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Renke G, Tostes F. Cardiovascular Safety and Benefits of Testosterone Implant Therapy in Postmenopausal Women: Where Are We? Pharmaceuticals (Basel) 2023; 16:ph16040619. [PMID: 37111376 PMCID: PMC10146246 DOI: 10.3390/ph16040619] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
We discuss the CV safety and efficacy data for subcutaneous testosterone therapy (STT) in postmenopausal women. We also highlight new directions and applications of correct dosages performed in a specialized center. To recommend STT, we propose innovative criteria (IDEALSTT) according to total testosterone (T) level, carotid artery intima-media thickness, and calculated SCORE for a 10-year risk of fatal cardiovascular disease (CVD). Despite all the controversies, hormone replacement therapy (HRT) with T has gained prominence in treating pre and postmenopausal women in the last decades. HRT with silastic and bioabsorbable testosterone hormone implants has gained prominence recently due to its practicality and effectiveness in treating menopausal symptoms and hypoactive sexual desire disorder. A recent publication on the complications of STT, looking at a large cohort of patients over seven years, demonstrated its long-term safety. However, the cardiovascular (CV) risk and safety of STT in women are still controversial.
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Affiliation(s)
- Guilherme Renke
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22411-040, Brazil
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil
| | - Francisco Tostes
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22411-040, Brazil
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil
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2
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Maiorana N, Brugnera A, Galiano V, Ferrara R, Poletti B, Marconi AM, Garzia E, Ticozzi N, Silani V, Priori A, Ferrucci R. Emotional and autonomic response to visual erotic stimulation in patients with functional hypothalamic amenorrhea. Front Endocrinol (Lausanne) 2022; 13:982845. [PMID: 36531461 PMCID: PMC9755206 DOI: 10.3389/fendo.2022.982845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Functional hypothalamic amenorrhea (FHA) is a clinical condition associated with high levels of physiological and psychological stress ranging from weight loss to maladaptive behavior and coping skills. A reliable measure of the psychophysiological response to stress and the ability to cope with stimuli is heart rate variability (HRV). Through the sympathetic (SNS) and parasympathetic nervous system (PNS), the autonomic nervous system (ANS) promotes various changes in HRV that reflect the individual's psychophysiological response to stress. FHA patients are characterized by high levels of PNS activation during psychological load, suggesting that parasympathetic hyperactivation could be a pathology marker. Methods In the present study, we examine changes in HRV during observation of erotic, neutral, and disgusting images in 10 patients with FHA [(mean ± S.D.) age: 26.8 ± 5.9] and in 9 controls (age: 25.4 ± 6.4; BMI: 22.47 ± 2.97) to assess the differential activation of PNS and SNS between FHA patients and controls matched for age and without other clinical conditions. Results Our results showed that FHA patients had significantly higher HRV activation while observing high emotional value images and not during the observation of neutral images confirming a parasympathetic hyperactivation. Discussion HRV and cognitive and psychological testing, could provide new insights into understanding such a clinically understudied condition and provide further tools for clinical diagnosis and treatment.
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Affiliation(s)
- Natale Maiorana
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Rosanna Ferrara
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Anna Maria Marconi
- ASST-Santi Paolo e Carlo, Milan, Italy
- Department of Health Science, University of Milan, Milan, Italy
| | | | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
- ASST-Santi Paolo e Carlo, Milan, Italy
| | - Roberta Ferrucci
- Aldo Ravelli Research Center, Department of Health Science, University of Milan, Milan, Italy
- ASST-Santi Paolo e Carlo, Milan, Italy
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McCartney CR, Corrigan MD, Drake MT, El-Hajj Fuleihan G, Korytkowski MT, Lash RW, Lieb DC, McCall AL, Muniyappa R, Piggott T, Santesso N, Schünemann HJ, Wiercioch W, McDonnell ME, Murad MH. Enhancing the Trustworthiness of the Endocrine Society's Clinical Practice Guidelines. J Clin Endocrinol Metab 2022; 107:2129-2138. [PMID: 35690966 PMCID: PMC9653019 DOI: 10.1210/clinem/dgac290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 01/10/2023]
Abstract
In an effort to enhance the trustworthiness of its clinical practice guidelines, the Endocrine Society has recently adopted new policies and more rigorous methodologies for its guideline program. In this Clinical Practice Guideline Communication, we describe these recent enhancements-many of which reflect greater adherence to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to guideline development-in addition to the rationale for such changes. Improvements to the Society's guideline development practices include, but are not limited to, enhanced inclusion of nonendocrinologist experts, including patient representatives, on guideline development panels; implementation of a more rigorous conflict/duality of interest policy; a requirement that all formal recommendations must be demonstrably underpinned by systematic evidence review; the explicit use of GRADE Evidence-to-Decision frameworks; greater use and explanation of standardized guideline language; and a more intentional approach to guideline updating. Lastly, we describe some of the experiential differences our guideline readers are most likely to notice.
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Affiliation(s)
- Christopher R McCartney
- Correspondence: Christopher R. McCartney, Division of Endocrinology and Metabolism, Department of Medicine, Box 801406, UVA Health, Charlottesville, VA 22908, USA.
| | | | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55902, USA
| | - Ghada El-Hajj Fuleihan
- Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Mary T Korytkowski
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | | | - David C Lieb
- Division of Endocrine and Metabolic Disorders, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23501-1980, USA
| | - Anthony L McCall
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ranganath Muniyappa
- Clinical Endocrinology Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
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Wierman ME, Kiseljak-Vassiliades K. Should Dehydroepiandrosterone Be Administered to Women? J Clin Endocrinol Metab 2022; 107:1679-1685. [PMID: 35254428 PMCID: PMC9113789 DOI: 10.1210/clinem/dgac130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 01/11/2023]
Abstract
CONTEXT Androgen prohormones such as dehydroepiandrosterone (DHEA) increase in early puberty, peak in the second and third decade, and thereafter decline, independent of menopausal status. Investigators have examined their potential beneficial effects in normal women and those with DHEA-deficient states. EVIDENCE ACQUISITION A review of the literature from 1985 to 2021 on the potential benefits and risks of androgen prohormones in women. EVIDENCE SYNTHESIS Studies have examined the potential benefit of DHEA therapy for anti-aging, sexual dysfunction, infertility, metabolic bone health, cognition, and wellbeing in hormone-deficient states such as primary adrenal insufficiency, hypopituitarism, and anorexia as well as administration to normal women across the lifespan. CONCLUSIONS Data support small benefits in quality of life and mood but not for anxiety or sexual function in women with primary or secondary adrenal insufficiency or anorexia. No consistent beneficial effects of DHEA administration have been observed for menopausal symptoms, sexual function, cognition, or overall wellbeing in normal women. Local administration of DHEA shows benefit in vulvovaginal atrophy. Use of DHEA to improve induction of ovulation response in women with diminished ovarian reserve is not recommended. Risks of high physiologic or pharmacologic use of DHEA include androgenic and estrogenic side effects which are of concern for long-term administration. CLINICAL CASE A 49-year-old woman with Addison's disease who is on low dose estrogen with cyclic progesterone therapy for menopausal symptoms returns for follow-up. She is on a stable glucocorticoid replacement strategy of hydrocortisone 10 mg in the morning and 5 mg in the early afternoon and fludrocortisone 0.05 mg each morning. She has read on the internet that additional therapy with DHEA may help her overall quality of life and libido. She asks whether she should add this therapy to her regimen and at what dose.
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Affiliation(s)
- Margaret E Wierman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
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Bendarska-Czerwińska A, Zmarzły N, Morawiec E, Panfil A, Bryś K, Czarniecka J, Ostenda A, Dziobek K, Sagan D, Boroń D, Michalski P, Pallazo-Michalska V, Grabarek BO. Endocrine disorders and fertility and pregnancy: An update. Front Endocrinol (Lausanne) 2022; 13:970439. [PMID: 36733805 PMCID: PMC9887196 DOI: 10.3389/fendo.2022.970439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
It is estimated that more and more couples suffer from fertility and pregnancy maintenance disorders. It is associated with impaired androgen secretion, which is influenced by many factors, ranging from genetic to environmental. It is also important to remember that fertility disorders can also result from abnormal anatomy of the reproductive male and female organ (congenital uterine anomalies - septate, unicornuate, bicornuate uterus; acquired defects of the uterus structure - fibroids, polyps, hypertrophy), disturbed hormonal cycle and obstruction of the fallopian tubes resulting from the presence of adhesions due to inflammation, endometriosis, and surgery, abnormal rhythm of menstrual bleeding, the abnormal concentration of hormones. There are many relationships between the endocrine organs, leading to a chain reaction when one of them fails to function properly. Conditions in which the immune system is involved, including infections and autoimmune diseases, also affect fertility. The form of treatment depends on infertility duration and the patient's age. It includes ovulation stimulation with clomiphene citrate or gonadotropins, metformin use, and weight loss interventions. Since so many different factors affect fertility, it is important to correctly diagnose what is causing the problem and to modify the treatment regimen if necessary. This review describes disturbances in the hormone secretion of individual endocrine organs in the context of fertility and the maintenance of pregnancy.
