maintenance and the propagation of genetic information. The energy expenditure for mating is overtaken by motivational stimuli, such as orgasm, finely regulated by steroid hormones, gonadotropins, neurotransmitters and molecules acting in the brain and peripheral organs. These functions are often investigated using animal models and translated to humans, where the androgens action is mediated by nuclear and membrane receptors converging in the regulation of both long-term genomic and rapid non-genomic signals. In both sexes, testosterone is a central player of this game and is involved in the regulation of sexual desire and arousal, and, finally, in reproduction through cognitive and peripheral physiological mechanisms which may decline with aging and circadian disruption. Finally, genetic variations impact on reproductive behaviours, resulting in sex-specific effect and different reproductive strategies. In this review, androgen actions on sexual desire are evaluated, focusing on the molecular levels of interaction.
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Affiliation(s)
- Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Endocrinology, Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda OU of Modena, Modena, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Endocrinology, Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda OU of Modena, Modena, Italy
| | - Lisa Gilioli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Potì
- Department of Neurosciences, University of Parma, Parma, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Endocrinology, Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda OU of Modena, Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy.
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
PURPOSE OF REVIEW Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide an overview of these findings and the utility of TTh. We specifically examine the role of TTh on erectile function, coadministration with phosphodiesterase type 5 inhibitors, and libido. RECENT FINDINGS Recent publications suggest that TTh improves mild erectile dysfunction, though may be less useful in men with more severe erectile dysfunction. In men unresponsive to phosphodiesterase type 5 inhibitors and with mild erectile dysfunction, TTh can further improve erectile function. TTh has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized. SUMMARY The available literature supports a role for TTh in men with low testosterone levels, erectile dysfunction, and low libido, with symptomatic improvement in these men.
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Rastrelli G, Corona G, Maggi M. Testosterone and sexual function in men. Maturitas 2018; 112:46-52. [PMID: 29704917 DOI: 10.1016/j.maturitas.2018.04.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023]
Abstract
Testosterone (T) is deeply involved in every step of the male sexual response. However, the occurrence of sexual disorders cannot be automatically related to a decline in T levels. In fact, this relationship is complicated by organic, relational and psychological factors, which can independently impair sexual function. For example, it is recognized that erectile dysfunction (ED) can result from vascular damage as well as from low levels of T. T therapy (TTh) can improve sexual function but meta-analyses show that it improves erectile function only in men with ED and overt hypogonadism. Similarly, impaired sexual desire can result from a wide range of organic, relational and psychological factors, although it is recognized as one of the most specific symptoms of hypogonadism. Accordingly, low desire is improved by TTh in men with overt hypogonadism. The association between low T levels and delayed ejaculation has not been well studied and needs further confirmation, as does the role of TTh in such cases. Meta-analyses have found that TTh can improve orgasmic function in hypogonadal men. Clinicians should bear in mind that sexual dysfunctions have multifactorial causes and hypogonadism represents only one of these. Only hypogonadal men are likely to improve their sexual symptoms when treated with TTh. The assessment of serum T levels is mandatory before patients are prescribed TTh, as are the assessment and possible treatment of other concomitant conditions.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy
| | - Giovanni Corona
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy; Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2, 40133 Bologna, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy; I.N.B.B., Istituto Nazionale Biostrutture e Biosistemi, Viale delle Medaglie d'Oro, 305, 00136 Rome, Italy.
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31
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Li W, Quan Y, Zhang M, Wang K, Zhu M, Chen Y, Li Q, Wu K. Effects of pituitary-specific overexpression of FSHα/β on reproductive traits in transgenic boars. J Anim Sci Biotechnol 2017; 8:84. [PMID: 29090093 PMCID: PMC5655851 DOI: 10.1186/s40104-017-0208-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/29/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Follicle-stimulating hormone (FSH) is a gonadotropin synthesized and secreted by the pituitary gland. FSH stimulates follicle development and maturation in females. It also plays an important role in spermatogenesis in males, including humans and mice. However, the effects of FSH on male pigs are largely unknown. In this study, we generated transgenic pigs to investigate the effects of FSHα/β overexpression on reproductive traits in boars. RESULTS After five transgenic F0 founders were crossed with wide-type pigs, 193 F1 animals were obtained. Of these, 96 were confirmed as transgenic. FSHα and FSHβ mRNAs were detected only in pituitary tissue. Transgenic boars exhibited significantly higher levels of FSHα and FSHβ mRNA, serum FSH, and serum testosterone, compared to full-sib non-transgenic boars. Significant increases in testis weight, vas deferens diameter, seminiferous tubule diameter, and the number of Leydig cells were observed, suggesting that the exogenous FSHα/β affects reproductive traits. Finally, transgenic and non-transgenic boars had similar growth performance and biochemical profiles. CONCLUSIONS Pituitary-specific overexpression of FSHα/β genes is likely to impact reproductive traits positively, as indicated by enhancements in serum testosterone level, testis weight, the development of vas deferens, seminiferous tubules, and Leydig cells in transgenic boars. A high level of serum FSH induces secretion of serum testosterone, possibly by boosting the number of Leydig cells, which presumably increases the libido and the frequency of sexual activity in transgenic boars. Our study provides a preliminary foundation for the genetic improvement of reproductive traits in male pigs.
