Safety and Efficacy of Testosterone Therapy on Musculoskeletal Health and Clinical Outcomes in Men: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Synthetic androgens for male contraception

High global rates of unintended pregnancy (>40% of all pregnancies) are relatively stagnant despite a broad array of female contraceptive options. Data suggest many men are enthusiastic to utilize novel, reversible, male contraceptives, particularly those that may be administered orally. Hormonal male contraception utilizes androgens or androgen-progestin combinations to exploit endocrine negative feedback, interrupting the hypothalamic-pituitary-testicular axis to suppress spermatogenesis. Modifications of testosterone allow for tailoring of steroid activity and show promise as single agent hormonal male contraceptives. The addition of progestin activity by molecular modification of testosterone could enhance the degree and speed of sperm suppression compared to testosterone alone using a single, exogenous steroid. Moreover, modifications that block reduction of testosterone to dihydrotestosterone could diminish androgenic stimulation of prostate tissue. This review summarizes data in the development of modified androgens for male hormonal contraception and suggest a path forward for these molecules in helping to fill the gap in contraceptive technologies for men.

Predictive model for sarcopenia in chronic kidney disease: a nomogram and machine learning approach using CHARLS data

Background

Sarcopenia frequently occurs as a complication among individuals with chronic kidney disease (CKD), contributing to poorer clinical outcomes. This research aimed to create and assess a predictive model for the risk of sarcopenia in CKD patients, utilizing data obtained from the China Health and Retirement Longitudinal Study (CHARLS).

Methods

Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS 2019) criteria, including low muscle strength, reduced physical performance, and low muscle mass. The 2015 CHARLS data were split randomly into a training set (70%) and a testing set (30%). Forty-nine variables encompassing socio-demographic, behavioral, health status, and biochemical factors were analyzed. LASSO regression identified the most relevant predictors, and a logistic regression model was used to explore factors associated with sarcopenia. A nomogram was developed for risk prediction. Model accuracy was evaluated using calibration curves, while predictive performance was assessed through receiver operating characteristic (ROC) and decision curve analysis (DCA). Four machine learning algorithms were utilized, with the optimal model undergoing hyperparameter optimization to evaluate the significance of predictive factors.

Results

A total of 1,092 CKD patients were included, with 231 (21.2%) diagnosed with sarcopenia. Multivariate logistic regression revealed that age, waist circumference, LDL-C, HDL-C, triglycerides, and diastolic blood pressure are significant predictors. These factors were used to construct the nomogram. The predictive model achieved an AUC of 0.886 (95% CI: 0.858-0.912) in the training set and 0.859 (95% CI: 0.811-0.908) in the validation set. Calibration curves showed good agreement between predicted and actual outcomes. ROC and DCA analyses confirmed the model's strong predictive performance. The Gradient Boosting Machine (GBM) outperformed other machine learning models. Applying Bayesian optimization to the GBM achieved an AUC of 0.933 (95% CI: 0.913-0.953) on the training set and 0.932 (95% CI: 0.905-0.960) on the validation set. SHAP values identified age and waist circumference as the most influential factors.

Conclusion

The nomogram provides a reliable tool for predicting sarcopenia in CKD patients. The GBM model exhibits strong predictive accuracy, positioning it as a valuable tool for clinical risk assessment and management of sarcopenia in this population.

Testosterone therapy for functional hypogonadism in middle-aged and elderly males: current evidence and future perspectives

Population aging is a global phenomenon driving research focus toward preventing and managing age-related disorders. Functional hypogonadism (FH) has been defined as the combination of low testosterone levels, typically serum total testosterone below 300-350 ng/dL, together with manifestations of hypogonadism, in the absence of an intrinsic pathology of the hypothalamic-pituitary-testicular (HPT) axis. It is usually seen in middle-aged or elderly males as a product of aging and multimorbidity. This age-related decline in testosterone levels has been associated with numerous adverse outcomes. Testosterone therapy (TTh) is the mainstay of treatment for organic hypogonadism with an identifiable intrinsic pathology of the HPT axis. Current guidelines generally make weak recommendations for TTh in patients with FH, mostly in the presence of sexual dysfunction. Concerns about long-term safety have historically limited TTh use in middle-aged and elderly males with FH. However, recent randomized controlled trials and meta-analyses have demonstrated safe long-term outcomes regarding prostatic and cardiovascular health, together with decreases in all-cause mortality and improvements in various domains, including sexual function, body composition, physical strength, bone density, and hematopoiesis. Furthermore, there are numerous insightful studies suggesting additional benefits of TTh, for instance in cardio-renal-metabolic conditions. Specifically, future trials should investigate the role of TTh in improving symptoms and prognosis in various clinical contexts, including sarcopenia, frailty, dyslipidemia, arterial hypertension, diabetes mellitus, fracture risk, heart failure, stable angina, chronic kidney disease, mood disorders, and cognitive dysfunction.

Biomarkers of frailty

Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.

Insufficient Bone Mineralization to Sustain Mechanical Load of Weight in Obese Boys: A Cross-Sectional Study

CONTEXT

The increase in bone mineral content (BMC) and density (BMD) measured by dual-energy x-ray absorptiometry (DXA) in obese children may not sustain the mechanical load associated with weight, and the factors influencing bone mineralization are not well known.

OBJECTIVE

We described bone mineralization in boys with overweight/obesity and leanness in relation to body composition.

METHODS

Cross-sectional study in the Pediatric Endocrinology Unit of Angers University Hospital with 249 overweight/obese boys aged 8-18 who underwent DXA and insulin, testosterone, and IGF-1 measurements. Bone mineralization was compared with data from 301 lean boys of similar age and height from NHANES 2011-2015, using the same DXA model. Path analyses were performed to evaluate factors associated with total body less head (TBLH) BMC.

RESULTS

The mean age- and height-adjusted difference in TBLH BMC between obese and lean boys was 241 ± 20 g/cm2. Each 1 kg/m2 increase in BMI was associated with +39 ± 6 g of TBLH BMC in lean subjects vs + 25 ± 3 g in obese subjects (P < .05). Each 1 kg/m2 increase in lean BMI (LBMI) was associated with +78 ± 5 g of TBLH BMC in lean and obese boys, and each 1 kg/m2 increase in fat mass index (FMI) was associated with a decrease of 9 ± 3 g of TBLH BMC. The TBLH BMC was directly positively influenced by LBMI and indirectly and positively influenced by IGF-1, testosterone, and insulin (mediated through height and LBMI). FMI indirectly influenced TBLH BMC, both positively through LBMI and negatively through its negative impact on IGF-1 and testosterone.

CONCLUSION

The increase in bone mineralization in obese children does not adapt to the increase in body mass.