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Sansone A, Kliesch S, Dugas M, Sandhowe-Klaverkamp R, Isidori AM, Schlatt S, Zitzmann M. Serum concentrations of dihydrotestosterone are associated with symptoms of hypogonadism in biochemically eugonadal men. J Endocrinol Invest 2021; 44:2465-2474. [PMID: 33811609 PMCID: PMC8502125 DOI: 10.1007/s40618-021-01561-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Symptoms of hypogonadism are often reported by subjects with normal serum testosterone (T) levels. We aimed to assess the association between clinical symptoms in andrological outpatients and sex steroids levels. METHODS This is a retrospective cross-sectional cohort study in an Academic clinic and research unit. International Index of Erectile Function (IIEF, EF domain) and Aging Males Symptoms scale (AMS) questionnaires were completed by 635 and 574 men, respectively (mean age: 47.3 ± 13.9 and 47.4 ± 13.8 years, p = 0.829), free of interfering medications with complaints possibly related to hypogonadism. RESULTS Serum total/free T as well as dihydro-T (DHT) was associated with IIEF-EF and AMS scores in the overall population using univariate analyses. Multivariate approaches revealed DHT concentrations in subjects with normal T levels (n = 416, Total T > 12 nmol/L) to be significant predictors of AMS scores. A 0.1 nmol/l serum DHT increase within the eugonadal range was associated with a 4.67% decrease in odds of having worse symptoms (p = 0.011). In men with biochemical hypogonadism (Total T < 12 nmol/L), total and free T rather than DHT were associated with AMS results. This association was not found for IIEF-EF scores. Indirect effects of age and BMI were seen for relations with hormone concentrations but not questionnaire scores. CONCLUSION DHT can be associated with symptoms of hypogonadism in biochemically eugonadal men. Serum DHT measurement might be helpful once the diagnosis of hypogonadism has been ruled out but should not be routinely included in the primary diagnostic process.
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Affiliation(s)
- A Sansone
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Münster, Germany.
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - S Kliesch
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - R Sandhowe-Klaverkamp
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Münster, Germany
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Schlatt
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Münster, Germany
| | - M Zitzmann
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Münster, Germany
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Sansone A, Sansone M, Selleri R, Schiavo A, Gianfrilli D, Pozza C, Zitzmann M, Lenzi A, Romanelli F. Monitoring testosterone replacement therapy with transdermal gel: when and how? J Endocrinol Invest 2019; 42:1491-1496. [PMID: 31267510 DOI: 10.1007/s40618-019-01082-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Testosterone replacement therapy (TRT) is recommended for the treatment of most cases of male hypogonadism. Transdermal testosterone (T) gels are commonly used in clinical practice; however, there is little evidence concerning how to monitor dosage to bring and maintain serum T levels in the normal physiologic range. METHODS We examined 30 hypogonadal patients undergoing treatment with 40 mg/day transdermal 2% testosterone gel. After a week from treatment onset, all patients underwent a total of four measurements to assess serum total T, bioavailable T and free T at + 2 h (samples A and A') and + 23 h (samples B and B'). RESULTS No significant difference was found concerning total, free and bioavailable T between the two samples taken at the same time points (A vs A' and B vs B'). A repeated-measures mixed effects regression model showed significantly lower serum levels of total, free and bioavailable T at + 23 h compared to + 2 h (total T, β = - 3.050 ± 0.704, p < 0.001; free T, β = - 85.187 ± 22.746, p < 0.001; bioavailable T, β = - 1.519 ± 0.497, p = 0.003) without a significant between-sample variability. Serum T > 3.5 ng/ml at + 2 h was reached in 21/30 patients (70%), but only 11 (36.7%) still had adequate serum T at + 23 h. CONCLUSION Assessment of TRT with transdermal gels at its peak and at its minimum could be useful in providing a finely tailored treatment for hypogonadal men, both preventing supra-physiological levels and maintaining adequate concentrations through the day.
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Affiliation(s)
- A Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy.
- Department of Clinical and Surgical Andrology, Center of Reproductive Medicine and Andrology, University of Münster, Münster, Germany.
| | - M Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - R Selleri
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - A Schiavo
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - C Pozza
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - M Zitzmann
- Department of Clinical and Surgical Andrology, Center of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - A Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - F Romanelli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
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Ragab MW, Cremers JF, Zitzmann M, Nieschlag E, Kliesch S, Rohayem J. A history of undescended testes in young men with Klinefelter syndrome does not reduce the chances for successful microsurgical testicular sperm extraction. Andrology 2018; 6:525-531. [DOI: 10.1111/andr.12503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/28/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. W. Ragab
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
- Department of Clinical and Surgical Andrology; Cairo University; Cairo Egypt
| | - J.-F. Cremers
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - M. Zitzmann
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - E. Nieschlag
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - S. Kliesch
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - J. Rohayem
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
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Heckmann L, Langenstroth-Röwer D, Pock T, Wistuba J, Stukenborg JB, Zitzmann M, Kliesch S, Schlatt S, Neuhaus N. A diagnostic germ cell score for immature testicular tissue at risk of germ cell loss. Hum Reprod 2018; 33:636-645. [DOI: 10.1093/humrep/dey025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- L Heckmann
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - D Langenstroth-Röwer
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - T Pock
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - J Wistuba
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - J -B Stukenborg
- Department of Women's and Children's Health, NORDFERTIL Research Lab Stockholm, Paediatric Endocrinology Unit, Q2:08, Karolinska Institutet and Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - M Zitzmann
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - S Schlatt
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - N Neuhaus
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
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Mousa W, Kliesch S, Sandhowe R, Zitzmann M. HP-03-006 Association between premature ejaculation (PE) and serum sex steroid concentrations. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Zitzmann M, Rohayem J, Raidt J, Kliesch S, Kumar N, Sitruk-Ware R, Nieschlag E. Impact of various progestins with or without transdermal testosterone on gonadotropin levels for non-invasive hormonal male contraception: a randomized clinical trial. Andrology 2017; 5:516-526. [DOI: 10.1111/andr.12328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/05/2016] [Accepted: 12/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M. Zitzmann
- Institute of Reproductive Medicine; University Clinics; Muenster Germany
| | - J. Rohayem
- Institute of Reproductive Medicine; University Clinics; Muenster Germany
| | - J. Raidt
- Institute of Reproductive Medicine; University Clinics; Muenster Germany
| | - S. Kliesch
- Institute of Reproductive Medicine; University Clinics; Muenster Germany
| | - N. Kumar
- Population Council; Rockefeller University; New York NY USA
| | - R. Sitruk-Ware
- Population Council; Rockefeller University; New York NY USA
| | - E. Nieschlag
- Institute of Reproductive Medicine; University Clinics; Muenster Germany
- Center of Excellence in Genomic Medicine Research; King Abdulaziz University; Jeddah Saudi Arabia
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Morgentaler A, Zitzmann M, Traish AM, Fox AW, Jones TH, Maggi M, Arver S, Aversa A, Chan J, Dobs AS, Hackett GI, Hellstrom WJ, Lim P, Lunenfeld B, Mskhalaya G, Schulman CC, Torres LO. The consensus recommendations of a group of international experts on the fundamental concepts related to the issues of testosterone deficiency and its treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.14341/omet2016315-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Conference on the development of the international expert consensus to address frequently asked questions related to a medical condition of testosterone deficiency (TD, male hypogonadism) and testosterone therapy was held in Prague (Czech Republic) on October 1, 2015. The included experts were representatives from a variety of medical specialties, including urology, endocrinology, diabetology, internal medicine, as well as representatives of basic medical sciences. An international team of experts came to the following conclusions: TD - an important medical condition that affects the health and well-being of men; TD symptoms is a consequence of low testosterone levels, regardless of whether background etiology installed; TD consequences are global; care must be taken in an attempt to use any uniform threshold levels of testosterone for a decision on the appointment of testosterone therapy; a person does not have any reason to refrain from appointing testosterone therapy only on the basis of age; the existing evidence does not suggest increasing the prostate cancer or cardiovascular disease risk during testosterone therapy; there is evidence conserning the feasibility of a major research initiative to explore possible cardioprotective beneficial effects of testosterone therapy in men with metabolic disorders, including diabetes.