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Affiliation(s)
- Wenting Li
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193 China
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, 450002 China
| | - Yujun Quan
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193 China
- Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101 China
| | - Mengmeng Zhang
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193 China
| | - Kejun Wang
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193 China
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, 450002 China
| | - Muzhen Zhu
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193 China
| | - Ye Chen
- The Department of Animal Husbandry, Rongchang Campus, Southwest University, Rongchang, Chongqing, 402460 China
| | - Qiuyan Li
- State Key Laboratory for Agrobiotechnology, China Agricultural University, Beijing, 100193 China
| | - Keliang Wu
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193 China
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32
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Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence 2017; 8:545-570. [PMID: 27831823 PMCID: PMC5538340 DOI: 10.1080/21505594.2016.1259053] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 01/07/2023] Open
Abstract
Several large cohort studies have disclosed the trajectories of sex steroids changes overtime in men and their clinical significance. In men the slow, physiological decline of serum testosterone (T) with advancing age overlaps with the clinical condition of overt, pathological hypogonadism. In addition, the increasing number of comorbidities, together with the high prevalence of chronic diseases, all further contribute to the decrease of serum T concentrations in the aging male. For all these reasons both the diagnosis of late-onset hypogonadism (LOH) in men and the decision about starting or not T replacement treatment remain challenging. At present, the biochemical finding of T deficiency alone is not sufficient for diagnosing hypogonadism in older men. Coupling hypogonadal symptoms with documented low serum T represents the best strategy to refine the diagnosis of hypogonadism in older men and to avoid unnecessary treatments.
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Affiliation(s)
- Maria Chiara Decaroli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Azienda USL of Modena, Modena, Italy
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Asano M, Hitaka T, Imada T, Yamada M, Morimoto M, Shinohara H, Hara T, Yamaoka M, Santou T, Nakayama M, Imai Y, Habuka N, Yano J, Wilson K, Fujita H, Hasuoka A. Synthesis and biological evaluation of novel selective androgen receptor modulators (SARMs). Part II: Optimization of 4-(pyrrolidin-1-yl)benzonitrile derivatives. Bioorg Med Chem Lett 2017; 27:1897-1901. [DOI: 10.1016/j.bmcl.2017.03.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 12/20/2022]
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Fugl-Meyer KS, Nilsson M, Hylander B, Lehtihet M. Sexual Function and Testosterone Level in Men With Conservatively Treated Chronic Kidney Disease. Am J Mens Health 2017; 11:1069-1076. [PMID: 28423972 PMCID: PMC5675345 DOI: 10.1177/1557988317703207] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sexual dysfunctions are common, but underrecognized, in patients with chronic kidney disease (CKD) and are inversely associated with the glomerular filtration rate (GFR). Sexual dysfunctions may affect quality of life in males with CKD. The aim of this study was to analyze the relationship among sex hormones, sexual function, and sexual satisfaction in a group of men between 18 and 50 years of age with CKD Stages 1 to 5 not treated with hemodialysis or peritoneal dialysis. Fasting blood samples for hemoglobin, testosterone, prolactin, and luteinizing hormone and questionnaire surveys (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) were evaluated in 100consecutive men. Higher CKD stage (i.e., lower renal function) had a statistically significant ( p < .01) correlation with lower total testosterone, free testosterone, and hemoglobin levels, and higher luteinizing hormone and prolactin levels. Sexual function/dysfunctions were not significantly associated with CKD stage, even after adjustment for age and serum testosterone. The results indicate that CKD stage is a factor affecting testosterone levels in combination with age in men between 18 and 50 years of age at different stages of CKD but not treated with hemodialysis or peritoneal dialysis. Sexual dysfunctions are common but not strongly correlated to testosterone levels, prolactin levels, and survey (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) responses in patients with CKD.
