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Schmidt MK, Rohayem J, Zitzmann M, Gelhorn H, Schneider G. German version of the Hypogonadism Impact of Symptoms Questionnaire: Psychometric properties and association with testosterone levels. Andrologia 2022; 54:e14370. [DOI: 10.1111/and.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Martina Kathrin Schmidt
- Psychosomatic Medicine and Psychotherapy Department of Mental Health University Hospital Münster Münster Germany
| | - Julia Rohayem
- Centre for Reproductive Medicine and Andrology University Hospital Münster Münster Germany
| | - Michael Zitzmann
- Centre for Reproductive Medicine and Andrology University Hospital Münster Münster Germany
| | | | - Gudrun Schneider
- Psychosomatic Medicine and Psychotherapy Department of Mental Health University Hospital Münster Münster Germany
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Lunenfeld B, Mskhalaya G, Zitzmann M, Corona G, Arver S, Kalinchenko S, Tishova Y, Morgentaler A. Recommendations on the diagnosis, treatment and monitoring of testosterone deficiency in men. Aging Male 2021; 24:119-138. [PMID: 34396893 DOI: 10.1080/13685538.2021.1962840] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age globally. One in four persons living in Europe and Northern America will be aged 65 or over. One of the goals of ISSAM is to raise awareness of the special health needs of older men. Since a significant number of aging men will eventually become testosterone deficient, the Hypogonadism panel of ISSAM updates its guidelines.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - Michael Zitzmann
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Giovanni Corona
- Medical Department, Endocrinology Unit, Maggiore Bellaria Hospital, Bologna, Italy
| | - Stefan Arver
- Department of Medicine/Huddinge Karolinska Institutet and ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Svetlana Kalinchenko
- Department of Endocrinology, People's Friendship University of Russia, Moscow, Russia
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Shorter androgen receptor polyQ alleles protect against life-threatening COVID-19 disease in European males. EBioMedicine 2021; 65:103246. [PMID: 33647767 PMCID: PMC7908850 DOI: 10.1016/j.ebiom.2021.103246] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
Background While SARS-CoV-2 similarly infects men and women, COVID-19 outcome is less favorable in men. Variability in COVID-19 severity may be explained by differences in the host genome. Methods We compared poly-amino acids variability from WES data in severely affected COVID-19 patients versus SARS-CoV-2 PCR-positive oligo-asymptomatic subjects. Findings Shorter polyQ alleles (≤22) in the androgen receptor (AR) conferred protection against severe outcome in COVID-19 in the first tested cohort (both males and females) of 638 Italian subjects. The association between long polyQ alleles (≥23) and severe clinical outcome (p = 0.024) was also validated in an independent cohort of Spanish men <60 years of age (p = 0.014). Testosterone was higher in subjects with AR long-polyQ, possibly indicating receptor resistance (p = 0.042 Mann-Whitney U test). Inappropriately low serum testosterone level among carriers of the long-polyQ alleles (p = 0.0004 Mann-Whitney U test) predicted the need for intensive care in COVID-19 infected men. In agreement with the known anti-inflammatory action of testosterone, patients with long-polyQ and age ≥60 years had increased levels of CRP (p = 0.018, not accounting for multiple testing). Interpretation We identify the first genetic polymorphism that appears to predispose some men to develop more severe disease. Failure of the endocrine feedback to overcome AR signaling defects by increasing testosterone levels during the infection leads to the polyQ tract becoming dominant to serum testosterone levels for the clinical outcome. These results may contribute to designing reliable clinical and public health measures and provide a rationale to test testosterone as adjuvant therapy in men with COVID-19 expressing long AR polyQ repeats. Funding MIUR project “Dipartimenti di Eccellenza 2018-2020” to Department of Medical Biotechnologies University of Siena, Italy (Italian D.L. n.18 March 17, 2020) and “Bando Ricerca COVID-19 Toscana” project to Azienda Ospedaliero-Universitaria Senese. Private donors for COVID-19 research and charity funds from Intesa San Paolo.
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Mobasseri N, Babaei F, Karimian M, Nikzad H. Androgen receptor ( AR)-CAG trinucleotide repeat length and idiopathic male infertility: a case-control trial and a meta-analysis. EXCLI JOURNAL 2018; 17:1167-1179. [PMID: 30713477 PMCID: PMC6341423 DOI: 10.17179/excli2018-1744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/15/2018] [Indexed: 01/22/2023]
Abstract
CAG trinucleotide repeats in androgen receptor (AR) gene encode a polyglutamine tract in AR N-terminal transactivation domain. Studies have been conducted to evaluate the effect of CAG repeat length on male infertility, which have yielded contradictory results. This study aimed to explore the number of AR-CAG repeats in 150 fertile controls and 150 idiopathic infertile men, divided into four azoospermia, oligozoospermia, asthenozoospermia, and teratozoospermia subgroups. In addition, a meta-analysis was conducted based on previous studies to assess the association of the mentioned variation with male infertility in recent years. Polymerase chain reaction (PCR) targeting followed by an electrophoresis on polyacrylamide gel was used for AR-CAG genotype detecting. Moreover, a systematic search was performed in PubMed, Web of Science, Science Direct, and Google Scholar databases to collect eligible studies for meta-analysis purpose. According to the results, a significant association was observed between increased length of AR-CAG polymorphism and male infertility (p< 0.0001). Furthermore, there were similar significant associations in the azoospermia (p= 0.048), asthenozoospermia (p= 0.013) and teratozoospermia (p= 0.002) subgroups. In addition, meta-analysis on forty studies showed a significant association between AR-CAG polymorphism in the overall analysis (SMD= 0.199, 95 % CI= 0.112-0.287, p<0.001) and the Caucasian subgroup (SMD= 0.151, 95 % CI= 0.040-0.263, p= 0.008). Our results elucidated that long stretches of CAG repeat might lead to AR dysfunction, contributing to male infertility especially in the Caucasian population.