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Rohayem J, Nieschlag E, Zitzmann M, Kliesch S. Testicular function during puberty and young adulthood in patients with Klinefelter's syndrome with and without spermatozoa in seminal fluid. Andrology 2016; 4:1178-1186. [PMID: 27611179 DOI: 10.1111/andr.12249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 02/05/2023]
Abstract
Patients with Klinefelter's syndrome experience progressive testicular degeneration resulting in impaired endocrine function and azoospermia. What proportion of adolescents develop testosterone deficiency during puberty and how many have spermatozoa in their semen is unclear to date. We aimed to investigate testicular function during puberty and young adulthood in patients with Klinefelter's syndrome and to assess testosterone effects in target tissues. The clinical data of 281 patients with non-mosaic Klinefelter's syndrome aged 10-25 years without previous testosterone replacement were reviewed. In late pubertal adolescents, semen analyses were evaluated, and testicular volumes, hormone and haemoglobin (Hb) levels, the number of CAG repeats and final height data were compared to those of 233 age-matched controls with pubertal gynaecomastia. Spontaneous pubertal virilisation to Tanner stages IV-V occurred. Serum T levels ≥10 nmol/L were reached in 62% of patients with Klinefelter's syndrome and in 85% of controls at ages 15-25 (TKFS : 12.2 ± 5.4 vs. TC : 16.6 ± 7.2 nmol/L). LHKFS levels were elevated >10 U/L in 84%, and normal in all controls (LHKFS : 18.6 ± 12.2 vs. LHC : 3.5 ± 1.6 U/L). In nine of 130 (7%) adolescents with Klinefelter's syndrome, spermatozoa (oligozoospermia) were found in semen; all had T levels >7 nmol/L and eight of nine had LH levels ≤18 U/L, while their hormone levels, number of CAG repeats and testicular volumes were not different from those of adolescents with azoospermia. Controls had normal sperm concentrations in 73% (46/63). Semen volumesKFS were normal in 55% vs. 78% in controls; HbKFS was normal in 89% (HbC : 97%). Mean final heightKFS was 185 ± 8 cm vs. 181 ± 7 cm in controls. Hypergonadotropic hypogonadism develops during early puberty in adolescents with Klinefelter's syndrome and remains compensated in over 60% during ages 15-25, with sufficient testosterone secretion for spontaneous accomplishment of pubertal development. Spermatozoa in semen are rare and associated with T levels >7 nmol/L. Parameters reflecting androgen deficiency in target tissues may help to optimise timing of testosterone substitution, which should preferably not be initiated before fertility status has been clarified.
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Affiliation(s)
- J Rohayem
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - E Nieschlag
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
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9
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Corona G, Giagulli VA, Maseroli E, Vignozzi L, Aversa A, Zitzmann M, Saad F, Mannucci E, Maggi M. Testosterone supplementation and body composition: results from a meta-analysis of observational studies. J Endocrinol Invest 2016; 39:967-81. [PMID: 27241317 DOI: 10.1007/s40618-016-0480-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 05/03/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE The concept of testosterone (T) supplementation (TS) as a new anti-obesity medication in men with testosterone deficiency syndrome (TDS) is emerging. Data from placebo-controlled trials are more conflicting. The aim of this study is to systematically review and meta-analyze available observational and register studies reporting data on body composition in studies on TS in TDS. METHODS An extensive MEDLINE, Embase, and Cochrane search was performed including the following words: "testosterone" and "body composition." All observational studies comparing the effect of TS on body weight and other body composition and metabolic endpoints were considered. RESULTS Out of 824 retrieved articles, 32 were included in the study enrolling 4513 patients (mean age 51.7 ± 6.1 years). TS was associated with a time-dependent reduction in body weight and waist circumference (WC). The estimated weight loss and WC reduction at 24 months were -3.50 [-5.21; -1.80] kg and -6.23 [-7.94; -4.76] cm, respectively. TS was also associated with a significant reduction in fat and with an increase in lean mass as well as with a reduction in fasting glycemia and insulin resistance. In addition, an improvement of lipid profile (reduction in total cholesterol as well as of triglyceride levels and an improvement in HDL cholesterol levels) and in both systolic and diastolic blood pressure was observed. CONCLUSIONS Present data support the view of a positive effect of TS on body composition and on glucose and lipid metabolism. In addition, a significant effect on body weight loss was observed, which should be confirmed by a specifically designed RCT.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, AziendaUsl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - V A Giagulli
- Unit of Metabolic Diseases and Endocrinology, Conversano, Italy
| | - E Maseroli
- Andrology and Sexual Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - L Vignozzi
- Andrology and Sexual Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - A Aversa
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Department of Experimental and Clinical Medicine, University Magna Graecia, Catanzaro, Italy
| | - M Zitzmann
- Centre for Reproductive Medicine and Andrology, Muenster, Germany
| | - F Saad
- Bayer Pharma, Global Medical Affairs Andrology, Berlin, Germany
- Gulf Medical University School of Medicine, Ajman, United Arab Emirates
| | - E Mannucci
- Diabetes Agency, Careggi Hospital, Florence, Italy
| | - M Maggi
- Andrology and Sexual Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Maseroli E, Corona G, Giagulli V, Vignozzi L, Aversa A, Zitzmann M, Saad F, Mannucci E, Maggi M. PS-01-008 Testosterone supplementation and body composition: results from a meta-analysis study. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rohayem J, Sinthofen N, Nieschlag E, Kliesch S, Zitzmann M. Causes of hypogonadotropic hypogonadism predict response to gonadotropin substitution in adults. Andrology 2016; 4:87-94. [DOI: 10.1111/andr.12128] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/01/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Rohayem
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
| | - N. Sinthofen
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
| | - E. Nieschlag
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
- Center of Excellence in Genomic Medicine Research; King Abdulaziz University; Jeddah Saudi Arabia
| | - S. Kliesch
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
| | - M. Zitzmann
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
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12
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Rohayem J, Nieschlag E, Kliesch S, Zitzmann M. Inhibin B, AMH, but not INSL3, IGF1 or DHEAS support differentiation between constitutional delay of growth and puberty and hypogonadotropic hypogonadism. Andrology 2015; 3:882-7. [PMID: 26266675 DOI: 10.1111/andr.12088] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