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Affiliation(s)
- Kerstin S Fugl-Meyer
- 1 Karolinska Institute, Stockholm, Sweden.,2 Karolinska University Hospital, Stockholm, Sweden
| | - Marie Nilsson
- 1 Karolinska Institute, Stockholm, Sweden.,2 Karolinska University Hospital, Stockholm, Sweden
| | - Britta Hylander
- 1 Karolinska Institute, Stockholm, Sweden.,2 Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lehtihet
- 1 Karolinska Institute, Stockholm, Sweden.,3 Karolinska University Hospital, Huddinge, Sweden
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35
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Liu ZY, Zhou RY, Lu X, Zeng QS, Wang HQ, Li Z, Sun YH. Identification of late-onset hypogonadism in middle-aged and elderly men from a community of China. Asian J Androl 2017; 18:747-53. [PMID: 26354142 PMCID: PMC5000798 DOI: 10.4103/1008-682x.160883] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In this study, we investigated the essential criteria for late-onset hypogonadism (LOH) syndrome based on the presence of symptoms associated with low testosterone levels in Han Chinese men. Blood tests for total testosterone (TT) and sex hormone–binding globulin (SHBG) were performed, and the aging male symptoms (AMS) questionnaire was conducted in a randomly selected cohort composed of 944 Chinese men aged 40 to 79 years from nine urban communities. Three sexual symptoms (decreased ability/frequency of sexual activity, decreased number of morning erections, and decreased libido) were confirmed to be related to the total and free testosterone levels. The thresholds for TT were approximately 12.55 nmol l−1 for a decreased ability/frequency to perform sex, 12.55 nmol l−1 for decreased frequency of morning erections, and 14.35 nmol l−1 for decreased sexual desire. The calculated free testosterone (CFT) thresholds for these three sexual symptoms were 281.14, 264.90, and 287.21 pmol l−1, respectively. TT <13.21 nmol l−1 (OR = 1.4, 95%CI: 1.0–1.9, P = 0.037) or CFT <268.89 pmol l−1 (OR = 1.5, 95%CI: 1.1–20, P = 0.020) was associated with an increase in the aforementioned three sexual symptoms. The prevalence of LOH was 9.1% under the criteria, including all three sexual symptoms with TT levels <13.21 nmol l−1 and CFT levels <268.89 pmol l−1. Our results may improve the diagnostic accuracy of LOH in older men.
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Affiliation(s)
- Zhi-Yong Liu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ren-Yuan Zhou
- Department of Urology, Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Xin Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qin-Song Zeng
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hui-Qing Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zheng Li
- Department of Urology, Renji Hospital, Jiao Tong University, Shanghai, China
| | - Ying-Hao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl 2017; 18:435-40. [PMID: 26908066 PMCID: PMC4854098 DOI: 10.4103/1008-682x.173932] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Traditionally, testosterone and estrogen have been considered to be male and female sex hormones, respectively. However, estradiol, the predominant form of estrogen, also plays a critical role in male sexual function. Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis. Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function. In the brain, estradiol synthesis is increased in areas related to sexual arousal. In addition, in the penis, estrogen receptors are found throughout the corpus cavernosum with high concentration around neurovascular bundles. Low testosterone and elevated estrogen increase the incidence of erectile dysfunction independently of one another. In the testes, spermatogenesis is modulated at every level by estrogen, starting with the hypothalamus-pituitary-gonadal axis, followed by the Leydig, Sertoli, and germ cells, and finishing with the ductal epithelium, epididymis, and mature sperm. Regulation of testicular cells by estradiol shows both an inhibitory and a stimulatory influence, indicating an intricate symphony of dose-dependent and temporally sensitive modulation. Our goal in this review is to elucidate the overall contribution of estradiol to male sexual function by looking at the hormone's effects on erectile function, spermatogenesis, and libido.