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Affiliation(s)
- Narges Mobasseri
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Faezeh Babaei
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Karimian
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Nikzad
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
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5
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British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. J Sex Med 2017; 14:1504-1523. [DOI: 10.1016/j.jsxm.2017.10.067] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 01/01/2023]
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6
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Khan HL, Bhatti S, Abbas S, Khan YL, Aslamkhan M, Gonzalez RMM, Gonzalez GR, Aydin HH, Trinidad MS. Tri-nucleotide consortium of androgen receptor is associated with low serum FSH and testosterone in asthenospermic men. Syst Biol Reprod Med 2017; 64:112-121. [DOI: 10.1080/19396368.2017.1384080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Haroon Latif Khan
- Lahore Institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan
| | - Shahzad Bhatti
- Lahore Institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
- Institute of Molecular Biology and Biotechnology, University of Lahore, Pakistan
- Department of Medical Education, Rashid Latif Medical College, Lahore, Pakistan
| | - Sana Abbas
- Lahore Institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan
| | - Yousaf Latif Khan
- Lahore Institute of Fertility and Endocrinology, Hameed Latif Hospital, Lahore, Pakistan
| | - Muhammad Aslamkhan
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
| | | | | | - Hikmet Hakan Aydin
- Department of Medical Biochemistry, Ege University School of Medicine, Bornova Izmir, Turkey
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7
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Eisenegger C, Kumsta R, Naef M, Gromoll J, Heinrichs M. Testosterone and androgen receptor gene polymorphism are associated with confidence and competitiveness in men. Horm Behav 2017; 92:93-102. [PMID: 27702564 DOI: 10.1016/j.yhbeh.2016.09.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 11/27/2022]
Abstract
A contribution to a special issue on Hormones and Human Competition. Studies in non-human animals and humans have demonstrated the important role of testosterone in competitive interactions. Here, we investigated whether endogenous testosterone levels predict the decision to compete, in a design excluding spite as a motive underlying competitiveness. In a laboratory experiment with real monetary incentives, 181 men solved arithmetic problems, first under a noncompetitive piece rate, followed by a competition incentive scheme. We also assessed several parameters relevant to competition, such as risk taking, performance, and confidence in one's own performance. Salivary testosterone levels were measured before and 20min after the competition task using mass spectrometry. Participants were also genotyped for the CAG repeat polymorphism of the androgen receptor gene, known to influence the efficacy of testosterone signaling in a reciprocal relationship to the number of CAG repeats. We observed a significant positive association between basal testosterone levels and the decision to compete, and that higher testosterone levels were related to greater confidence in one's own performance. Whereas the number of CAG repeats was not associated with the choice to compete, a lower number of CAG repeats was related to greater confidence in those who chose to compete, but this effect was attributable to the polymorphism's effect on actual performance. An increase in testosterone levels was observed following the experiment, and this increase varied with self-reported high-school math grades. We expand upon the latest research by documenting effects of the androgen system in confidence in one's own ability, and conclude that testosterone promotes competitiveness without spite.
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Affiliation(s)
- Christoph Eisenegger
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Austria.
| | - Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Germany.
| | - Michael Naef
- Department of Economics, Royal Holloway, University of London, United Kingdom
| | - Jörg Gromoll
- Department of Reproductive Medicine, University of Münster, Germany
| | - Markus Heinrichs
- Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Germany
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Ryan CP, McDade TW, Gettler LT, Eisenberg DTA, Rzhetskaya M, Hayes MG, Kuzawa CW. Androgen receptor CAG repeat polymorphism and hypothalamic-pituitary-gonadal function in Filipino young adult males. Am J Hum Biol 2016; 29. [PMID: 27417274 DOI: 10.1002/ajhb.22897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/30/2016] [Accepted: 06/22/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Testosterone (T), the primary androgenic hormone in males, is stimulated through pulsatile secretion of LH and regulated through negative feedback inhibition at the hypothalamus and pituitary. The hypothalamic-pituitary-gonadal (HPG) axis also controls sperm production through the secretion of follicle-stimulating hormone (FSH). Negative feedback in the HPG axis is achieved in part through the binding of T to the androgen receptor (AR), which contains a highly variable trinucleotide repeat polymorphism (AR-CAGn). The number of repeats in the AR-CAGn inversely correlates with transcriptional activity of the AR. Thus, we predicted longer AR-CAGn to be associated with higher T, LH, and FSH levels. METHODS We examined the relationship between AR-CAGn and total plasma T, LH, and FSH, as well as "bioavailable" morning (AM-T) and evening (PM-T) testosterone in 722 young (21.5 ± 0.5 years) Filipino males. RESULTS There was no relationship between AR-CAGn and total T, AM-T, or LH (P > .25 for all). We did observe a marginally non-significant (P = .066) correlation between AR-CAGn and PM-T in the predicted direction, and a negative correlation between AR-CAGn and FSH (P = .005). CONCLUSIONS Our results both support and differ from previous findings in this area, and study parameters that differ between our study and others, such as participant age, sample time, and the role of other hormones should be considered when interpreting our findings. While our data point to a modest effect of AR-CAGn on HPG regulation at best, the AR-CAGn may still affect somatic traits by regulating androgenic activity at peripheral tissues.