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Affiliation(s)
- Anna Bendarska-Czerwińska
- Department of Molecular, Biology Gyncentrum Fertility Clinic, Katowice, Poland
- Faculty of Medicine, Academy of Silesia, Zabrze, Poland
- American Medical Clinic, Katowice, Poland
- *Correspondence: Anna Bendarska-Czerwińska, ; Nikola Zmarzły, ; Beniamin Oskar Grabarek,
| | - Nikola Zmarzły
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- *Correspondence: Anna Bendarska-Czerwińska, ; Nikola Zmarzły, ; Beniamin Oskar Grabarek,
| | - Emilia Morawiec
- Department of Molecular, Biology Gyncentrum Fertility Clinic, Katowice, Poland
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- Department of Microbiology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | - Agata Panfil
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | - Kamil Bryś
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | - Justyna Czarniecka
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | | | | | - Dorota Sagan
- Medical Center Dormed Medical SPA, Busko-Zdroj, Poland
| | - Dariusz Boroń
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Academy of Silesia, Zabrze, Poland
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland
- Department of Gynecology and Obstetrics, TOMMED Specjalisci od Zdrowia, Katowice, Poland
| | | | | | - Beniamin Oskar Grabarek
- Department of Molecular, Biology Gyncentrum Fertility Clinic, Katowice, Poland
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Academy of Silesia, Zabrze, Poland
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland
- Department of Gynecology and Obstetrics, TOMMED Specjalisci od Zdrowia, Katowice, Poland
- *Correspondence: Anna Bendarska-Czerwińska, ; Nikola Zmarzły, ; Beniamin Oskar Grabarek,
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Amiel Castro R, Kunovac Kallak T, Sundström Poromaa I, Willebrand M, Lager S, Ehlert U, Skalkidou A. Pregnancy-related hormones and COMT genotype: Associations with maternal working memory. Psychoneuroendocrinology 2021; 132:105361. [PMID: 34333317 DOI: 10.1016/j.psyneuen.2021.105361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
Women experience different degrees of subjective cognitive changes during pregnancy. The exact mechanism underlying these changes is unknown, although endocrine alterations and genetics may be contributing factors. We investigated whether multiple pregnancy-related hormones were associated with working memory function assessed with the Digit Span Test (DST) in late pregnancy. Moreover, we examined whether the catechol-O-methyltransferase (COMT) genotype, previously related to working memory, was an effect modifier in this association. In this population-based panel study, we recorded psychiatric history, medication use, socio-demographic characteristics, and psychological well-being, gathered blood and saliva samples, and administered the DST at gestational weeks 35-39 (N = 216). We conducted multivariate linear regressions with DST as outcome, with different hormones and COMT genotype, adjusting for covariates including maternal age, BMI, education, depressive symptoms, and parity. We repeated these analyses excluding women with elevated depressive symptoms. Higher DST total scores were associated with increased free estradiol concentrations (B = 0.01, p = 0.03; B = 0.01, p = 0.02) in all participants and in participants without depressive symptoms, respectively, whereas DST forward was positively associated with free estradiol only in women without depressive symptoms (B = 0.01, p = 0.04). Lower total testosterone concentrations (B = -0.03, p = 0.01) enhanced DST backward performance in non-depressed women. Maternal higher education was significantly associated with the DST subscales in all participants. No significant differences emerged when considering the COMT genotype. Our results suggest differential associations of free estradiol and total testosterone levels with working memory function in late pregnancy.
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Affiliation(s)
- Rita Amiel Castro
- University of Zurich, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050 Zurich, Switzerland.
| | - Theodora Kunovac Kallak
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
| | - Inger Sundström Poromaa
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
| | - Mimmie Willebrand
- Uppsala University, Department of Neuroscience, Akademiska sjukhuset 75185 Uppsala, Sweden
| | - Susanne Lager
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
| | - Ulrike Ehlert
- University of Zurich, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050 Zurich, Switzerland
| | - Alkistis Skalkidou
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
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Zamponi V, Lardo P, Maggio R, Simonini C, Mazzilli R, Faggiano A, Pugliese G, Stigliano A. Female Sexual Dysfunction in Primary Adrenal Insufficiency. J Clin Med 2021; 10:jcm10132767. [PMID: 34202462 PMCID: PMC8268403 DOI: 10.3390/jcm10132767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose. No data are currently available on female sexual dysfunction (FSD) in primary adrenal insufficiency (PAI) and the possible impact of replacement therapy. The aim of this study was to evaluate the prevalence of FSD and sexual distress (SD), and to evaluate the possible impact of replacement therapy on sexuality in women with PAI. Methods. Female Sexual Function Index-6 (FSFI-6) and Sexual Distress Scale (SDS) questionnaires were administered to 22 women with PAI and 23 healthy women matched for age as controls. Results. The prevalence of sexual symptoms measured by FSFI-6 (total score < 19) was significantly higher in women with PAI (15/22; 68.2%) compared to the controls (2/23; 8.7%; p = 0.001). Regarding the questionnaire items, significantly different scores were found for desire (p < 0.001), arousal (p = 0.0006), lubrication (p = 0.046) and overall sexual satisfaction (p < 0.0001) in women with PAI compared to the controls. The rate of FSD (FSFI < 19 with SDS >15) was 60% in patients with PAI. A significant inverse correlation was found between FSFI-6 total scores and SD (r = −0.65; p = 0.0011), while a significant direct correlation was found between FSFI-6 total scores and serum cortisol levels (r = 0.55; p = 0.035). Conclusions. A higher prevalence of FSD was found in women affected by PAI compared to healthy women. Desire seems to be the most impaired aspect of sexual function. Moreover, sexual dysfunction in this population seems to be related to sexual distress and cortisol levels.
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Javadpour S, Sharifi N, Mosallanezhad Z, Rasekhjahromi A, Jamali S. Assessment of premature menopause on the sexual function and quality of life in women. Gynecol Endocrinol 2021; 37:307-311. [PMID: 33432868 DOI: 10.1080/09513590.2021.1871894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Premature Ovarian Insufficiency (POI) is characterized by ending menstruation in women under 40 years of age. It has a significant effect on women's sexuality and mental health and quality of life. This study aimed to evaluate the sexual function and quality of life of premature menopausal women. METHODS This study was a case-control study on 132 people (66 women with a diagnosis of POF and 66 women of reproductive age with normal ovarian function) who were matched in terms of the age, presenting to Women's Clinic in Jahrom in 2019. The WHOQOL-BREF questionnaire and the Female Sexual Function Index (FSFI) questionnaire were used to collect data. p < .05 was considered statistically significant. RESULTS The mean score of sexual function in premature menopausal women was 21.35 ± 4.82 and in non-menopausal women was 25.4 ± 6.61 (OR = 0.11, 95% CI = 0.04-0.28). All areas of sexual function; desires disorder (OR = 0.21 95% CI = 0.07-0.56), Arousal disorder(OR = 0.28, 95% CI = 0.08-0.93), orgasm disorder (OR = 0.36 95% CI = 0.16-0.80), lubrication disorder (OR = 0.21 95% CI= 0.05-0.78), satisfaction disorder (OR = 0.11, 95% CI = 0.04-0.28) and quality of life domains: physical health (OR = 0.4 95%CI = 0.06-0.3), mental health (OR = 0.28 95% CI = 0.06-0.1), environmental health (OR = 0.22 95%CI = 0.04-0.6) and social health (OR = 0.28 95%CI = 0.01-0.2) saw a decrease in the premature menopausal women group compared to the control group. CONCLUSION The results demonstrated that premature menopausal women are found to be weaker than the control group in all areas of sexual function and quality of life. Among the areas of sexual function, such as libido, arousal, satisfaction, and pain have the most impact on quality of life. Therefore, based on the results from improving sexual function, this issue can improve the quality of life.
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Affiliation(s)
- Shohreh Javadpour
- Department of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Nader Sharifi
- Health Education and Health Promotion, Research center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Zahra Mosallanezhad
- Department of Gynecology and Obstetrics, University of Medical Sciences, Jahrom, Iran
| | - Athar Rasekhjahromi
- Department of Gynecology and Obstetrics, University of Medical Sciences, Jahrom, Iran
| | - Safieh Jamali
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
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Abstract
Hyperandrogenic anovulation refers to the constellation of disorders that present in women with irregular menses, hirsutism and/or acne across the lifespan. Understanding the clinical signs and symptoms of each diagnosis in the differential and laboratory testing to confirm or exclude a diagnosis allows a clinician to appropriately counsel and treat the patient.
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Affiliation(s)
- Margaret E Wierman
- Diabetes and Metabolism Division, Department of Medicine, University of Colorado Anschutz Medical Campus, Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado School of Medicine, Endocrinology MS8106, 12801 East 17 Avenue, RC1S, Aurora, CO 80045, USA.
