1
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Coelingh Bennink HJT, Prowse A, Egberts JFM, Debruyne FMJ, Huhtaniemi IT, Tombal B. The Loss of Estradiol by Androgen Deprivation in Prostate Cancer Patients Shows the Importance of Estrogens in Males. J Endocr Soc 2024; 8:bvae107. [PMID: 38883397 PMCID: PMC11177789 DOI: 10.1210/jendso/bvae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Indexed: 06/18/2024] Open
Abstract
The role of estradiol (E2; an estrogen) in men needs to be more appreciated. In this review, we address the clinical situations that allow the study of the clinical consequences of E2 deficiency in men and discuss the effects of restoration of levels of this reproductive steroid hormone. In men with advanced prostate cancer (PCa) undergoing androgen deprivation therapy (ADT), E2 is suppressed along with testosterone, leading to side effects affecting the quality of life. These include hot flashes, arthralgia, fatigue, mood changes, cognition problems, weight gain, bone loss, and increased risk of cardiovascular disease. Transdermal E2 alone for ADT has shown equivalent testosterone suppression compared to gonadotropin-releasing hormone (GnRH) agonists while also preventing estrogen-deficiency side effects, including hot flashes and bone loss. Co-treatment of ADT with fetal estrogen estetrol (E4) has shown significant improvements of estrogen-deficiency symptoms. These observations emphasize the need to raise awareness of the importance of estrogens in men among clinicians and the lay public.
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Affiliation(s)
| | - Amanda Prowse
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | - Jan F M Egberts
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | | | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Imperial College London, London SW7 2AZ, UK
| | - Bertrand Tombal
- Division of Urology, University Clinic Saint-Luc, 1200 Brussels, Belgium
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2
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Zhang Q, Wei H, Lee A, Felmlee MA. Sex and Cross-Sex Testosterone Treatment Alters Gamma-Hydroxybutyrate Acid Toxicokinetics and Toxicodynamics in Rats. Pharmaceutics 2024; 16:143. [PMID: 38276513 PMCID: PMC10821532 DOI: 10.3390/pharmaceutics16010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Γ-hydroxybutyric acid (GHB) is widely abused due to its sedative/hypnotic and euphoric effects. In recent years, GHB use has witnessed a notable rise within the LGBTQ+ community. GHB is a substrate of monocarboxylate transporters (MCTs) and exhibits nonlinear toxicokinetics, characterized by saturable metabolism, absorption, and renal reabsorption. This study investigates the impact of exogenous testosterone administration on GHB toxicokinetics and toxicodynamics, exploring the potential of MCT1 inhibition as a strategy to counteract toxicity. Ovariectomized (OVX) females and castrated (CST) male Sprague Dawley rats were treated with testosterone or placebo for 21 days. GHB was administered at two doses (1000 mg/kg or 1500 mg/kg i.v.), and the MCT1 inhibitor AR-C 155858 (1 mg/kg i.v.) was administered 5 min after GHB (1500 mg/kg i.v.) administration. Plasma and urine were collected up to 8 h post-dose, and GHB concentrations were quantified via a validated LC/MS/MS assay. Sleep time (sedative/hypnotic effect) was utilized as the toxicodynamic endpoint. Testosterone treatment significantly affected GHB toxicokinetics and toxicodynamics. Testosterone-treated CST rats exhibited significantly lower renal clearance, higher AUC, and increased sedative effect, while testosterone-treated OVX rats demonstrated higher metabolic clearance. AR-C 155858 treatment led to an increase in GHB renal and total clearance together with an improvement in sedative/hypnotic effect. In conclusion, exogenous testosterone treatment induces significant alterations in GHB toxicokinetics and toxicodynamics, and MCT inhibition can serve as a potential therapeutic strategy for GHB overdose in both cisgender and transgender male populations.
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Affiliation(s)
- Qing Zhang
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
| | - Hao Wei
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
- QPS LLC, Newark, DE 19711, USA
| | - Annie Lee
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
| | - Melanie A. Felmlee
- Department of Pharmaceutics and Medicinal Chemistry, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA; (Q.Z.)
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3
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Duarte-Silva M, Oliveira CNS, Fuzo C, Silva-Neto PV, Toro DM, Pimentel VE, Pérez MM, Fraga-Silva TFC, Carvalho JCS, Neto FMS, Júnior RBM, Arruda E, Vilar FC, Degiovani AM, Ostini FM, Feitosa MR, Parra RS, Gaspar GG, Rocha JJR, Feres O, Fernandes APM, Maruyama SR, Russo EMS, Bonato VLD, Santos IKFM, Sorgi CA, Dias-Baruffi M, Faccioli LH, Cardoso CRB. Divergent androgenic modulation of SARS-CoV-2 infection cooperates with dysregulated immune response to dictate worse COVID-19 outcomes in men. Brain Behav Immun 2023; 114:275-286. [PMID: 37648004 DOI: 10.1016/j.bbi.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Sex-determined differences are rarely addressed in the management of diseases, despite well-known contrasting outcomes between female and male patients. In COVID-19 there is a remarkable disparity, with higher rates of mortality and more severe acute disease in men compared to women, who are mostly affected by long COVID-19. Furthermore, whether androgens play a protective or detrimental role in COVID-19 is still a matter of debate. Hence, the adequate management of the disease, especially regarding men presenting acute disease aggravation, still needs important data to elucidate the interplay between sex hormones and host immune responses that drive the worse evolution in male patients. METHODS A cohort of 92 controls and 198 non-severe and severe COVID-19 patients, from both sexes, was assessed for clinical outcomes, plasma steroids, gonadotropins, sex hormone binding globulin (SHBG) and immune mediators, before vaccination. These data were correlated with the global gene expression of blood leukocytes. The androgen receptor (AR) signaling pathway was investigated by transcriptomics and tracheal aspirate was obtained from severe patients for SARS-COV-2 quantification in the respiratory tract. The interplay among clinical, endocrine and immunological data deciphered the sex differences in COVID-19. Importantly, statistical analyses, using 95% confidence interval, considered confounding factors such as age and comorbidities, to definitely parse the role of androgens in the disease outcome. RESULTS There were notable contrasting levels of testosterone and dihydrotestosterone (DHT) throughout the disease course in male but not female patients. Inflammatory mediators presented significant negative correlations with testosterone, which was partially dependent on age and diabetes in men. Male subjects with severe COVID-19 had a significant up regulation of the AR signaling pathway, including modulation of TMPRSS2 and SRD5A1 genes, which are related to the viral infection and DHT production. Indeed, men had a higher viral load in the tracheal aspirate and levels of DHT were associated with increased relative risk of death. In contrast, the testosterone hormone, which was notably reduced in severe disease, was significantly related with susceptibility to COVID-19 worsening in male patients. Secondary hypogonadism was ruled out in the male severe COVID-19 subjects, as FSH, LH, and SHBG levels were not significantly altered. Instead, these subjects tended to have increased gonadotropin levels. Most interestingly, in this study we identified, for the first time, combined sets of clinical and immunoendocrine parameters that together predicted progression from non-severe to severe COVID-19 in men. One of the limitations of our study was the low or undetectable levels of DHT in many patients. Then, the evaluation of enzymes related to biosynthesis and signaling by androgens was mandatory and reiterated our findings. CONCLUSIONS These original results unraveled the disease immunoendocrine regulation, despite vaccination or comorbidities and pointed to the fundamental divergent role of the androgens testosterone and DHT in the determination of COVID-19 outcomes in men. Therefore, sex-specific management of the dysregulated responses, treatments or public health measures should be considered for the control of COVID-19 pandemic.
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Affiliation(s)
- Murillo Duarte-Silva
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Camilla N S Oliveira
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Carlos Fuzo
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil
| | - Pedro V Silva-Neto
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Instituto de Ciências Biológicas Amazonas, Universidade Federal do Amazonas - UFAM, Brazil
| | - Diana M Toro
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Instituto de Ciências Biológicas Amazonas, Universidade Federal do Amazonas - UFAM, Brazil
| | - Vinícius E Pimentel
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Malena M Pérez
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil
| | - Thais F C Fraga-Silva
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Jonatan C S Carvalho
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - FFCLRP/USP, Brazil
| | - Firmino M S Neto
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil
| | - Ronaldo B M Júnior
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil; Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Eurico Arruda
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Fernando C Vilar
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | | | - Fátima M Ostini
- Hospital Santa Casa de Misericórdia de Ribeirão Preto, Brazil
| | - Marley R Feitosa
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Rogerio S Parra
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Gilberto G Gaspar
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - José J R Rocha
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Omar Feres
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | | | - Sandra R Maruyama
- Departamento de Genética e Evolução, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos - UFSCar, Brazil
| | - Elisa M S Russo
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil
| | - Vânia L D Bonato
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Isabel K F M Santos
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil
| | - Carlos A Sorgi
- Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto - FMRP/USP, Brazil; Instituto de Ciências Biológicas Amazonas, Universidade Federal do Amazonas - UFAM, Brazil; Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - FFCLRP/USP, Brazil
| | - Marcelo Dias-Baruffi
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil
| | - Lúcia H Faccioli
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil
| | - Cristina R B Cardoso
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto - FCFRP/USP, Brazil.
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Margolis LM, Marlatt KL, Berryman CE, Howard EE, Murphy NE, Carrigan CT, Harris MN, Beyl RA, Ravussin E, Pasiakos SM, Rood JC. Metabolic Adaptations and Substrate Oxidation are Unaffected by Exogenous Testosterone Administration during Energy Deficit in Men. Med Sci Sports Exerc 2023; 55:661-669. [PMID: 36563086 DOI: 10.1249/mss.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION/PURPOSE The effects of testosterone on energy and substrate metabolism during energy deficit are unknown. The objective of this study was to determine the effects of weekly testosterone enanthate (TEST; 200 mg·wk -1 ) injections on energy expenditure, energy substrate oxidation, and related gene expression during 28 d of energy deficit compared with placebo (PLA). METHODS After a 14-d energy balance phase, healthy men were randomly assigned to TEST ( n = 24) or PLA ( n = 26) for a 28-d controlled diet- and exercise-induced energy deficit (55% below total energy needs by reducing energy intake and increasing physical activity). Whole-room indirect calorimetry and 24-h urine collections were used to measure energy expenditure and energy substrate oxidation during balance and deficit. Transcriptional regulation of energy and substrate metabolism was assessed using quantitative reverse transcription-polymerase chain reaction from rested/fasted muscle biopsy samples collected during balance and deficit. RESULTS Per protocol design, 24-h energy expenditure increased ( P < 0.05) and energy intake decreased ( P < 0.05) in TEST and PLA during deficit compared with balance. Carbohydrate oxidation decreased ( P < 0.05), whereas protein and fat oxidation increased ( P < 0.05) in TEST and PLA during deficit compared with balance. Change (∆; deficit minus balance) in 24-h energy expenditure was associated with ∆activity factor ( r = 0.595), but not ∆fat-free mass ( r = 0.147). Energy sensing (PRKAB1 and TP53), mitochondria (TFAM and COXIV), fatty acid metabolism (CD36/FAT, FABP, CPT1b, and ACOX1) and storage (FASN), and amino acid metabolism (BCAT2 and BCKHDA) genes were increased ( P < 0.05) during deficit compared with balance, independent of treatment. CONCLUSIONS These data demonstrate that increased physical activity and not exogenous testosterone administration is the primary determinate of whole-body and skeletal muscle metabolic adaptations during diet- and exercise-induced energy deficit.