In pre-pubertal boys ≥ 14 years, the differentiation between constitutional delay of growth and puberty (CDGP) and hypogonadotropic hypogonadism (HH) is challenging, as current diagnostic tools have limitations in sensitivity and specificity. The aim of this study was to assess the usefulness of markers of gonadal activity, growth axis activation and adrenarche in differentiation between pre-pubertal CDGP and HH. This retrospective study was carried out between 2006 and 2015 in an academic out-patient referral centre. The clinical data of 94 boys, aged 13.9-23.2 years and referred for "pubertal delay" were reviewed. Definite diagnoses were established on initial work-up and clinical follow-up: 24 boys were diagnosed with HH, 22 boys with CDGP, pre-pubertal (PP CDGP) at referral and 28 boys with CDGP, early pubertal at referral (EP CDGP), the latter serving as control group. Twenty patients were excluded from evaluation because of previous sex steroid treatment or associated chronic disease. Inhibin B and AMH were measured in all (n = 74); INSL3, IGF1, IGFBP3 and DHEAS in a subset of patients (n = 45) in serum of first presentation. Inhibin B and AMH were higher in boys with PP CDGP than in boys with HH: inhibin B: 87.6 ± 42.5 vs. 19.8 ± 13.9 pg/mL; p < 0.001; AMH: 44.9 ± 27.1 vs. 15.4 ± 8.3 ng/mL; p < 0.001. Receiver operating characteristics (ROC) for the diagnosis of PPCDGP vs. HH (inhibin B ≥ 28.5 pg/mL): sensitivity: 95%, specificity: 75%; AUC: 0.955. In combination with an AMH cut-off ≥20 ng/mL the specificity increased to 83%. INSL3, IGF1, IGFBP3 and DHEAS levels were not different. In boys with EP CDGP, inhibin B and IGF1 levels were highest (138.7 ± 59.9 pg/mL/289.7 ± 117 ng/mL), whereas AMH levels were lowest (11.7 ± 9.1 ng/mL). Sertoli cell markers are helpful for establishing a prognosis, whether a boy with pubertal delay will enter puberty spontaneously, whereas Leydig cell, growth and adrenal markers are not.
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Affiliation(s)
- J Rohayem
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Münster, Germany
| | - E Nieschlag
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Münster, Germany.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S Kliesch
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Münster, Germany
| | - M Zitzmann
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Münster, Germany
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13
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Nordhoff V, Fricke RK, Schüring AN, Zitzmann M, Kliesch S. Treatment strategies for severe oligoasthenoteratozoospermia (OAT) (<0.1 million/mL) patients. Andrology 2015; 3:856-63. [PMID: 26266459 DOI: 10.1111/andr.12077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/27/2015] [Accepted: 06/20/2015] [Indexed: 12/23/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) using spermatozoa from patients with severe oligoasthenoteratozoospermia is still a challenge. Although spermatozoa are available, lower fertilisation rates as well as compromised pregnancy rates are observed after ICSI. We aimed at identifying respective parameters in the pre-values of ejaculate samples used for couple counselling. The clinical pre-values of 121 patients and their corresponding 228 ICSI cycles performed between 2002 and 2010 were retrospectively analysed. Patients were divided into three groups: (i) group 1 (G1, n = 51) where all patients showed at least once <0.1 million/mL and ICSI was performed using ejaculate alone; (ii) group 2 (G2, n = 14) patients had once <0.1 Mill/mL or azoospermia and a testicular biopsy before start of ICSI; (iii) group 3 (G3, n = 56) patients were azoospermic and directed immediately to testicular sperm extraction (TESE). The pre-values of G2 differed significantly from G1 in terms of volume and motility. Lutenizing hormone (LH) and follicle-stimulating hormone (FSH) values were equal in G1 and G2, but showed significant differences in comparison to G3. Testis volume was significantly higher in G3. In the corresponding ICSI cycles, the percentage of cancelled embryo transfers was highest in G3. We did not find any correlations of hormonal markers or sperm pre-values with the success rates of ICSI. In our patient cohort, spermatozoa retrieved either from ejaculate or testicular biopsies have nearly identical chances in achieving pregnancies. Patients in need of TESE before ICSI have significantly lower sperm counts. However, it is not possible to calculate threshold values as indicator for TESE.
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Affiliation(s)
- V Nordhoff
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - R K Fricke
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - A N Schüring
- UKM Kinderwunschzentrum, Department of Gynaecology and Obstetrics, University Hospital of Münster, Münster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
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Rohayem J, Fricke R, Czeloth K, Mallidis C, Wistuba J, Krallmann C, Zitzmann M, Kliesch S. Age and markers of Leydig cell function, but not of Sertoli cell function predict the success of sperm retrieval in adolescents and adults with Klinefelter's syndrome. Andrology 2015; 3:868-75. [PMID: 26235799 DOI: 10.1111/andr.12067] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 04/13/2015] [Accepted: 05/30/2015] [Indexed: 01/31/2023]
Abstract
Microsurgical testicular sperm extraction (mTESE), combined with intracytoplasmic sperm injection (ICSI) represents a chance for azoospermic men with Klinefelter's syndrome (KS) to father children. The objective of this study was to identify predictive factors for the success of mTESE from adolescents and adults with KS. The clinical data of 50 late pubertal adolescents (13-19 years) and 85 adult patients (20-61 years) with non-mosaic KS, who underwent mTESE, were analysed with respect to factors, potentially predictive of active spermatogenesis; specifically a history of cryptorchidism, age, testicular volumes, serum levels of LH, FSH, testosterone (T) and estradiol at the time of surgery. Inhibin B, AMH and INSL3 were additionally analysed in the adolescents. A younger age and a near-compensated Leydig cell function were associated with higher success of sperm retrieval via mTESE: In adolescents ≥15-19 years, spermatozoa were retrieved in 45%, compared to 31% in adults; in adolescents aged 13-14 years, spermatozoa were collected in only 10%. Adolescents with an LH ≤17.5 U/L, along with a T level ≥7.5 nmol/L had the best success rate (54%), which fell to 44% with higher LH, whereas those with low T (<7.5 nmol/L), irrespective of LH had no sperm retrieval. In adults with T levels above and LH below these thresholds, the success rate was 51%, falling to 19%, if LH was higher. When T was lower than threshold, the rate was 17%. No association between testicular volumes, serum levels of FSH, Inhibin B, AMH, estradiol and mTESE success was found. A history of cryptorchidism was associated with lower retrieval rates. A window of opportunity for an approximate 50% chance to retrieve spermatozoa via mTESE exists for young, late pubertal KS patients between age 15 and young adulthood, when Leydig cell function is at its best. In these cases, referral to a centre of expertise should be considered.