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Affiliation(s)
| | | | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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Tiya S, Sewani-Rusike CR, Shauli M. Effects of treatment with Hypoxis hemerocallidea extract on sexual behaviour and reproductive parameters in male rats. Andrologia 2016; 49. [PMID: 28000943 DOI: 10.1111/and.12742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/29/2022] Open
Abstract
Hypoxis hemerocallidea is used in traditional medicine in South Africa, for the treatment of male reproductive ailments and various chronic illnesses. Despite chronic use, its effects on male reproductive system are unknown. Male Wistar rats were treated orally daily for 28 (n = 18) and 56 days (n = 18). Treatment groups (n = 6/group) per treatment period were as follows: untreated control, 150 mg/kg and 300 mg/kg 70% ethanolic extract of H. hemerocallidea. Sexual behaviour observations were performed on days 17 and 42 of the study. Sperm, biochemical and testicular histopathological studies were carried out. Arousal and libido and serum testosterone increased after 56 days of treatment. There was an increase in epididymal sperm count at both treatment doses, with the 300 mg/kg dose showing a higher sperm count (p < .05) compared to the 150 mg/kg treatment group. The higher 300 mg/kg dose also showed an increase (p < .05) in sperm motility after 56 days of treatment. Histology showed an increase in germinal layer thickness, consistent with the observed increase in sperm count. Testicular oxidative status improved after 56 days of treatment. Results suggest that chronic treatment with H. hemerocallidea may improve male sexual function and fertility parameters and may protect testes from oxidative damage.
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Affiliation(s)
- S Tiya
- Faculty of Health Sciences, Department of Human Biology, Walter Sisulu University, Mthatha, South Africa
| | - C R Sewani-Rusike
- Faculty of Health Sciences, Department of Human Biology, Walter Sisulu University, Mthatha, South Africa
| | - M Shauli
- Faculty of Health Sciences, Department of Human Biology, Walter Sisulu University, Mthatha, South Africa
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Corona G, Isidori AM, Aversa A, Burnett AL, Maggi M. Endocrinologic Control of Men's Sexual Desire and Arousal/Erection. J Sex Med 2016; 13:317-37. [PMID: 26944463 DOI: 10.1016/j.jsxm.2016.01.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Several hormones and neurotransmitters orchestrate men's sexual response, including the appetitive (sexual desire) and consummative (arousal and penile erection) phases. AIM To provide an overview and recommendations regarding endocrinologic control of sexual desire and arousal and erection and their disturbances. METHODS Medical literature was reviewed by the subcommittee of the International Consultation of Sexual Medicine, followed by extensive internal discussion, and then public presentation and discussion with other experts. The role of pituitary (prolactin, oxytocin, growth hormone, and α-melanocyte-stimulating hormone), thyroid, and testicular hormones was scrutinized and discussed. MAIN OUTCOME MEASURES Recommendations were based on grading of evidence-based medical literature, followed by interactive discussion. RESULTS Testosterone has a primary role in controlling and synchronizing male sexual desire and arousal, acting at multiple levels. Accordingly, meta-analysis indicates that testosterone therapy for hypogonadal individuals can improve low desire and erectile dysfunction. Hyperprolactinemia is associated with low desire that can be successfully corrected by appropriate treatments. Oxytocin and α-melanocyte-stimulating hormone are important in eliciting sexual arousal; however, use of these peptides, or their analogs, for stimulating sexual arousal is still under investigation. Evaluation and treatment of other endocrine disorders are suggested only in selected cases. CONCLUSION Endocrine abnormalities are common in patients with sexual dysfunction. Their identification and treatment is strongly encouraged in disturbances of sexual desire and arousal.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL Bologna, Maggiore-Bellaria Hospital, Bologna, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Aversa
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; Deptartment of Experimental and Clinical Medicine, University Magna Graecia, Catanzaro, Italy
| | - Arthur L Burnett
- Department of Urology, the James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Florence, Italy
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Millar AC, Lau ANC, Tomlinson G, Kraguljac A, Simel DL, Detsky AS, Lipscombe LL. Predicting low testosterone in aging men: a systematic review. CMAJ 2016; 188:E321-E330. [PMID: 27325129 DOI: 10.1503/cmaj.150262] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men. We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men. METHODS We searched the MEDLINE and Embase databases (January 1966 to July 2014) for studies that compared clinical features with a measurement of serum testosterone in men. Three of the authors independently reviewed articles for inclusion, assessed quality and extracted data. RESULTS Among 6053 articles identified, 40 met the inclusion criteria. The prevalence of low testosterone ranged between 2% and 77%. Threshold testosterone levels used for reference standards also varied substantially. The summary likelihood ratio associated with decreased libido was 1.6 (95% confidence interval [CI] 1.3-1.9), and the likelihood ratio for absence of this finding was 0.72 (95% CI 0.58-0.85). The likelihood ratio associated with the presence of erectile dysfunction was 1.5 (95% CI 1.3-1.8) and with absence of erectile dysfunction was 0.83 (95% CI 0.76-0.91). Of the multiple-item instruments, the ANDROTEST showed both the most favourable positive likelihood ratio (range 1.9-2.2) and the most favourable negative likelihood ratio (range 0.37-0.49). INTERPRETATION We found weak correlation between signs, symptoms and testosterone levels, uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition. It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men.
