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Zhang K, Li C, Feng X, Zhang N, Gao X, Lv G, Shen J, Wu P, Lv J, Sun J. Integrated cell metabolomics and network pharmacology approach deciphers the anti-testosterone deficiency mechanisms of Bushen Zhuanggu Tang. J Pharm Biomed Anal 2024; 239:115919. [PMID: 38134707 DOI: 10.1016/j.jpba.2023.115919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Testicular dysfunction is distinguished by a deficiency in testosterone levels, which can be attributed to the occurrence of oxidative stress injury in Leydig cells. The empirical prescription known as Bushen Zhuanggu Tang, developed by a highly experienced traditional Chinese medicine practitioner with six decades of clinical expertize, aligns with the traditional Chinese medicine principle of "kidney governing bone". Researchers have demonstrated that the administration of BSZGT can effectively enhance testosterone production. The objective of this study is to investigate the potential anti-testicular dysfunction effects of BSZGT and elucidate its underlying mechanism in an in vitro setting. Specifically, the impact of oxidative stress induced by H2O2 on the activity and testosterone levels of Leydig cells (TM3) was examined. Furthermore, the utilization of UPLC-QE-Qrbitrap-MS enabled the identification of the involvement of BSZGT in various metabolic pathways, including arginine biosynthesis, amino acyl-tRNA biosynthesis, Alanine, aspartate and glutamine metabolism, and Citrate Cycle, through the modulation of 25 distinct metabolites. Additionally, a network pharmacological analysis was conducted to investigate the pivotal protein targets associated with the therapeutic effects of BSZGT. The findings demonstrate the identification of six key proteins (CYP19A1, CYP1B1, ALOX5, ARG1, XDH, and MPO) that play a significant role in augmenting testicular function through their involvement in the ovarian steroid production pathway. In summary, our study presents a comprehensive research methodology that combines cell metabonomics and network pharmacology to enhance the discovery of new therapeutic agents for TD.
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Affiliation(s)
- Kaiyue Zhang
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Chunnan Li
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Xueqin Feng
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Nanxi Zhang
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Xiaochen Gao
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Guangfu Lv
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Jiaming Shen
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Peitong Wu
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China
| | - Jingwei Lv
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China.
| | - Jiaming Sun
- Jilin Institute of Ginseng Science, Changchun University of Chinese Medicine, Changchun 130117, PR China.
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Gurayah AA, Dullea A, Weber A, Masterson JM, Khodamoradi K, Mohamed AI, Ramasamy R. Long vs Short Acting Testosterone Treatments: A Look at the Risks. Urology 2023; 172:5-12. [PMID: 36455678 PMCID: PMC9925408 DOI: 10.1016/j.urology.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
Prescriptions for testosterone therapy (TT) to treat testosterone deficiency have increased in recent years. The purpose of this review was to evaluate the risks of several treatment modalities to better counsel patients. Both short-acting and long-acting TT has been shown to restore normal serum testosterone levels and improve symptoms of testosterone deficiency. Short-acting pharmacology mimics normal physiology more closely than long-acting TT but requires multiple doses per day. Long-acting TT has a higher rate of patient adherence but is more likely to create supraphysiologic serum testosterone and pathologic sequelae.
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Affiliation(s)
| | - Alexandra Dullea
- Department of Urology, University of Miami Miller School of Medicine, University of Miami, Miami, FL
| | | | - John M Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kajal Khodamoradi
- Department of Urology, University of Miami Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, University of Miami, Miami, FL.
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3
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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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4
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Kim M, Byun SS, Hong SK. Testosterone Replacement Therapy in Men with Untreated or Treated Prostate Cancer: Do We Have Enough Evidences? World J Mens Health 2021; 39:705-723. [PMID: 32648377 PMCID: PMC8443987 DOI: 10.5534/wjmh.190158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To investigate the oncologic safety of testosterone replacement therapy (TRT) in men with untreated or treated prostate cancer. MATERIALS AND METHODS We systematically searched PubMed, Embase, and Cochrane library database from January 1941 to March 2019. RESULTS In total, 36 articles met the eligibility criteria for this systematic review. They included a total of 2,459 TRT-treated patients, with a median of 20 patients per study (range: 1-1,142). Except for four studies, all were single-armed studies with poor quality scores (median MINOR, 9 of 24). Of the 36 studies, prostate cancer was managed through active surveillance (AS), in 5 studies; radical prostatectomy, in 11 studies; radiation therapy, in 5 studies; multiple intervention modalities, in 5 studies; and systemic therapy, in 9 studies. In comparison with TRT-treated and untreated patients, the pooled risk ratio (RR) was not significantly higher than one in comparisons of risk for disease progression (pooled RR, 0.83; 95% confidence interval, 0.57-1.21). The results of systematic review implied that TRT might be harmful in men with advanced disease (progression rate: 38.5%-100.0%), who undergo AS (15.4%-57.1%), and who successfully treated but having high-risk disease (0.0%-50.0%). CONCLUSIONS Compared to TRT-untreated patients, TRT-treated patients may not have increased risks for disease progression in prostate cancer. However, the quality of currently available evidence is extremely poor. TRT may be harmful in men with advanced disease burden, in those with untreated prostate cancer undergoing AS, and in those with successfully treated prostate cancer but having high-risk disease.