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Affiliation(s)
- Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | | | | | - Emily E Howard
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Nancy E Murphy
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Christopher T Carrigan
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | | | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Stefan M Pasiakos
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA
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5
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Age-related decrease in serum dihydrotestosterone concentration is accompanied by impaired vascular status. Exp Gerontol 2023; 173:112104. [PMID: 36693531 DOI: 10.1016/j.exger.2023.112104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/03/2022] [Accepted: 01/20/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The effect of androgens on the cardiovascular system in humans is ambiguous. Moreover, still little is known about the effects of the most potent androgen, dihydrotestosterone, on arterial stiffness and endothelial function. The aim of this study was to evaluate whether age-dependent alterations in serum concentration of dihydrotestosterone and its circulating metabolite are accompanied by changes in endothelial function and arterial stiffness. METHODS In 12 young and 11 older men, basal serum concentrations of testosterone, dehydroepiandrosterone sulfate (DHAE-S), androstenedione (AE), dihydrotestosterone (DHT) and androstanediol glucuronide (ADG) were analyzed in relation to vascular status including cIMT - carotid intima media thickness, cAI - central augmentation index, crPWV - carotid radial pulse wave velocity, SI - stiffness index, endothelial and inflammatory markers. RESULTS Although concentration of testosterone was not different between young and older group, it was demonstrated that DHT, DHEA-S, AE and ADG were significantly lower in older men in comparison to young men (p < 0.01). Interestingly the most surprising difference was found for DHT concentration, that was as much as 61 % lower in aged men that displayed significantly higher values of cIMT, AI, crPWV and SI (p < 10-4), suggestive of arterial stiffness. Furthermore, DHT was negatively correlated to all arterial wall parameters (cAI, crPWV, SI and cIMT), c-reactive protein (CRP) and hyaluronic acid (HA) concentration, as well as positively correlated to markers of endothelial function (MNA and 6-keto-PGF1α) in all studied individuals (n = 23). CONCLUSIONS We have shown that ageing leads to a significant decrease in DHT concentration that is accompanied by impaired arterial wall characteristics and worsened endothelial function. Therefore more attention should be paid to the DHT, DHEA-S and ADG concentrations as a biomarkers for vascular dysfunction in ageing men.
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How Estrogen, Testosterone, and Sex Differences Influence Serum Immunoglobulin Isotype Patterns in Mice and Humans. Viruses 2023; 15:v15020482. [PMID: 36851695 PMCID: PMC9961480 DOI: 10.3390/v15020482] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Females often exhibit superior immune responses compared to males toward vaccines and pathogens such as influenza viruses and SARS-CoV-2. To help explain these differences, we first studied serum immunoglobulin isotype patterns in C57BL/6 male and female mice. We focused on IgG2b, an isotype that lends to virus control and that has been previously shown to be elevated in murine females compared to males. Improvements in IgG2b serum levels, and/or IgG2b ratios with other non-IgM isotypes, were observed when: (i) wildtype (WT) female mice were compared to estrogen receptor knockout mice (IgG2b, IgG2b/IgG3, IgG2b/IgG1, and IgG2b/IgA were all higher in WT mice), (ii) unmanipulated female mice were compared to ovariectomized mice (IgG2b/IgA was higher in unmanipulated animals), (iii) female mice were supplemented with estrogen in the context of an inflammatory insult (IgG2b and IgG2b/IgG3 were improved by estrogen supplementation), and (iv) male mice were supplemented with testosterone, a hormone that can convert to estrogen in vivo (IgG2b, IgG2b/IgG3, IgG2b/IgG1, and IgG2b/IgA were all improved by supplementation). We next examined data from three sets of previously described male and female human blood samples. In each case, there were higher IgG2 levels, and/or ratios of IgG2 with non-IgM isotypes, in human females compared to males. The effects of sex and sex hormones in the mouse and human studies were subtle, but frequent, suggesting that sex hormones represent only a fraction of the factors that influence isotype patterns. Examination of the gene loci suggested that upregulation of murine IgG2b or human IgG2 could be mediated by estrogen receptor binding to estrogen response elements and cytosine-adenine (CA) repeats upstream of respective Cγ genes. Given that murine IgG2b and human IgG2 lend to virus control, the isotype biases in females may be sufficient to improve outcomes following vaccination or infection. Future attention to sex hormone levels, and consequent immunoglobulin isotype patterns, in clinical trials are encouraged to support the optimization of vaccine and drug products for male and female hosts.
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Bond P, Smit DL, de Ronde W. Anabolic-androgenic steroids: How do they work and what are the risks? Front Endocrinol (Lausanne) 2022; 13:1059473. [PMID: 36644692 PMCID: PMC9837614 DOI: 10.3389/fendo.2022.1059473] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Anabolic-androgenic steroids (AAS) are a class of hormones that are widely abused for their muscle-building and strength-increasing properties in high, nontherapeutic, dosages. This review provides an up-to-date and comprehensive overview on how these hormones work and what side effects they might elicit. We discuss how AAS are absorbed into the circulation after intramuscular injection or oral ingestion and how they are subsequently transported to the tissues, where they will move into the extravascular compartment and diffuse into their target cells. Inside these cells, AAS can biotransform into different metabolites or bind to their cognate receptor: the androgen receptor. AAS and their metabolites can cause side effects such as acne vulgaris, hypertension, hepatotoxicity, dyslipidemia, testosterone deficiency, erectile dysfunction, gynecomastia, and cardiomyopathy. Where applicable, we mention treatment options and self-medication practices of AAS users to counteract these side effects. Clinicians may use this review as a guide for understanding how AAS use can impact health and to assist in patient education and, in some cases, the management of side effects.
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Affiliation(s)
| | - Diederik L. Smit
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Willem de Ronde
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, Netherlands
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8
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Morales A, Siemens DR. Testosterone Therapy and Prostate Cancer. Urol Clin North Am 2022; 49:573-582. [DOI: 10.1016/j.ucl.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Huhtaniemi IT, Wu FCW. Ageing male (part I): Pathophysiology and diagnosis of functional hypogonadism. Best Pract Res Clin Endocrinol Metab 2022; 36:101622. [PMID: 35210191 DOI: 10.1016/j.beem.2022.101622] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This narrative review summarizes key points of the pathogenesis and diagnosis of the ageing-related decline of testosterone (T) in men. The condition is commonly termed late-onset hypogonadism (LOH), but because it is more often caused by other factors than chronological ageing (obesity and other comorbidities), a more appropriate term is functional hypogonadism (FH). Unlike the classical organic hypogonadism, no anatomical or genetic aberrations are found in FH, and the suppression of T is milder. Moreover, FH can be reversible if the underlying cause (e.g. obesity, chronic disease) is removed/treated. Low serum total T in connection with more specific hypogonadism-associated symptoms (primarily sexual) form the basis of the diagnosis of FH. When T concentrations are borderline, the accuracy of diagnosis can be improved by assessment of free or calculated free T, especially when suppressed SHBG levels (usually related to obesity) are likely. Current data indicate that FH (low T and sexual symptoms) is not a common condition, and it is detectable in about 2% of community-dwelling men aged 40-80 years.
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Affiliation(s)
- Ilpo T Huhtaniemi
- Department of Digestion, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Hammersmith Campus, Imperial College London, London W12 0NN, UK.
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK
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10
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Desai A, Yassin M, Cayetano A, Tharakan T, Jayasena CN, Minhas S. Understanding and managing the suppression of spermatogenesis caused by testosterone replacement therapy (TRT) and anabolic–androgenic steroids (AAS). Ther Adv Urol 2022; 14:17562872221105017. [PMID: 35783920 PMCID: PMC9243576 DOI: 10.1177/17562872221105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Use of testosterone replacement therapy (TRT) and anabolic–androgenic steroids
(AAS) has increased over the last 20 years, coinciding with an increase in men
presenting with infertility and hypogonadism. Both agents have a detrimental
effect on spermatogenesis and pose a clinical challenge in the setting of
hypogonadism and infertility. Adding to this challenge is the paucity of data
describing recovery of spermatogenesis on stopping such agents. The unwanted
systemic side effects of these agents have driven the development of novel
agents such as selective androgen receptor modulators (SARMs). Data showing
natural recovery of spermatogenesis following cessation of TRT are limited to
observational studies. Largely, these have shown spontaneous recovery of
spermatogenesis after cessation. Contemporary literature suggests the time frame
for this recovery is highly variable and dependent on several factors including
baseline testicular function, duration of drug use and age at cessation. In some
men, drug cessation alone may not achieve spontaneous recovery, necessitating
hormonal stimulation with selective oestrogen receptor modulators
(SERMs)/gonadotropin therapy or even the need for assisted reproductive
techniques. However, there are limited prospective randomized data on the role
of hormonal stimulation in this clinical setting. The use of hormonal
stimulation with agents such as gonadotropins, SERMs, aromatase inhibitors and
assisted reproductive techniques should form part of the counselling process in
this cohort of hypogonadal infertile men. Moreover, counselling men regarding
the detrimental effects of TRT/AAS on fertility is very important, as is the
need for robust randomized studies assessing the long-term effects of novel
agents such as SARMs and the true efficacy of gonadotropins in promoting
recovery of spermatogenesis.
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Affiliation(s)
- Ankit Desai
- Department of Andrology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Musaab Yassin
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
| | - Axel Cayetano
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
| | - Tharu Tharakan
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
| | - Channa N. Jayasena
- Department of Reproductive Endocrinology, Imperial Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
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11
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Preparation and characterization of steroid and umbelliferone-based hetero-bifunctional poly(ε-caprolactone)s for potential drug delivery systems: antimicrobial and anticancer activities. JOURNAL OF POLYMER RESEARCH 2022. [DOI: 10.1007/s10965-022-03059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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de Paiva Gonçalves V, Steffens JP, Junior CR, Spolidorio LC. Supraphysiological testosterone supplementation improves granulation tissue maturation through angiogenesis in the early phase of a cutaneous wound healing model in rats. Inflamm Res 2022; 71:473-483. [PMID: 35355085 DOI: 10.1007/s00011-022-01553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of both testosterone depletion and supraphysiological testosterone supplementation in the early phase of an animal cutaneous wound healing model in comparison with the physiological hormonal condition. MATERIAL AND METHODS Forty rats were distributed into the following four groups: Control, Orchiectomy (OCX), Durateston (Dura) and OCX+Dura. On day 1, the testicles were removed (OCX group) and the rats (Dura group) received a supraphysiological dose (250 mg/kg) of exogenous testosterone weekly. After 15 days a full-thickness excisional skin wound was created in all animals, which was healed by the second intention for 7 days. On day 22, the rats were euthanatized and the wounds were harvested for histopathological evaluation, immunohistochemistry analyses and multiplex immunoassay. One-way ANOVA and post-hoc Tukey tests were performed. RESULTS It was found that the supraphysiological testosterone level increased extracellular matrix deposition, promoted higher blood vessel formation and reduced wound contraction (p < 0.05). Additionally, it also stimulated PCNA-positive fibroblasts and KGF-positive cells (p < 0.05), while orchiectomy reduced the expression of IL-6 and TNF-α and increased VEGF and PDGF (p < 0.05) . CONCLUSION In conclusion, the results provide evidence that supraphysiological testosterone supplementation plays a positive role in the early phase of cutaneous wound healing, thus improving granulation tissue maturation through the enhancement of angiogenesis.
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Affiliation(s)
- Vinícius de Paiva Gonçalves
- Department of Physiology and Pathology, Araraquara School of Dentistry, University of São Paulo State, UNESP, Humaitá St., 1680 - Center, Araraquara, SP, 14801-903, Brazil.
| | - João Paulo Steffens
- Department of Stomatology, Federal University of Paraná, UFPR, Pref. Lothário Meissner Av., 632 - Center, Curitiba, PR, 80210-170, Brazil
| | - Carlos Rossa Junior
- Department of Diagnosis and Surgery, Araraquara School of Dentistry, University of São Paulo State, UNESP, Humaitá St., 1680 - Center, Araraquara, SP, 14801-903, Brazil
| | - Luís Carlos Spolidorio
- Department of Physiology and Pathology, Araraquara School of Dentistry, University of São Paulo State, UNESP, Humaitá St., 1680 - Center, Araraquara, SP, 14801-903, Brazil
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13
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Horwath O, Moberg M, Hirschberg AL, Ekblom B, Apró W. Molecular Regulators of Muscle Mass and Mitochondrial Remodeling Are Not Influenced by Testosterone Administration in Young Women. Front Endocrinol (Lausanne) 2022; 13:874748. [PMID: 35498440 PMCID: PMC9046720 DOI: 10.3389/fendo.2022.874748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/18/2022] [Indexed: 01/07/2023] Open
Abstract
Testosterone (T) administration has previously been shown to improve muscle size and oxidative capacity. However, the molecular mechanisms underlying these adaptations in human skeletal muscle remain to be determined. Here, we examined the effect of moderate-dose T administration on molecular regulators of muscle protein turnover and mitochondrial remodeling in muscle samples collected from young women. Forty-eight healthy, physically active, young women (28 ± 4 years) were assigned in a random double-blind fashion to receive either T (10 mg/day) or placebo for 10-weeks. Muscle biopsies collected before and after the intervention period were divided into sub-cellular fractions and total protein levels of molecular regulators of muscle protein turnover and mitochondrial remodeling were analyzed using Western blotting. T administration had no effect on androgen receptor or 5α-reductase levels, nor on proteins involved in the mTORC1-signaling pathway (mTOR, S6K1, eEF2 and RPS6). Neither did it affect the abundance of proteins associated with proteasomal protein degradation (MAFbx, MuRF-1 and UBR5) and autophagy-lysosomal degradation (AMPK, ULK1 and p62). T administration also had no effect on proteins in the mitochondria enriched fraction regulating mitophagy (Beclin, BNIP3, LC3B-I, LC3B-II and LC3B-II/I ratio) and morphology (Mitofilin), and it did not alter the expression of mitochondrial fission- (FIS1 and DRP1) or fusion factors (OPA1 and MFN2). In summary, these data indicate that improvements in muscle size and oxidative capacity in young women in response to moderate-dose T administration cannot be explained by alterations in total expression of molecular factors known to regulate muscle protein turnover or mitochondrial remodeling.