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Affiliation(s)
- Adam C Millar
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont
| | - Adrian N C Lau
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont
| | - George Tomlinson
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont
| | - Alan Kraguljac
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont
| | - David L Simel
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont
| | - Allan S Detsky
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont.
| | - Lorraine L Lipscombe
- Department of Medicine (Millar, Tomlinson, Detsky, Lipscombe) and Institute of Health Policy, Management and Evaluation (Tomlinson, Detsky, Lipscombe), University of Toronto, Toronto, Ont.; Department of Medicine (Millar, Lau, Tomlinson, Kraguljac, Detsky), Mount Sinai Hospital and University Health Network, Toronto, Ont.; Durham Veterans Affairs Medical Center (Simel), Durham, NC; Department of Medicine (Simel), Duke University, Durham, NC; Department of Medicine (Lipscombe), Women's College Research Institute of Women's College Hospital, Toronto, Ont
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Wankhede S, Mohan V, Thakurdesai P. Beneficial effects of fenugreek glycoside supplementation in male subjects during resistance training: A randomized controlled pilot study. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:176-182. [PMID: 30356905 PMCID: PMC6191980 DOI: 10.1016/j.jshs.2014.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/15/2014] [Accepted: 09/17/2014] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of the glycoside fraction of fenugreek (Trigonella foenum-graecum) seeds (Fenu-FG) on physiological parameters related to muscle anabolism, androgenic hormones, and body fat in healthy male subjects during an 8-week resistance training program using a prospective, randomized, double-blind, placebo controlled design. METHODS Sixty healthy male subjects were randomized to ingest capsules of Fenu-FG (1 capsule of 300 mg, twice per day) or the matching placebo at a 1:1 ratio. The subjects participated in a supervised 4-day per week resistance-training program for 8 weeks. The outcome measurements were recorded at recruitment (baseline) and at the end of the treatment (8 weeks). The efficacy outcome included serum testosterone (total and free) levels, muscle strength and repetitions to failure, metabolic markers for anabolic activity (serum creatinine and blood urea nitrogen), and % body fat. The standard safety measurements such as adverse events monitoring, vital signs, hematology, biochemistry, and urinalysis were performed. RESULTS Fenu-FG supplementation demonstrated significant anabolic and androgenic activity as compared with the placebo. Fenu-FG treated subjects showed significant improvements in body fat without a reduction in muscle strength or repetitions to failure. The Fenu-FG supplementation was found to be safe and well-tolerated. CONCLUSION Fenu-FG supplementation showed beneficial effects in male subjects during resistance training without any clinical side effects.
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Affiliation(s)
- Sachin Wankhede
- Department of Microbiology, Smt. Kashibai Navale Medical College, Pune, Maharashtra 411041, India
| | - Vishwaraman Mohan
- Department of Scientific Affairs, Indus Biotech Private Limited, Pune, Maharashtra 411048, India
| | - Prasad Thakurdesai
- Department of Scientific Affairs, Indus Biotech Private Limited, Pune, Maharashtra 411048, India
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Rao A, Steels E, Inder WJ, Abraham S, Vitetta L. Testofen, a specialised Trigonella foenum-graecum seed extract reduces age-related symptoms of androgen decrease, increases testosterone levels and improves sexual function in healthy aging males in a double-blind randomised clinical study. Aging Male 2016; 19:134-42. [PMID: 26791805 DOI: 10.3109/13685538.2015.1135323] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study examined the effect of Testofen, a specialised Trigonella foenum-graecum seed extract on the symptoms of possible androgen deficiency, sexual function and serum androgen concentrations in healthy aging males. This was a double-blind, randomised, placebo-controlled trial involving 120 healthy men aged between 43 and 70 years of age. The active treatment was standardised Trigonella foenum-graecum seed extract at a dose of 600 mg/day for 12 weeks. The primary outcome measure was the change in the Aging Male Symptom questionnaire (AMS), a measure of possible androgen deficiency symptoms; secondary outcome measures were sexual function and serum testosterone. There was a significant decrease in AMS score over time and between the active and placebo groups. Sexual function improved, including number of morning erections and frequency of sexual activity. Both total serum testosterone and free testosterone increased compared to placebo after 12 weeks of active treatment. Trigonella foenum-graecum seed extract is a safe and effective treatment for reducing symptoms of possible androgen deficiency, improves sexual function and increases serum testosterone in healthy middle-aged and older men.