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10
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Gravitte A, Archibald T, Cobble A, Kennard B, Brown S. Liquid chromatography-mass spectrometry applications for quantification of endogenous sex hormones. Biomed Chromatogr 2020; 35:e5036. [PMID: 33226656 DOI: 10.1002/bmc.5036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 01/18/2023]
Abstract
Liquid chromatography, coupled with tandem mass spectrometry, presents a powerful tool for the quantification of the sex steroid hormones 17-β estradiol, progesterone and testosterone from biological matrices. The importance of accurate quantification with these hormones, even at endogenous levels, has evolved with our understanding of the role these regulators play in human development, fertility and disease risk and manifestation. Routine monitoring of these analytes can be accomplished by immunoassay techniques, which face limitations on specificity and sensitivity, or using gas chromatography-mass spectrometry. LC-MS/MS is growing in capability and acceptance for clinically relevant quantification of sex steroid hormones in biological matrices and is able to overcome many of the limitations of immunoassays. Analyte specificity has improved through the use of novel derivatizing agents, and sensitivity has been refined through the use of high-resolution chromatography and mass spectrometric technology. This review highlights these innovations, among others, in LC-MS/MS steroid hormone analysis captured in the literature over the last decade.
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Affiliation(s)
- Amy Gravitte
- James H Quillen College of Medicine, East Tennessee State University, Department of Biomedical Sciences, Johnson City, TN, USA
| | - Timothy Archibald
- Bill Gatton College of Pharmacy, East Tennessee State University, Department of Pharmaceutical Sciences, Johnson City, TN, USA
| | - Allison Cobble
- Bill Gatton College of Pharmacy, East Tennessee State University, Department of Pharmaceutical Sciences, Johnson City, TN, USA
| | - Benjamin Kennard
- Bill Gatton College of Pharmacy, East Tennessee State University, Department of Pharmaceutical Sciences, Johnson City, TN, USA
| | - Stacy Brown
- Bill Gatton College of Pharmacy, East Tennessee State University, Department of Pharmaceutical Sciences, Johnson City, TN, USA
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Huang IS, Mazur DJ, Kahn BE, Kate Keeter M, Desai AS, Lewis K, Tatem AJ, Hehemann MC, Brannigan RE, Bennett NE. Risk factors for hypogonadism in young men with erectile dysfunction. J Chin Med Assoc 2019; 82:477-481. [PMID: 30932936 DOI: 10.1097/jcma.0000000000000099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this study is to evaluate the hormone profile of young men with the chief complaint of erectile dysfunction (ED) and determine the comorbidities in this population. METHODS A retrospective chart review of men aged 18 to 40 years who presented with ED and had a hormone evaluation but without prior medication for hormone manipulation from 2002 to 2016 was performed at a tertiary care institution. Data were obtained on demographics, comorbidities, medications, and hormonal evaluations. RESULTS A total of 2292 men with ED were identified and 2130 of them received testosterone level evaluation. The most common comorbidities that men were actively being treated for were depression (22.3%), anxiety (16.1%), hypertension (15.6%), diabetes (7.2%), cancer (6.2%), and cardiovascular disease (3.3%). The average total testosterone level was 368 ± 160 ng/dL; 10.7% of men had hypogonadism. Multivariate analysis demonstrated age, body mass index (BMI), depression, and cancer predicted a hypogonadal status. Patients with BMI > 28.2 kg/m, age > 34 years, cancer diagnosis, or depression were 3.350-fold, 1.447-fold, 2.317-fold, or 1.420-fold more likely to be diagnosed hypogonadal than nonoverweight, age ≤ 34 years, noncancer, or nondepressive patients. CONCLUSION The majority of men under the age of 40 with ED exhibit a normal hormonal milieu. Young ED men with BMI > 28.2 kg/m, age >34 years, cancer diagnosis, or depression are at risk for hypogonadism.
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Affiliation(s)
- I-Shen Huang
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Daniel J Mazur
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Barbara E Kahn
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Kate Keeter
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anuj S Desai
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Lewis
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander J Tatem
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Marah C Hehemann
- Loyola Medicine Chicago Stritch School of Medicine, Chicago, Illinois, USA
| | - Robert E Brannigan
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nelson E Bennett
- Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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12
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Impact of testosterone assay standardization efforts assessed via accuracy-based proficiency testing. Clin Biochem 2019; 68:37-43. [DOI: 10.1016/j.clinbiochem.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/07/2019] [Accepted: 03/27/2019] [Indexed: 11/18/2022]
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13
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Abstract
There are an estimated 1.4 million transgender adults in the United States, and lack of providers knowledgeable in transgender care is a barrier to health care. Obstetricians and Gynecologists can help increase access in part by becoming competent in gender-affirming hormone therapy. For transgender men, testosterone protocols can be extrapolated from those used for hypogonadal cisgender men. Unfortunately, there are not any high-quality, long-term prospective studies on the effectiveness and safety of different testosterone regimens specifically in transgender men, but the available data suggest that gender-affirming testosterone therapy is safe and effective with proper screening and monitoring.
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Zhou Y, Wang S. A robust LC-MS/MS assay with online cleanup for measurement of serum testosterone. J Sep Sci 2019; 42:2561-2568. [PMID: 31106475 DOI: 10.1002/jssc.201801189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 11/12/2022]
Abstract
Accurate measurement of low levels of testosterone is critical for diagnosis and treatment of androgen disorders. The very low concentrations of testosterone in children, females, and males with androgen suppression therapies necessitate the use of mass spectrometry-based methods. We aimed to develop a liquid chromatography with tandem mass spectrometry method with simplified sample preparation and online solid-phase extraction cleanup to achieve enhanced precision, accuracy, robustness, and cost-effectiveness. The assay was linear from 10 to 20 000 pg/mL with an analytical recovery of 93-104%. The total coefficient of variation was 2.5, 1.9, and 1.7% at concentration levels of 348, 5432, and 10 848 pg/mL, respectively. No significant carryover was observed from samples with concentrations up to 20 000 pg/mL. No significant interference was observed from androstenedione, dehydroepiandrosterone, epi-testosterone, and estriol. Comparison with CDC Hormone Standardization program (HoSt) reference samples with defined values (n = 40) showed a Deming regression slope of 0.963, intercept of 28.06 pg/mL, standard error of estimate was 66.9, a correlation coefficient of 0.9996, and a mean bias of -0.6%. The method met the accuracy criteria by the CDC HoSt program. In addition, we achieved >12 000 injections on a single analytical column without significant performance deterioration due to the specific online solid-phase extraction settings.
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Affiliation(s)
- Yu Zhou
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sihe Wang
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA.,Pathology and Laboratory Medicine, Akron Children's Hospital, Akron, OH, USA
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15
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Estevez MB, Monteagudo PT, Oliveira KC, Verreschi ITDN. Does having Turner syndrome affect quality of life in Brazilian women compared to common population? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:208-214. [PMID: 31066761 PMCID: PMC10522194 DOI: 10.20945/2359-3997000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We aimed to measure the quality of life (QoL) of patients with Turner syndrome (PTS) and determine the extent to which their clinical or laboratory alterations influence QoL compared to reference women (RW) of the same age range. SUBJECTS AND METHODS From Dec-2013 to Dec-2014, 90 participants were recruited. They were 18 years and older: 48 with Turner syndrome (TS) (PTS) and 42 without (RW). Recruited subjects completed the Portuguese version of Short Form 36 (SF-36) questionnaire, and blood was drawn to measure LH, FSH, oestradiol (E2), progesterone (P4), SHBG, and SDHEA (by ECLIA) and testosterone (by LC MS/MS). RESULTS Age and schooling were similar between groups. The most common occupations for PTS were health worker, administration and education, and health worker or cashier for RW. Most participants were Catholic or Evangelical. Eighty-one percent (39/48) of cases used Hormonal Replacement Therapy (HRT), mostly transdermal (23/39). RW and PTS scored similarly on the SF-36 questionnaire. RW had higher oestradiol (p = 0,01), lower FSH (p = 0,01) and higher testosterone (p = 0,01) than PTS. Concentrations of P4, LH, SHBG or SDHEA were similar. Significant associations were found among QoL and hormones (E2 with Vitality and LH with Physical Role) only in the PTS group. CONCLUSIONS PTS do not consider that TS affects their QoL as measured by domains on the SF-36. Oestradiol was related with QoL, emphasising the importance of HRT.