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Affiliation(s)
- J Rohayem
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - R Fricke
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - K Czeloth
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - C Mallidis
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Muenster, Muenster, Germany
| | - J Wistuba
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Muenster, Muenster, Germany
| | - C Krallmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
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Zitzmann M, Kliesch S. [Erectile Dysfunction in Diabetic Men - Current Diagnostics and Therapy]. Aktuelle Urol 2015; 46:303-8. [PMID: 26227131 DOI: 10.1055/s-0035-1555797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sexual functional dysfunctions represent a multidimensional nosological entity. Apart from the directly measurable pathophysiological parameters, psychological and dynamic partnership aspects are almost always involved. These can exert a triggering and a potentiating influence. Similarly, sociocultural factors have to be taken into account. In men the problem most frequently has a physiological focus and the main symptom within the complex of sexual difficulties, especially for diabetic patients, is erectile dysfunction. Disorders of ejaculation and orgasm may also occur. Testosterone production in men may be impaired due to obesity-related dysfunctions of the hypothalamic-pituitary-gonadal axis and this can lead to a clinically significant androgen deficit and thus also to a decline of libido.
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Affiliation(s)
- M Zitzmann
- Abteilung für Klinische Andrologie, Universitätsklinikum Münster
| | - S Kliesch
- Abteilung für Klinische Andrologie, Universitätsklinikum Münster
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Busch A, Gromoll J, Kliesch S, Zitzmann M, Tüttelmann F. FSHB -211G>T stratification for FSH treatment of male infertility patients: Making the case for a pharmacogenetic approach. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Damm OS, Warmeling AS, Sandhowe-Klaverkamp R, Werler S, Körner K, Stypmann J, Kuhlmann M, Holtmeier R, Zitzmann M, Tüttelmann F, Gromoll J, Wistuba J. Contrast enhanced ultrasound confirms testicular circulation to be hampered by disturbed vascularization in 41, XXY* mice, a model for Klinefelter syndrome. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tuttelmann F, Damm OS, Luetjens CM, Baldi M, Zitzmann M, Kliesch S, Nieschlag E, Gromoll J, Wistuba J, Simoni M. Intratesticular testosterone is increased in men with Klinefelter syndrome and may not be released into the bloodstream owing to altered testicular vascularization– a preliminary report. Andrology 2014. [PMID: 24574169 DOI: 10.1111/j.2047-927.2014.00190.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Klinefelter syndrome (KS, 47,XXY) is associated with low serum testosterone (T), long thought to arise from disturbed steroidogenesis in Leydig cells. However, intratesticular testosterone (ITT) concentrations were recently found to be normal in a KS mouse model(41,XXY*). So far, nothing was known about ITT concentrations in human patients with KS. Therefore, ITT, sex hormone-binding globulin (SHBG) and histological parameters were measured in human testicular biopsies of 11 KS patients, 30 azoospermic patients with Sertoli-cell-only syndrome and nine men with normal spermatogenesis as controls. ITT concentrations showed an overall pronounced excess over intratesticular SHBG in molar terms and were significantly increased in men with KS despite of reduced serum T levels. While the ratio of ITT/serum T was markedly increased in KS, the ITT/LH-ratio was comparable between all groups. After finding significantly increased ITT levels in men with KS, a finding even more striking than in the 41,XXY* KS mouse model, we set out to find a possible 'vascular' explanation for the lack of T release into the testicular blood stream. In testis biopsies from patients,reliable analysis of the vessels is, however, not possible because of the bias resulting from the dissection technique requiring avoidance of larger blood vessels to prevent bleeding. Consequently, the blood vessel constitution was evaluated in whole testis sections from adult male 41,XXY* and 40,XY*mice (n=5, each). Indeed, the blood vessel/testes surface ratio correcting for the smaller testes of XXY*mice was significantly lower in these mice compared with XY*controls. In conclusion, testicular T production does not seem to be impaired in men with KS. On the contrary, ITT concentrations are increased, but not because of increased SHBG activity. The data from the mouse model let us speculate that a reduced vascular bed might be involved in lower release of T into the blood stream.
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Paradowska-Dogan A, Fernandez A, Bergmann M, Kretzer K, Mallidis C, Vieweg M, Waliszewski P, Zitzmann M, Weidner W, Steger K, Kliesch S. Protamine mRNA ratio in stallion spermatozoa correlates with mare fecundity. Andrology 2014; 2:521-30. [DOI: 10.1111/j.2047-2927.2014.00211.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 01/12/2023]
Affiliation(s)
- A. Paradowska-Dogan
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - A. Fernandez
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
| | - M. Bergmann
- Institute for Veterinary Anatomy, Histology and Embryology; Justus Liebig University of Giessen; Giessen Germany
| | - K. Kretzer
- Institute for Veterinary Anatomy, Histology and Embryology; Justus Liebig University of Giessen; Giessen Germany
| | - C. Mallidis
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
| | - M. Vieweg
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - P. Waliszewski
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - M. Zitzmann
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
| | - W. Weidner
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - K. Steger
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - S. Kliesch
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
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Tüttelmann F, Damm OS, Luetjens CM, Baldi M, Zitzmann M, Kliesch S, Nieschlag E, Gromoll J, Wistuba J, Simoni M. Intratesticular testosterone is increased in men with Klinefelter syndrome and may not be released into the bloodstream owing to altered testicular vascularization - a preliminary report. Andrology 2014; 2:275-81. [DOI: 10.1111/j.2047-2927.2014.00190.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 12/01/2022]
Affiliation(s)
- F. Tüttelmann
- Institute of Human Genetics; University of Münster; Münster Germany
| | - O. S. Damm
- Institute of Reproductive and Regenerative Biology; University of Münster; Münster Germany
| | - C. M. Luetjens
- Institute of Reproductive and Regenerative Biology; University of Münster; Münster Germany
| | - M. Baldi
- Division of Endocrinology and Metabolism; Department of Internal Medicine; University of Turin; Turin Italy
| | - M. Zitzmann