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Affiliation(s)
- Oscar Horwath
- Department of Physiology, Nutrition and Biomechanics, Åstrand Laboratory, Swedish School of Sport and Health Sciences, Stockholm, Sweden
- *Correspondence: Oscar Horwath,
| | - Marcus Moberg
- Department of Physiology, Nutrition and Biomechanics, Åstrand Laboratory, Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women´s and Children´s Health, Division of Neonatology, Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden
- Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Ekblom
- Department of Physiology, Nutrition and Biomechanics, Åstrand Laboratory, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - William Apró
- Department of Physiology, Nutrition and Biomechanics, Åstrand Laboratory, Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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14
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Khera M, Miner M, Jaffe J, Pastuszak AW. Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk. J Sex Med 2020; 18:83-98. [PMID: 33317996 DOI: 10.1016/j.jsxm.2020.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment of "adult-onset hypogonadism" (AOH) with exogenous testosterone therapy (TTh) to raise serum testosterone (T) levels may influence cardiovascular (CV) risk factors in patients with AOH, whereas low endogenous T levels are associated with an increased CV risk and mortality. AIM To critically evaluate studies reporting increased CV risk associated with TTh and to provide an overview of the risks and benefits of restoring T levels through exogenous TTh. METHODS A review of publications focusing on the association between TTh and increased CV risk was conducted, and the study methodologies and conclusions of each were critically evaluated. Further, recent clinical and epidemiological studies associating AOH or TTh with a change in CV risk, and pertinent hematologic and vascular effects noted in animal studies and in vitro, as well as in clinical practice were also reviewed. OUTCOMES A review of the literature shows that untreated testosterone deficiency and/or low T is associated with an increase in CV risk and adverse outcomes, with numerous studies and meta-analyses to support a positive association between exogenous TTh and an improvement in CV risk factors in men with AOH. RESULTS Numerous studies in the literature demonstrate the positive benefits of using TTh; however, since 2013, some publications have suggested a link to increased CV risk associated with TTh. A number of these studies retrospectively analyzed insurance claims databases using diagnosis codes, procedures codes, and prescription information. Many reviews published since have pointed out the methodological flaws and debatable conclusions of these studies. CLINICAL IMPLICATIONS A careful assessment of the patient's current health status and CV risk factors should be weighed against the benefits and possible risks resulting from TTh, and consideration should be given to deferring treatment pending resolution or stabilization of CV disease or risk factors. STRENGTHS & LIMITATIONS In this review, we provide an in-depth analysis of studies reporting increased CV risk with TTh. Many of the studies were not well-designed, randomized, double-blind, prospective clinical trials but rather post hoc analyses of cohort data. These studies may reflect bias in how treatment and nontreatment decisions are made or reflect conclusions based on widely cited methodological flaws. CONCLUSION Appropriate patient selection supported by low pre-treatment T levels and monitoring T levels during treatment with the goal of achieving and maintaining physiologic levels all contribute to the safe and effective use of TTh in men with AOH. Khera M, Miner M, Jaffe J, et al. Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk. J Sex med 2021;18:83-98.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | - Martin Miner
- Clinical Professor of Family Medicine and Urology, Brown University, Providence, RI, USA
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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15
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Howard EE, Margolis LM, Berryman CE, Lieberman HR, Karl JP, Young AJ, Montano MA, Evans WJ, Rodriguez NR, Johannsen NM, Gadde KM, Harris MN, Rood JC, Pasiakos SM. Testosterone supplementation upregulates androgen receptor expression and translational capacity during severe energy deficit. Am J Physiol Endocrinol Metab 2020; 319:E678-E688. [PMID: 32776828 PMCID: PMC7750513 DOI: 10.1152/ajpendo.00157.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Testosterone supplementation during energy deficit promotes whole body lean mass accretion, but the mechanisms underlying that effect remain unclear. To elucidate those mechanisms, skeletal muscle molecular adaptations were assessed from muscle biopsies collected before, 1 h, and 6 h after exercise and a mixed meal (40 g protein, 1 h postexercise) following 14 days of weight maintenance (WM) and 28 days of an exercise- and diet-induced 55% energy deficit (ED) in 50 physically active nonobese men treated with 200 mg testosterone enanthate/wk (TEST) or placebo (PLA) during the ED. Participants (n = 10/group) exhibiting substantial increases in leg lean mass and total testosterone (TEST) were compared with those exhibiting decreases in both of these measures (PLA). Resting androgen receptor (AR) protein content was higher and fibroblast growth factor-inducible 14 (Fn14), IL-6 receptor (IL-6R), and muscle ring-finger protein-1 gene expression was lower in TEST vs. PLA during ED relative to WM (P < 0.05). Changes in inflammatory, myogenic, and proteolytic gene expression did not differ between groups after exercise and recovery feeding. Mechanistic target of rapamycin signaling (i.e., translational efficiency) was also similar between groups at rest and after exercise and the mixed meal. Muscle total RNA content (i.e., translational capacity) increased more during ED in TEST than PLA (P < 0.05). These findings indicate that attenuated proteolysis at rest, possibly downstream of AR, Fn14, and IL-6R signaling, and increased translational capacity, not efficiency, may drive lean mass accretion with testosterone administration during energy deficit.
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Affiliation(s)
- Emily E Howard
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
- University of Connecticut, Storrs, Connecticut
| | - Lee M Margolis
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Claire E Berryman
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
- Florida State University, Tallahassee, Florida
| | - Harris R Lieberman
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - J Philip Karl
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Andrew J Young
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Monty A Montano
- MyoSyntax Corporation, Worcester, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | - William J Evans
- University of California at Berkeley, Berkeley, California
- Duke University, Durham, North Carolina
| | | | - Neil M Johannsen
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Kishore M Gadde
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Melissa N Harris
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Jennifer C Rood
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Stefan M Pasiakos
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
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16
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Chadid S, Barber JR, Rohrmann S, Nelson WG, Yager JD, Kanarek NF, Bradwin G, Dobs AS, McGlynn KA, Platz EA. Age-Specific Serum Total and Free Estradiol Concentrations in Healthy Men in US Nationally Representative Samples. J Endocr Soc 2019; 3:1825-1836. [PMID: 31555753 PMCID: PMC6749840 DOI: 10.1210/js.2019-00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose To report age-specific serum estradiol concentration in nonsmoking, lean US men without comorbidities. We provide concentrations from 30 and 15 to 20 years ago given previously described declines in serum estradiol in US men over time. Methods We used data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988 to 1991) and continuous NHANES (1999 to 2004). Serum estradiol and SHBG were previously measured by competitive electrochemiluminescence immunoassays. Free estradiol was estimated from estradiol, SHBG, and albumin. By age, we calculated median concentrations overall and for nonsmoking, lean (body mass index <25 kg/m2 and waist <102 cm) men without diabetes, cardiovascular disease, or cancer. Results Overall, respective total estradiol medians for men ages 20 to 39, 40 to 59, and ≥60 years old were 37.0, 33.9, and 33.5 pg/mL in NHANES III and 31.3, 30.5, and 27.0 pg/mL in continuous NHANES. In nonsmoking, lean men without comorbidities, respective total estradiol medians were 32.0, 32.1, and 32.0 pg/mL in NHANES III and 29.1, 22.7, and 26.1 pg/mL in continuous NHANES. Overall, respective free estradiol medians were 0.82, 0.72, and 0.64 pg/mL in NHANES III and 0.67, 0.61, and 0.47 pg/mL in continuous NHANES. In nonsmoking, lean men without comorbidities, respective free estradiol medians were 0.64, 0.67, and 0.62 pg/mL in NHANES III and 0.58, 0.42, and 0.40 pg/mL continuous NHANES. Conclusion We report US nationally representative serum estradiol concentrations in healthy men, which could be used for targeting estradiol during testosterone supplementation and for general good health.
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Affiliation(s)
- Susan Chadid
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John R Barber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - William G Nelson
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Urology and the James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - James D Yager
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F Kanarek
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gary Bradwin
- Department of Laboratory Medicine, Harvard Medical School and Children's Hospital, Boston, Massachusetts
| | - Adrian S Dobs
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Carter JR, Fonkoue IT, Greenlund IM, Schwartz CE, Mokhlesi B, Smoot CA. Sympathetic neural responsiveness to sleep deprivation in older adults: sex differences. Am J Physiol Heart Circ Physiol 2019; 317:H315-H322. [PMID: 31149842 DOI: 10.1152/ajpheart.00232.2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Our laboratory has previously reported that total sleep deprivation (TSD) modifies muscle sympathetic neural activity (MSNA) differently in young men and women. Because postmenopausal women are among the highest risk for hypertension, this study compares MSNA responses with TSD in older men and women. We hypothesized that TSD would alter MSNA in older adults, with greater sympathoexcitation in postmenopausal women. Twenty-seven participants (14 men and 13 women) between the ages of 55 and 75 yr were tested twice, once after 24-h TSD and once after normal sleep (randomized, crossover design). Our primary outcome measure of MSNA (microneurography) was successful across both conditions in 20 participants (10 men and 10 women). Secondary outcome measures included seated blood pressure, heart rate, and fasting plasma testosterone, estradiol, and progesterone. Age (60 ± 1 vs. 61 ± 2 yr) and BMI (27 ± 1 vs. 26 ± 1 kg/m2) were not different between groups. TSD increased systolic blood pressure in both men (124 ± 5 to 130 ± 4 mmHg) and women (107 ± 5 to 116 ± 4 mmHg), but the increases were not different between groups (condition, P = 0.014; condition × sex, P > 0.05). In contrast, TSD elicited divergent MSNA responses in older men and women. Specifically, MSNA burst frequency increased in postmenopausal women (28 ± 3 to 34 ± 3 burst/min), but not older men (38 ± 3 to 35 ± 3 bursts/min; condition × sex, P = 0.032). In conclusion, TSD elicited sympathoexcitation in postmenopausal women but not age-matched men. These findings provide new mechanistic insight into reported links between sleep deprivation and hypertension.NEW & NOTEWORTHY Epidemiological studies report that sleep deprivation is more strongly associated with hypertension in women than in men. In the present study, 24-h total sleep deprivation (TSD) increased blood pressure in postmenopausal women and age-matched men. In contrast, only women demonstrated increases in muscle sympathetic nerve activity after TSD. The sympathoexcitation observed in postmenopausal women suggests a potential contributing mechanism for epidemiological observations and advances our understanding of the complex relations between sleep, sex, and hypertension.