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Affiliation(s)
- Amanda Rao
- a Department of Medicine , University of Sydney , Sydney , Australia
| | - Elizabeth Steels
- b Integrated Health Group, Clinical Research , Brisbane , Australia
| | - Warrick J Inder
- c Department of Diabetes and Endocrinology , Princess Alexandra Hospital , Brisbane , Australia , and
| | - Suzanne Abraham
- a Department of Medicine , University of Sydney , Sydney , Australia
| | - Luis Vitetta
- a Department of Medicine , University of Sydney , Sydney , Australia
- d Medlab Pty Ltd , Sydney , Australia
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Bhattacharya RK, Bhattacharya SB. Late-Onset Hypogonadism and Testosterone Replacement in Older Men. Clin Geriatr Med 2016; 31:631-44. [PMID: 26476121 DOI: 10.1016/j.cger.2015.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Late-onset hypogonadism is an underdiagnosed and easily treated condition defined by low serum testosterone levels in men older than 65 years. When treated, a significant improvement in quality of life may be reached in this rapidly rising sector of the population. During the evaluation, laboratory tests and a full medication review should be performed to exclude other illnesses or adverse effects from medications. The major goal of treatment in this population is treating the symptoms related to hypogonadism. There has not been clear evidence supporting universally giving older men with low serum testosterone levels and hypogonadal symptoms testosterone replacement therapy.
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Affiliation(s)
- Rajib K Bhattacharya
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Kansas School of Medicine, 4023 Wescoe, Mailstop 2024, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Shelley B Bhattacharya
- Department of Family Medicine, Division of Geriatric Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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Abstract
Treatment for hypogonadism is on the rise, particularly in the aging population. Yet treatment in this population represents a unique challenge to clinicians. The physiology of normal aging is complex and often shares the same, often vague, symptoms of hypogonadism. In older men, a highly prevalent burden of comorbid medical conditions and polypharmacy complicates the differentiation of signs and symptoms of hypogonadism from those of normal aging, yet this differentiation is essential to the diagnosis of hypogonadism. Even in older patients with unequivocally symptomatic hypogonadism, the clinician must navigate the potential benefits and risks of treatment that are not clearly defined in older men. More recently, a greater awareness of the potential risks associated with treatment in older men, particularly in regard to cardiovascular risk and mortality, have been appreciated with recent changes in the US Food and Drug Administration recommendations for use of testosterone in aging men. The aim of this review is to provide a framework for the clinician evaluating testosterone deficiency in older men in order to identify correctly and treat clinically significant hypogonadism in this unique population while minimizing treatment-associated harm.
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Affiliation(s)
- J Abram McBride
- Department of Urology, University of North Carolina School of Medicine, 2113 Physician's Office Building, CB#7235, 170 Manning Drive, Chapel Hill, NC 27599-7235, USA
| | - Culley C Carson
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert M Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Singh N, Singh SK. Aqueous fruit extract of Mimusops elengi causes reversible suppression of spermatogenesis and fertility in male mice. Andrologia 2016; 48:807-16. [PMID: 27489141 DOI: 10.1111/and.12516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 11/29/2022] Open
Abstract
Antifertility efficacy of oral administration of aqueous fruit extract of Mimusops elengi (200, 400 and 600 mg kg(-1) body weight/day for 35 days) was evaluated in Parkes strain male mice. Various reproductive end points such as histopathology, sperm parameters, testosterone level, haematology, serum biochemistry and fertility indices were assessed; activities of 3β- and 17β-hydroxysteroid dehydrogenases, and immunoblot expressions of StAR and P450scc in the testis were also assessed. Histologically, testes in Mimusops-treated mice showed nonuniform and diverse degenerative changes in the seminiferous tubules; both affected and normal tubules were observed in the same sections of testis. The treatment had adverse effects on testicular hydroxysteroid dehydrogenases and StAR and P450scc, serum level of testosterone and on motility, viability and number of spermatozoa in cauda epididymis. However, serum levels of alanine aminotransferase, aspartate aminotransferase and creatinine, and haematological parameters were not affected by the treatment. Also, libido was not affected in treated males, but their fertility was markedly suppressed. By 56 days of treatment withdrawal, the alterations caused in the above parameters recovered to control levels, suggesting that Mimusops treatment causes reversible suppression of spermatogenesis and fertility in Parkes mice. Further, there were no detectable signs of toxicity in treated males.