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Affiliation(s)
- Maria Bernarda Estevez
- Ambulatório de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, SP, Brasil
| | - Patricia Teofilo Monteagudo
- Departamento de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, SP, Brasil
| | - Kelly Christina Oliveira
- Laboratório de Esteroides, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, SP, Brasil
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16
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Defreyne J, Van de Bruaene LDL, Rietzschel E, Van Schuylenbergh J, T'Sjoen GGR. Effects of Gender-Affirming Hormones on Lipid, Metabolic, and Cardiac Surrogate Blood Markers in Transgender Persons. Clin Chem 2019; 65:119-134. [DOI: 10.1373/clinchem.2018.288241] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022]
Abstract
Abstract
BACKGROUND
Gender-affirming hormonal therapy consists of testosterone in transgender men and estrogens and antiandrogens in transgender women. Research has concluded that gender-affirming therapy generally leads to high satisfaction rates, increased quality of life, and higher psychological well-being. However, given the higher incidence of cardiometabolic morbidity and mortality in cisgender men compared with cisgender women, concerns about the cardiometabolic risk of androgen therapy have been raised.
CONTENT
A literature research was conducted on PubMed, Embase, and Scopus, searching for relevant articles on the effects of gender-affirming hormone therapy on cardiometabolic risk and thrombosis. After screening 734 abstracts, 77 full text articles were retained, of which 11 were review articles.
SUMMARY
Studies describing a higher risk for cardiometabolic and thromboembolic morbidity and/or mortality in transgender women (but not transgender men) mainly covered data on transgender women using the now obsolete ethinyl estradiol and, therefore, are no longer valid. Currently, most of the available literature on transgender people adhering to standard treatment regimens consists of retrospective cohort studies of insufficient follow-up duration. When assessing markers of cardiometabolic disease, the available literature is inconclusive, which may be ascribed to relatively short follow-up duration and small sample size. The importance of ongoing large-scale prospective studies/registries and of optimal management of conventional risk factors cannot be overemphasized.
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Affiliation(s)
- Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | | | - Ernst Rietzschel
- Department of Cardiology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | | | - Guy G R T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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17
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Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy. Menopause 2018; 25:1275-1285. [DOI: 10.1097/gme.0000000000001229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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18
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Tchernof A, Brochu D, Maltais‐Payette I, Mansour MF, Marchand GB, Carreau A, Kapeluto J. Androgens and the Regulation of Adiposity and Body Fat Distribution in Humans. Compr Physiol 2018; 8:1253-1290. [DOI: 10.1002/cphy.c170009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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McKenzie N. Female Sexual Interest and Arousal Disorder. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
This article reviews the history of the treatment of women's sexual problems from the Victorian era to the twenty-first century. The contextual nature of determining what constitutes female sexual psychopathology is highlighted. Conceptions of normal sexuality are subject to cultural vagaries, making it difficult to identify female sexual dysfunctions. A survey of the inclusion, removal, and collapsing of women's sexual diagnoses in the Diagnostic and Statistical Manual of Mental Disorders from 1952 to 2013 illuminates the biases in the various editions. Masters and Johnson's models of sexual response and dysfunction paved the way for the diagnosis and treatment of women's sexual dysfunctions. Their sex therapy paradigm is described. Conceptions of and treatments for anorgasmia, arousal difficulties, vaginismus, dyspareunia, and low desire are reviewed. The medicalization of human sexuality and the splintering of sex therapy are discussed, along with current trends and new directions in sexual health care for women.
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Affiliation(s)
- Peggy J. Kleinplatz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
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21
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Wong EL, Huang F, Cheung AW, Wong CK. The impact of menopause on the sexual health of Chinese Cantonese women: A mixed methods study. J Adv Nurs 2018. [DOI: 10.1111/jan.13568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Eliza L.Y. Wong
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| | - Fenwei Huang
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| | - Annie W.L. Cheung
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
| | - Carmen K.M. Wong
- Faculty of Medicine; The Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Sha Tin Hong Kong
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22
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Martin KA, Anderson RR, Chang RJ, Ehrmann DA, Lobo RA, Murad MH, Pugeat MM, Rosenfield RL. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018. [PMID: 29522147 DOI: 10.1210/jc.2018-00241] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008. PARTICIPANTS The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. CONCLUSION We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.
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Affiliation(s)
| | | | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
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23
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Anderson R, Moffatt CE. Ignorance Is Not Bliss: If We Don't Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It? Commentary. J Sex Med 2018; 15:273-283. [PMID: 29396022 DOI: 10.1016/j.jsxm.2018.01.001] [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: 08/09/2017] [Revised: 11/17/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Female sexual dysfunction (FSD) affects as many as 1 in every 3 women, with a significant portion of these with hypoactive sexual desire disorder (HSDD). These figures alone present significant psychological and pharmacologic challenges. Partly in response to this situation, in 2015 the US Food and Drug Administration approved flibanserin for the treatment of HSDD. This approval has drawn criticism on the grounds of efficacy and necessity. AIM To better inform potential consumers about FSD, flibanserin and other interventions for the treatment of HSDD, the importance of understanding the mechanism of FSD, and the efficacy of flibanserin and to review existing relevant knowledge. METHODS A literature review of extant clinic studies and theoretical discussion articles was performed. OUTCOMES Efficacy of flibanserin for addressing symptoms associated with HSDD in premenopausal women. RESULTS Extant literature and empirical evidence suggest that the efficacy of flibanserin for the treatment of HSDD in premenopausal women is at least questionable. CLINICAL TRANSLATION Clinicians considering the prescription of flibanserin would be well advised to appreciate some of the controversies concerning the efficacy of the drug. STRENGTHS AND LIMITATIONS The prohibitive usage guidelines, tenuous risk-benefit profile, and considerable cost of use of flibanserin are each worthy of consideration. Flibanserin thus far has been trialed in only a narrow patient range: premenopausal women in long-term relationships with acquired or generalized HSDD. CONCLUSIONS Although we acknowledge that the discovery and use of flibanserin constitute a compelling narrative, we conclude by questioning the specific efficacy and necessity of flibanserin in providing a treatment for HSDD in women. Anderson R, Moffatt CE. Ignorance Is Not Bliss: If We Don't Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It? COMMENTARY J Sex Med 2018;15:273-283.
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Affiliation(s)
- Ryan Anderson
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia.
| | - Claire E Moffatt
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia; Neurosurgery and Neuropsychology Research Group (NNRG), James Cook University, Townsville, QLD, Australia
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Deng Y, Zhang Y, Li S, Zhou W, Ye L, Wang L, Tao T, Gu J, Yang Z, Zhao D, Gu W, Hong J, Ning G, Liu W, Wang W. Steroid hormone profiling in obese and nonobese women with polycystic ovary syndrome. Sci Rep 2017; 7:14156. [PMID: 29074860 PMCID: PMC5658378 DOI: 10.1038/s41598-017-14534-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/11/2017] [Indexed: 02/06/2023] Open
Abstract
The study explored differences in the steroidogenic pathway between obese and nonobese women with polycystic ovary syndrome (PCOS) using liquid chromatography-tandem mass spectrometry (LC-MS/MS). 1044 women with PCOS (including 350 lean, 312 overweight and 382 obese) and 366 control women without PCOS (including 203 lean, 32 overweight and 131 obese) were enrolled. The differences in steroid hormones were amplified in lean PCOS versus lean controls compared with obese PCOS versus obese controls. Compared with obese PCOS, lean PCOS demonstrated increased dehydroepiandrosterone sulfate (P = 0.015), 17-hydropregnenolone (P = 0.003), 17-hydroprogesterone (17-OHP) (P < 0.001), progesterone (P < 0.001) and estrone (P < 0.001) levels. Enzyme activity evaluation showed that lean PCOS had increased activity of P450c17 (17-hydropregnenolone/pregnenolone, P < 0.001), P450aro (P < 0.001), 3βHSD2 (progesterone/ pregnenolone and 17-OHP/17-hydropregnenolone, both P < 0.001) and decreased activity of P450c21(11-deoxycorticorsterone/progesterone and 11-deoxycortisol/17-OHP, P < 0.001). Moreover, we found higher frequencies of CYP21A2- (encoding P450c21) c.552 C > G (p. D184E) in lean PCOS compared with obese PCOS patients (P = 0.006). In conclusion, this study demonstrated for the first time that the adrenal-specific enzyme P450c21 showed decreased activity in lean PCOS patients, and that the adrenal androgen excess may play different roles in lean and obese PCOS patients, which represents as different enzyme activity in the steroidogenic pathway.
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Affiliation(s)
- Yuying Deng
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yifei Zhang
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Shengxian Li
- Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Wenzhong Zhou
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Lei Ye
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Lihua Wang
- Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Tao Tao
- Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Junjie Gu
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zuwei Yang
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Dandan Zhao
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Weiqiong Gu
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jie Hong
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Guang Ning
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wei Liu
- Department of Endocrinology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Weiqing Wang
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
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Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertil Steril 2017; 106:1588-1599. [PMID: 27912889 DOI: 10.1016/j.fertnstert.2016.09.046] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/16/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychologic impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy (HRT) to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective HRT options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ∼50 years. We address special populations of women with POI, including women with Turner syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women.