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Affiliation(s)
- Jason R Carter
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Ida T Fonkoue
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Ian M Greenlund
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | | | - Babak Mokhlesi
- Sleep Research Center, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Carl A Smoot
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
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18
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Maldonado O, Ramos A, Guapillo M, Rivera J, Palma I, Rubio-Gayosso I, Ramirez-Sanchez I, Najera N, Ceballos G, Mendez-Bolaina E. Effects of chronic inhibition of Testosterone metabolism on cardiac remodeling after ischemia/reperfusion-induced myocardial damage in gonadectomized rats. Biol Open 2019; 8:bio.041905. [PMID: 31085546 PMCID: PMC6550079 DOI: 10.1242/bio.041905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The effects of testosterone on cardiovascular homeostasis are still not well understood. The objective of this work was to evaluate the effects of testosterone in the absence or presence of inhibition of Aromatase (4-hydroxyandrostenedione) and/or 5α reductase (Finasteride) enzymatic activities on the myocardial remodeling 30 days after ischemia/reperfusion (I/R) injury in gonadectomized rats. Results showed that testosterone administration to ORX rats resulted in decreased myocardial damaged area, inflammatory infiltrates and reduced MMP-3 and 13 expressions. Interestingly, Finasteride administration resulted in a greater decrease in scar tissue, inflammatory infiltrates, along with a significant decrease in MMP-3 and 13 expressions. In contrast, 4-hydroxyandrostenedione administrations increased all parameters. Our results suggest that testosterone does not have a direct effect since simultaneous inhibition of aromatase and 5α-reductase did not induce significant changes in I/R induced myocardial injury. Summary: Coronary ischemia/reperfusion-induced injury in gonadectomyzed male rats is decreased by testosterone, protection is increased by blocking its 5α-reduction and blocked by inhibition of its aromatization.
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Affiliation(s)
- Octavio Maldonado
- CIB-Doctorado en Ciencias Biomédicas-UV. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n, Colonia Industrial Anima, CP. 91000, Xalapa, Veracruz, Mexico.,Departamento de Nanotecnología, Universidad Tecnológica del Centro de Veracruz, Av. Universidad No. 350, Carretera Federal Cuitláhuac - La Tinaja, Localidad Dos Caminos, CP. 94910, Cuitláhuac, Veracruz, Mexico
| | - Angel Ramos
- MCPB-Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
| | - Mario Guapillo
- Laboratorio de Biología Molecular, Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
| | - Jose Rivera
- MCPB-Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
| | - Icela Palma
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Ivan Rubio-Gayosso
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Israel Ramirez-Sanchez
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Nayelli Najera
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Guillermo Ceballos
- Seccion de Estudios de posgrado, Escuela Superior de Medicina, Instituto Politecnico Nacional, Plan de San Luis y Díaz Mirón, CP. 11340, Ciudad de México, Mexico
| | - Enrique Mendez-Bolaina
- CIB-Doctorado en Ciencias Biomédicas-UV. Centro de Investigaciones Biomédicas, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n, Colonia Industrial Anima, CP. 91000, Xalapa, Veracruz, Mexico.,MCPB-Facultad de Ciencias Químicas, Universidad Veracruzana, Prolongación Oriente 6, No. 1009, Colonia Rafael Alvarado, CP. 94340, Orizaba, Veracruz, Mexico
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19
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Yeap BB, Hui J, Knuiman MW, Handelsman DJ, Flicker L, Divitini ML, Arscott GM, McLennan SV, Twigg SM, Almeida OP, Hankey GJ, Golledge J, Norman PE, Beilby JP. Cross-sectional associations of sex hormones with leucocyte telomere length, a marker of biological age, in a community-based cohort of older men. Clin Endocrinol (Oxf) 2019; 90:562-569. [PMID: 30561819 DOI: 10.1111/cen.13918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 01/29/2023]
Abstract
CONTEXT Telomeres protect chromosomes from damage, and shorter leucocyte telomere length (LTL) is a marker of advancing biological age. The association between testosterone (T) and its bioactive metabolites, dihydrotestosterone (DHT) and oestradiol (E2) with telomere length, particularly in older men, is uncertain. The study aimed to clarify associations of sex hormones with LTL in older men. PARTICIPANTS AND METHODS We used cross-sectional data from 2913 men aged 76.7 ± 3.2 years with morning blood samples assayed for T, DHT, E2 (mass spectrometry), and sex hormone-binding globulin (SHBG, immunoassay), to correlate sex hormones with LTL measured using PCR and expressed as T/S ratio in multivariable linear regression models adjusted for age, cardiometabolic risk factors and cardiovascular disease history. RESULTS Average difference per decade of age was T -0.46 nmol/L, DHT -0.11 nmol/L, E2 -7.5 pmol/L, SHBG +10.2 nmol/L and LTL (T/S ratio) -0.065. E2 correlated with T/S ratio (r = 0.038, P = 0.039) and SHBG was inversely correlated (r = -0.053, P = 0.004). After multivariable adjustment, E2 was associated with T/S ratio (per 1 SD increase E2: coefficient 0.011, P = 0.043), T and DHT were not associated. When E2 and SHBG were simultaneously included, E2 remained positively (coefficient 0.014, P = 0.014) and SHBG inversely (coefficient -0.013, P = 0.037) associated with T/S ratio. CONCLUSIONS In older men, neither T nor DHT is associated with LTL while E2 is independently associated with LTL and SHBG is inversely associated, thus relating sex hormone exposure to lower biological age. Further research is needed to determine causality and clarify the role of sex hormones in male ageing.
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jennie Hui
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Matthew W Knuiman
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Mark L Divitini
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Gillian M Arscott
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Susan V McLennan
- Department of Endocrinology, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen M Twigg
- Department of Endocrinology, University of Sydney, Sydney, New South Wales, Australia
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
| | - Paul E Norman
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - John P Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Houghton DE, Alsawas M, Barrioneuvo P, Tello M, Farah W, Beuschel B, Prokop LJ, Layton JB, Murad MH, Moll S. Testosterone therapy and venous thromboembolism: A systematic review and meta-analysis. Thromb Res 2018; 172:94-103. [PMID: 30396049 PMCID: PMC10601700 DOI: 10.1016/j.thromres.2018.10.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Testosterone prescribing for men has dramatically increased, and there have been concerns about inappropriate use and adverse events. While regulatory bodies have warned about increased risk of venous thromboembolism (VTE), published clinical data supporting an increased risk for VTE are limited. OBJECTIVE To conduct a systematic review of studies examining the association between testosterone therapy in men and VTE. METHODS Comprehensive searches of multiple databases were performed from inception through October 3rd, 2018. Randomized control trials (RCTs) and observational studies examining the association between exogenous testosterone (any route) and VTE. Study selection and data extraction were performed by two independent investigators. Random-effect model meta-analyses were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CIs). Heterogeneity among studies was evaluated using the I2 statistic. Risk of bias was assessed using the Cochrane and Newcastle-Ottawa tools. RESULTS Six RCTs (n = 2236) and 5 observational studies (n = 1,249,640) were included. Five RCTs were performed in men with documented hypogonadism. The observational studies included: 2 case-control studies, 2 retrospective cohorts, and 1 retrospective cohort with a nested case-control study. There was no evidence of a statistically significant association between VTE and testosterone (OR 1.41, 95%CI 0.96-2.07). Heterogeneity was high (I-squared = 84.4%). The association remained nonsignificant when the analysis was stratified by study design: RCTs (2.05, 95% CI 0.78-5.39); cohort (1.06, 95% CI 0.85-1.33); and case-control (1.34, 95% CI 0.78-2.28). The overall risk of bias was moderate. CONCLUSIONS The current evidence is of low certainty but does not support an association between testosterone use and VTE in men.
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Affiliation(s)
- Damon E Houghton
- Mayo Clinic, Department of Cardiovascular Diseases, Division of Vascular Medicine & Department of Internal Medicine, Division of Hematology/Oncology, 200 1st St SW, Rochester, MN 55905, USA.
| | - Mouaz Alsawas
- Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st St SW, Rochester, MN 55901, USA
| | - Patricia Barrioneuvo
- Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st St SW, Rochester, MN 55901, USA
| | - Mouaffaa Tello
- Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st St SW, Rochester, MN 55901, USA
| | - Wigdan Farah
- Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st St SW, Rochester, MN 55901, USA
| | - Brad Beuschel
- Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st St SW, Rochester, MN 55901, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, 200 1st St SW, Rochester, MN 55901, USA
| | - J Bradley Layton
- RTI Health Solutions, Research Triangle Park, NC 27709-2194, USA
| | - M Hassan Murad
- Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st St SW, Rochester, MN 55901, USA
| | - Stephan Moll
- University of North Carolina School of Medicine, Department of Medicine, Division of Hematology/Oncology, Chapel Hill, NC, USA
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Jung K, Park JC, Kang H, Brandes JC. Androgen deprivation therapy is associated with decreased second primary lung cancer risk in the United States veterans with prostate cancer. Epidemiol Health 2018; 40:e2018040. [PMID: 30121970 PMCID: PMC6232654 DOI: 10.4178/epih.e2018040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/11/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We investigated whether androgen deprivation therapy (ADT) in prostate cancer patients was associated with a decreased risk for second primary lung cancer in US veterans. METHODS Prostate cancer diagnoses in the US Veterans Affairs Cancer Registry between 1999 and 2008 were identified. Use of hormonal therapy and diagnoses of second primary lung cancer were determined from the registry. Synchronous prostate and lung cancers, defined as 2 diagnoses made within 1 year, were excluded from the analysis. Cancer-free survival was estimated using the Kaplan-Meier method and hazard ratios were estimated using Cox proportional hazard models. RESULTS Among the 63,141 identified patients with prostate cancer, 18,707 subjects were eligible for the study. Hormonal therapy was used in 38% of patients and the median follow-up period was 28 months. ADT use was associated with longer lung cancer-free survival in prostate cancer patients (log-rank p=0.01). After adjusting for age, race, smoking and prostate cancer stage, ADT use was associated with decreased lung cancer risk by 15, 21, and 24% after 1, 2, and 3 years, respectively. CONCLUSIONS ADT in prostate cancer patients may be associated with decreased second primary lung cancer risk among US veterans.
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Affiliation(s)
- Kyungsuk Jung
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jong Chul Park
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Hyunseok Kang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Johann Christoph Brandes
- Department of Oncology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Wu A, Shi Z, Martin S, Vincent A, Heilbronn L, Wittert G. Age-related changes in estradiol and longitudinal associations with fat mass in men. PLoS One 2018; 13:e0201912. [PMID: 30071117 PMCID: PMC6072119 DOI: 10.1371/journal.pone.0201912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Context In men, circulating 17β-estradiol originates primarily from peripheral aromatization of testosterone particularly in adipose tissue. The effect of ageing and obesity on circulating estradiol remains unclear. Objective Determine five-year changes in serum estradiol and the association with testosterone and fat mass in Australian men. Design Longitudinal cohort study. At baseline and five-year follow-up, socio-demographic and health-related data including behaviors, chronic conditions, and medication use were collected by questionnaire. Estradiol and testosterone were assayed by liquid chromatography-tandem mass spectrometry and sex hormone-binding globulin by immunochemiluminescent assay. Fat mass was assessed by dual-energy X-ray absorptiometry. Participants Community-dwelling men aged 35 years and older at enrollment, resident in the northern and western suburbs of Adelaide without established disease of, or medications affecting, the hypothalamus-pituitary-gonadal axis (n = 725). Main outcome measures The dependence of change in serum estradiol over five years on age, testosterone and fat mass after adjustment for multiple confounders. Results At baseline, mean age was 53.0 ± 10.8 years. Mean serum estradiol levels at baseline and five-year follow-up were 94.9 ± 34.8 and 89.4 ± 30.4 pmol/L respectively (-1.1 pmol/L/year). On multivariable analyses, estradiol change was associated with changes in testosterone (B-estimate = 2.719, standard error = 0.369, p˂0.001), but not age or total fat mass. Change in testosterone/estradiol ratio was inversely associated with change in fat mass (B = -1.450, SE = 0.575, p = 0.012), and this was consistent across quartiles of fat mass change. Conclusions In healthy men, circulating estradiol is primarily dependent on testosterone. With increasing fat mass, estradiol decreases less than testosterone. From a clinical standpoint these data indicate that obesity is associated with a change in the testosterone to estradiol ratio, but a change in estradiol does not occur unless some other pathology is present.