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Affiliation(s)
- Calen P Ryan
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois
| | - Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois.,Institute for Policy Research, Northwestern University, Evanston, 60208, Illinois
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, South Bend, Indiana
| | - Dan T A Eisenberg
- Department of Anthropology, University of Washington, Seattle, Washington
| | - Margarita Rzhetskaya
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, 60611, Illinois
| | - M Geoffey Hayes
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois.,Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, 60611, Illinois.,Northwestern University Feinberg School of Medicine, Center for Genetic Medicine, Chicago, 60611, Illinois
| | - Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, 60208, Illinois.,Institute for Policy Research, Northwestern University, Evanston, 60208, Illinois
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Hamson DK, Roes MM, Galea LAM. Sex Hormones and Cognition: Neuroendocrine Influences on Memory and Learning. Compr Physiol 2016; 6:1295-337. [DOI: 10.1002/cphy.c150031] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Xiao F, Lan A, Lin Z, Song J, Zhang Y, Li J, Gu K, Lv B, Zhao D, Zeng S, Zhang R, Zhao W, Pan Z, Deng X, Yang X. Impact of CAG repeat length in the androgen receptor gene on male infertility - a meta-analysis. Reprod Biomed Online 2016; 33:39-49. [PMID: 27157932 DOI: 10.1016/j.rbmo.2016.03.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 12/18/2022]
Abstract
CAG repeats are polymorphic nucleotide repeats present in the androgen receptor gene. Many studies have estimated the association between CAG repeat length and male infertility, but the conclusions are controversial. Previous meta-analyses have come to different conclusions; however, new studies have been published. An updated meta-analysis was conducted. PubMed, CBM, CNKI and Web of Science databases were systematically searched for studies published from 1 January 2000 to 1 October 2015. Case-control studies on the association between CAG repeat length and male infertility using appropriate methodology were included. Forty studies were selected, including 3858 cases and 3161 controls. Results showed statistically significantly longer CAG repeat length among cases compared with controls (SMD = 0.14; 95% CI, 0.02-0.26). Shorter repeat length was associated with a lower risk of male infertility compared with a longer repeat length in the overall analysis (OR = 0.79, 95% CI: 0.66-0.95). Moreover, CAG repeat length was associated with male infertility in Caucasian populations, but not Asian or Egyptian populations. Subgroup analysis revealed no significant difference in German populations, but CAG repeat length was associated with male infertility in China and the USA. There were no significant differences between cases and controls in azoospermia and severe oligozoospermia.
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Affiliation(s)
- Feifan Xiao
- The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China; Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Aihua Lan
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhidi Lin
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China; Department of Urology, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, Guangxi, China
| | - Jianfei Song
- The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Yuening Zhang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiatong Li
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Kailong Gu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Baihao Lv
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Dong Zhao
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Siping Zeng
- Urology Medical Research Center, Department of Guangxi Medical University Affiliated Hospital, Nanning, Guangxi, China
| | - Ruoheng Zhang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Zhao
- First Clinical Academy, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhengyan Pan
- First Clinical Academy, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaozhen Deng
- First Clinical Academy, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoli Yang
- Medical Scientific Research Center, Guangxi Medical University, Nanning, Guangxi, China.
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Pan B, Li R, Chen Y, Tang Q, Wu W, Chen L, Lu C, Pan F, Ding H, Xia Y, Hu L, Chen D, Sha J, Wang X. Genetic Association Between Androgen Receptor Gene CAG Repeat Length Polymorphism and Male Infertility: A Meta-Analysis. Medicine (Baltimore) 2016; 95:e2878. [PMID: 26962784 PMCID: PMC4998865 DOI: 10.1097/md.0000000000002878] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The association between polymorphism of androgen receptor gene CAG (AR-CAG) and male infertility in several studies was controversial. Based on studies on association between AR-CAG repeat length and male infertility in recent years, an updated meta-analysis is needed. We aimed to evaluate the association between AR-CAG repeat length and male infertility in advantage of the data in all published reports.We searched for reports published before August 2015 using PubMed, CNKI, VIP, and WanFang. Data on sample size, mean, and standard deviation (SD) of AR-CAG repeat length were extracted independently by 3 investigators.Forty-four reports were selected based on criteria. The overall infertile patients and azoospermic patients were found to have longer AR-CAG repeat length (standard mean difference (SMD) = 0.19, 95% confidence interval (CI): 0.10-0.28, P < 0.01; SMD = 0.36, 95% CI: 0.10-0.61, P < 0.01). AR-CAG repeat length was longer in infertile men in Asian, Caucasian, and mixed races (SMD = 0.25, 95% CI: 0.08-0.43, P <0.01; SMD = 0.13, 95% CI: 0.02-0.25, P <0.05; SMD = 0.39, 95% CI: 0.15-0.63, P <0.01). The overall study shows that increased AR-CAG repeat length was associated with male infertility. The subgroup study on races shows that increased AR-CAG repeat length was associated with male infertility in Asian, Caucasian, and mixed races. Increased AR-CAG repeat length was also associated with azoospermia.This meta-analysis supports that increased androgen receptor CAG length is capable of causing male infertility susceptibility.