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Affiliation(s)
| | - Philip M Sarrel
- Obstetrics, Gynecology, and Reproductive Sciences and Psychiatry, Yale University, New Haven, Connecticut
| | - Lawrence M Nelson
- Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Cao ZT, Botelho JC, Rej R, Vesper H. Accuracy-based proficiency testing for testosterone measurements with immunoassays and liquid chromatography-mass spectrometry. Clin Chim Acta 2017; 469:31-36. [PMID: 28288785 DOI: 10.1016/j.cca.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accurate testosterone measurements are needed to correctly diagnose and treat patients. Proficiency Testing (PT) programs using modified specimens for testing can be limited because of matrix effects and usage of non-reference measurement procedure (RMP)-defined targets for evaluation. Accuracy-based PT can overcome such limitations; however, there is a lack of information on accuracy-based PT and feasibility of its implementation in evaluation for testosterone measurements. METHODS Unaltered, single-donor human serum from 2 male and 2 female adult donors were analyzed for testosterone by 142 NYSDH-certified clinical laboratories using 16 immunoassays and LC-MS/MS methods. Testosterone target values were determined using an RMP. RESULTS The testosterone target concentrations for the 4 specimens were 15.5, 30.0, 402 and 498ng/dl. The biases ranged from -17.8% to 73.1%, 3.1% to 21.3%, -24.8% to 8.6%, and -22.1% to 6.8% for the 4 specimens, respectively. Using a total error target of ±25.1%, which was calculated using the minimum allowable bias and imprecision, 73% of participating laboratories had ≥3 of the 4 results within these limits. CONCLUSIONS The variability in total testosterone measurements can affect clinical decisions. Accuracy-based PT can significantly contribute to improving testosterone testing by providing reliable data on accuracy in patient care to laboratories, assay manufacturers, and standardization programs.
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Affiliation(s)
- Zhimin Tim Cao
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; College of Arts and Sciences, University at Albany, State University of New York, Albany, NY, United States
| | | | - Robert Rej
- Wadsworth Center, New York State Department of Health, Albany, NY, United States; School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Hubert Vesper
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
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Asih PR, Tegg ML, Sohrabi H, Carruthers M, Gandy SE, Saad F, Verdile G, Ittner LM, Martins RN. Multiple Mechanisms Linking Type 2 Diabetes and Alzheimer's Disease: Testosterone as a Modifier. J Alzheimers Dis 2017; 59:445-466. [PMID: 28655134 PMCID: PMC6462402 DOI: 10.3233/jad-161259] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Evidence in support of links between type-2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) has increased considerably in recent years. AD pathological hallmarks include the accumulation of extracellular amyloid-β (Aβ) and intracellular hyperphosphorylated tau in the brain, which are hypothesized to promote inflammation, oxidative stress, and neuronal loss. T2DM exhibits many AD pathological features, including reduced brain insulin uptake, lipid dysregulation, inflammation, oxidative stress, and depression; T2DM has also been shown to increase AD risk, and with increasing age, the prevalence of both conditions increases. In addition, amylin deposition in the pancreas is more common in AD than in normal aging, and although there is no significant increase in cerebral Aβ deposition in T2DM, the extent of Aβ accumulation in AD correlates with T2DM duration. Given these similarities and correlations, there may be common underlying mechanism(s) that predispose to both T2DM and AD. In other studies, an age-related gradual loss of testosterone and an increase in testosterone resistance has been shown in men; low testosterone levels can also occur in women. In this review, we focus on the evidence for low testosterone levels contributing to an increased risk of T2DM and AD, and the potential of testosterone treatment in reducing this risk in both men and women. However, such testosterone treatment may need to be long-term, and would need regular monitoring to maintain testosterone at physiological levels. It is possible that a combination of testosterone therapy together with a healthy lifestyle approach, including improved diet and exercise, may significantly reduce AD risk.
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Affiliation(s)
- Prita R. Asih
- Department of Anatomy, Dementia Research Unit, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- KaRa Institute of Neurological Diseases, Sydney, NSW, Australia
| | - Michelle L. Tegg
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Hamid Sohrabi
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Australian Alzheimer’s Research Foundation Perth, WA, Australia
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | | | - Samuel E. Gandy
- Departments of Neurology and Psychiatry and the Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY, USA
| | - Farid Saad
- Bayer Pharma AG, Global Medical Affairs Andrology, Berlin, Germany
- Gulf Medical University School of Medicine, Ajman, UAE
| | - Giuseppe Verdile
- Australian Alzheimer’s Research Foundation Perth, WA, Australia
- School of Biomedical Sciences, Curtin University of Technology, Bentley, WA, Australia
| | - Lars M. Ittner
- Department of Anatomy, Dementia Research Unit, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Ralph N. Martins
- KaRa Institute of Neurological Diseases, Sydney, NSW, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Australian Alzheimer’s Research Foundation Perth, WA, Australia
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
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Handelsman DJ, Matsumoto AM, Gerrard DF. Doping Status of DHEA Treatment for Female Athletes with Adrenal Insufficiency. Clin J Sport Med 2017; 27:78-85. [PMID: 26844622 DOI: 10.1097/jsm.0000000000000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the doping status of dehydroepiandrosterone (DHEA) for female athletes with adrenal insufficiency within the framework of Therapeutic Use Exemption (TUE) applications for this proandrogen, which is included on the World Anti-Doping Agency (WADA)'s Prohibited List. DATA SOURCES AND MAIN RESULTS Current knowledge of adrenal pathophysiology with a focus on the physiological role and pharmacological effects of DHEA in female athletes including placebo-controlled clinical trials of DHEA and consensus clinical practice and prescribing guidelines. CONCLUSIONS Because there is no convincing clinical evidence to support the use of DHEA replacement therapy in women with adrenal failure, a TUE for DHEA is not justified by definite health benefit for either secondary or primary adrenal failure. This is consistent with the 2014 update of the US Endocrine Society guidelines, meta-analyses of DHEA treatment in women with or without adrenal failure, current WADA TUE guidance document for adrenal insufficiency and recent case law of WADA's Court of Arbitration for Sport.
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Affiliation(s)
- David J Handelsman
- *ANZAC Research Institute, University of Sydney, Concord Hospital, New South Wales, Australia; †Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, and Department of Medicine, University of Washington School of Medicine, Seattle, Washington; and ‡Dunedin School of Medicine, University of Otago, New Zealand Chair, WADA TUE Expert Group, Dunedin, New Zealand
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Lamont J. Directive clinique de consensus sur la santé sexuelle de la femme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S79-S142. [DOI: 10.1016/j.jogc.2016.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clifton S, Macdowall W, Copas AJ, Tanton C, Keevil BG, Lee DM, Mitchell KR, Field N, Sonnenberg P, Bancroft J, Mercer CH, Wallace AM, Johnson AM, Wellings K, Wu FCW. Salivary Testosterone Levels and Health Status in Men and Women in the British General Population: Findings from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). J Clin Endocrinol Metab 2016; 101:3939-3951. [PMID: 27552539 PMCID: PMC5095233 DOI: 10.1210/jc.2016-1669] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Salivary T (Sal-T) measurement by liquid chromatography-tandem mass spectroscopy resents the opportunity to examine health correlates of Sal-T in a large-scale population survey. OBJECTIVE This study sought to examine associations between Sal-T and health-related factors in men and women age 18-74 years. DESIGN AND SETTING Morning saliva samples were obtained from participants in a cross-sectional probability-sample survey of the general British population (Natsal-3). Self-reported health and lifestyle questions were administered as part of a wider sexual health interview. PARTICIPANTS Study participants included 1599 men and 2123 women. METHODS Sal-T was measured using liquid chromatography-tandem mass spectroscopy. Linear regression was used to examine associations between health factors and mean Sal-T. RESULTS In men, mean Sal-T was associated with a range of health factors after age adjustment, and showed a strong independent negative association with body mass index (BMI) in multivariable analysis. Men reporting cardiovascular disease or currently taking medication for depression had lower age-adjusted Sal-T, although there was no association with cardiovascular disease after adjustment for BMI. The decline in Sal-T with increasing age remained after adjustment for health-related factors. In women, Sal-T declined with increasing age; however, there were no age-independent associations with health-related factors or specific heath conditions with the exception of higher Sal-T in smokers. CONCLUSIONS Sal-T levels were associated, independently of age, with a range of self-reported health markers, particularly BMI, in men but not women. The findings support the view that there is an age-related decline in Sal-T in men and women, which cannot be explained by an increase in ill health. Our results demonstrate the potential of Sal-T as a convenient measure of tissue androgen exposure for population research.