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Affiliation(s)
- Albert Wu
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
- * E-mail: (AW); (GW)
| | - Zumin Shi
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Sean Martin
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Andrew Vincent
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Leonie Heilbronn
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
- * E-mail: (AW); (GW)
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23
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Sadaie MR, Farhoudi M, Zamanlu M, Aghamohammadzadeh N, Amouzegar A, Rosenbaum RE, Thomas GA. What does the research say about androgen use and cerebrovascular events? Ther Adv Drug Saf 2018; 9:439-455. [PMID: 30364888 DOI: 10.1177/2042098618773318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
Many studies have investigated the benefits of androgen therapy and neurosteroids in aging men, while concerns remain about the potential associations of exogenous steroids and incidents of cerebrovascular events and ischemic stroke (IS). Testosterone is neuroprotective, neurotrophic and a potent stimulator of neuroplasticity. These benefits are mediated primarily through conversion of a small amount of testosterone to estradiol by the catalytic activity of estrogen synthetase (aromatase cytochrome P450 enzyme). New studies suggest that abnormal serum levels of the nonaromatized potent metabolite of testosterone, either high or low dihydrotestosterone (DHT), is a risk factor for stroke. Associations between pharmacologic androgen use and the incidence of IS are questionable, because a significant portion of testosterone is converted to DHT. There is also insufficient evidence to reject a causal relationship between the pro-testosterone adrenal androgens and incidence of IS. Moreover, vascular intima-media thickness, which is a predictor of stroke and myocardial symptoms, has correlations with sex hormones. Current diagnostic and treatment criteria for androgen therapy for cerebrovascular complications are unclear. Confounding variables, including genetic and metabolic alterations of the key enzymes of steroidogenesis, ought to be considered. Information extracted from pharmacogenetic testing may aid in expounding the protective-destructive properties of neurosteroids, as well as the prognosis of androgen therapy, in particular their cerebrovascular outcomes. This investigative review article addresses relevant findings of the clinical and experimental investigations of androgen therapy, emphasizes the significance of genetic testing of androgen responsiveness towards individualized therapy in post-IS injuries as well as identifying pertinent questions.
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Affiliation(s)
| | - Mehdi Farhoudi
- Neurosciences Research Center (NSRC), Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masumeh Zamanlu
- Neurosciences Research Center (NSRC), Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasser Aghamohammadzadeh
- Department of Endocrinology, Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gary A Thomas
- Penn State Hershey Neurology, Penn State University, PA, USA
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Badawy AAB. Modulation of Tryptophan and Serotonin Metabolism as a Biochemical Basis of the Behavioral Effects of Use and Withdrawal of Androgenic-Anabolic Steroids and Other Image- and Performance-Enhancing Agents. Int J Tryptophan Res 2018; 11:1178646917753422. [PMID: 29487480 PMCID: PMC5821294 DOI: 10.1177/1178646917753422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/29/2017] [Indexed: 01/01/2023] Open
Abstract
Modulation of tryptophan (Trp) metabolism may underpin the behavioral effects of androgenic-anabolic steroids (AAS) and associated image and performance enhancers. Euphoria, arousal, and decreased anxiety observed with moderate use and exercise may involve enhanced cerebral serotonin synthesis and function by increased release of albumin-bound Trp and estrogen-mediated liver Trp 2,3-dioxygenase (TDO) inhibition and enhancement of serotonin function. Aggression, anxiety, depression, personality disorders, and psychosis, observed on withdrawal of AAS or with use of large doses, can be caused by decreased serotonin synthesis due to TDO induction on withdrawal, excess Trp inhibiting the 2 enzymes of serotonin synthesis, and increased cerebral levels of neuroactive kynurenines. Exercise and excessive protein and branched-chain amino acid intakes may aggravate the effects of large AAS dosage. The hypothesis is testable in humans and experimental animals by measuring parameters of Trp metabolism and disposition and related metabolic processes.
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Affiliation(s)
- Abdulla A-B Badawy
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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25
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Increased estrogen level can be associated with depression in males. Psychoneuroendocrinology 2018; 87:196-203. [PMID: 29107881 DOI: 10.1016/j.psyneuen.2017.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have shown a positive association between depression and obesity; however the underlying mechanisms are not fully understood. It is not known if this association is driven by altered sex hormone levels in men due to increased BMI. PATIENTS AND METHODS Data were obtained from the LIFE-Adult-Study, a population-based cohort study. A total of 3925 men (2244<60years and 1681>60years) were included into analyses. Associations between BMI, sex hormones and depressive symptomatology according to CES-D score were evaluated. RESULTS Obese men had compared to normal weight controls lower total testosterone (12.6±4.7 vs 19.4±5.5 nmol/L, p<0.001 in <60years, and 13.8±6.9 vs 18.3±5.9 nmol/L, p<0.001 in >60years group) and free testosterone (249.0±73.9 vs 337.2±82.0pmol/L, p<0.001, and 217.8±71.2 vs 263.4±72.2pmol/L, p<0.001), and increased estradiol in older group only (97.3±43.0 vs 82.3±34.2pmol/L, p<0.001 in obese). Men <60years old with depressive symptomatology had higher estradiol levels compared to those without depressive symptomatology (96.3±40.7 vs 84.4±36.6pmol/L, p<0.001), however no association with BMI was observed. CONCLUSIONS Selected sex hormone parameters were significantly different in overweight and obese compared to normal weight males and certain differences could be seen between younger and older males. Depressive symptomatology was associated with increased estradiol levels in younger men, regardless of BMI.
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26
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Chasland LC, Knuiman MW, Divitini ML, Chan YX, Handelsman DJ, Naylor LH, Green DJ, Yeap BB. Greater physical activity and higher androgen concentrations are independently associated with lower cardiometabolic risk in men. Clin Endocrinol (Oxf) 2017; 87:466-474. [PMID: 28656662 DOI: 10.1111/cen.13407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/21/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Abstract
CONTEXT Male ageing is associated with lower circulating testosterone (T) and increased incidence of cardiovascular disease (CVD). Whether physical activity (PA) interacts with hormones to modify CVD risk is unclear. OBJECTIVE We assessed whether PA and sex hormone concentrations were independently associated with measures of CVD risk. PARTICIPANTS A total of 1649 men. METHODS Leisure, home, work and total PA were ascertained. At baseline, serum T, dihydrotestosterone (DHT) and oestradiol (E2) were assayed. Men were stratified into high PA+high hormone (H/H); low PA+high hormone (L/H); high PA+low hormone (H/L); and low PA+low hormone (L/L). RESULTS Mean age was 49.8 years at outset with 415 CVD events and 127 CVD deaths occurring during 20-year follow-up. Men with higher PA and higher T or DHT had lower odds of metabolic syndrome (eg leisure H/H vs L/L odds ratio [OR] 0.17 P<.001 for T, 0.26 P<.001 for DHT). Men with higher PA and E2 had lower risk of metabolic syndrome (eg leisure PA H/H vs L/L OR 0.51, P=.001). Men with higher leisure, work or total PA and higher DHT had the lowest risk of CVD death (eg leisure H/H hazard ratio [HR] 0.55 vs L/L, P=.033). Men with lower leisure, home or work PA and higher E2 were at greater risk of CVD death (eg leisure L/H HR 1.60 vs L/L, P=.039). CONCLUSIONS Considering T, DHT and E2 in the context of PA better informs consideration of cardiovascular risk. A 2×2 factorial RCT assessing PA and androgens would illuminate the scope for preventing CVD in men.
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Affiliation(s)
- Lauren C Chasland
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Matthew W Knuiman
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Mark L Divitini
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Yi X Chan
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Louise H Naylor
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Daniel J Green
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia
| | - Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
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27
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28
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Russell N, Cheung A, Grossmann M. Estradiol for the mitigation of adverse effects of androgen deprivation therapy. Endocr Relat Cancer 2017; 24:R297-R313. [PMID: 28667081 DOI: 10.1530/erc-17-0153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023]
Abstract
Prostate cancer (PCa) is the second most commonly diagnosed cancer in men. Conventional endocrine treatment for PCa leads to global sex steroid deprivation. The ensuing severe hypogonadism is associated with well-documented adverse effects. Recently, it has become apparent that many of the biological actions attributed to androgens in men are in fact not direct, but mediated by estradiol. Available evidence supports a primary role for estradiol in vasomotor stability, skeletal maturation and maintenance, and prevention of fat accumulation. Hence there has been interest in revisiting estradiol as a treatment for PCa. Potential roles for estradiol could be in lieu of conventional androgen deprivation therapy or as low-dose add-back treatment while continuing androgen deprivation therapy. These strategies may limit some of the side effects associated with conventional androgen deprivation therapy. However, although available data are reassuring, the potential for cardiovascular risk and pro-carcinogenic effects on PCa via estrogen receptor signalling must be considered.
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Affiliation(s)
- Nicholas Russell
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Victoria, Australia
| | - Ada Cheung
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of EndocrinologyAustin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Victoria, Australia
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29
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Yarrow JF, Phillips EG, Conover CF, Bassett TE, Chen C, Teurlings T, Vasconez A, Alerte J, Prock H, Jiron JM, Flores M, Aguirre JI, Borst SE, Ye F. Testosterone Plus Finasteride Prevents Bone Loss without Prostate Growth in a Rodent Spinal Cord Injury Model. J Neurotrauma 2017; 34:2972-2981. [PMID: 28338402 DOI: 10.1089/neu.2016.4814] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We have reported that testosterone-enanthate (TE) prevents the musculoskeletal decline occurring acutely after spinal cord injury (SCI), but results in a near doubling of prostate mass. Our purpose was to test the hypothesis that administration of TE plus finasteride (FIN; type II 5α-reductase inhibitor) would prevent the chronic musculoskeletal deficits in our rodent severe contusion SCI model, without inducing prostate enlargement. Forty-three 16-week-old male Sprague-Dawley rats received: 1) SHAM surgery (T9 laminectomy); 2) severe (250 kdyne) contusion SCI; 3) SCI+TE (7.0 mg/week, intramuscular); or 4) SCI+TE+FIN (5 mg/kg/day, subcutaneous). At 8 weeks post-surgery, SCI animals exhibited reduced serum testosterone and levator ani/bulbocavernosus (LABC) muscle mass, effects that were prevented by TE. Cancellous and cortical (periosteal) bone turnover (assessed by histomorphometry) were elevated post-SCI, resulting in reduced distal femur cancellous and cortical bone mass (assessed by microcomputed tomography). TE treatment normalized cancellous and cortical bone turnover and maintained cancellous bone mass at the level of SHAM animals, but produced prostate enlargement. FIN coadministration did not inhibit the TE-induced musculoskeletal effects, but prevented prostate growth. Neither drug regimen prevented SCI-induced cortical bone loss, although no differences in whole bone strength were present among groups. Our findings indicate that TE+FIN prevented the chronic cancellous bone deficits and LABC muscle loss in SCI animals without inducing prostate enlargement, which provides a rationale for the inclusion of TE+FIN in multimodal therapeutic interventions intended to alleviate the musculoskeletal decline post-SCI.
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Affiliation(s)
- Joshua F Yarrow
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida.,2 Department of Applied Physiology and Kinesiology, University of Florida , Gainesville, Florida
| | - Ean G Phillips
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Christine F Conover
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Taylor E Bassett
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Cong Chen
- 3 Department of Orthopedics and Rehabilitation, University of Florida , Gainesville, Florida
| | - Tyler Teurlings
- 3 Department of Orthopedics and Rehabilitation, University of Florida , Gainesville, Florida
| | - Andrea Vasconez
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Jonathan Alerte
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Hannah Prock
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Jessica M Jiron
- 4 Physiological Sciences, University of Florida , Gainesville, Florida
| | - Micah Flores
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - J Ignacio Aguirre
- 4 Physiological Sciences, University of Florida , Gainesville, Florida
| | - Stephen E Borst
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida.,2 Department of Applied Physiology and Kinesiology, University of Florida , Gainesville, Florida
| | - Fan Ye
- 1 Research Service, Malcom Randall Department of Veterans Affairs Medical Center , North Florida/South Georgia Veterans Health System, Gainesville, Florida
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30
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Swerdloff RS, Dudley RE, Page ST, Wang C, Salameh WA. Dihydrotestosterone: Biochemistry, Physiology, and Clinical Implications of Elevated Blood Levels. Endocr Rev 2017; 38:220-254. [PMID: 28472278 PMCID: PMC6459338 DOI: 10.1210/er.2016-1067] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 04/20/2017] [Indexed: 02/07/2023]
Abstract
Benefits associated with lowered serum DHT levels after 5α-reductase inhibitor (5AR-I) therapy in men have contributed to a misconception that circulating DHT levels are an important stimulus for androgenic action in target tissues (e.g., prostate). Yet evidence from clinical studies indicates that intracellular concentrations of androgens (particularly in androgen-sensitive tissues) are essentially independent of circulating levels. To assess the clinical significance of modest elevations in serum DHT and the DHT/testosterone (T) ratio observed in response to common T replacement therapy, a comprehensive review of the published literature was performed to identify relevant data. Although the primary focus of this review is about DHT in men, we also provide a brief overview of DHT in women. The available published data are limited by the lack of large, well-controlled studies of long duration that are sufficiently powered to expose subtle safety signals. Nonetheless, the preponderance of available clinical data indicates that modest elevations in circulating levels of DHT in response to androgen therapy should not be of concern in clinical practice. Elevated DHT has not been associated with increased risk of prostate disease (e.g., cancer or benign hyperplasia) nor does it appear to have any systemic effects on cardiovascular disease safety parameters (including increased risk of polycythemia) beyond those commonly observed with available T preparations. Well-controlled, long-term studies of transdermal DHT preparations have failed to identify safety signals unique to markedly elevated circulating DHT concentrations or signals materially different from T.