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Affiliation(s)
- N Singh
- Department of Zoology, Banaras Hindu University, Varanasi, India
| | - S K Singh
- Department of Zoology, Banaras Hindu University, Varanasi, India
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Hirokawa K, Taniguchi T, Fujii Y, Takaki J, Tsutsumi A. Modification Effects of Changes in Job Demands on Associations Between Changes in Testosterone Levels and Andropause Symptoms: 2-Year Follow-up Study in Male Middle-Aged Japanese Workers. Int J Behav Med 2015; 23:464-72. [PMID: 26714462 DOI: 10.1007/s12529-015-9530-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this longitudinal study was to ascertain if changes in job demands modify associations between changes in testosterone levels and andropause symptoms in male Japanese workers. METHOD A baseline survey including job demands and the Aging Males' Symptoms scale, lifestyle factors, and blood levels of testosterone was conducted in 2007. Among 192 men (mean age ± SD 52.2 ± 7.6 years) who completed all relevant questionnaires and provided blood at baseline, 104 men (50.9 ± 7.2 years) were followed up in 2009. Changes of variables in 2 years were calculated (data of follow-up minus those of baseline). RESULTS Testosterone levels were increased significantly, whereas job demands and somatic symptoms were reduced significantly, at follow-up. Changes in testosterone levels were negatively associated with changes in total andropause symptoms, psychological symptoms, and sexual symptoms (standardized β = -0.27, -0.24, and, -0.29, p < 0.05, respectively), after adjustment for confounders. Changes in job demands were positively associated with changes in somatic symptoms (standardized β = 0.21, p < 0.05). Significant interactions of changes in testosterone levels and job demands were noted for changes in psychological symptoms (standardized β = 0.26, p < 0.05). For men with a 1-SD reduction in job demands, negative associations between changes in testosterone levels and psychological symptoms were intensified, but not for men with a 1-SD increase in job demands. CONCLUSION Andropause symptoms may be affected by changes in testosterone levels and job demands. Change in job demands may modify associations between changes in testosterone levels and andropause symptoms.
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Affiliation(s)
- Kumi Hirokawa
- Department of Nursing, Baika Women's University, 2-19-5 Shukunosho, Ibaraki, Osaka, 567-8578, Japan.
| | - Toshiyo Taniguchi
- Department of Welfare System and Health Science, Okayama Prefectural University, 111 Kuboki, Soja City, Okayama, 719-1197, Japan
| | - Yasuhito Fujii
- Department of Welfare System and Health Science, Okayama Prefectural University, 111 Kuboki, Soja City, Okayama, 719-1197, Japan
| | - Jiro Takaki
- Department of Public Health, Sanyo Gakuen University Graduate School of Nursing, 1-14-1 Hirai, Naka-ku, Okayama, 703-8501, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
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Abstract
Testosterone supplementation therapy (TST) use has dramatically increased over the past decade, due to the availability of newer agents, aggressive marketing, and an increasing incidence of testosterone deficiency (TD). Despite the increase in TST, a degree of ambiguity remains as to the exact diagnostic criteria of TD, and administration and monitoring of TST. One explanation for this phenomenon is the complex role testosterone plays in multiple physiologic pathways. Numerous medical co-morbidities and medications can alter testosterone levels resulting in a wide range of nonspecific clinical signs and symptoms of TD. The diagnosis is also challenging due to the lack of a definitive serum total testosterone level that reliably correlates with symptoms. This observation is particularly true in the aging male and is exacerbated by inconsistencies between different laboratory assays. Several prominent medical societies have developed guideline statements to clarify the diagnosis, but they differ from each other and with expert opinion in several ways. Aside from diagnostic dilemmas, there are numerous subtle advantages and disadvantages of the various testosterone agents to appreciate. The available TST agents have changed significantly over the past decade similar to the trends in the diagnosis of TD. Therefore, as the usage of TST increases, clinicians will be challenged to maintain an up-to-date understanding of TD and TST. The purpose of this review is to provide a clear description of the current strategies for diagnosis and management of TD.