- Department of Clinical Andrology; Centre of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - S. Kliesch
- Department of Clinical Andrology; Centre of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - E. Nieschlag
- Department of Clinical Andrology; Centre of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - J. Gromoll
- Institute of Reproductive and Regenerative Biology; University of Münster; Münster Germany
| | - J. Wistuba
- Institute of Reproductive and Regenerative Biology; University of Münster; Münster Germany
| | - M. Simoni
- Department of Biomedicine, Metabolism and Neural Sciences; Azienda USL di Modena, NOCSAE; University of Modena and Reggio Emilia; Modena Italy
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Rohayem J, Zitzmann M, Kliesch S. Do serum Inhibin B levels allow a discrimination between constitutional delay of growth and puberty (CDGP) and hypogonadotropic hypogonadism (HH) in boys with delayed puberty? Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nordhoff V, Schüring AN, Krallmann C, Zitzmann M, Schlatt S, Kiesel L, Kliesch S. Optimizing TESE-ICSI by laser-assisted selection of immotile spermatozoa and polarization microscopy for selection of oocytes. Andrology 2012; 1:67-74. [DOI: 10.1111/j.2047-2927.2012.00020.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/13/2012] [Accepted: 08/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - A. N. Schüring
- Department of Gynaecology and Obstetrics; University Hospital of Münster; Münster; Germany
| | - C. Krallmann
- Department of Clinical Andrology; Centre of Reproductive Medicine and Andrology; University Hospital of Münster; Münster; Germany
| | - M. Zitzmann
- Department of Clinical Andrology; Centre of Reproductive Medicine and Andrology; University Hospital of Münster; Münster; Germany
| | - S. Schlatt
- Institute of Reproductive and Regenerative Biology; Centre of Reproductive Medicine and Andrology; University Hospital of Münster; Münster; Germany
| | - L. Kiesel
- Department of Gynaecology and Obstetrics; University Hospital of Münster; Münster; Germany
| | - S. Kliesch
- Department of Clinical Andrology; Centre of Reproductive Medicine and Andrology; University Hospital of Münster; Münster; Germany
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Saad F, Haider A, Yassin A, Gooren L, Zitzmann M, Nieschlag E. 3 CONTINUOUS IMPROVEMENTS OF THE METABOLIC SYNDROME UNDER TESTOSTERONE TREATMENT OVER 48 MONTHS IN THREE COHORTS, IN TOTAL 410 MEN. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zitzmann M. Hormonelle Kontrazeption beim Mann. Gynäkologische Endokrinologie 2012. [DOI: 10.1007/s10304-011-0447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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25
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Schüring AN, Welp A, Gromoll J, Zitzmann M, Sonntag B, Nieschlag E, Greb RR, Kiesel L. Role of the CAG repeat polymorphism of the androgen receptor gene in polycystic ovary syndrome (PCOS). Exp Clin Endocrinol Diabetes 2011; 120:73-9. [PMID: 22068615 DOI: 10.1055/s-0031-1291343] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a frequent heterogenic disorder with a familial background. Androgenic effects, determining the clinical features of the syndrome, are mediated by the androgen receptor (AR), whose activity is modulated by a genetic polymorphism. We investigated the role of the CAG repeat polymorphism of the androgen receptor in PCOS. METHODS In the infertility unit of a university clinic, 72 PCOS patients were compared with 179 ovulatory controls undergoing a standardized diagnostic work-up. The number of CAG repeats was determined by PCR, labelling with IR-800 and PAGE. X-chromosome inactivation was assessed by a methylation-sensitive assay. RESULTS Compared to controls, PCOS patients displayed a shorter mean CAG repeat length, encoding for higher AR activity (P=0.001). CAG repeat length correlated inversely with oligomenorrhea, a central androgen dependent feature of the syndrome (P=0.005). In a binomial regression analysis including BMI, LH and free testosterone, CAG repeat length was identified as an independent risk factor for PCOS (P=0.002). CONCLUSIONS The CAG repeat polymorphism could constitute one of the genetic factors modulating the syndrome's phenotype, contributing to its clinical heterogeneity and associated metabolic consequences.
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Affiliation(s)
- A N Schüring
- Department of Obstetrics and Gynecology, Münster University Hospital, Münster, Germany.
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Nieschlag E, Vorona E, Wenk M, Hemker AK, Kamischke A, Zitzmann M. Hormonal male contraception in men with normal and subnormal semen parameters. ACTA ACUST UNITED AC 2011; 34:556-67. [DOI: 10.1111/j.1365-2605.2011.01142.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zitzmann M. 25 Testosterone in the aging male – Is it safe or do we have to worry? Journal of Men's Health 2011. [DOI: 10.1016/s1875-6867(11)60058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dul EC, van Ravenswaaij-Arts CMA, Groen H, van Echten-Arends J, Land JA, Tyulenev Y, Naumenko V, Kurilo L, Shileiko L, Segal A, Klimova R, Kushch A, Ribas-Maynou J, Garcia-Peiro A, Abad C, Amengual MJ, Benet J, Navarro J, Colasante A, Lobascio AM, Scarselli F, Minasi MG, Alviggi E, Rubino P, Casciani V, Pena R, Varricchio MT, Litwicka K, Ferrero S, Zavaglia D, Franco G, Nagy ZP, Greco E, Romany L, Meseguer M, Garcia-Herrero S, Pellicer A, Garrido N, Dam A, Pijnenburg A, Hendriks JC, Westphal JR, Ramos L, Kremer JAM, Eertmans F, Bogaert V, Puype B, Geisler W, Clusmann C, Klopsch I, Strowitzki T, Eggert-Kruse W, Maettner R, Isachenko E, Isachenko V, Strehler E, Sterzik K, Band G, Madgar I, Brietbart H, Naor Z, Cunha-Filho JS, Souza CA, Krebs VG, Santos KD, Koff WJ, Stein A, Hammoud I, Albert M, Bergere M, Bailly M, Boitrelle F, Vialard F, Wainer R, Izard V, Selva J, Cohen - Bacrie P, Belloc S, de mouzon J, Cohen-Bacrie M, Alvarez S, Junca AM, Dumont M, Douard S, Prisant N, Tomita K, Hashimoto S, Akamatsu Y, Satoh M, Mori R, Inoue T, Ohnishi Y, Ito K, Nakaoka Y, Morimoto Y, Smith VJH, Ahuja KK, Atig F, Raffa M, Sfar MT, Saad A, Ajina M, Braga DPAF, Halpern G, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Medeiros GS, Borges Jr. E, Pasqualotto EB, Pasqualotto FF, Nadalini M, Tarozzi N, Di Santo M, Borini A, Lopez-Fernandez C, Arroyo F, Caballero P, Nunez-Calonge R, Fernandez JL, Gosalvez J, Gosalvez J, Lopez-Fernandez C, Gosalbez A, Cortes S, Caballero P, Nunez-Calonge R, Zikopoulos K, Lazaros L, Vartholomatos G, Kaponis A, Makrydimas G, Plachouras N, Sofikitis N, Kalantaridou S, Hatzi E, Georgiou I, Belloc S, de Mouzon J, Cohen-Bacrie M, Junca AM, Dumont M, Amar E, Cohen-Bacrie P, Vuillaume ML, Brugnon F, Artonne C, Janny L, Pons-Rejraji H, Fedder J, Bosco L, Ruvolo G, Bruccoleri AM, Manno M, Roccheri MC, Cittadini E, Bochev I, Gavrilov P, Kyurkchiev S, Shterev A, Carlomagno G, Colone M, Condorelli RA, Stringaro A, Calogero AE, Zakova J, Kralikova M, Crha I, Ventruba P, Melounova J, Matejovicova M, Vodova M, Lousova