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Affiliation(s)
- Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California 90502
| | | | - Stephanie T Page
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle, Washington 98195
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California 90502.,UCLA Clinical and Translational Science Institute, Harbor-UCLA Medical Center, and Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, California 90509
| | - Wael A Salameh
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California 90502
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Pasiakos SM, Berryman CE, Karl JP, Lieberman HR, Orr JS, Margolis LM, Caldwell JA, Young AJ, Montano MA, Evans WJ, Vartanian O, Carmichael OT, Gadde KM, Harris M, Rood JC. Physiological and psychological effects of testosterone during severe energy deficit and recovery: A study protocol for a randomized, placebo-controlled trial for Optimizing Performance for Soldiers (OPS). Contemp Clin Trials 2017; 58:47-57. [PMID: 28479217 DOI: 10.1016/j.cct.2017.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The physiological consequences of severe energy deficit include hypogonadism and the loss of fat-free mass. Prolonged energy deficit also impacts physical performance, mood, attentiveness, and decision-making capabilities. This study will determine whether maintaining a eugonadal state during severe, sustained energy deficit attenuates physiological decrements and maintains mental performance. This study will also assess the effects of normalizing testosterone levels during severe energy deficit and recovery on gut health and appetite regulation. METHODS Fifty physically active men will participate in a 3-phase, randomized, placebo-controlled study. After completing a 14-d, energy-adequate, diet acclimation phase (protein: 1.6g∙kg-1∙d-1; fat: 30% total energy intake), participants will be randomized to undergo a 28-d, 55% energy deficit phase with (DEF+TEST: 200mg testosterone enanthate per week) or without (DEF) exogenous testosterone. Diet and physical activity will be rigorously controlled. Recovery from the energy deficit (ad libitum diet, no testosterone) will be assessed until body mass has been recovered within ±2.5% of initial body mass. Body composition, stable isotope methodologies, proteomics, muscle biopsies, whole-room calorimetry, molecular biology, activity/sleep monitoring, personality and cognitive function assessments, functional MRI, and comprehensive biochemistries will be used to assess physiological and psychological responses to energy restriction and recovery feeding while volunteers are in an expected hypogonadal versus eugonadal state. DISCUSSION The Optimizing Performance for Soldiers (OPS) study aims to determine whether preventing hypogonadism will mitigate declines in physical and mental function that typically occur during prolonged energy deficit, and the efficacy of testosterone replacement on recovery from severe underfeeding. TRIAL REGISTRATION NCT02734238.
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Affiliation(s)
- Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Claire E Berryman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, USA.
| | - J Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Jeb S Orr
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - John A Caldwell
- Oak Ridge Institute for Science and Education, Belcamp, MD, USA
| | - Andrew J Young
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, USA.
| | | | - William J Evans
- University of California at Berkeley, Berkeley, CA, USA; Duke University, Durham, NC, USA.
| | - Oshin Vartanian
- Oak Ridge Institute for Science and Education, Belcamp, MD, USA; Defence Research and Development Canada, University of Toronto, Canada.
| | | | - Kishore M Gadde
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Melissa Harris
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Jennifer C Rood
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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Abstract
A 20-year-old male with asymptomatic inherited type 1 antithrombin deficiency and a family history of thrombosis started injecting himself with testosterone 250 mg intramuscularly twice weekly for 5 weeks. He presented to the hospital with progressive dyspnea on exertion, chest pain and hemoptysis. Workup revealed bilateral submassive pulmonary embolism and proximal right lower extremity deep vein thrombosis. He was treated with intravenous (IV) unfractionated heparin and underwent catheter-directed thrombolysis with alteplase to the main pulmonary arteries. Postprocedure, he remained on IV alteplase infusion for 24 h and unfractionated heparin in the intensive care unit. Concomitantly he received plasma-derived antithrombin concentrate. He was transitioned to subcutaneous enoxaparin twice daily and discharged from the hospital on oral rivaroxaban 15 mg twice a day. This case highlights the heightened thrombogenic effect of anabolic steroids in the setting of underlying thrombophilia especially in younger subjects.
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Nutsch VL, Bell MR, Will RG, Yin W, Wolfe A, Gillette R, Dominguez JM, Gore AC. Aging and estradiol effects on gene expression in the medial preoptic area, bed nucleus of the stria terminalis, and posterodorsal medial amygdala of male rats. Mol Cell Endocrinol 2017; 442:153-164. [PMID: 28007657 PMCID: PMC5276730 DOI: 10.1016/j.mce.2016.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/17/2016] [Accepted: 12/18/2016] [Indexed: 12/27/2022]
Abstract
Studies on the role of hormones in male reproductive aging have traditionally focused on testosterone, but estradiol (E2) also plays important roles in the control of masculine physiology and behavior. Our goal was to examine the effects of E2 on the expression of genes selected for E2-sensitivity, involvement in behavioral neuroendocrine functions, and impairments with aging. Mature adult (MAT, 5 mo) and aged (AG, 18 mo) Sprague-Dawley male rats were castrated, implanted with either vehicle or E2 subcutaneous capsules, and euthanized one month later. Bilateral punches were taken from the bed nucleus of the stria terminalis (BnST), posterodorsal medial amygdala (MePD) and the preoptic area (POA). RNA was extracted, and expression of 48 genes analyzed by qPCR using Taqman low-density arrays. Results showed that effects of age and E2 were age- and region-specific. In the POA, 5 genes were increased with E2 compared to vehicle, and there were no age effects. By contrast the BnST showed primarily age-related changes, with 6 genes decreasing with age. The MePD had 5 genes that were higher in aged than mature males, and 17 genes with significant interactions between age and E2. Gene families identified in the MePD included nuclear hormone receptors, neurotransmitters and neuropeptides and their receptors. Ten serum hormones were assayed in these same males, with results revealing both age- and E2-effects, in several cases quite profound. These results support the idea that the male brain continues to be highly sensitive to estradiol even with aging, but the nature of the response can be substantially different in mature and aging animals.
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Affiliation(s)
- Victoria L Nutsch
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Margaret R Bell
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA
| | - Ryan G Will
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Weiling Yin
- Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA
| | - Andrew Wolfe
- Johns Hopkins University School of Medicine, Baltimore, MD, 21298, USA
| | - Ross Gillette
- Institute of Cellular and Molecular Biology, The University of Texas at Austin, Austin, TX, USA
| | - Juan M Dominguez
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA; Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Andrea C Gore
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA; Division of Pharmacology and Toxicology, The University of Texas at Austin, Austin, TX, USA; Department of Psychology, The University of Texas at Austin, Austin, TX, USA; Institute of Cellular and Molecular Biology, The University of Texas at Austin, Austin, TX, USA.
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Wahjoepramono EJ, Asih PR, Aniwiyanti V, Taddei K, Dhaliwal SS, Fuller SJ, Foster J, Carruthers M, Verdile G, Sohrabi HR, Martins RN. The Effects of Testosterone Supplementation on Cognitive Functioning in Older Men. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2016; 15:337-43. [PMID: 26553159 PMCID: PMC5078598 DOI: 10.2174/1871527315666151110125704] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/03/2015] [Indexed: 11/22/2022]
Abstract
Reduction in testosterone levels in men during aging is associated with cognitive decline and risk of dementia. Animal studies have shown benefits for testosterone supplementation in improving cognition and reducing Alzheimer’s disease pathology. In a randomized, placebo-controlled, crossover study of men with subjective memory complaint and low testosterone levels, we investigated whether testosterone treatment significantly improved performance on various measures of cognitive functioning. Forty-four men were administered a battery of neuropsychological tests to establish the baseline prior to being randomly divided into two groups. The first group (Group A) received 24 weeks of testosterone treatment (T treatment) followed by 4 weeks washout, and then 24 weeks of placebo (P); the second group (Group B) received the same treatments, in reverse order (Placebo, washout, and then T treatment). In group A (TèP), compared to baseline, there was a modest (1 point) but significant improvement in general cognitive functioning as measured by the Mini Mental State Examination (MMSE) following testosterone treatment. This improvement from baseline was sustained following the washout period and crossover to placebo treatment. Similar Mini Mental State Examination (MMSE) scores were observed when comparing testosterone treatment with placebo. In group B (PèT) a significant increase was observed from baseline following testosterone treatment and a trend towards an increase when compared to placebo treatment. Improvements in baseline depression scores (assessed by Geriatric Depression Scale) were observed following testosterone/placebo treatment in both groups, and no difference was observed when comparing testosterone with placebo treatment. Our findings indicate a modest improvement on global cognition with testosterone treatment. Larger clinical trials with a longer follow- up and with the inclusion of blood and brain imaging markers are now needed to conclusively determine the significance of testosterone treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ralph N Martins
- School of Medical Sciences, Faculty of Computing, Health, and Science, Edith Cowan University, Joondalup, WA, Australia.
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Gysel T, Tonoli C, Pardaens S, Cambier D, Kaufman JM, Zmierczak HG, Goemaere S, Lapauw B, Calders P. Lower insulin sensitivity is related to lower relative muscle cross-sectional area, lower muscle density and lower handgrip force in young and middle aged non-diabetic men. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2016; 16:302-309. [PMID: 27973382 PMCID: PMC5259571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study investigated whether an association between insulin resistance (IR) and muscle parameters is appreciable in young healthy men, independent of obesity. Furthermore, markers of muscle metabolism and hormones/possible determinants, were explored. METHODS 358 healthy young men were divided into a less and more insulin sensitive (LIS [age=33.2±5.4, BMI=23.4±2.3] and MIS [age=35.5±5.3, BMI=28.1±3.7]) group based on upper and lower quartile of HOMA-IR. Muscle cross-sectional area (CSA), -density, handgrip force, serum testosterone, estradiol, SHBG, Vitamin 25(OH)D, creatinine, IGF-1, IGFBP-3 and leptin levels were compared between these groups, correcting for differences in age, physical activity and fat mass. Correlations between HOMA-IR and these parameters, and between muscle measures and biochemical parameters, were calculated. RESULTS LIS is related to lower relative muscle CSA, muscle density, muscle/fat CSA ratio, relative handgrip force and level of physical activity. Furthermore, lower levels in SHBG, testosterone, Vitamin 25(OH)D and higher leptin, IGF-1 and IGFBP-3 levels were observed in LIS. Bio available T, FT, TE2, FE2, bioavailable E2, serum and urinary creatinine levels did not differ between groups. CONCLUSION Differences in muscle performance are already present in healthy men with lower insulin sensitivity and could be possibly modifiable risk factors for the development of type 2 diabetes.