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Affiliation(s)
- Bihui Pan
- From the State Key Laboratory of Reproductive Medicine (BP, RL, YC, WW, CL, YX, XW), Institute of Toxicology, School of Public Health; Key Laboratory of Modern Toxicology of Ministry of Education (BP, RL, YC, WW, CL, YX, XW), Nanjing Medical University; State Key Laboratory of Reproductive Medicine (QT, HD), Department of Obstetrics, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing; State Key Laboratory of Reproductive Medicine (WW, LH, DC), Wuxi Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Wuxi; Department of Gynecology and Obstetrics (LC), The Second Affiliated Hospital of Nantong University, Nantong; State Key Laboratory of Reproductive Medicine (FP), Department of Andrology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; and State Key Laboratory of Reproductive Medicine (JS), Nanjing Medical University, Nanjing, China
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Lunenfeld B, Mskhalaya G, Zitzmann M, Arver S, Kalinchenko S, Tishova Y, Morgentaler A. Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male 2015; 18:5-15. [PMID: 25657080 PMCID: PMC4648196 DOI: 10.3109/13685538.2015.1004049] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 12/26/2014] [Indexed: 01/02/2023] Open
Abstract
Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter syndrome, Kallmann syndrome, pituitary or testicular disorders, as well as in men with idiopathic, metabolic or iatrogenic conditions that result in testosterone deficiency. These recommendations do not encompass the full range of pathologies leading to hypogonadism (testosterone deficiency), but instead focus on the clinical spectrum of hypogonadism related to metabolic and idiopathic disorders that contribute to the majority of cases that occur in adult men.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - George Mskhalaya
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Michael Zitzmann
- Centre for Reproductive Medicine and Andrology, University Clinics Muenster, Münster, Germany
| | - Stefan Arver
- Centre for Andrology and Sexual Medicine, Karolinska University Hospital and Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Svetlana Kalinchenko
- Clinical Endocrinology, Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Yuliya Tishova
- Clinical Endocrinology, Peoples' Friendship University of Russia, Moscow, Russian Federation
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13
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Giagulli VA, Carbone MD, De Pergola G, Guastamacchia E, Resta F, Licchelli B, Sabbà C, Triggiani V. Could androgen receptor gene CAG tract polymorphism affect spermatogenesis in men with idiopathic infertility? J Assist Reprod Genet 2014; 31:689-97. [PMID: 24691874 PMCID: PMC4048386 DOI: 10.1007/s10815-014-0221-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/14/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study examined whether the AR-CAG repeat length might affect clinical characteristics (testis volume) seminal parameters (sperm count and its mobility) along with hormonal serum profile [FSH, LH, Testosterone (T) and Inhibin B (InhB)] both in idiopathic male infertility (IM) and in infertility due to a previous condition of cryptorchidism (CryM) or to Y chromosome long arm microdeletions (YM). DESIGN Observational study without intervention(s). PATIENTS One hundred and ten IM patients [90 idiopathic olizoospermic males (IOM) and 20 idiopathic azoospermic males (IAM)], 19 CryM male and 10 YM patients were included. Sixty-one age-matched healthy men who had fathered within 3 years were involved representing the control group (FM). RESULTS AR-CAG repeats stretch was significantly longer in IOM (p<0.05), CryM (p<0.05) and YM (p<0.001) than FM. When the AR-CAG repeat tracts were subdivided in three subgroups according to the length of CAG repeats tract assessed in fertile subjects (the one with the middle (n 19-21) belonging to the 25 and 75 % inter-quartile, the ends belonging to the <25 % inter-quartile and >75 % inter-quartile, respectively), there was a statistically significant difference of distribution of AR-CAG tract length among fertile and different groups of infertile men (p=<0.0005; chi-square test). Moreover, the subgroup of AR-CAG repeat stretch with 22-28 triplets was associated with lower levels of InhB both in idiopathic oligozoospermic (Scheffe, Bonferroni and Dunett tests p=<0.01) and azoospermic men (Scheffe, Bonferroni and Dunett test p=<0.05), while, when FM and men with idiopathic infertility were gathered in a single group, both the subgroup of AR- CAG tract with 15-18 repeats and the one with 22-28 repeats are associated with lower testis volume, reduced sperm count and serum InhB levels. CONCLUSIONS Our study showed that the outliers of AR-CAG repeat length seem to influence the function of AR, affecting testis volume and Sertoli cell function and consequently sperm production in both fertile and idiopathic infertile men.