E, Sanchez Toledo M, Alvarez LLeo C, Garcia Garrido C, Resta Serra M, Belmonte Andujar LL, Gonzalez de Merlo G, Crha I, Zakova J, Ventruba P, Lousova E, Pohanka M, Huser M, Amiri I, Karimi J, Goodarzi MT, Tavilani H, Filannino A, Magli MC, Boudjema E, Crippa A, Ferraretti AP, Gianaroli L, Robles F, Magli MC, Crippa A, Filannino A, Ferraretti AP, Gianaroli L, Huang H, Yao DJ, Huang HJ, Li JR, Fan SK, Wang ML, Yung-Kuei S, Amer S, Mahran A, Darne J, Shaw R, Boudjema E, Magli MC, Borghi E, Cetera C, Ferraretti AP, Gianaroli L, Shukla U, Ogutu D, Deval B, Jansa M, Savvas M, Narvekar N, Houska P, Dackland AL, Bjorndahl L, Kvist U, Crippa A, Magli MC, Muzii L, Barboni B, Ferraretti AP, Gianaroli L, Samanta L, Kar S, Yakovenko SA, Troshina MN, Rutman BK, Dyakonov SA, Holmes E, Bjorndahl L, Kvist U, Feijo C, Verza Junior S, Esteves SC, Berta CL, Caille AM, Ghersevich SA, Zumoffen C, Munuce MJ, San Celestino M, Agudo D, Alonso M, Sanjurjo P, Becerra D, Bronet F, Garcia-Velasco JA, Pacheco A, Lafuente R, Lopez G, Checa MA, Carreras R, Brassesco M, Oneta M, Savasi V, Parrilla B, Guarneri D, Laureti A, Pagano F, Cetin I, Ekwurtzel E, Bjorndahl L, Kvist U, Morgante G, Piomboni P, Stendardi A, Serafini F, De Leo V, Focarelli R, Dumont M, Belloc S, Junca AM, Benkhalifa M, Cohen-Bacrie M, De Mouzon J, Entezami F, Cohen-Bacrie P, Junca A, Belloc S, Dumont M, Cohen-Bacrie M, Benkhalifa M, De Mouzon JJ, Entezami F, Cohen-Bacrie P, Mangiarini A, Capitanio E, Paffoni A, Restelli L, Guarneri C, Scarduelli C, Ragni G, Harrison K, Irving J, Martin N, Sherrin D, Yazdani A, Almeida C, Correia S, Rocha E, Alves A, Cunha M, Ferraz L, Silva S, Sousa M, Barros A, Perdrix A, Travers A, Milazzo JP, Clatot F, Mousset-Simeon N, Mace B, Rives N, Clarke HS, Callow A, Saxton D, Pacey AA, Sapir O, Oron G, Ben-Haroush A, Garor R, Feldberg D, Pinkas H, Stein A, Wertheimer A, Fisch B, Palacios E, Gonzalvo MC, Clavero A, Ramirez JP, Rosales A, Mozas J, Bjorndahl L, Castilla JA, Mugica J, Ramon O, Valdivia A, Exposito A, Casis L, Matorras R, Bongers R, Gottardo F, Zitzmann M, Kliesch S, Cordes T, Kamischke A, Schultze-Mosgau A, Buendgen N, Diedrich K, Griesinger G, Crisol L, Aspichueta F, Exposito A, Hernandez ML, Ruiz-Sanz JI, Mendoza R, Matorras R, Sanchez-Tusie AA, Bermudez A, Lopez P, Churchill GC, Trevino CL, Maldonado I, Dabbah J. POSTER VIEWING SESSION - ANDROLOGY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Flöel A, Ruscheweyh R, Krüger K, Willemer C, Winter B, Völker K, Lohmann H, Zitzmann M, Mooren F, Breitenstein C, Knecht S. Physical activity and memory functions: Are neurotrophins and cerebral gray matter volume the missing link? Neuroimage 2010; 49:2756-63. [PMID: 19853041 DOI: 10.1016/j.neuroimage.2009.10.043] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 10/01/2009] [Accepted: 10/14/2009] [Indexed: 12/11/2022] Open
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Zitzmann M. TREATMENT OPTIONS FOR TESTOSTERONE DEFICIENCY. Maturitas 2009. [DOI: 10.1016/s0378-5122(09)70028-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kornmann B, Nieschlag E, Zitzmann M, Gromoll J, Simoni M, Von Eckardstein S. Body Fat Content and Testosterone Pharmacokinetics Determine Gonadotropin Suppression After Intramuscular Injections of Testosterone Preparations in Normal Men. ACTA ACUST UNITED AC 2009; 30:602-13. [DOI: 10.2164/jandrol.108.006296] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Shabsigh R, Arver S, Channer KS, Eardley I, Fabbri A, Gooren L, Heufelder A, Jones H, Meryn S, Zitzmann M. The triad of erectile dysfunction, hypogonadism and the metabolic syndrome. Int J Clin Pract 2008; 62:791-8. [PMID: 18266714 PMCID: PMC2327081 DOI: 10.1111/j.1742-1241.2008.01696.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM To identify the relationship of erectile dysfunction, hypogonadism and the metabolic syndrome in the context of men's health. METHODS An Expert Panel Meeting was held in December 2006 in Vienna, Austria. In addition a comprehensive literature search was conducted. RESULTS Men have a higher incidence of cardiovascular events than women of similar ages which has led to the belief that testosterone is a risk factor for cardiovascular disease in men. The latter hypothesis is no longer tenable. On the contrary, low testosterone levels are associated with (visceral) obesity, the metabolic syndrome, diabetes mellitus, cardiovascular disease and erectile dysfunction (ED). Testosterone therapy does not lead to an increased incidence of cardiovascular disease or events such as myocardial infarction, stroke or angina. Until recently (visceral) obesity, the metabolic syndrome, diabetes mellitus, cardiovascular disease and ED were viewed as more or less independent entities affecting the ageing male. It was not recognised that hypogonadism is a common denominator. With a more integrative approach to the health situation of middle-aged and elderly men, these conditions appear closely interrelated in their manifestations, hypothetically in their aetiology, diagnostic strategy and also their treatment. CONCLUSION Improving sexual health is a portal to identify health hazards and improving men's health. Appropriate diagnosis and medical work up of men presenting with sexual symptoms may have the benefit of the diagnosing and treating other important conditions, such as obesity, diabetes, hypertension and hyperlipidaemia.
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Affiliation(s)
- R Shabsigh
- Division of Urology, Maimonides Medical Center, Columbia University, Brooklyn, NY 11219, USA.
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Zitzmann M. [Therapy of male hypogonadism]. Internist (Berl) 2008; 49:559-60, 562-4, 566-9. [PMID: 18351310 DOI: 10.1007/s00108-008-2108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
One of the most frequent, but also most undiagnosed, endocrinopathies is male hypogonadism (testosterone deficiency). Understanding the variety of clinical pictures male hypogonadism exhibits is pivotal for diagnosis and putative treatment. There can be disturbances of mood and cognitive abilities as well as sexual functions. Further on, a decrease in muscle mass and strength, an accumulation of body fat and osteopenia/osteoporosis as well as anemia might be observed. There are indications that insulin sensitivity is mitigated in a state of androgen depletion, especially due to an inverse association of testosterone to the metabolic syndrome. In older men, symptoms of androgen deficiency may feature a differential profile due to accompanying co-morbidities. Restoring serum testosterone levels by substitution therapy can markedly attenuate, if not relieve, the clinical picture of hypogonadism. New treatment modalities have been introduced, including short-acting transdermal as well as long-acting depot preparations. Herewith, the diagnostic pathways to describe or exclude male hypogonadism and as well as various options of initiation and surveillance of testosterone substitution therapy are elucidated. Future perspectives of andrology regarding metabolic and pharmacogenetic aspects are discussed.