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Affiliation(s)
- Myong Kim
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
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5
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Al-Zoubi RM, Yassin AA, Alwani M, Al-Qudimat A, Aboumarzouk OM, Zarour A, Al Ansari A. A systematic review on the latest developments in testosterone therapy: Innovations, advances, and paradigm shifts. Arab J Urol 2021; 19:370-375. [PMID: 34552788 PMCID: PMC8451690 DOI: 10.1080/2090598x.2021.1959260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To review the latest innovations and advances in testosterone treatments including their advantages and disadvantages and to address important issues in testosterone therapy (TTh). Methods This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-analyses guidelines. The PubMed, MEDLINE, Scopus and Cochrane databases were searched using specifically related key words. The identified studies were screened for inclusion criteria that included studies discussing one of the four objectives of the systematic review: 1) cut–off references, 2) prevention/remission of type II diabetes mellitus (T2DM), 3) duration of treatment, and 4) prostate, lower urinary tract symptoms, prostate health, or cancer. The search was limited to the past 15 years. Any studies were not written in English were excluded. Results The initial literature search retrieved 393 studies. After screening four studies were removed due to duplication, 360 studies were further excluded after reviewing the title, abstract or the whole manuscript due to different exclusion criteria or being not focussed on the objective. Finally, 29 studies were included in the review. One study discussed the cut–off value, four studies discussed the effect of testosterone replacement therapy (TRT) on the control of T2DM, four studies on duration of TRT, and 20 studies discussed the effects of TRT on the prostate Conclusions Numerous studies have demonstrated the benefits of TTh in overtly hypogonadal men. There are several possible administration routes for testosterone treatment. Each approach has advantages and disadvantages, and the choice of the method of TRT will often be determined by patient preference or co-medication (no intramuscular injections in patients under coumarin or similar anticoagulants). Although new developments are promising, it seems that among the available treatments, only transdermal gel delivery and long-acting injectable testosterone undecanoate provide pharmacokinetic behaviour that gives a steady state level within a physiological range.
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Affiliation(s)
- Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Aksam A Yassin
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar.,Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Mustafa Alwani
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Al-Qudimat
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Zarour
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function. J Sex Med 2020; 17:1687-1693. [PMID: 32736945 DOI: 10.1016/j.jsxm.2020.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 05/09/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Here we examine the association between shift work sleep disorder (SWSD) and erectile dysfunction (ED) in shift workers. METHODS Men presenting to a single andrology clinic between January 2014 and July 2017 completed validated questionnaires: International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and the nonvalidated SWSD Questionnaire. Men were also asked about shift work schedule, comorbidities, phosphodiesterase 5 (PDE5) inhibitor use, and testosterone use. Serum total testosterone values were determined for each visit. Linear regression was performed controlling for testosterone use, testosterone levels, PDE5 inhibitor use, age, and comorbidities to determine the effect of SWSD on ED as assessed using the IIEF. RESULTS Of the 754 men completing questionnaires, 204 reported nonstandard shift work (begins before 7 am or after 6 pm, regularly extends out of that frame, or rotates frequently) and 48 were found to have SWSD using a screening questionnaire. Nonstandard shift work alone did not result in worse IIEF-EF scores (P = .31), but those who worked nonstandard shifts and had SWSD demonstrated IIEF-EF scores 2.8 points lower than men without SWSD (P < .01). When assessing for the type of shift work performed, men who worked night shifts had IIEF-EF scores 7.6 points lower than men who worked during the day or evening (P < .01). Testosterone use improved IIEF-EF scores for men with SWSD by 2.9 points, ameliorating the effect of SWSD on ED. However, baseline testosterone levels were not associated with worse erectile function in this cohort. CONCLUSION Men with SWSD have worse erectile function, with men who work night shifts having even poorer erectile function. These findings suggest that circadian rhythm disturbance may significantly impact erectile function. While testosterone therapy may partly reverse the effects of SWSD, shift work is a potential risk factor for ED and should be assessed for as part of the evaluation of men with ED. Rodriguez KM, Kohn TP, Kohn JR, et al. Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function. J Sex Med 2020;17:1687-1693.