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Affiliation(s)
- V A Giagulli
- Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy,
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14
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Olsen NJ, Benko AL, Kovacs WJ. Variation in the androgen receptor gene exon 1 CAG repeat correlates with manifestations of autoimmunity in women with lupus. Endocr Connect 2014; 3:99-109. [PMID: 24711544 PMCID: PMC4012646 DOI: 10.1530/ec-14-0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Clinical and experimental evidence support a role for gonadal steroids in modulating the expression and course of autoimmune diseases such as lupus. Whether or not inherited variation in sensitivity to circulating androgenic hormones could influence the manifestations of such disease is, however, unknown. We sought to determine whether differences in androgen sensitivity conferred by variation in the exon 1 CAG repeat region of the androgen receptor (AR) gene were associated with differences in the clinical or humoral immune manifestations of lupus in a cohort of female subjects. We found that shorter AR CAG repeat lengths in lupus subjects correlated with a higher Systemic Lupus Erythematosus Disease Activity Index score, higher ANA levels, and expression of a broader array of IgG autoantibodies. Our findings of more severe clinical manifestations and more exuberant humoral autoimmunity in women with a shorter AR exon 1 CAG repeat length suggest a role for genetically determined sensitivity to androgens as a modulator of autoimmune processes.
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Affiliation(s)
- Nancy J Olsen
- Division of RheumatologyCollege of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State UniversityMail Code H044, 500 University Drive, Hershey, Pennsylvania, 17033-0850USA
| | - Ann L Benko
- Division of Endocrinology, Diabetes and MetabolismCollege of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State UniversityMail Code H044, 500 University Drive, Hershey, Pennsylvania, 17033-0850USA
| | - William J Kovacs
- Division of Endocrinology, Diabetes and MetabolismCollege of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State UniversityMail Code H044, 500 University Drive, Hershey, Pennsylvania, 17033-0850USA
- Correspondence should be addressed to W J Kovacs,
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15
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Prostate cancer. Mol Oncol 2013. [DOI: 10.1017/cbo9781139046947.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Zitzmann M. Hypogonadism: Biochemical Diagnosis, Treatment, and the Myth of Uniform Thresholds. JOURNAL OF MEN'S HEALTH 2013. [DOI: 10.1089/jomh.2009.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Liu CC, Lee YC, Wang CJ, Yeh HC, Li WM, Wu WJ, Huang CN, Bao BY, Huang CH, Huang SP. The impact of androgen receptor CAG repeat polymorphism on andropausal symptoms in different serum testosterone levels. J Sex Med 2012; 9:2429-37. [PMID: 22429282 DOI: 10.1111/j.1743-6109.2012.02672.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In addition to a depletion of androgen, attenuated action of androgen receptor (AR) might also contribute to andropausal symptoms. AIM To evaluate the interaction of AR cytosine adenine guanine (CAG) repeat polymorphism and serum testosterone levels and their effect on andropausal symptoms in aging Taiwanese men. METHODS From August 2007 to April 2008, a free health screening for men older than 40 years was conducted by a medical center in Kaohsiung City, Taiwan. All participants received physical examination, answered questionnaires to collect their demographic information and medical histories, completed the Androgen Deficiency in the Aging Male (ADAM) questionnaire, and provided 20-cm(3) whole blood samples for biochemical and genetic evaluation. MAIN OUTCOME MEASURES The ADAM questionnaire was used to evaluate andropausal symptoms. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. RESULTS Seven hundred two men with the mean age of 57.2 ± 6.5 years were included. There was no significant association between TT levels and the distribution of AR CAG repeat polymorphism. When TT levels were above 340 ng/dL, subjects with AR CAG repeat lengths ~25 showed significantly higher risk of developing andropausal symptoms, as compared with those with AR CAG repeat lengths ~22 (P = 0.006), but this was not observed when TT levels were 340 ng/dL or below. Age and number of comorbidities were also independent risk factors for andropausal symptoms. CONCLUSION In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing andropausal symptoms. Age and number of comorbidities can also influence the appearance of andropausal symptoms. In clinical practice, a multifactorial approach to evaluate andropausal symptoms and the interactions between those risk factors is suggested.
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Affiliation(s)
- Chia-Chu Liu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Mostafa T, El-Shahid LH, El Azeem AA, Shaker O, Gomaa H, Abd El Hamid HM. Androgen receptor-CAG repeats in infertile Egyptian men. Andrologia 2011; 44:147-51. [PMID: 21714804 DOI: 10.1111/j.1439-0272.2010.01125.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to assess the androgen receptor (AR) codon amino acids glutamine (CAG) repeats in 185 Egyptian men divided into fertile controls (n = 30), oligoasthenoteratozoospermic (OAT) men (n = 35), nonobstructive azoospermic (NOA) men (n = 120; 18 successful testicular sperm extraction (TESE) and 102 unsuccessful TESE cases). They were subjected to history taking, genital examination, semen analysis, testicular biopsies for NOA cases, serum hormones and CAG repeats by PCR. The mean AR-CAG repeats showed significant difference between NOA group compared with fertile controls or OAT groups. Nonsignificant difference was elicited between OAT group and fertile controls. In NOA cases, CAG repeats demonstrated nonsignificant difference between unsuccessful and successful TESE. AR-CAG repeats elicited significant negative correlation with sperm count, significant positive correlation with sperm normal forms percentage and nonsignificant correlations with sperm motility per cent, tested serum hormones or testicular volume. It is concluded that AR-CAG repeats in Egyptian infertile men are in the range of other international or regional studies. AR-CAG repeats have demonstrated nonsignificant difference regarding TESE outcome in NOA cases.
