The Safety of Human Chorionic Gonadotropin Monotherapy Among Men With Previous Exogenous Testosterone Use

Background and objective

Human chorionic gonadotropin (hCG) is homologous to luteinizing hormone (LH) and stimulates endogenous testosterone (T) production. Current American Urological Association (AUA) guidelines recommend hCG for T-deficient men who wish to preserve their fertility. However, there is no data available regarding the long-term efficacy and safety of hCG monotherapy in men with a history of exogenous T use. We hypothesized that transitioning to hCG would be a safe and effective option in this population.

Methodology

We performed a retrospective analysis involving 28 men with previous exogenous T use who were switched to hCG monotherapy and underwent follow-up lab work at least one month later. We evaluated changes in hormones [T, LH, follicle-stimulating hormone (FSH), and estradiol], hematocrit (HCT), glycated hemoglobin (HbA1c), and prostate-specific antigen (PSA).

Results

Among the entire cohort, we found no significant change in mean hormone levels (including T), HbA1c, or PSA. There was a significant (p<0.05) decrease in HCT (45.27 ±4.06 to 44.16 ±3.48%, n=15). No thromboembolic events were reported. Additionally, among men who had their baseline labs completed outside their previous T therapy therapeutic time window prior to starting hCG monotherapy, there was a statistically significant increase in mean T levels (307.36 ±148.74 to 422.11 ±268.15 ng/dL, n=30 and 31, pre- and post-hCG, respectively) and a statistically significant decrease in mean PSA levels (0.91 ±0.35 to 0.69 ±0.23 ng/mL, n=5).

Conclusions

These results suggest that hCG is a safe and effective alternative to traditional T therapy for men with a history of exogenous T use and may lead to an advantageous decrease in HCT. hCG may serve as an alternative form of T therapy with a lower risk for secondary erythrocytosis, and further research is warranted to gain deeper insights into the topic.

Efficacy and Safety of Human Chorionic Gonadotropin Monotherapy for Men With Hypogonadal Symptoms and Normal Testosterone

Background

Male hypogonadism has a prevalence of about 6% and is defined by two-morning testosterone levels below 300 ng/dl associated with symptoms. This definition presents a challenging problem for patients without other medical problems but with symptoms of low testosterone (T) who do not meet the biochemical criteria for therapy.

Objectives

Our objective was to evaluate changes in symptoms and side effects in men with T levels >300ng/dL using human chorionic gonadotropin (hCG) monotherapy for the treatment of hypogonadal symptoms.

Methods

After IRB approval, 31 male patients treated with hCG monotherapy for low T symptoms were retrospectively reviewed. We evaluated changes in hormones, hypogonadal symptoms, and the incidence of thromboembolic events before and after starting hCG.

Results

We found subjective improvement in erectile dysfunction, 86% (19/22), and libido, 80% (20/25), with no patient experiencing a thromboembolic event. In addition, no change was observed in the follicle-stimulating hormone, luteinizing hormone, estradiol, hematocrit, hemoglobin A1c, and prostate-specific antigen.

Conclusion

Weekly treatment with hCG appears safe and can improve hypogonadal symptoms in patients with T >300 ng/dl without changes to hematocrit, prostate-specific antigen, and hemoglobin A1c.

Peyronie's disease in a patient after COVID-19 infection: A case report

Coronavirus disease 2019 (COVID‐19) is an emerging infectious disease caused by a novel coronavirus (SARS‐CoV‐2), which demonstrates the ability to invade endothelial cells and cause systemic inflammation. Many possible long‐term sequelae of COVID‐19 remain unidentified. We describe a case of a man who developed Peyronie's disease after a resolved COVID‐19 infection. Erectile dysfunction was confirmed by the International Index of Erectile Function‐15(IIEF) and Sexual Health Inventory for Men(SHIM) scores. A diagnosis was Peyronie's disease was confirmed on ultrasound. Furthermore, he was found to have low endothelial progenitor cells colony‐forming units and low brachial artery flow‐mediated vasodilation, both of that are indicative of endothelial dysfunction. This case suggests Peyronie's disease should be considered as a possible sequela of COVID‐19 infection and providers should inquire about a history of COVID‐19 infection in patients presenting with Peyronie's disease.

Survey of Microsurgery Training Availability in US Urology Residency Programs

Purpose

The Accreditation Council of Graduate Medical Education (ACGME) establishes surgical minimum numbers of cases for urologic training. Currently there is not a requirement for microsurgery, likely from a belief that programs do not offer exposure. In an effort to evaluate the availability of microsurgery training among urology residency programs we surveyed the programs.