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Affiliation(s)
| | | | - Robert M Coward
- Department of Urology, University of North Carolina School of Medicine, NC, USA
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Melehan KL, Hoyos CM, Yee BJ, Wong KK, Buchanan PR, Grunstein RR, Liu PY. Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study. Andrology 2015; 4:55-61. [PMID: 26610430 DOI: 10.1111/andr.12132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/27/2015] [Accepted: 10/18/2015] [Indexed: 12/21/2022]
Abstract
Testosterone (T) deficiency, sexual dysfunction, obesity and obstructive sleep apnea (OSA) are common and often coexist. T prescriptions have increased worldwide during the last decade, including to those with undiagnosed or untreated OSA. The effect of T administration on sexual function, neurocognitive performance and quality of life in these men is poorly defined. The aim of this study was to examine the impact of T administration on sexual function, quality of life and neurocognitive performance in obese men with OSA. We also secondarily examined whether baseline T might modify the effects of T treatment by dichotomizing on baseline T levels pre-specified at 8, 11 and 13 nmol/L. This was a randomized placebo-controlled study in which 67 obese men with OSA (mean age 49 ± 1.3 years) were randomized to receive intramuscular injections of either 1000 mg T undecanoate or placebo at baseline, week 6 and week 12. All participants were concurrently enrolled in a weight loss program. General and sleep-related quality of life, neurocognitive performance and subjective sexual function were assessed before and 6, 12 and 18 weeks after therapy. T compared to placebo increased sexual desire (p = 0.004) in all men, irrespective of baseline T levels. There were no differences in erectile function, frequency of sexual attempts, orgasmic ability, general or sleep-related quality of life or neurocognitive function (all p = NS). In those with baseline T levels below 8 nmol/L, T increased vitality (p = 0.004), and reduced reports of feeling down (p = 0.002) and nervousness (p = 0.03). Our findings show that 18 weeks of T therapy increased sexual desire in obese men with OSA independently of baseline T levels whereas improvements in quality of life were evident only in those with T levels below 8 nmol/L. These small improvements would need to be balanced against potentially more serious adverse effects of T therapy on breathing.
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Affiliation(s)
- K L Melehan
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - C M Hoyos
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - B J Yee
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - K K Wong
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P R Buchanan
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Department of Respiratory Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - R R Grunstein
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - P Y Liu
- NHMRC Centre for The Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
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Singh N, Singh SK. Citrus limonextract: possible inhibitory mechanisms affecting testicular functions and fertility in male mice. Syst Biol Reprod Med 2015; 62:39-48. [DOI: 10.3109/19396368.2015.1078422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Traish AM. Role of androgens in modulating male and female sexual function. Horm Mol Biol Clin Investig 2015; 4:521-8. [PMID: 25961228 DOI: 10.1515/hmbci.2010.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 09/29/2010] [Indexed: 02/03/2023]
Abstract
Advancement in basic and clinical research has provided considerable evidence suggesting a key role of androgens in the physiology and pathophysiology of sexual function. Evidence from clinical studies in men and women with androgen deficiency support a role of androgens in maintaining sexual function in men and women and are integral in maintaining sexual health. Preclinical studies utilizing male animal models demonstrated a role of androgens in maintenance of: (i) penile tissue structural integrity, (ii) penile trabecular smooth muscle growth and function, (iii) integrity of penile nerve fiber network, (iv) signaling pathways in the corpora cavernosa, (v) myogenic and adipogenic differentiation in the corpora cavernosa, (vi) physiological penile response to stimuli, and (vii) facilitating corporeal hemodynamics. These findings strongly suggest a role for androgen in the physiology of penile erection. In addition, clinical studies in hypogonadal men with erectile dysfunction treated with testosterone provided invaluable information on restoring erectile function and improving ejaculatory function. Similarly, clinical studies in surgically or naturally postmenopausal women with androgen deficiency suggested that androgens are important for maintaining sexual desire and testosterone treatment was shown to improve sexual desire, arousal and orgasm. Furthermore, studies in female animal models demonstrated that androgens maintain the integrity of vaginal nerve fiber network, muscularis volume, and enhance genital blood flow and mucification. Based on the biochemical, physiological and clinical findings from human and animal studies, we suggest that androgens are integral for maintaining sexual function and play a critical role in maintaining sexual health in men and women.
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