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Affiliation(s)
- T. Gysel
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 1B3, Ghent, Belgium
| | - C. Tonoli
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 1B3, Ghent, Belgium
| | - S. Pardaens
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 1B3, Ghent, Belgium
| | - D. Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 1B3, Ghent, Belgium
| | - J-M. Kaufman
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9K12 Ghent, Belgium
| | - H-G. Zmierczak
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, De Pintelaan 185, 9K12 Ghent, Belgium
| | - S. Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, De Pintelaan 185, 9K12 Ghent, Belgium
| | - B. Lapauw
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9K12 Ghent, Belgium
| | - P. Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 1B3, Ghent, Belgium,Corresponding author: Prof. dr. Patrick Calders, Ghent University, Dept. of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185, 1B3, 9000 Ghent, Belgium E-mail:
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Chan YX, Knuiman MW, Hung J, Divitini ML, Beilby JP, Handelsman DJ, Beilin J, McQuillan B, Yeap BB. Neutral associations of testosterone, dihydrotestosterone and estradiol with fatal and non-fatal cardiovascular events, and mortality in men aged 17-97 years. Clin Endocrinol (Oxf) 2016; 85:575-82. [PMID: 27106765 DOI: 10.1111/cen.13089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/01/2015] [Accepted: 04/21/2016] [Indexed: 01/18/2023]
Abstract
CONTEXT Lower testosterone (T) is associated with poorer health outcomes in older men, however, the relationship between T, dihydrotestosterone (DHT) and estradiol (E2) with cardiovascular disease (CVD) in younger to middle-aged men remains unclear. OBJECTIVES We assessed associations between endogenous sex hormones with mortality (all-cause and CVD) and CVD events, in a cohort of men aged 17-97 years. PARTICIPANTS AND METHODS Sex hormones were assayed using mass spectrometry in 2143 men from the 1994/5 Busselton Health Survey. Outcomes to December 2010 were analysed. RESULTS Of the 1804 men included in the analysis, mean age was 50·3 ± 16·8 years and 68·9% of men were aged <60. Mean follow-up period was 14·9 years. There were 319 deaths, 141 CVD deaths and 399 CVD events. Compared to the full cohort, men who died had lower baseline T (12·0 ± 4·4 vs 13·6 ± 4·9 nmol/l), free T (181·9 ± 52·9 vs 218·3 ± 63·8 pmol/l) and DHT (1·65 ± 0·64 vs 1·70 ± 0·72 nmol/l), but higher E2 (64·0 ± 32 vs 60·1 ± 30·2 pmol/l). After adjustment for risk factors, T was not associated with mortality (adjusted HR = 0·90, 95% CI 0·79-1·04; P = 0·164 for every increase in 1 SD of T), CVD deaths (adjusted HR = 1·04, 95% CI 0·84-1·29; P = 0·708) or CVD events (adjusted HR = 1·03, 95% CI 0·92-1·15, P = 0·661). No associations were found for free T, DHT or E2. Results were similar for men older and younger than 60 years. CONCLUSIONS In predominantly middle-aged men, T, DHT and E2 do not influence mortality or CVD outcomes. This neutral association of hormones with CVD contrasts with prior studies of older men.
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Affiliation(s)
- Yi X Chan
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Matthew W Knuiman
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - Joseph Hung
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Mark L Divitini
- School of Population Health, University of Western Australia, Perth, WA, Australia
| | - John P Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | | | - Jonathan Beilin
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Brendan McQuillan
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
- Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia.
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia.
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Rambhatla A, Mills JN, Rajfer J. The Role of Estrogen Modulators in Male Hypogonadism and Infertility. Rev Urol 2016; 18:66-72. [PMID: 27601965 DOI: 10.3909/riu0711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Estradiol, normally considered a female hormone, appears to play a significant role in men in a variety of physiologic functions, such as bone metabolism, cardiovascular health, and testicular function. As such, estradiol has been targeted by male reproductive and sexual medicine specialists to help treat conditions such as infertility and hypogonadism. The compounds that modulate estradiol levels in these clinical conditions are referred to as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). In a certain subset of infertile men, particularly those with hypogonadism, or those who have a low serum testosterone to estradiol ratio, there is some evidence suggesting that SERMs and AIs can reverse the low serum testosterone levels or the testosterone to estradiol imbalance and occasionally improve any associated infertile or subfertile state. This review focuses on the role these SERMs and AIs play in the aforementioned reproductive conditions.
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Affiliation(s)
- Amarnath Rambhatla
- Department of Urology, David Geffen School of Medicine at UCLA Los Angeles, CA
| | - Jesse N Mills
- Department of Urology, David Geffen School of Medicine at UCLA Los Angeles, CA
| | - Jacob Rajfer
- Department of Urology, David Geffen School of Medicine at UCLA Los Angeles, CA
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Yeap BB, Grossmann M, McLachlan RI, Handelsman DJ, Wittert GA, Conway AJ, Stuckey BGA, Lording DW, Allan CA, Zajac JD, Burger HG. Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations. Med J Aust 2016; 205:228-31. [DOI: 10.5694/mja16.00448] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/06/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
| | - Mathis Grossmann
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC
| | | | | | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, SA
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney, Sydney, NSW
| | - Bronwyn GA Stuckey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
- Keogh Institute for Medical Research, Sir Charles Gairdner Hospital, Perth, WA
| | | | | | - Jeffrey D Zajac
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC
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Yeap BB, Knuiman MW, Divitini ML, Hui J, Arscott GM, Handelsman DJ, McLennan SV, Twigg SM, McQuillan B, Hung J, Beilby JP. Epidemiological and Mendelian Randomization Studies of Dihydrotestosterone and Estradiol and Leukocyte Telomere Length in Men. J Clin Endocrinol Metab 2016; 101:1299-306. [PMID: 26789780 DOI: 10.1210/jc.2015-4139] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Advancing age is accompanied by an accumulation of ill health and shortening of chromosomal telomeres signifying biological aging. T is metabolized to DHT by 5α-reductase (SRD5A2) and to estradiol (E2) by aromatase (CYP19A1). Telomerase preserves telomeres, and T and E2 regulate telomerase expression and activity in vitro. OBJECTIVE The objective of the study was to establish whether circulating T or its metabolites, DHT or E2, and single-nucleotide polymorphisms in SRD5A2 or CYP19A1 associate with leucocyte telomere length (LTL) in men. PARTICIPANTS AND METHODS Early-morning serum T, DHT, and E2 were assayed using mass spectrometry, and SRD5A2 and CYP19A1 single-nucleotide polymorphisms and LTL analyzed by PCR in 980 men from the Western Australian Busselton Health Survey who participated in the study. LTL was expressed as the T/S ratio. RESULTS Men were aged (mean ± SD) 53.7 ± 15.6 years. LTL decreased linearly with age, from the T/S ratio of 1.89 ± 0.41 at younger than 30 years to 1.50 ± 0.49 at 70 to younger than 80 years (r = -0.225, P < .0001). After adjustment for age, DHT and E2 were positively correlated with LTL (DHT, r = 0.069, P = .030; E2, r = 0.068, P = .034). The SRD5A2 rs9282858 polymorphism was associated with serum DHT but not with LTL. Three dominant alleles of CYP19A1 were each associated with lower serum E2 and shorter LTL: rs2899470 T (E2, 59.3 vs 68.6 pmol/L, P < .0001; T/S ratio, 1.54 vs 1.62, P = .045), rs10046 C (60.5 vs 68.1 pmol/L, P = .0005, 1.54 vs 1.62, P = .035), and rs700518 A (59.9 vs 68.9 pmol/L, P < .0001, 1.54 vs 1.63, P = .020). A single-copy haplotype C/T/I/A/T rs10046/rs2899470/rs11575899/rs700518/rs17703883 (52% prevalence) was associated with both lower E2 and shorter LTL. CONCLUSIONS In men, serum DHT and E2 correlate with LTL independently of age. Aromatase gene polymorphisms include three dominant alleles that are associated with both lower serum E2 and shorter LTL. E2 influences telomere length in vivo, thus warranting further studies to examine whether hormonal interventions might slow biological aging in men.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Matthew W Knuiman
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Mark L Divitini
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Jennie Hui
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Gillian M Arscott
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - David J Handelsman
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Susan V McLennan
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Stephen M Twigg
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Brendan McQuillan
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - Joseph Hung
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
| | - John P Beilby
- School of Medicine and Pharmacology (B.B.Y., B.M., J.Hun.), School of Population Health (M.W.K., M.L.D.), and School of Pathology and Laboratory Medicine (J.P.B.), University of Western Australia, Crawley, Western Australia 6009, Australia; PathWest Laboratory Medicine (J.Hui., G.M.A., J.P.B.) and Department of Cardiovascular Medicine (B.M., J.Hun.), Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; Department of Endocrinology and Diabetes (B.B.Y.), Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; ANZAC Research Institute (D.J.H.), Sydney, New South Wales 2138, Australia; and Department Endocrinology (S.V.M., S.M.T.), University of Sydney, Sydney, New South Wales 2006, Australia
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Hahn A, Kranz GS, Sladky R, Kaufmann U, Ganger S, Hummer A, Seiger R, Spies M, Vanicek T, Winkler D, Kasper S, Windischberger C, Swaab DF, Lanzenberger R. Testosterone affects language areas of the adult human brain. Hum Brain Mapp 2016; 37:1738-48. [PMID: 26876303 PMCID: PMC4949561 DOI: 10.1002/hbm.23133] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/17/2015] [Accepted: 01/25/2016] [Indexed: 12/19/2022] Open
Abstract
Although the sex steroid hormone testosterone is integrally involved in the development of language processing, ethical considerations mostly limit investigations to single hormone administrations. To circumvent this issue we assessed the influence of continuous high-dose hormone application in adult female-to-male transsexuals. Subjects underwent magnetic resonance imaging before and after 4 weeks of testosterone treatment, with each scan including structural, diffusion weighted and functional imaging. Voxel-based morphometry analysis showed decreased gray matter volume with increasing levels of bioavailable testosterone exclusively in Broca's and Wernicke's areas. Particularly, this may link known sex differences in language performance to the influence of testosterone on relevant brain regions. Using probabilistic tractography, we further observed that longitudinal changes in testosterone negatively predicted changes in mean diffusivity of the corresponding structural connection passing through the extreme capsule. Considering a related increase in myelin staining in rodents, this potentially reflects a strengthening of the fiber tract particularly involved in language comprehension. Finally, functional images at resting-state were evaluated, showing increased functional connectivity between the two brain regions with increasing testosterone levels. These findings suggest testosterone-dependent neuroplastic adaptations in adulthood within language-specific brain regions and connections. Importantly, deteriorations in gray matter volume seem to be compensated by enhancement of corresponding structural and functional connectivity. Hum Brain Mapp 37:1738-1748, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andreas Hahn
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ronald Sladky
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Sebastian Ganger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Allan Hummer
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Rene Seiger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Thomas Vanicek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Dick F Swaab
- Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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42
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McNerney EM, Onate SA. New Insights in the Role of Androgen-to-Estrogen Ratios, Specific Growth Factors and Bone Cell Microenvironment to Potentiate Prostate Cancer Bone Metastasis. NUCLEAR RECEPTOR RESEARCH 2015. [DOI: 10.11131/2015/101186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eileen M. McNerney
- Molecular Endocrinology and Oncology Laboratory, School of Medicine, University of Concepcion, Chile
| | - Sergio A. Onate
- Molecular Endocrinology and Oncology Laboratory, School of Medicine, University of Concepcion, Chile
- Molecular Endocrinology and Oncology Laboratory, Anatomy and Pathology Building, 2nd Floor, School of Medicine, University of Concepcion, Concepcion, Chile
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Abstract
Despite increased global interest in testosterone deficiency in men and its treatment with testosterone therapy, practical aspects of care remain confusing to many practitioners. Testosterone deficiency can result from testicular dysfunction (primary hypogonadism) or hypothalamic-pituitary dysfunction (secondary hypogonadism), and be congenital or acquired. Sexual and nonsexual symptoms of testosterone deficiency can negatively affect quality of life and cause considerable general health concerns. Investigation of testosterone deficiency should be undertaken in men with symptoms of reduced libido, erectile dysfunction, depression, fatigue, poor concentration, and poor memory. Total and free testosterone are the most frequently used tests and evaluating serum concentrations of luteinizing hormone aids determination of primary versus secondary testosterone deficiency. Multiple formulations of testosterone therapy are available, but symptomatic benefits might not manifest for several weeks to many months; long-acting formulations are convenient and improve compliance. Concerns regarding cardiovascular and prostate cancer risks are not supported by current evidence, monitoring during therapy is mandatory. On balance, testosterone therapy can be considered a safe and effective treatment for testosterone deficiency.