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Affiliation(s)
- T Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Egypt.
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Tessnow AH, Olsen NJ, Kovacs WJ. Expression of humoral autoimmunity is related to androgen receptor CAG repeat length in men with systemic lupus erythematosus. J Clin Immunol 2011; 31:567-73. [PMID: 21445561 DOI: 10.1007/s10875-011-9519-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 03/10/2011] [Indexed: 01/19/2023]
Abstract
We sought to explore whether inherited differences in androgen sensitivity conferred by variation in the length of a CAG repeat in exon 1 of the androgen receptor gene could be correlated with differing manifestations of humoral autoimmunity in men with lupus. In a sample of 15 men with lupus, AR CAG repeat length was linearly correlated with levels of antibodies against extractable nuclear antigens and with the number of diagnostic criteria for lupus. Protein microarrays were used to assess levels of 86 different IgG and IgM autoantibodies in the sera of these patients. IgG autoantibodies were more frequently observed in male lupus patients with longer AR CAG repeat length (>23), while IgM autoantibodies were more prevalent in subjects with shorter CAG repeat length (≤23). These data support a potential role for androgen signaling in the modulation of immunoglobulin class switching processes, with consequent impact on the autoimmune phenotype in men with lupus.
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Affiliation(s)
- Alex H Tessnow
- Division of Endocrinology, Diabetes, and Metabolism, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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20
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Depressive symptoms in men aged 50 years and older and their relationship to genetic androgen receptor polymorphism and sex hormone levels in three different samples. Am J Geriatr Psychiatry 2011; 19:274-83. [PMID: 20808127 DOI: 10.1097/jgp.0b013e3181e70c22] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression in aging men has been related to low sex hormone concentrations; the putatively modulating effects of the genetically determined androgen receptor (AR) cytosine-adenosine-guanine (CAG) repeat polymorphism are often not taken into account. The aim of this study was to determine how sex hormone levels and the AR polymorphism relate to depressive symptoms in aging men. METHODS This cross-sectional study of men aged 50 years and older included 120 consecutive patients of the Department of Psychosomatics and Psychotherapy, 76 consecutive patients of the Andrologic Clinic, and 100 participants from the community sample (CS); all participants completed the Patient Health Questionnaire. Morning blood samples were analyzed for total and free testosterone, estradiol, and the AR CAG polymorphism. Patients on hormone substitution or other medication known to influence testosterone levels were excluded. RESULTS The two clinical samples had significantly longer AR CAG repeats and higher depression levels compared with the CS. When controlling for possible confounders, depression scores were positively correlated with CAGn (r = 0.20, df: 107, p ≤ 0.038) in psychosomatic patients and with CAGn (r = 0.27, df: 55, p ≤ 0.043) and estradiol (r = 0.31, df: 55, p ≤ 0.019) in andrologic patients, whereas the CS showed no significant correlations between depression scores, CAGn, and sex hormones. CAGn did not correlate significantly with testosterone in the three samples. Regression analysis confirmed association of CAGn with depression. CONCLUSIONS Conclusions from these data must be considered to be preliminary and need to be replicated. However, our results point to associations between the genetic AR polymorphism and vulnerability to depressive symptomatology.
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Nenonen HA, Giwercman A, Hallengren E, Giwercman YL. Non-linear association between androgen receptor CAG repeat length and risk of male subfertility--a meta-analysis. ACTA ACUST UNITED AC 2010; 34:327-32. [PMID: 20579136 DOI: 10.1111/j.1365-2605.2010.01084.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The CAG repeat in the androgen receptor (AR) has been widely studied in association with male infertility, but the results are conflicting. In a recent meta-analysis, infertile men had <1 repeat longer CAG stretch than fertile men when analysed in a linear regression model assuming that AR function diminishes with increasing CAG length. However, in vitro, a non-linear activity pattern was recently demonstrated so that ARs containing short and long stretches, respectively, displayed lower activity than the AR of median length. These results prompted us to explore the possible association between CAG number and male infertility risk in a stratified manner on the basis of data from the mentioned meta-analysis and subjects from our clinical unit. The study population included 3915 men, 1831 fertile and 2084 infertile. Data were divided into three categories: CAG<22, CAG 22-23 (reference) and CAG>23 and analysed in a binary logistic regression model. Men with CAG<22 and CAG>23 had 20% increased odds ratio of infertility compared with carriers of the median lengths [for CAG<22: p=0.03, 95% confidence interval (CI): 1.02-1.39; for CAG>23: p=0.02, 95% CI: 1.03-1.44]. These results show that an alternative model to a linear one for the genotype-phenotype association in relation to AR CAG repeats is likely, as lengths close to the median confine lowest risk of infertility.