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Kokal M, Mirzakhani K, Pungsrinont T, Baniahmad A. Mechanisms of Androgen Receptor Agonist- and Antagonist-Mediated Cellular Senescence in Prostate Cancer. Cancers (Basel) 2020; 12:cancers12071833. [PMID: 32650419 PMCID: PMC7408918 DOI: 10.3390/cancers12071833] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
The androgen receptor (AR) plays a leading role in the control of prostate cancer (PCa) growth. Interestingly, structurally different AR antagonists with distinct mechanisms of antagonism induce cell senescence, a mechanism that inhibits cell cycle progression, and thus seems to be a key cellular response for the treatment of PCa. Surprisingly, while physiological levels of androgens promote growth, supraphysiological androgen levels (SAL) inhibit PCa growth in an AR-dependent manner by inducing cell senescence in cancer cells. Thus, oppositional acting ligands, AR antagonists, and agonists are able to induce cellular senescence in PCa cells, as shown in cell culture model as well as ex vivo in patient tumor samples. This suggests a dual AR-signaling dependent on androgen levels that leads to the paradox of the rational to keep the AR constantly inactivated in order to treat PCa. These observations however opened the option to treat PCa patients with AR antagonists and/or with androgens at supraphysiological levels. The latter is currently used in clinical trials in so-called bipolar androgen therapy (BAT). Notably, cellular senescence is induced by AR antagonists or agonist in both androgen-dependent and castration-resistant PCa (CRPC). Pathway analysis suggests a crosstalk between AR and the non-receptor tyrosine kinase Src-Akt/PKB and the PI3K-mTOR-autophagy signaling in mediating AR-induced cellular senescence in PCa. In this review, we summarize the current knowledge of therapeutic induction and intracellular pathways of AR-mediated cellular senescence.
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Affiliation(s)
| | | | | | - Aria Baniahmad
- Correspondence: ; Tel.: +49-3641-9396820; Fax: +49-3641-99396822
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8
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Ahlering TE, My Huynh L, Towe M, See K, Tran J, Osann K, El Khatib FM, Yafi FA. Testosterone replacement therapy reduces biochemical recurrence after radical prostatectomy. BJU Int 2020; 126:91-96. [PMID: 32124531 DOI: 10.1111/bju.15042] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate risk of prostate cancer biochemical recurrence (BCR) after radical prostatectomy (RP) in men receiving vs not receiving testosterone replacement therapy (TRT). PATIENTS AND METHODS A total of 850 patients underwent RP by a single surgeon. All patients had preoperative testosterone and sex hormone-binding globulin levels determined; free testosterone was calculated prospectively. In all, 152 (18%) patients with low preoperative calculated free testosterone (cFT) levels and delayed postoperative sexual function recovery were placed on TRT and proportionately matched to 419 control patients by pathological Gleason Grade Group (GGG) and stage. Rates and time to BCR [two consecutive prostate-specific antigen (PSA) levels of ≥0.2 ng/mL] were compared in univariate and multivariate regression; Cox regression was used to generate a survival function at the mean of covariates. RESULTS The median follow-up was 3.5 years. There were no statistically significant differences in demographics or general health complications between groups. BCR occurred in 11/152 (7.2%) and 53/419 (12.6%) patients in the TRT and control groups, respectively. In adjusted time-to-event analysis, TRT was an independent predictor of recurrence-free survival. After accounting for GGG, pathological stage, preoperative PSA level, and cFT, patients on TRT were ~54% less likely to recur (hazard ratio 0.54, 95% confidence interval 0.292-0.997). In men destined to recur, TRT delayed time to recurrence by an average of 1.5 years. CONCLUSION In our experience, TRT after RP significantly reduced BCR and delayed time to BCR. There was no identifiable general health complications associated with TRT. These findings are hypothesis-generating and require confirmation with multi-centred, prospective randomised controlled trials.