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Affiliation(s)
- Antonio Aversa
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Abraham Morgentaler
- Men's Health Boston, 200 Boylston Street, A309, Chestnut Hill, MA 02647, USA
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Pastuszak AW, Gomez LP, Scovell JM, Khera M, Lamb DJ, Lipshultz LI. Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen. Sex Med 2015; 3:165-73. [PMID: 26468380 PMCID: PMC4599554 DOI: 10.1002/sm2.76] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Numerous testosterone (T) formulations are available, each with differing effects on serum parameters. Aim The aim of this study was to compare the long-term effects of topical, injectable, and implantable pellet T formulations in hypogonadal men. Methods Retrospective review of hypogonadal men treated with a single T formulation was performed: 47 men on T gels, 57 on injectable T, and 74 on T pellets were identified. Total T (TT), calculated free T (FT), estradiol (E), hemoglobin (Hgb), hematocrit (Hct), prostate-specific antigen (PSA), total cholesterol (Tchol), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were evaluated at baseline and every 3–6 months for 3 years. Serum parameters were compared using a mixed model linear regression for repeated measures. Main Outcome Measures Effects of topical, injectable, and pellet T formulations on serum hormone levels, Hgb, Hct, lipid parameters and PSA. Results Men in the injectable T group were younger (42.5 ± 12.3 years) than in the gel (54.1 ± 9.8 years) or pellet groups (53.8 ± 13.0 years), and baseline FT, Hgb, and Hct were higher in the injectable T group than in gel or pellet groups. Increases in TT and FT were observed throughout follow-up in all groups. Increases in E were observed at in all T groups and throughout follow-up in injectable and gel groups. No PSA increases were observed. Erythrocytosis (Hct > 50%) was more common with injectable T (66.7%) than with T gels (12.8%) or pellets (35.1%, P < 0.0001). Transient changes in cholesterol, TG, and LDL were observed, and no significant changes were seen in HDL for any group. Conclusions All T formulations increase serum T and FT. More significant increases in E occur with injectable T and T gels. Changes in Hgb and Hct are most significant with injectable T, and effects on lipids are variable and inconsistent. Selection of T formulations must account for individual patient preferences and the effects of each formulation.
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Affiliation(s)
- Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
| | - Lissette P Gomez
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Dolores J Lamb
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA ; Department of Cell Biology, Baylor College of Medicine Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
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45
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Leung KMYB, Alrabeeah K, Carrier S. Update on Testosterone Replacement Therapy in Hypogonadal Men. Curr Urol Rep 2015; 16:57. [DOI: 10.1007/s11934-015-0523-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW Ageing is accompanied by a reduction in circulating testosterone and progressive accumulation of medical morbidities. There is an intense debate whether low testosterone contributes to ill-health as opposed to being a biomarker for its presence. Prescriptions for testosterone are rising on a background of concern over potential adverse effects. This review examines evidence relating androgens to cardiovascular risk in older men. RECENT FINDINGS Observational studies show lower risk of cardiovascular events in older men with higher testosterone, and lower mortality from ischaemic heart disease in men with higher concentrations of its more potent androgenic metabolite dihydrotestosterone. However, randomized controlled trials of testosterone supplementation have been underpowered for the outcome of cardiovascular events. Recent meta-analyses have reached contrasting conclusions regarding cardiovascular adverse events associated with testosterone therapy. Retrospective studies of prescription databases have produced controversial and conflicting results. SUMMARY Additional randomized controlled trials are required to clarify the role of testosterone supplementation in older men in the absence of pituitary or gonadal disease. Pending such studies, testosterone therapy should be considered in androgen-deficient men, with evaluation of potential benefits and risks.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia
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47
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Okamoto K, Sekine Y, Nomura M, Koike H, Matsui H, Shibata Y, Ito K, Suzuki K. Effects of a luteinizing hormone-releasing hormone agonist on cognitive, sexual, and hormonal functions in patients with prostate cancer: relationship with testicular and adrenal androgen levels. Basic Clin Androl 2015; 25:3. [PMID: 28435682 PMCID: PMC5395772 DOI: 10.1186/s12610-015-0019-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/05/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the cognitive and sexual/hormonal functioning of prostate cancer patients treated with a luteinizing hormone-releasing hormone (LH-RH) agonist, and the relationships thereof with adrenal and residual testicular androgen levels. MATERIALS AND METHODS Previously, we reported the effect of a luteinizing hormone-releasing hormone (LH-RH) agonist on testicular and adrenal androgen production in patients with prostate cancer. A 6-month treatment with an LH-RH agonist significantly reduced testicular androgens by 90-95% and adrenal androgens by 26-40%. This study evaluated the changes in cognitive and sexual/hormonal functions in the same cohort using the Mini-Mental State Evaluation (MMSE) and Expanded Prostate Cancer Index Composite (EPIC) questionnaire, respectively. In addition, the associations of each function with the serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2), dehydroepiandrosterone-sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione (A-dione), and cortisol levels were studied. RESULTS Cognitive functions did not change significantly during the treatment. Sexual functions were relatively low before treatment and worsened significantly after 6 and 12 months of treatment. Interestingly, sexual bothers were improved with the treatment. The treatment significantly worsened hormonal functions and bothers. Regarding specific items in the hormonal domains, hot flashes and body weight changes were the main effects of worsened hormonal function. Low levels of T and E2 and high levels of A-dione were associated with low MMSE scores at 6 months. Regarding sexual and hormonal functions, A-dione, E2, T, cortisol, and DHEA-S were associated with poorer functioning and bother. Especially, low T levels and high E2 levels were the most significant factors associated with worse sexual and hormonal bothers. CONCLUSION The LH-RH agonist monotherapy worsened sexual and hormonal functions and hormonal bothers, but not sexual bothers or cognitive functions. The changes in these functions were related to the testicular and adrenal androgens levels.
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Affiliation(s)
- Kohei Okamoto
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Yositaka Sekine
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Masashi Nomura
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Hidekazu Koike
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Hiroshi Matsui
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Yasuhiro Shibata
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Kazuto Ito
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Gunma Japan
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Camozzi V, Bonanni G, Frigo A, Piccolo M, Ferasin S, Zaninotto M, Boscaro M, Luisetto G. Effect of a single injection of testosterone enanthate on 17β estradiol and bone turnover markers in hypogonadal male patients. J Endocrinol Invest 2015; 38:389-97. [PMID: 25319469 DOI: 10.1007/s40618-014-0183-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/22/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Several clinical studies testify the critical role played by estrogens in male bone metabolism. The aim of our study is to assess the effect of a single injection of testosterone enanthate in a group of hypogonadal men on 17β estradiol serum levels and some bone metabolic parameters. METHOD Twenty-one hypogonadal males were given one testosterone enanthate injection (250 mg). Blood samples were drawn before the injection and after 1, 2 and 3 weeks. The following variables were measured: Total testosterone (TT), 17β estradiol (17β E2), Sex hormone binding globulin, total alkaline phosphatase, osteocalcin, and C-telopeptide of type I collagen (CTx). RESULTS After testosterone injection, both TT and 17β E2 increased, peaking 1 week after the injection. Individual observation of the response of 17β E2 to testosterone showed that a subgroup (n = 9) failed to respond with any increase in 17β E2 at any of the weekly tests (group E2-), while the remainder (n = 12) showed a significant increase in 17β E2, which reached a mean value three times higher than at baseline (group E2+). The E2- patients reached a TT peak lower than that observed in the E+ group. CTx serum levels declined progressively in the E2+ group, reaching the significance (p = 0.03) at the end of the study, while it did not change in E- group. CONCLUSION This study suggests that a single injection of testosterone might have different effects on the production of endogenous estrogens, and a significant reduction of bone resorption parameters takes place only in the patients who show a significant increase of 17ß estradiol in response to testosterone administration.
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Affiliation(s)
- V Camozzi
- Department of Medicine, Unit of Endocrinology, University of Padova, via Ospedale 105, 35128, Padua, Italy.
| | - G Bonanni
- Department of Medicine, Unit of Endocrinology, University of Padova, via Ospedale 105, 35128, Padua, Italy.
| | - A Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, via Loredan 18, 35131, Padua, Italy.
| | - M Piccolo
- Department of Medicine, Unit of Endocrinology, University of Padova, via Ospedale 105, 35128, Padua, Italy.
| | - S Ferasin
- Department of Medicine, Unit of Endocrinology, University of Padova, via Ospedale 105, 35128, Padua, Italy.
| | - M Zaninotto
- Department of Medical Laboratory, University of Padova, via Giustiniani 2, 35128, Padua, Italy.
| | - M Boscaro
- Department of Medicine, Unit of Endocrinology, University of Padova, via Ospedale 105, 35128, Padua, Italy.
| | - G Luisetto
- Department of Medicine, Unit of Endocrinology, University of Padova, via Ospedale 105, 35128, Padua, Italy.
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49
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Hsu HK, Brown TT, Li X, Young S, Cranston RD, D’Souza G, Jacobson LP, Martínez-Maza O, Seaberg EC, Margolick JB, Jenkins FJ, Moran MG, Chua K, Bolan RK, Detels R, Wiley DJ. Association between free testosterone levels and anal human papillomavirus types 16/18 infections in a cohort of men who have sex with men. PLoS One 2015; 10:e0119447. [PMID: 25794147 PMCID: PMC4368778 DOI: 10.1371/journal.pone.0119447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 01/26/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) types 16 and 18 cause invasive cervical cancer and most invasive anal cancers (IACs). Overall, IAC rates are highest among men who have sex with men (MSM), especially MSM with HIV infection. Testosterone is prescribed for men showing hypogonadism and HIV-related wasting. While there are direct and indirect physiological effects of testosterone in males, its role in anal HPV16/18 infections in men is unknown. METHODS Free testosterone (FT) was measured in serum from 340 Multicenter AIDS Cohort Study (MACS) participants who were tested for anal HPV16/18-DNA approximately 36 months later. The effect of log10-transformed current FT level on anal HPV16/18 prevalence was modeled using Poisson regression with robust error variance. Multivariate models controlled for other HPV types, cumulative years of exogenous testosterone use, race, age, lifetime number of receptive anal intercourse partnerships, body mass index, tobacco smoking, HIV-infection and CD4+ T-cell counts among HIV-infected, and blood draw timing. RESULTS Participants were, on average, 60 (+5.4) years of age, White (86%), and HIV-uninfected (56%); Twenty-four percent tested positive for anal HPV16 and/or 18-DNA (HPV16 prevalence=17.1%, HPV18=9.1%). In adjusted analysis, each half-log10 increase of FT was associated with a 1.9-fold (95% Confidence Interval: 1.11, 3.24) higher HPV16/18 prevalence. Additionally, other Group 1 high-risk HPVs were associated with a 1.56-fold (1.03, 2.37) higher HPV16/18 prevalence. Traditional risk factors for HPV16/18 infection (age, tobacco smoking; lifetime number of sexual partners, including the number of receptive anal intercourse partnerships within 24 months preceding HPV testing) were poorly correlated with one another and not statistically significantly associated with higher prevalence of HPV16/18 infection in unadjusted and adjusted analyses. CONCLUSIONS Higher free testosterone was associated with increased HPV16/18 prevalence measured approximately three years later, independent of sexual behavior and other potential confounders. The mechanisms underlying this association remain unclear and warrant further study.
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Affiliation(s)
- Hilary K. Hsu
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Todd T. Brown
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Xiuhong Li
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stephen Young
- Tricore Reference Laboratories, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Lisa P. Jacobson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Otoniel Martínez-Maza
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Eric C. Seaberg
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph B. Margolick
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Frank J. Jenkins
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Matthew G. Moran
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
- Desert AIDS Project, Palm Springs, California, United States of America
| | - Kristofer Chua
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Robert K. Bolan
- Los Angeles LGBT Center, Jeffrey Goodman Clinic, Hollywood, California, United States of America
| | - Roger Detels
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dorothy J. Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
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50
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The Role of Testosterone Therapy in Cardiovascular Mortality: Culprit or Innocent Bystander? Curr Atheroscler Rep 2015; 17:490. [DOI: 10.1007/s11883-015-0490-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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