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Affiliation(s)
- S Clifton
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - W Macdowall
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - A J Copas
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - C Tanton
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - B G Keevil
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - D M Lee
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - K R Mitchell
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - N Field
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - P Sonnenberg
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - J Bancroft
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - C H Mercer
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - A M Wallace
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - A M Johnson
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - K Wellings
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - F C W Wu
- Research Department of Infection and Population Health (S.C., A.J.C., C.T., N.F., P.S., C.H.M., A.M.J.), University College London, London WC1E 6BT, United Kingdom; Department of Social and Environmental Health Research (W.M., K.R.M., K.W.), London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Department of Clinical Biochemistry (B.G.K.), University Hospital S Manchester, Manchester M13 9WL, United Kingdom; Cathie Marsh Institute for Social Research, School of Social Sciences (D.M.L.), The University of Manchester, Manchester M13 9WL, United Kingdom; MRC/CSO Social and Public Health Sciences Unit (K.R.M.), University of Glasgow, Glasgow G12 8QQ, United Kingdom; Kinsey Institute (J.B.), Indiana University, Bloomington, Indiana 47405; Department of Clinical Biochemistry (A.M.W.), Royal Infirmary, Glasgow G4 0SF, United Kingdom; and Andrology Research Unit (F.C.W.W.), Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
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Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals. Taiwan J Obstet Gynecol 2016; 55:686-691. [DOI: 10.1016/j.tjog.2016.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/17/2022] Open
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Abstract
Premature menopause, that is, menopause – spontaneous or iatrogenic – occurring at or before the age of 40 years, affects sexual identity, sexual function and sexual relationships. The woman's health, wellbeing and achievement of life's goals may be variably impaired. Factors modulating the individual's sexual outcome after premature menopause include: etiological heterogeneity of premature menopause and associated medical and sexual comorbidities; psychosexual vulnerability to premature menopause and associated infertility in survivors of childhood and adolescent cancers; impact of premature menopause on women's sexual identity, sexual function – particularly the biological basis of desire, arousal, orgasm and vaginal receptivity – and sexual relationships; partner-related factors; fertility issues; and preventive/therapeutic measures. Hormone therapy is indicated but long-term safety data are lacking. An interdisciplinary medical and psychosexual approach comprises appropriate counseling, fertility protection, when feasible, individualized hormone therapy and specific psychosexual treatment(s). Further research on fertility protection and the safety of long-term hormone therapy after premature menopause is needed.
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Affiliation(s)
- Alessandra Graziottin
- San Raffaele Resnati Hospital, Center for Gynecology and Medical Sexology, Via E. Panzacchi 6, 20123 Milan, Italy, Tel.: +39 027 200 2177; Fax: +39 028 767 58;Web:
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Trost LW, Mulhall JP. Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials. J Sex Med 2016; 13:1029-46. [PMID: 27209182 PMCID: PMC5516925 DOI: 10.1016/j.jsxm.2016.04.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Male hypogonadism is a common condition, with an increasing body of literature on diagnosis, implications, and management. Given the significant variability in testosterone (T) from a physiologic and assay perspective, a thorough understanding of factors affecting T values and study methodology is essential to interpret reported study outcomes appropriately. However, despite the large number of publications on T, there are no reference materials consolidating all relevant and potentially confounding factors necessary to interpret T studies appropriately. AIMS To create a resource document that reviews sources of T variability, free vs total T, assay techniques and questionnaires, and study methodology relevant to interpreting outcomes. METHODS A PubMed search was performed of all the T literature published on T variability, assay techniques, and T-specific questionnaires. Results were summarized in the context of their impact on interpreting T literature outcomes and methodology. MAIN OUTCOME MEASURES Effect of various factors on T variability and their relevance to study methodology and outcomes. RESULTS Several factors affect measured T levels, including aging, circadian rhythms, geography, genetics, lifestyle choices, comorbid conditions, and intraindividual daily variability. The utility of free T over total T is debatable and must be compared using appropriate threshold levels. Among various assay techniques, mass spectrometry and equilibrium dialysis are gold standards. Calculated empirical estimates of free T also are commonly used and accepted. Hypogonadism-specific questionnaires have limited utility in screening for hypogonadism, and their role as objective end points for quantifying symptoms remains unclear. Numerous aspects of study methodology can directly or indirectly affect reported outcomes, including design (randomized, prospective, retrospective), duration, populations studied (age, comorbid conditions), low T threshold, therapeutic agent used, objective measurements and end points selected, and statistical interpretation. CONCLUSION Critical appraisal of the T literature requires an understanding of numerous factors resulting in T variability, study design and methodology, and limitations of assay techniques and objective measurement scales.
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Affiliation(s)
- Landon W Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Ouyang P, Wenger NK, Taylor D, Rich-Edwards JW, Steiner M, Shaw LJ, Berga SL, Miller VM, Merz NB. Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientists. Biol Sex Differ 2016; 7:19. [PMID: 27034774 PMCID: PMC4815158 DOI: 10.1186/s13293-016-0073-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In 2001, the Institute of Medicine's (IOM) report, "Exploring the Biological Contributions to Human Health: Does Sex Matter?" advocated for better understanding of the differences in human diseases between the sexes, with translation of these differences into clinical practice. Sex differences are well documented in the prevalence of cardiovascular (CV) risk factors, the clinical manifestation and incidence of cardiovascular disease (CVD), and the impact of risk factors on outcomes. There are also physiologic and psychosocial factors unique to women that may affect CVD risk, such as issues related to reproduction. METHODS The Society for Women's Health Research (SWHR) CV Network compiled an inventory of sex-specific strategies and methods for the study of women and CV health and disease across the lifespan. References for methods and strategy details are provided to gather and evaluate this information. Some items comprise robust measures; others are in development. RESULTS To address female-specific CV health and disease in population, physiology, and clinical trial research, data should be collected on reproductive history, psychosocial variables, and other factors that disproportionately affect CVD in women. Variables related to reproductive health include the following: age of menarche, menstrual cycle regularity, hormone levels, oral contraceptive use, pregnancy history/complications, polycystic ovary syndrome (PCOS) components, menopause age, and use and type of menopausal hormone therapy. Other factors that differentially affect women's CV risk include diabetes mellitus, autoimmune inflammatory disease, and autonomic vasomotor control. Sex differences in aging as well as psychosocial variables such as depression and stress should also be considered. Women are frequently not included/enrolled in mixed-sex CVD studies; when they are included, information on these variables is generally not collected. These omissions limit the ability to determine the role of sex-specific contributors to CV health and disease. Lack of sex-specific knowledge contributes to the CVD health disparities that women face. CONCLUSIONS The purpose of this review is to encourage investigators to consider ways to increase the usefulness of physiological and psychosocial data obtained from clinical populations, in an effort to improve the understanding of sex differences in clinical CVD research and health-care delivery for women and men.
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Affiliation(s)
- Pamela Ouyang
- />Johns Hopkins University, Baltimore, MD USA
- />Division of Cardiology, Johns Hopkins Bayview Medical Center, 301 Building, Suite 2400, 4940 Eastern Ave, Baltimore, MD 21224 USA
| | | | | | | | | | | | | | | | - Noel Bairey Merz
- />Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA USA
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Abstract
Women experience multiple changes in social and reproductive statuses across the life span which can affect sexual functioning. Various phases of the sexual response cycle may be impacted and can lead to sexual dysfunction. Screening for sexual problems and consideration of contributing factors such as neurobiology, reproductive life events, medical problems, medication use, and depression can help guide appropriate treatment and thereby improve the sexual functioning and quality of life of affected women. Treatment options include psychotropic medications, hormone therapy, and psychotherapy.
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Affiliation(s)
- Anita H Clayton
- University of Virginia Department of Psychiatry and Neurobehavioral Sciences, 2955 Ivy Rd, Suite 210, Charlottesville, VA, 22903, USA.
| | - Veronica Harsh
- University of Virginia Department of Psychiatry and Neurobehavioral Sciences, 2955 Ivy Rd, Suite 210, Charlottesville, VA, 22903, USA.
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Parish SJ, Hahn SR. Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment. Sex Med Rev 2016; 4:103-120. [PMID: 27872021 DOI: 10.1016/j.sxmr.2015.11.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/06/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Hypoactive Sexual Desire Disorder (HSDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DSM-IV-TR) as persistent deficient sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), HSDD has been subsumed by Female Sexual Interest/Arousal Disorder. However, decades of research based on DSM-IV-TR HSDD criteria form the foundation of our understanding of the essential symptom of distressing low sexual desire, its epidemiology, clinical management, and treatment. AIM This publication reviews the state of knowledge about HSDD. METHODS A literature search was performed using terms HSDD and female sexual dysfunction (FSD). MAIN OUTCOME MEASURES Physicians acknowledge that FSD is common and distressing; however, they infrequently address it, citing low confidence, time constraints, and lack of treatment as barriers. RESULTS HSDD is present in 8.9% of women ages 18 to 44, 12.3% ages 45 to 64, and 7.4% over 65. Although low sexual desire increases with age, distress decreases; so prevalence of HSDD remains relatively constant across age. HSDD is associated with lower health-related quality of life; lower general happiness and satisfaction with partners; and more frequent negative emotional states. HSDD is underdetected and undertreated. Less than half of patients with sexual problems seek help from or initiate discussions with physicians. Patients are inhibited by fear of embarrassing physicians and believe that physicians should initiate discussions. The Decreased Sexual Desire Screener, a tool for detecting and diagnosing HSDD, is validated for use in general practice. CONCLUSION Women can benefit from intervention in primary care, behavioral health and sexual medicine settings. Psychotherapeutic and pharmacological interventions aim to enhance sexual excitatory process and decrease inhibitory processes. Flibanserin, the first centrally acting daily medication for HSDD, was recently approved in the US for premenopausal women.