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Affiliation(s)
- M Zitzmann
- WHO Collaborating Center for Male Reproduction, Institut für Reproduktionsmedizin der Universitätskliniken Münster, Domagkstrasse 11, 48149, Münster, Deutschland.
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Shabsigh R, Arver S, Channer KS, Eardley I, Fabbri A, Gooren L, Heufelder A, Jones H, Meryn S, Zitzmann M. Sexual health as a portal to men's health: a problem turned around into an opportunity. Int J Clin Pract 2008; 62:179-81. [PMID: 18199276 PMCID: PMC2327223 DOI: 10.1111/j.1742-1241.2007.01657.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pfleiderer B, Kreifels A, Zitzmann M, Sehlmeyer C, Jansen A, Heindel W. Geschlechtsspezifische Hirnaktivierung und Einfluss von Hormonen beim Einspeichern von verbalisierbaren Informationen – eine fMRT-Studie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schneider G, Nienhaus K, Heuft G, Zitzmann M. Testosteron, genetisch determinierte Androgenrezeptorfunktionalität und psychische Störungen bei über 49jährigen Patienten einer psychosomatischen und einer andrologischen Ambulanz im Vergleich zu gesunden Kontrollpersonen. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Morales A, Nieschlag E, Schubert M, Yassin AA, Zitzmann M, Oettel M. Clinical experience with the new long-acting injectable testosterone undecanoate. Report on the educational symposium on the occasion of the 5th World Congress on the Aging Male, 9-12 February 2006, Salzburg, Austria. Aging Male 2006; 9:221-7. [PMID: 17178558 DOI: 10.1080/13685530601063689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This symposium report summarizes first extensive clinical findings with injectable testosterone undecanoate (Nebido) in hypogonadal patients showing clinical symptoms of androgen deficiency with or without erectile dysfunction (ED). This new testosterone formulation (1000 mg testosterone undecanoate in 4 ml castor oil) possesses nearly ideal long-term kinetics, i.e. sustained close mimicking of eugonadal testosterone serum levels without supra- or sub-physiological serum concentrations. The generally accepted administration scheme recommends the second injection 6 weeks after the first one followed by further injections every 12 weeks. Applying this regimen, administration intervals are drastically reduced in comparison to conventional i.m. testosterone preparations (e.g. about 16 injections of testosterone enanthate vs. 4-5 injections of testosterone undecanoate per year). Depending on the testosterone serum levels, individualized therapy is possible by shortening (every 10 weeks) or prolonging (every 14 weeks) the injection intervals. In hypogonadal patients with ED 58% respond to testosterone undecanoate alone. Best results are seen in diabetic hypogonadal patients. The regimen of injectable testosterone undecanoate administration ideally fits recommendations regarding pharmacokinetics, efficacy and safety monitoring.
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Affiliation(s)
- A Morales
- Centre for Urological Research, Queen's University, Kingston, Canada
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Affiliation(s)
- M Zitzmann
- Institute for Reproductive Medicine, Münster, Germany
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Brady BM, Amory JK, Perheentupa A, Zitzmann M, Hay CJ, Apter D, Anderson RA, Bremner WJ, Pollanen P, Nieschlag E, Wu FCW, Kersemaekers WM. A multicentre study investigating subcutaneous etonogestrel implants with injectable testosterone decanoate as a potential long-acting male contraceptive. Hum Reprod 2005; 21:285-94. [PMID: 16172147 DOI: 10.1093/humrep/dei300] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The combination of etonogestrel implants with injectable testosterone decanoate was investigated as a potential male contraceptive. METHODS One hundred and thirty subjects were randomly assigned to three treatment groups, all receiving two etonogestrel rods (204 mg etonogestrel) and 400 mg testosterone decanoate either every 4 weeks (group I, n = 42), or every 6 weeks (group II, n = 51) or 600 mg testosterone decanoate every 6 weeks (group III, n = 37) for a treatment period of 48 weeks. RESULTS One hundred and ten men completed 48 weeks of treatment. Sperm concentrations of <1 x 10(6)/ml were achieved in 90% (group I), 82% (group II) and 89% (group III) of subjects by week 24. Suppression was slower in group II, which also demonstrated more frequent escape from gonadotrophin suppression than groups I and III. Peak testosterone concentrations remained in the normal range throughout in all groups. Mean trough testosterone concentrations were initially subphysiological but increased into the normal range during treatment. Mean haemoglobin levels increased in group I, and a non-significant increase in weight and decline in high-density lipoprotein cholesterol was observed in all groups. Fourteen subjects discontinued treatment due to adverse events. CONCLUSIONS Subcutaneous etonogestrel implants in combination with injectable testosterone decanoate resulted in profound suppression of spermatogenesis that could be maintained for up to 1 year. Efficacy of suppression was less in group II, probably due to inadequate testosterone dosage. This combination has potential as a long-acting male hormonal contraceptive.
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Affiliation(s)
- B M Brady
- Centre for Reproductive Biology, University of Edinburgh, Edinburgh EH16 4TJ, UK.
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Zitzmann M, Ezgimen H, Nieschlag E. Confounders of fertility induction in 83 men with secondary hypogonadism. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-862840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lanfranco F, Zitzmann M, Simoni M, Nieschlag E. Hypogonadal men have higher plasma adiponectin levels than eugonadal men: Effects of testosterone replacement therapy. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zitzmann M, Lanfranco F, Simoni M, Nieschlag E. The relation of adiponectin (APN) to androgen activity in healthy men involves a pivotal role of sex hormone binding globulin (SHBG) and the CAG repeat polymorphism of the androgen receptor gene. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
The definition of late-onset-hypogonadism as a hybrid form of primary and secondary hypogonadism corresponds to pathophysiological facts of the age-related decline in gonadal as well as hypothalamic-pituitary functions, eventually manifesting in clinically relevant hypogonadism. To what extent advancing age modulates incidence and nature of hypogonadal symptoms has not been completely investigated. The benefits of testosterone substitution therapy in older men await demonstration in long-term studies and to date, it should be restricted to specialized centers. Currently, serum testosterone levels <12 nmol/l, accompanied by symptoms of androgen deficiency, are regarded as an indication for substitution, provided a prostate carcinoma has been excluded. While late-onset hypogonadism decreases libido, it does not play a direct role in the increasing incidence of erectile dysfunction with advancing age; this symptom is rather associated with vessel-endothelial impairment and may serve as a sentinel symptom for cardiovascular disease. Treatment with phosphodiesterase-5-inhibitors can be regarded as standard; in case of concomitant late-onset hypogonadism, testosterone will have a positive synergistic effect on erectile function.
