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Su L, Zhang SZ, Cheng HY, Zhou ZY, Zhang Q, Wu J, Jiao YZ. Association between systemic immune inflammation index and serum testosterone and free testosterone in middle-aged and elderly men. Andrology 2025. [PMID: 40202053 DOI: 10.1111/andr.70036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Revised: 02/24/2025] [Accepted: 03/22/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND Chronic inflammation is a pervasive feature of aging and may be associated with testosterone in middle-aged and older men. Systemic immune-inflammation index (SII) is a novel inflammatory biomarker. We aimed to assess the association between SII and serum testosterone and free testosterone (FT) in middle-aged and older men. METHODS Our study included males ≥ 40 years old in the 2011-2016 and 2021-2023 National Health and Nutrition Examination Survey. Multivariable regression analysis was used to explore the associations between SII and serum testosterone and FT in middle-aged and older men. Subgroup analysis was performed according to age. RESULTS About 5354 participants were included, of which 2450 contained FT data. Multivariable linear regression found that SII exhibited an inverse association with serum testosterone (β -0.05, 95% CI -0.07 to -0.03, P < 0.001) and FT (β -0.03, 95% CI -0.05 to -0.01, P = 0.032) in middle-aged and elderly men. After SII was grouped as quartiles, serum testosterone was significantly lower in SII quartile 4 than in SII quartile 1 (β -0.05, 95% CI -0.08 to -0.02, P < 0.001). However, FT was not significantly lower in SII quartile 4 than in SII quartile 1 (β -0.03, 95% CI -0.07 to 0.01, P = 0.135). In subgroup analysis, the serum testosterone results were consistent with the overall results. However, only in the ≥60 years group, SII exhibited an inverse association with FT (β -0.06, 95% CI -0.1 to -0.02, P = 0.002) and was significantly lower in SII quartile 4 than in SII quartile 1 (β -0.06, 95% CI -0.12 to -0.01, P = 0.049). CONCLUSIONS Our study revealed an inverse association between SII and serum testosterone and FT in middle-aged and elderly men, particularly among men ≥ 60 years.
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Affiliation(s)
- Liang Su
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Si-Zheng Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao-Yang Cheng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zheng-Yang Zhou
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yong-Zheng Jiao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Williams A, Bissinger R, Shamaa H, Patel S, Bourne L, Artunc F, Qadri SM. Pathophysiology of Red Blood Cell Dysfunction in Diabetes and Its Complications. PATHOPHYSIOLOGY 2023; 30:327-345. [PMID: 37606388 PMCID: PMC10443300 DOI: 10.3390/pathophysiology30030026] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
Diabetes Mellitus (DM) is a complex metabolic disorder associated with multiple microvascular complications leading to nephropathy, retinopathy, and neuropathy. Mounting evidence suggests that red blood cell (RBC) alterations are both a cause and consequence of disturbances related to DM-associated complications. Importantly, a significant proportion of DM patients develop varying degrees of anemia of confounding etiology, leading to increased morbidity. In chronic hyperglycemia, RBCs display morphological, enzymatic, and biophysical changes, which in turn prime them for swift phagocytic clearance from circulation. A multitude of endogenous factors, such as oxidative and dicarbonyl stress, uremic toxins, extracellular hypertonicity, sorbitol accumulation, and deranged nitric oxide metabolism, have been implicated in pathological RBC changes in DM. This review collates clinical laboratory findings of changes in hematology indices in DM patients and discusses recent reports on the putative mechanisms underpinning shortened RBC survival and disturbed cell membrane architecture within the diabetic milieu. Specifically, RBC cell death signaling, RBC metabolism, procoagulant RBC phenotype, RBC-triggered endothelial cell dysfunction, and changes in RBC deformability and aggregation in the context of DM are discussed. Understanding the mechanisms of RBC alterations in DM provides valuable insights into the clinical significance of the crosstalk between RBCs and microangiopathy in DM.
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Affiliation(s)
- Alyssa Williams
- Faculty of Science, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4M1, Canada
| | - Rosi Bissinger
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Hala Shamaa
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Shivani Patel
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Lavern Bourne
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Ferruh Artunc
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research at the University of Tübingen, 72076 Tübingen, Germany
| | - Syed M. Qadri
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
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Campbell K, Muthigi A, Ghomeshi A, Schuppe K, Sandler MD, Ramasamy R. Safety Aspects and Rational Use of Testosterone Undecanoate in the Treatment of Testosterone Deficiency: Clinical Insights. Drug Healthc Patient Saf 2023; 15:73-84. [PMID: 37025099 PMCID: PMC10072151 DOI: 10.2147/dhps.s383130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Testosterone deficiency is diagnosed by a serum total testosterone level below 300 ng/dL in combination with symptoms such as decreased energy and libido. These symptoms can be ameliorated by restoring serum testosterone to the physiologic range with testosterone therapy (TT). There are numerous forms of testosterone therapy, such as injectable, transdermal, nasal, and subcutaneous applications. There are also multiple formulations of injection, such as testosterone cypionate, testosterone enanthate, and testosterone undecanoate. Testosterone undecanoate (TU) is a long-acting ester formulation of testosterone that can be provided in an injectable or oral form. Oral testosterone undecanoate is marketed as Andriol, Jatenzo, Tlando, and Kyzatrex. Oral TU provides a convenient option for many patients, which may increase compliance with TT. Injectable testosterone undecanoate is marketed as Aveed and Nebido. Injectable TT remains the most cost-effective therapeutic option and is appropriate for most patients as an initial therapy. This review describes the pharmacokinetics of these testosterone undecanoate products and provides a guide for prescribers using these medications. While many forms of testosterone are appropriate for TT, a patient-centered discussion focused on goals of care should best guide physician prescription of these medications.