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Affiliation(s)
- Sharon J Parish
- Weill Cornell Medical College/NY Presbyterian Hospital, Westchester Division, White Plains, NY, USA.
| | - Steven R Hahn
- Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
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Buscarini M, Cardi A. RETRACTED ARTICLE: Importance of hypogonadism and testosterone replacement therapy in current urologic practice: a review. Int Urol Nephrol 2015. [DOI: 10.1007/s11255-010-9717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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The Female Sexual Response: Current Models, Neurobiological Underpinnings and Agents Currently Approved or Under Investigation for the Treatment of Hypoactive Sexual Desire Disorder. CNS Drugs 2015; 29:915-33. [PMID: 26519340 DOI: 10.1007/s40263-015-0288-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
How a woman responds to sexual cues is highly dependent on a number of distinct, yet related, factors. Researchers have attempted to explain the female sexual response for decades, but no single model reigns supreme. Proper female sexual function relies on the interplay of somatic, psychosocial and neurobiological factors; misregulation of any of these components could result in sexual dysfunction. The most common sexual dysfunction disorder is hypoactive sexual desire disorder (HSDD). HSDD is a disorder affecting women across the world; a recent in-person diagnostic interview study conducted in the USA found that an estimated 7.4% of US women suffer from HSDD. Despite the disorder's prevalence, it is often overlooked as a formal diagnosis. In a survey of primary care physicians and obstetrics/gynaecology specialists, the number one reason for not assigning an HSDD diagnosis was the lack of a safe and effective therapy approved by the US Food and Drug Administration (FDA). This changed with the recent FDA approval of flibanserin (Addyi™) for the treatment of premenopausal women with acquired, generalized HSDD; there are still, however, no treatments approved outside the USA. HSDD is characterized by a marked decrease in sexual desire, an absence of motivation (also known as avolition) to engage in sexual activity, and the condition's hallmark symptom, marked patient distress. Research suggests that HSDD may arise from an imbalance of the excitatory and inhibitory neurobiological pathways that regulate the mammalian sexual response; top-down inhibition from the prefrontal cortex may be hyperactive, and/or bottom-up excitation to the limbic system may be hypoactive. Key neuromodulators for the excitatory pathways include norepinephrine, oxytocin, dopamine and melanocortins. Serotonin, opioids and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Evolving treatment strategies have relied heavily on these crucial research findings, as many of the agents currently being investigated as treatment options for HSDD target and influence key players within these excitatory and inhibitory pathways, including various hormone therapies and centrally acting drugs, such as buspirone, bupropion and bremelanotide.
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Miller VM. Congress on women's health Trudy Bush lecture 2014: new insights into sex Hormones and Cardiovascular disease. J Womens Health (Larchmt) 2015; 23:997-1004. [PMID: 25495365 DOI: 10.1089/jwh.2014.4995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Many basic, mechanistic studies of how sex steroids alter vascular function proceeded from Dr. Bush's seminal epidemiologic observations that noncontraceptive use of estrogen reduced all-cause and cardiovascular mortality. However, translating findings from these basic science studies into clinical trials and clinical guidelines has been controversial. This commentary reviews the development of sex steroid vascular research, identifies mechanisms by which sex steroids affect vascular function, reviews findings from recent clinical hormone trials, and identifies challenges and the need for continued funding of such investigations.
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Affiliation(s)
- Virginia M Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
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Singh Ospina N, Rodriguez-Gutierrez R, Brito JP, Young WF, Montori VM. Is the endocrine research pipeline broken? A systematic evaluation of the Endocrine Society clinical practice guidelines and trial registration. BMC Med 2015; 13:187. [PMID: 26265226 PMCID: PMC4533940 DOI: 10.1186/s12916-015-0435-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/24/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Very low quality (VLQ) evidence translates into very low confidence in the balance of risk and benefits based on the estimates drawn from the body of evidence. Consequently, this assessment highlights gaps in the research evidence, i.e. knowledge gaps, for important clinical questions. In this way, expert guideline panels identify priority knowledge gaps that, arguably, should inform the research agenda and prioritize scarce research economical resources. The extent to which the research agenda reflects the knowledge gaps identified in clinical practice guidelines is unknown. METHODS A systematic evaluation of the Endocrine Society (ES) clinical practice guidelines portfolio from 2008 to 2014 was conducted with the objectives to identify (1) recommendations in the ES clinical practice guidelines based on VLQ evidence reflecting knowledge gaps in endocrinology, and (2) active research designed to address these gaps by searching the clinical trial registry, clinicaltrials.gov, using terms describing patients (diseases), interventions, comparison, and outcomes. RESULTS In 25 ES guidelines, we found 660 recommendations, of which 131 (20 %) were supported by VLQ evidence. Clinical trialists are attempting to answer 28 (21 %) of these knowledge gaps by performing 69 clinical trials. CONCLUSION The research enterprise is addressing one in five knowledge gaps identified in clinical practice recommendations in endocrinology. These findings suggest an inefficiency in the allocation of very scarce research economical resources. Linking the research agenda to evidence gaps in clinical practice guidelines may improve both the efficiency of the research enterprise and the translation of evidence into more confident clinical practice.
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Affiliation(s)
- Naykky Singh Ospina
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Perry AC, Martin L. Race differences in obesity and its relationship to the sex hormone milieu. Horm Mol Biol Clin Investig 2015; 19:151-61. [PMID: 25390023 DOI: 10.1515/hmbci-2014-0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/30/2014] [Indexed: 01/23/2023]
Abstract
A sexual dimorphism exists in which increased abdominal and visceral adipose tissue (VAT) - found in women and marked by low sex hormone binding globulin (SHBG) and high bioavailable testosterone (BT) - is related to the metabolic risk profile. In men, increased BT is related to decreased abdominal obesity and a decrease in the metabolic risk profile. In women, race differences have been found in androgenic sex steroids including SHBG and BT as well as central fat distribution, creating inherently greater metabolic risk for certain populations. Estrogen and estrogen receptor isoforms play a role in fat deposition and distribution and may influence the changes that occur during the menopausal transition. Androgenic sex steroids serve a mediating role, influencing VAT accumulation and its associated metabolic risk factors while VAT also serves a mediating role influencing the androgenic sex steroid-metabolic risk relationship in women. Furthermore, androgenic sex steroids and VAT may independently contribute to the variance in several metabolic variables associated with cardiovascular disease, type 2 diabetes, and their antecedent conditions such as the metabolic syndrome. Race has been shown to modify the relationship between androgenic sex steroids and metabolic variables associated with risk for diabetes in Black and White women. Further research is warranted to examine the mechanisms involved in race differences. Total adiposity and central fat distribution in accordance with changes in the hormone and metabolic milieu influence breast cancer risk, which varies by race and menopausal status. These findings have broader implications for the study of health promotion/disease prevention in women.
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Effects of physiologic testosterone therapy on quality of life, self-esteem, and mood in women with primary ovarian insufficiency. Menopause 2015; 21:952-61. [PMID: 24473536 DOI: 10.1097/gme.0000000000000195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women with primary ovarian insufficiency (POI) display low androgen levels, which could contribute to mood and behavioral symptoms observed in this condition. We examined the effects of physiologic testosterone therapy added to standard estrogen/progestin therapy on quality of life, self-esteem, and mood in women with POI. METHODS One hundred twenty-eight women with 46,XX spontaneous POI participated in a 12-month randomized, placebo-controlled, parallel-design investigation of the efficacy of testosterone augmentation of estrogen/progestin therapy. Quality of life, self-esteem, and mood symptoms were evaluated with standardized rating scales and a structured clinical interview. Differences in outcome measures between the testosterone and placebo treatments were analyzed by Wilcoxon rank sum tests. RESULTS No differences in baseline characteristics, including serum hormone levels (P > 0.05), were found. Baseline mean (SD) Center for Epidemiologic Studies Depression Scale scores were 10.7 (8.6) and 9.2 (7.8) for testosterone and placebo, respectively (P = 0.35). After 12 months of treatment, measures of quality of life, self-esteem, and mood symptoms did not differ between treatment groups. Serum testosterone levels achieved physiologic levels in the testosterone group and were significantly higher compared with placebo (P < 0.001). Baseline testosterone levels were not associated with either adverse or beneficial clinical effects. CONCLUSIONS A 150-μg testosterone patch achieves physiologic hormone levels in women with POI. Our findings suggest that augmentation of standard estrogen/progestin therapy with physiologic testosterone therapy in young women with POI neither aggravates nor improves baseline reports of quality of life or self-esteem and had minimal effects on mood. Other mechanisms might play a role in the altered mood accompanying this disorder.