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Affiliation(s)
- M Zitzmann
- Institut für Reproduktionsmedizin, Westfälische Wilhelms-Universität Münster
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Abstract
Hypogonadism in men is associated with decreased physical performance. This phenomenon depends on significantly measurable adverse traits in body composition, namely increased body fat content and reduced muscle mass. Physical abilities in hypogonadal men are further hampered by lower oxygen supply due to decreased hemoglobin concentrations and by poor glucose utilization. In addition, dysthymia and lack of necessary aggressiveness contribute to further deterioration of physical features. T substitution can improve lipid and insulin metabolism, resuiting in changes of body composition, such as decreasing fat depots. Growth of muscle fibers can also be observed. Stabilization of the musculo-skeletal system by increased bone density will further contribute to increased physical fitness, reflected by increased strength and endurance. Treatment outcome is strongly influenced by age and training. The issues reviewed strongly support T treatment of hypogonadal men accompanied by regular monitoring.
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Affiliation(s)
- M Zitzmann
- Institute of Reproductive Medicine, University of Münster, Münster, Germany
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Affiliation(s)
- M Zitzmann
- Institute of Reproductive Medicine, University of Münster, Münster, Germany
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Zitzmann M, Nieschlag E. Review about "Androgen-induced vasorelaxation: a potential vascular protective effect" by M. Perusquía--Exp Clin Endocrinol Diabetes 2003; 111: 55-59. Exp Clin Endocrinol Diabetes 2003; 111:232-3. [PMID: 12845563 DOI: 10.1055/s-2003-40469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yeung CH, Anapolski M, Depenbusch M, Zitzmann M, Cooper TG. Human sperm volume regulation. Response to physiological changes in osmolality, channel blockers and potential sperm osmolytes. Hum Reprod 2003; 18:1029-36. [PMID: 12721181 DOI: 10.1093/humrep/deg204] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Volume regulation is an important sperm function because defective sperm cannot negotiate the female tract in an infertile mouse model and swollen human sperm cannot penetrate and migrate through mucus. METHODS AND RESULTS The size of sperm from 52 donor ejaculates incubated in medium of female tract fluid osmolality (BWW290) was measured by flow cytometry to be identical to that in homologous semen osmolality (289-351 mosmol/kg), indicating effective volume regulation. Inhibition of anticipated regulatory volume decrease in BWW290 by the channel blocker quinine induced size increases and associated kinematic changes measured by computer-aided sperm analysis. Incubation in L-carnitine, myo-inositol and taurine did not change sperm volume or kinematics, but the presence of glutamate and K(+) decreased the efficiency of forward progression indicative of volume increase, suggesting them as potential osmolytes for human sperm. Linear regression suggested correlations of changes in cell volume and in kinematic parameters, and the association of faster forward progressive sperm with smaller cell size. CONCLUSIONS Sperm volume and its regulation may be crucial to natural fertility. The identification of sperm osmolytes, ion channels and mechanisms involved would contribute to the understanding of male infertility and offer a lead for male contraception.
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Affiliation(s)
- C H Yeung
- Institute of Reproductive Medicine of the University, Domagkstrasse 11, D-48129 Münster, Germany.
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Zitzmann M, Gromoll J, von Eckardstein A, Nieschlag E. The CAG repeat polymorphism in the androgen receptor gene modulates body fat mass and serum concentrations of leptin and insulin in men. Diabetologia 2003; 46:31-9. [PMID: 12637980 DOI: 10.1007/s00125-002-0980-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2002] [Revised: 08/21/2002] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS The relationship of androgens to the metabolic syndrome has not been resolved. The polymorphic number of CAG repeats within the androgen receptor gene is inversely associated with the transcriptional activity of target genes. This polymorphism might thus influence testosterone effects on body fat content and serum concentrations of leptin and insulin. The direct and indirect role of androgens within the metabolic syndrome should become clearer if this genetically determined effector is taken into account. METHODS The hypothesis was investigated in a cross-sectional study involving 106 healthy 20-50 year old males. RESULTS Multiple regression models showed a positive independent correlation of the CAG repeat number with body fat content, leptin and insulin (partial r=0.39, 0.36 and 0.28, p<0.001, p<0.001 and p=0.006, respectively). Factor analysis yielded a five-dimensional model: two dimensions were influenced by the androgen receptor polymorphism, namely "body composition" which consisted of leptin, body fat mass, insulin, the number of CAG repeats (positive loadings) and physical activity (negative loading), and "lipid profile" which comprised low density lipoprotein cholesterol, cigarette smoking, triglycerides (positive loadings) as well as high density lipoprotein cholesterol and number of CAG repeats (negative loadings). CONCLUSIONS/INTERPRETATION A low number of CAG repeats were independently associated with protective parameters (low body fat mass and plasma insulin) as well as with adverse parameters (low high density lipoprotein cholesterol concentrations). This suggests that the pivotal role of this polymorphism in modulating androgen effects on cardiovascular risk factors is of a complex nature and implies that its clinical impact, similar to that of androgens, is dependent on exogenous cofactors.
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Affiliation(s)
- M Zitzmann
- Institute of Reproductive Medicine of the University, Münster, Germany
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Abstract
Monitoring bone density (BMD) in hypogonadal and testosterone (T) substituted men is a major component of andrological therapy and is performed by methods that are cost-intensive and use radiation, such as quantitative computer tomography (QCT). Therefore, we assessed the feasibility of a more practical and inexpensive approach through application of phalangeal quantitative ultrasound (pQUS; IGEA DBM BP Sonic 1200, Sensweiler, Germany) in a cross-sectional study of 521 men, aged 18-91 years (224 healthy controls, 156 newly diagnosed hypogonadal, and 141 T substituted men). The method was compared with QCT of the lumbar spine in the first 80 patients. We evaluated longitudinal changes of amplitude-dependent speed-of-sound (AdSoS) in 54 hypogonadal men from the beginning of T substitution. AdSoS decreased with age (p < 0.0001) and with declining total T concentration, with a four to fivefold larger reduction in AdSoS for each nanomole-per-liter decrement in total T in the hypogonadal range (<12 nmol/L) compared with the eugonadal range (p < 0.0001). AdSoS was higher in eugonadal and substituted men than in hypogonadal patients (p < 0.0001, by analysis of covariance [ANCOVA]). Substituted men <50 years of age showed lower AdSoS than eugonadal men (p = 0.004) and untreated men with secondary hypogonadism had lower values than men with primary hypogonadism (p = 0.005). Therapeutic effects were seen regardless of age, diagnosis, or T substitution modality. In the longitudinal approach, AdSoS increased from 1986 +/- 93 to 2035 +/- 77 m/sec over 237 +/- 57 days with the highest gain in those men with initially the lowest values (p < 0.0001, by ANCOVA for repeated measurements). In comparison to QCT, patients with a lumbar content of hydroxylapatite of <100 mg/cm(3) were reliably identified by pQUS (cutoff level 1965 m/sec, T score -3.5 based on eugonadal subjects; receiver operating characteristics: area under the curve [AUC] 0.94, sensitivity 94.1, specificity 92%, p < 0.0001), but specific values of lumbar BMD could not be predicted by pQUS. pQUS represents a feasible, sensitive, and inexpensive method for assessing bone tissue in hypogonadal men over the full age range and also for monitoring the effects of T substitution.
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Affiliation(s)
- M Zitzmann
- Institute of Reproductive Medicine, Münster, Germany
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