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Affiliation(s)
- H A Nenonen
- Department of Clinical Sciences, Molecular Genetic Reproductive Medicine, Lund University Reproductive Medicine Centre, Molecular Reproductive Medicine Research Unit, Malmö University Hospital, Lund University, Malmö, Sweden.
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Schneider G, Nienhaus K, Gromoll J, Heuft G, Nieschlag E, Zitzmann M. Aging males' symptoms in relation to the genetically determined androgen receptor CAG polymorphism, sex hormone levels and sample membership. Psychoneuroendocrinology 2010; 35:578-87. [PMID: 19804943 DOI: 10.1016/j.psyneuen.2009.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 09/08/2009] [Accepted: 09/10/2009] [Indexed: 11/18/2022]
Abstract
Late-onset hypogonadism describes the co-occurrence of a range of physical, psychological and sexual symptoms in aging men, with the implication that these symptoms are caused by androgen deficiency. Previous investigations examined mostly population samples and did not take into account the testosterone modulating effects of the genetically determined CAG repeat polymorphism (CAGn) of the androgen receptor (AR) gene. This is the first study which investigates aging male symptoms (AMS) in relation to the genetically determined androgen receptor CAG polymorphism, estradiol and testosterone levels in men > or =50 years of age in a healthy population sample (n=100), outpatients of an andrological department (n=76) who presented with sexual and "aging male" symptoms and a psychosomatic/psychiatric sample (n=120) who presented with various psychological and medically unexplained somatic complaints. Although the population sample was significantly older than the two patient groups, they reported significantly fewer AMS and had higher testosterone levels and shorter CAG repeats of the AR. Regression analysis revealed influences of CAGn on the AMS global score and the psychological and somatic subscale only in the two patient samples, while testosterone had some impact on the sexual subscale. Our results suggest that the so-called aging male symptoms show a certain association to androgenicity, but that they are rather unspecific and of multifactorial origin. Other factors contributing to AMS need further clarification.
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Affiliation(s)
- Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University of Münster, Domagkstrasse 22, 48149 Münster, Germany
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Manuck SB, Marsland AL, Flory JD, Gorka A, Ferrell RE, Hariri AR. Salivary testosterone and a trinucleotide (CAG) length polymorphism in the androgen receptor gene predict amygdala reactivity in men. Psychoneuroendocrinology 2010; 35:94-104. [PMID: 19493626 PMCID: PMC2825741 DOI: 10.1016/j.psyneuen.2009.04.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 03/05/2009] [Accepted: 04/22/2009] [Indexed: 01/21/2023]
Abstract
In studies employing functional magnetic resonance imaging (fMRI), reactivity of the amygdala to threat-related sensory cues (viz., facial displays of negative emotion) has been found to correlate positively with interindividual variability in testosterone levels of women and young men and to increase on acute administration of exogenous testosterone. Many of the biological actions of testosterone are mediated by intracellular androgen receptors (ARs), which exert transcriptional control of androgen-dependent genes and are expressed in various regions of the brain, including the amygdala. Transactivation potential of the AR decreases (yielding relative androgen insensitivity) with expansion a polyglutamine stretch in the N-terminal domain of the AR protein, as encoded by a trinucleotide (CAG) repeat polymorphism in exon 1 of the X-chromosome AR gene. Here we examined whether amygdala reactivity to threat-related facial expressions (fear, anger) differs as a function of AR CAG length variation and endogenous (salivary) testosterone in a mid-life sample of 41 healthy men (mean age=45.6 years, range: 34-54 years; CAG repeats, range: 19-29). Testosterone correlated inversely with participant age (r=-0.39, p=0.012) and positively with number of CAG repeats (r=0.45, p=0.003). In partial correlations adjusted for testosterone level, reactivity in the ventral amygdala was lowest among men with largest number of CAG repeats. This inverse association was seen in both the right (r(p)=-0.34, p<0.05) and left (r(p)=-0.32, p<0.05) hemisphere. Activation of dorsal amygdala, correlated positively with individual differences in salivary testosterone, also in right (r=0.40, p<0.02) and left (r=0.32, p<0.05) hemisphere, but was not affected by number of CAG repeats. Hence, androgenic influences on threat-related reactivity in the ventral amygdala may be moderated partially by CAG length variation in the AR gene. Because individual differences in salivary testosterone also predicted dorsal amygdala reactivity and did so independently of CAG repeats, it is suggested that androgenic influences within this anatomically distinct region may be mediated, in part, by non-genomic or AR-independent mechanisms.
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Affiliation(s)
- Stephen B Manuck
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, United States.