Materials and Methods

We obtained a list of the 138 ACGME-accredited urology residencies and contact information the American Urology Association (AUA). We contacted the residency programs by phone and e-mail. For programs that did not reply, we performed a search of the program website. We answered 3-questions to assess resident subspecialty training in microsurgery and used penile implant and artificial urinary sphincters as a comparison. Data are reported as frequencies.

Results

We obtained data from 134 programs (97.1%). A total of 104 programs (77.6%) had fellowship-trained physicians for training in microsurgery, 86.6% for penile implants, and 88.8% for artificial urinary sphincters. The percentage of fellowship-trained microsurgeons per program did not vary significantly when comparing the different sections of the AUA. The northeast and southeast sections had the lowest percentage (67% and 68%).

Conclusions

Nearly 80% of urology residency programs have a fellowship-trained microsurgeon on faculty, we therefore believe that microsurgery should be added as part of the ACGME minimums. In order to provide an equal exposure to all graduating urology residents, urology residency programs that lack microsurgery should identify potential faculty with fellowship training.

Polymer Pen Lithography with Lipids for Large-Area Gradient Patterns

Gradient patterns comprising bioactive compounds over comparably (in regard to a cell size) large areas are key for many applications in the biomedical sector, in particular, for cell screening assays, guidance, and migration experiments. Polymer pen lithography (PPL) as an inherent highly parallel and large area technique has a great potential to serve in the fabrication of such patterns. We present strategies for the printing of functional phospholipid patterns via PPL that provide tunable feature size and feature density gradients over surface areas of several square millimeters. By controlling the printing parameters, two transfer modes can be achieved. Each of these modes leads to different feature morphologies. By increasing the force applied to the elastomeric pens, which increases the tip-surface contact area and boosts the ink delivery rate, a switch between a dip-pen nanolithography (DPN) and a microcontact printing (μCP) transfer mode can be induced. A careful inking procedure ensuring a homogeneous and not-too-high ink-load on the PPL stamp ensures a membrane-spreading dominated transfer mode, which, used in combination with smooth and hydrophilic substrates, generates features with constant height, independently of the applied force of the pens. Ultimately, this allows us to obtain a gradient of feature sizes over a mm² substrate, all having the same height on the order of that of a biological cellular membrane. These strategies allow the construction of membrane structures by direct transfer of the lipid mixture to the substrate, without requiring previous substrate functionalization, in contrast to other molecular inks, where structure is directly determined by the printing process itself. The patterns are demonstrated to be viable for subsequent protein binding, therefore adding to a flexible feature library when gradients of protein presentation are desired.

Lipid Multilayer Grating Arrays Integrated by Nanointaglio for Vapor Sensing by an Optical Nose

Lipid multilayer gratings are recently invented nanomechanical sensor elements that are capable of transducing molecular binding to fluid lipid multilayers into optical signals in a label free manner due to shape changes in the lipid nanostructures. Here, we show that nanointaglio is suitable for the integration of chemically different lipid multilayer gratings into a sensor array capable of distinguishing vapors by means of an optical nose. Sensor arrays composed of six different lipid formulations are integrated onto a surface and their optical response to three different vapors (water, ethanol and acetone) in air as well as pH under water is monitored as a function of time. Principal component analysis of the array response results in distinct clustering indicating the suitability of the arrays for distinguishing these analytes. Importantly, the nanointaglio process used here is capable of producing lipid gratings out of different materials with sufficiently uniform heights for the fabrication of an optical nose.

Antidepressants recruit new neurons to improve stress response regulation

Recent research suggests an involvement of hippocampal neurogenesis in behavioral effects of antidepressants. However, the precise mechanisms through which newborn granule neurons might influence the antidepressant response remain elusive. Here, we demonstrate that unpredictable chronic mild stress in mice not only reduces hippocampal neurogenesis, but also dampens the relationship between hippocampus and the main stress hormone system, the hypothalamo-pituitary-adrenal (HPA) axis. Moreover, this relationship is restored by treatment with the antidepressant fluoxetine, in a neurogenesis-dependent manner. Specifically, chronic stress severely impairs HPA axis activity, the ability of hippocampus to modulate downstream brain areas involved in the stress response, the sensitivity of the hippocampal granule cell network to novelty/glucocorticoid effects and the hippocampus-dependent negative feedback of the HPA axis. Remarkably, we revealed that, although ablation of hippocampal neurogenesis alone does not impair HPA axis activity, the ability of fluoxetine to restore hippocampal regulation of the HPA axis under chronic stress conditions, occurs only in the presence of an intact neurogenic niche. These findings provide a mechanistic framework for understanding how adult-generated new neurons influence the response to antidepressants. We suggest that newly generated neurons may facilitate stress integration and that, during chronic stress or depression, enhancing neurogenesis enables a dysfunctional hippocampus to restore the central control on stress response systems, then allowing recovery.