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Affiliation(s)
- Katherine Campbell
- Desai Sethi Urology Institute, University of Miami, Miami, Fl, 33136, USA
| | - Akhil Muthigi
- Desai Sethi Urology Institute, University of Miami, Miami, Fl, 33136, USA
| | - Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Kyle Schuppe
- Washington State University Elson S. Floyd College of Medicine, Spokane, WA, 99202-2131, USA
| | - Max D Sandler
- University of Miami Miller of Medicine, Miami, Fl, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami, Miami, Fl, 33136, USA
- Correspondence: Ranjith Ramasamy, Desai Sethi Urology Institute, University of Miami, 1120 NW 14th St, Miami, Fl, 33136, USA, Tel +1 305-243-6090, Email
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Testosterone Deficiency as One of the Major Endocrine Disorders in Chronic Kidney Disease. Nutrients 2022; 14:nu14163438. [PMID: 36014945 PMCID: PMC9415930 DOI: 10.3390/nu14163438] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
Reduced testosterone concentration is nowadays thought to be one of the main endocrine disorders in chronic kidney disease (CKD). It is caused by the dysfunction of the hypothalamic-pituitary-gonadal axis. The role of testosterone is multifactorial. Testosterone is responsible not only for reproductive processes, but it is a hormone which increases bone and muscle mass, improves lipid profile, insulin sensitivity, erythropoiesis, reduces blood pressure, and ameliorates mood and perception. The implications of hypogonadism in CKD are infertility and loss of libido, reduction of muscle mass and strength, disorders in bone mineralization, the development of sarcopenia and protein energy wasting (PEW), progression of atherosclerosis, increased visceral adiposity, insulin resistance, and anaemia. Reduced testosterone serum concentrations in CKD are associated with increased mortality rate. Testosterone supplementation improves sexual functions, reduces the level of inflammatory markers and blood pressure, stimulates muscle protein synthesis, improves insulin sensitivity and lipid profile, and increases muscle mass, bone mineral density, and haemoglobin concentration. It positively affects mood and well-being. The modes of testosterone supplementation are intramuscular injections, subcutaneous pellets, and percutaneous methods—patches and gels. Successful kidney transplantation may improve gonadal function and testosterone production, however, half of men with low testosterone concentrations before kidney transplantation do not restore hormonal function.
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Lee JH, Choi JD, Kang JY, Yoo TK, Park YW. Testosterone deficiency and the risk of anemia: A propensity score-matched analysis. Am J Hum Biol 2022; 34:e23751. [PMID: 35398959 DOI: 10.1002/ajhb.23751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE There are little data on the endogenous testosterone effect on hemoglobin or hematocrit. Moreover, these data are limited by a cross-sectional study design, a small participant number, and no adjustment for confounding factors. Therefore, the present study was conducted to address the aforementioned limitations of previous studies using a large dataset and propensity score matched analysis. MATERIALS AND METHODS Men who underwent health check-up were analyzed. Participants were divided into two groups using the cut-off testosterone value of 3.5 or 3.0 ng/ml according to a previous definition of testosterone deficiency. Using the cutoff testosterone value of 3.5 ng/ml, 966 cases (testosterone levels <3.5 ng/ml) and 7402 controls (testosterone level ≥3.5 ng/ml) were included, but following propensity score matching, there were 966 cases and 1932 controls. Using the cutoff testosterone value of 3.0 ng/ml, 444 cases (testosterone levels <3.0 ng/ml) and 7924 controls (testosterone level ≥3.0 ng/ml) were included, but following propensity score matching, there were 444 cases and 888 controls. RESULTS After matching, the groups were evenly distributed with respect to age, body mass index, estimated glomerular filtration rate, hypertension, and diabetes in both data sets. After matching, the mean Hb and Hct were significantly lower and the incidence of anemia was significantly greater in the case compared to the control in both data sets. The relative risk of anemia in the case was 2.4 compared to the control in both data sets. CONCLUSION Screening for anemia in patients with testosterone deficiency would be needed and vice versa.
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Affiliation(s)
- Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Jae Duck Choi
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Jung Yoon Kang
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yeon Won Park
- Department of Urology, National Police Hospital, Seoul, South Korea
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LI L, DENG H, MA W, ZHOU Y. Diagnosis of microcytic hypochromic anemia with red blood cell survival via carbon monoxide breath-red blood cell survival. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.53121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Wen MA
- Southern Medical University, China
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