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Goodrum BA. The Effects of Long-Term Testosterone Use on Lipid-Related Cardiovascular Risk Factors Among FtM Patients. Int J Transgend 2015. [DOI: 10.1080/15532739.2014.995261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Stieg MR, Sievers C, Farr O, Stalla GK, Mantzoros CS. Leptin: A hormone linking activation of neuroendocrine axes with neuropathology. Psychoneuroendocrinology 2015; 51:47-57. [PMID: 25290346 DOI: 10.1016/j.psyneuen.2014.09.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 09/03/2014] [Accepted: 09/06/2014] [Indexed: 11/24/2022]
Abstract
Leptin, a peptide hormone secreted by adipocytes, plays a central role in controlling appetite and weight in both rodents and humans. Basic science and clinical research suggest that this hormone not only affects the regulation of the neuroendocrine axes, but also exerts effects on the central nervous system with subsequent alterations in psychological functions. For instance, leptin suppresses cortisol secretion during stress-related activation of the adrenal axis. As psychiatric disorders like depression are associated with hypercortisolism, leptin is proposed to exert anti-depressant-like effects due to its inhibition of chronically overactive hypothalamo-pituitary-adrenal axis function. Moreover, leptin status of depressed patients could serve as a prognostic marker for therapy response. Besides its influence on neuroendocrine pathways leptin seems to have direct central effects on brain development and neuroplasticity. Low leptin levels have been shown to be associated with increased risk of developing dementia, supporting the idea of a pro-cognitive effect of leptin. These areas may have direct clinical implications and deserve to be studied further in the future.
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Affiliation(s)
- Mareike R Stieg
- Max-Planck-Institute of Psychiatry, Kreapelinstr. 2-10, 80804 Munich, Germany.
| | - Caroline Sievers
- Max-Planck-Institute of Psychiatry, Kreapelinstr. 2-10, 80804 Munich, Germany
| | - Olivia Farr
- Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA; Section of Endocrinology, Boston VA Healthcare System, Boston, USA
| | - Günter K Stalla
- Max-Planck-Institute of Psychiatry, Kreapelinstr. 2-10, 80804 Munich, Germany
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA; Section of Endocrinology, Boston VA Healthcare System, Boston, USA.
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Basson R, Bronner G. Management and rehabilitation of neurologic patients with sexual dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:415-34. [DOI: 10.1016/b978-0-444-63247-0.00024-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gama CR, Lasmar R, Gama GF, Abreu CS, Nunes CP, Geller M, Oliveira L, Santos A. Clinical Assessment of Tribulus terrestris Extract in the Treatment of Female Sexual Dysfunction. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2014; 7:45-50. [PMID: 25574150 PMCID: PMC4275110 DOI: 10.4137/cmwh.s17853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/21/2014] [Accepted: 11/19/2014] [Indexed: 01/04/2023]
Abstract
This is a qualitative–quantitative study based on hospital records of female patients of reproductive age, presenting sexual dysfunction, and treated with 250 mg Tribulus terrestris extract (1 tablet thrice daily for 90 days). Safety monitoring included vital signs, physical examination, laboratory tests, and occurrence of adverse events. Efficacy analysis included results of the Female Sexual Function Index (FSFI), dehydroepiandrosterone (DHEA) levels together with total and free testosterone, and the patient and physician assessments. There was a statistically significant improvement in total FSFI scores (P < 0.0001) post-treatment, with improvement among 106 (88.33%) subjects. There was a statistically significant (P < 0.0001) increase in the level of DHEA, while the levels of both serum testosterone (P = 0.284) and free testosterone decreased (P < 0.0001). Most adverse events recorded were related to the gastrointestinal tract. Physical examination showed no significant changes post-treatment. Based on the results, it is concluded that the T. terrestris extract is safe and effective in the treatment of female sexual dysfunction.
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Affiliation(s)
- Carlos Rb Gama
- Department of Gynecology-Universidade Estadual Paulista (UNESP) São Paulo-SP, Brazil. ; Department of Gynecology-Fundação Educacional Serra dos Órgãos (UNIFESO) Teresópolis-RJ, Brazil. ; Colégio Brasileiro de Cirurgiões-Rio de Janeiro-RJ, Brazil. ; Department of Gynecologic Endoscopy-UNIFESO Teresópolis-RJ, Brazil
| | - Ricardo Lasmar
- Department of Gynecology-Universidade Estadual Paulista (UNESP) São Paulo-SP, Brazil. ; Department of Gynecology-Universidade Federal Fluminense (UFF) Rio de Janeiro, RJ, Brazil
| | - Gustavo F Gama
- Department of Gynecologic Endoscopy-UNIFESO Teresópolis-RJ, Brazil. ; Department of Gynecology & Obstetrics Service-Hospital das Clínicas-UNIFESO Teresópolis-RJ, Brazil
| | - Camila S Abreu
- Department of Pharmaceutics-Universidade Federal do Rio de Janeiro (UFRJ) Rio de Janeiro-RJ, Brazil
| | - Carlos P Nunes
- Department of Internal Medicine-UNIFESO Teresópolis-RJ, Brazil. ; Department of Clinical Immunology-Instituto de Pós-Graduação Médica Carlos Chagas (IPGMCC) Rio de Janeiro-RJ, Brazil
| | - Mauro Geller
- Department of Clinical Immunology-Instituto de Pós-Graduação Médica Carlos Chagas (IPGMCC) Rio de Janeiro-RJ, Brazil. ; Department of Immunology-UNIFESO Teresópolis-RJ, Brazil
| | - Lisa Oliveira
- Researcher in Immunology and Microbiology-UNIFESO Teresópolis-RJ, Brazil
| | - Alessandra Santos
- Department of Clinical Immunology-Instituto de Pós-Graduação Médica Carlos Chagas (IPGMCC) Rio de Janeiro-RJ, Brazil. ; Department of Clinical Genetics-UFRJ Rio de Janeiro-RJ, Brazil
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Elraiyah T, Sonbol MB, Wang Z, Khairalseed T, Asi N, Undavalli C, Nabhan M, Firwana B, Altayar O, Prokop L, Montori VM, Murad MH. Clinical review: The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99:3543-50. [PMID: 25279572 PMCID: PMC5393495 DOI: 10.1210/jc.2014-2262] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/08/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT The use of T has been suggested to improve women's health during the postmenopausal period. OBJECTIVE We conducted a systematic review and meta-analysis of randomized trials to summarize the best available evidence regarding the benefits and harms of systemic T in postmenopausal women with normal adrenal function. METHODS A comprehensive search of MEDLINE, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EBSCO CINAHL, and Scopus was conducted through January 2014. We conducted study selection, data extraction, and appraisal in duplicate. Random-effects meta-analysis was used to pool results. RESULTS We identified 35 randomized trials (n = 5053) at a moderate risk of bias. T use was associated with statistically significant improvement in various domains of sexual function and personal distress in postmenopausal women, although the majority of the trials did not have specific or contemporary diagnostic criteria for androgen deficiency in women. T use was also associated with a reduction in total cholesterol, triglyceride, and high-density lipoprotein and an increase in low-density lipoprotein and in the incidence of acne and hirsutism. No significant effect was noted on anthropometric measures and bone density. Long-term safety data were sparse, and the quality of such evidence was low. CONCLUSION Despite the improvement in sexual function associated with T use in postmenopausal women, long-term safety data are lacking.
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Affiliation(s)
- Tarig Elraiyah
- Knowledge and Evaluation Research Unit (T.E., M.B.S., Z.W., T.K., N.A., C.U., M.N., B.F., O.A., V.M.M., M.H.M.), and Center for the Science of Healthcare Delivery (T.E., Z.W., N.A., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Internal Medicine Department (M.B.S.), Georgia Regents University, Augusta, Georgia 30901; and Mayo Clinic Libraries (L.P.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (V.M.M.), and Division of Preventive, Occupational, and Aerospace Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota 55905
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Abstract
Hypogonadism is common throughout the illness trajectory of patients with cancer. About two thirds of male patients with advanced cancer have hypothalamic-pituitary-gonadal dysfunction and low testosterone levels. Chronic inflammation, comorbidities, cachexia, chemotherapy, and medications such as opioids, megestrol acetate, and corticosteroids contribute to primary and secondary hypogonadism. Studies have reported increased symptom burden, diminished quality of life, and poor prognosis associated with low testosterone levels in males with cancer. The Endocrine Society has published clinical practice guidelines for replacing testosterone in symptomatic patients with chronic illness and in patients receiving opioids; however, the role of testosterone therapy specifically in patients with cancer is not addressed. This review explores the potential benefits and limitations of testosterone replacement on the basis of current evidence.
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