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Affiliation(s)
- Thomas E Ahlering
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
| | - Linda My Huynh
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
| | - Maxwell Towe
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
| | - Kaelyn See
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
| | - Joshua Tran
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
| | - Kathryn Osann
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Farouk M El Khatib
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
| | - Faysal A Yafi
- Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.,Department of Medicine, University of California, Irvine, CA, USA
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9
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Towe M, El-Khatib F, Osman M, Huynh L, Carrion R, Ward S, Reisman Y, Serefoglu EC, Pastuszak A, Yafi FA. “Doc, if it were you, what would you do?”: a survey of Men’s Health specialists’ personal preferences regarding treatment modalities. Int J Impot Res 2020; 33:303-310. [DOI: 10.1038/s41443-020-0263-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 11/10/2022]
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10
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Huynh LM, Ahlering TE. Challenging beliefs of testosterone therapy and prostate cancer. Nat Rev Urol 2019; 16:699-701. [PMID: 31659332 DOI: 10.1038/s41585-019-0253-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Linda My Huynh
- University of California, Irvine Health, Orange, CA, USA
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11
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Abstract
Hypogonadism is a common condition defined by the presence of low serum testosterone levels and hypogonadal symptoms, and most commonly treated using testosterone therapy (TTh). The accuracy of diagnosis and appropriateness of treatment, along with proper follow-up, are increasingly important given the large increase in testosterone prescriptions and the recent concern for cardiovascular (CV) risk associated with TTh. In March of 2015, the US Food and Drug Administration required that testosterone product labels disclose a potential CV risk, despite the evidence base for this association being weak and inconclusive. However, TTh may improve CV outcomes rather than increase risks.
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Affiliation(s)
- John T Sigalos
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, 1 Baylor Plaza, Room N730 Houston, TX 77030, USA; Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA.
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Corona G, Rastrelli G, Reisman Y, Sforza A, Maggi M. The safety of available treatments of male hypogonadism in organic and functional hypogonadism. Expert Opin Drug Saf 2018; 17:277-292. [PMID: 29334271 DOI: 10.1080/14740338.2018.1424831] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the case of primary male hypogonadism (HG), only testosterone (T) replacement therapy (TRT) is possible whereas when the problem is secondary to a pituitary or hypothalamus alteration both T production and fertility can be, theoretically, restored. We here systematically reviewed and discussed the advantages and limits of medications formally approved for the treatment of HG. AREAS COVERED Data derived from available meta-analyses of placebo controlled randomized trials (RCTs) were considered and analyzed. Gonadotropins are well-toleratedand their use is mainly limited by higher costs and a more cumbersome treatment schedule than TRT. Available RCTs on TRT suggest that cardiovascular (CV) and venous thromboembolism risk is not a major issue and that prostate safety is guaranteed. The risk of increased hematocrit is mainly limited to the use of short terminjectable preparations. EXPERT OPINION In the last few years the concept of 'organic' irreversible HG and 'functional' or age- and comorbidity-related HG has been introduced. This definition is not evidence-based. The majority of RCTs enrolled patients with 'functional' HG. Considering the significant improvement in body composition, glucose metabolism and sexual activity, TRT should not be limited to 'organic' HG, but also offered for 'functional'.
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Affiliation(s)
- G Corona
- a Endocrinology Unit, Medical Department , Maggiore-Bellaria Hospital, Azienda-Usl Bologna , Bologna , Italy
| | - G Rastrelli
- b Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences , University of Florence , Florence , Italy
| | - Y Reisman
- c Department of Urology , Amstelland Hospital , Amsterdam , The Netherlands
| | - A Sforza
- a Endocrinology Unit, Medical Department , Maggiore-Bellaria Hospital, Azienda-Usl Bologna , Bologna , Italy
| | - M Maggi
- b Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences , University of Florence , Florence , Italy
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13
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Wroclawski ML, Heldwein FL. Do we have enough evidences that make you safe to treat a man with hypogonadism one year after a radical prostatectomy for prostate cancer? | Opinion: Not Yet. Int Braz J Urol 2018; 44:8-13. [PMID: 29424507 PMCID: PMC5815527 DOI: 10.1590/s1677-5538.ibju.2018.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Flavio Lobo Heldwein
- Universidade do Sul de Santa Catarina, SC, Brasil
- Universidade Federal de Santa Catarina, SC, Brasil
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14
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Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2017; 6:106-113. [PMID: 29174957 DOI: 10.1016/j.sxmr.2017.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Although testosterone therapy (TTh) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. In 2015, the US Food and Drug Administration issued a warning about potential cardiovascular risks resulting from TTh. Fertility preservation is another reason to search for viable alternative therapies to conventional TTh, and in this review we evaluate the literature examining these alternatives. AIMS To review the role and limitations of non-testosterone treatments for hypogonadism. METHODS A literature search was conducted using PubMed to identify relevant studies examining medical and non-medical alternatives to TTh. Search terms included hypogonadism, testosterone replacement therapy, testosterone therapy, testosterone replacement alternatives, diet and exercise and testosterone, varicocele repair and testosterone, stress reduction and testosterone, and sleep apnea and testosterone. MAIN OUTCOME MEASURES Review of peer-reviewed literature. RESULTS Medical therapies examined include human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators. Non-drug therapies that are reviewed include lifestyle modifications including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair. The high prevalence of obesity and metabolic syndrome in the United States suggests that disease modification could represent a viable treatment approach for affected men with hypogonadism. CONCLUSIONS These alternatives to TTh can increase testosterone levels and should be considered before TTh. Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2018;6:106-113.
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Affiliation(s)
- Eric M Lo
- Baylor College of Medicine, Houston, TX, USA
| | | | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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15
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Felix-Patrício B, Miranda AF, Medeiros JL, Gallo CBM, Gregório BM, Souza DB, Costa WS, Sampaio FJB. The prostate after castration and hormone replacement in a rat model: structural and ultrastructural analysis. Int Braz J Urol 2017; 43:957-965. [PMID: 28379662 PMCID: PMC5678530 DOI: 10.1590/s1677-5538.ibju.2016.0484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/31/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation. Materials and Methods: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis. The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy. Results: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29μm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood. Conclusion: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.
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Affiliation(s)
- Bruno Felix-Patrício
- Instituto de Ciências Humanas e da Saúde, Universidade Federal Fluminense, Rio das Ostras, RJ, Brasil
| | - Alexandre F Miranda
- Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Carla B M Gallo
- Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Bianca M Gregório
- Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Diogo B Souza
- Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Waldemar S Costa
- Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Francisco J B Sampaio
- Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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16
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Matas D, Koren L. Age-related testosterone declines can be detected in men's fingernails. Can J Physiol Pharmacol 2017; 96:76-79. [PMID: 28763621 DOI: 10.1139/cjpp-2017-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Testosterone plays multiple roles in the regulation of development, physiology, reproduction, and behavior. Age-related testosterone declines are expected in the population. However, measuring circulating testosterone is especially challenging because concentrations are labile, responding to social situations and challenges. Matrices that integrate long-term testosterone levels are therefore valuable as biomarkers of endogenous levels as well as chronic exposures. Here, we report on a simple method to extract and measure accumulated testosterone from human fingernails using commercial enzyme immunoassay kits. Furthermore, we demonstrate known human testosterone sex and age trends. Our method is especially useful for quantifying testosterone in men's nails, where a small amount of matrix is required. Thus, this approach is a potential tool for biomonitoring endogenous as well as exogenous testosterone exposure. We suggest considering nails as an alternative matrix for quantifying other steroids as well.
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Affiliation(s)
- Devorah Matas
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Lee Koren
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
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17
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Morales A. Testosterone Replacement in a Man with Intermediate-risk Prostate Cancer. Eur Urol Focus 2017; 3:319-320. [PMID: 28753836 DOI: 10.1016/j.euf.2017.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
In brief, a hypogonadal man with successfully treated localized prostate cancer deserves testosterone therapy (TTh) regardless of grade. The evidence is not conclusive but compelling. The story is different for those with intermediate-risk disease who, for a variety of reasons, need TTh but cannot or elect not to have treatment of their primary malignancy, but still desire androgen supplementation.
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Affiliation(s)
- Alvaro Morales
- Urology Department, Queen's University, Kingston, Canada.
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18
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Corona G, Sforza A, Maggi M. Testosterone Replacement Therapy: Long-Term Safety and Efficacy. World J Mens Health 2017; 35:65-76. [PMID: 28497912 PMCID: PMC5583373 DOI: 10.5534/wjmh.2017.35.2.65] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 12/12/2022] Open
Abstract
Recent position statements and guidelines have raised the distinction between a true and false, age-related hypogonadism (HG) or late-onset hypogonadism (LOH). The former is the consequence of congenital or acquired “organic” damage of the brain centers or of the testis. The latter is mainly secondary to age-related comorbidities and does not require testosterone (T) therapy (TTh). In addition, concerns related to cardiovascular (CV) safety have further increased the scepticism related to TTh. In this paper, we reviewed the available evidence supporting the efficacy of TTh in non-organic HG and its long term safety. A large amount of evidence has documented that sexual symptoms are the most specific correlates of T deficiency. TTh is able to improve all aspects of sexual function independent of the pathogenetic origin of the disease supporting the scientific demonstration that LOH does exist according to an “ex-juvantibus” criterion. Although the presence of metabolic derangements could mitigate the efficacy of TTh on erectile dysfunction, the positive effect of TTh on body composition and insulin sensitivity might counterbalance the lower efficacy. CV safety concerns related to TTh are essentially based on a limited number of observational and randomized controlled trials which present important methodological flaws. When HG is properly diagnosed and TTh correctly performed no CV and prostate risk have been documented.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
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