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Abdel-Hamid IA, Andersson KE. Pharmacogenetics and pharmacogenomics of sexual dysfunction: current status, gaps and potential applications. Pharmacogenomics 2009; 10:1625-44. [DOI: 10.2217/pgs.09.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Although treatment of different types of sexual dysfunction has improved in the past decade with the introduction of phosphodiesterase type 5 inhibitors and selective serotonin reuptake inhibitors, response rates to these targeted therapies are variable. There are a number of studies in the published literature that provide proof-of-concept that genetic variation contributes to the variable response. Pharmacogenomics will most likely be one part of our therapeutic armamentarium in the future and will provide a stronger scientific basis for optimizing drug therapy on the basis of each patient’s genetic constitution. This article will review English language medical literature on the state-of-the-art genetic polymorphisms of drug targets, transporters and signaling molecules as well as pharmacogenetic studies of sexual dysfunction and suggested possible applications. Collectively, the data demonstrate that pharmacogenomics in the field of sexual medicine is still in its infancy. More research will provide further intriguing new discoveries in years to come.
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Affiliation(s)
- Ibrahim A Abdel-Hamid
- Sexual Medicine Unit, Department of Andrology, Mansoura Faculty of Medicine, Mansoura, PO Box 35516, Egypt
| | - Karl-Erik Andersson
- Wake Forest University, Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA
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Abstract
Variable phenotypes of androgen insensitivity exist in humans, mainly owing to defective, mutated androgen receptors. A more subtle modulation of androgen effects is related to the CAG repeat polymorphism ([CAG]n) in exon 1 of the androgen receptor gene, in vitro, transcription of androgen-dependent target genes is attenuated with increasing length of triplets. As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in (apparently) eugonadal men in various tissues and psychological traits, the longer the (CAG)n, the less prominent the androgen effect when individuals with similar testosterone concentrations are compared. A strictly defined threshold to hypogonadism is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, effects of externally applied testosterone can be markedly influenced by the (CAG)n and respective pharmacogenetic implications are likely influence indications as well as modalities of testosterone treatment of hypogonadal men.
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Affiliation(s)
- Michael Zitzmann
- Centre for Reproductive Medicine and Andrology, University Clinics Muenster, Domagkstr. 11, D-48149 Muenster, Germany
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26
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Campbell BC, Gray PB, Eisenberg DTA, Ellison P, Sorenson MD. Androgen receptor CAG repeats and body composition among Ariaal men. ACTA ACUST UNITED AC 2009; 32:140-8. [DOI: 10.1111/j.1365-2605.2007.00825.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Androgen receptor gene polymorphism and sex hormones in elderly men: the Tromsø study. Asian J Androl 2009; 11:222-8. [PMID: 19137002 DOI: 10.1038/aja.2008.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to examine whether CAG/GGN repeats are significant modulators of serum concentrations of total and free testosterone (T) as well as of luteinizing hormone (LH) in elderly men. Sixty-nine 60- to 80-year-old men with subnormal T levels (< or = 11.0 nmol L(-1)) and 104 men with normal T levels taking part in a nested case-control study were used for these analyses. Sex hormones were measured and free T was calculated. The CAG and GGN polymorphisms in the androgen receptor gene were determined by polymerase chain reaction and subsequent direct sequencing. There were no differences in the CAG and GGN repeat lengths between the groups. In cross-sectional analyses of the whole cohort, total and free T were positively associated with CAG length (all P < 0.05) before, but not after, waist circumference or body mass index was added to the model. CAG repeat lengths were weakly, but not independently, associated with total and free T. These findings indicate that when clinically evaluating T and LH levels in elderly men, the CAG and GGN repeat lengths do not need to be taken into consideration.
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Zitzmann M. Issues in testosterone management: terminology, safety, genetics. JOURNAL OF MEN'S HEALTH 2008. [DOI: 10.1016/j.jomh.2008.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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29
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Gooren L, Meryn S, Shabsigh R. The metabolic syndrome: when is testosterone treatment warranted. JOURNAL OF MENS HEALTH 2008. [DOI: 10.1016/j.jomh.2008.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zitzmann M. Effects of testosterone replacement and its pharmacogenetics on physical performance and metabolism. Asian J Androl 2008; 10:364-72. [DOI: 10.1111/j.1745-7262.2008.00405.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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] [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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Tüttelmann F, Rajpert-De Meyts E, Nieschlag E, Simoni M. Gene polymorphisms and male infertility--a meta-analysis and literature review. Reprod Biomed Online 2008; 15:643-58. [PMID: 18062861 DOI: 10.1016/s1472-6483(10)60531-7] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Many genetic polymorphisms have been studied extensively to elucidate their role in the pathophysiology of male infertility. This article presents a review of the literature following a thorough search of PubMed, a compilation of meta-analyses of studies reporting an association with male fertility where the population(s) could be clearly identified as fertile and/or infertile, and a summary of all polymorphisms that have been investigated in single case-control studies to date. The meta-analyses revealed significant associations between polymorphism and male fertility only for AZF gr/gr deletions (OR 1.81, 1.46-2.24 CI, P<0.00001) and MTHFR 677C-->T (OR 1.39, 1.15-2.69 95% CI, P=0.0006) but not for POLG, DAZL, USP26 or FSHR. The influence of CAG repeat length in AR remains open and debated. Genes encoding nuclear proteins (PRM1/2, TNP1/2) and ER1 are possible candidates for further examination, while the role of TAF7L remains unclear. Polymorphisms in 16 other genes have been investigated in single studies, but the results remain doubtful due to often small and heterogeneous cohorts and in the absence of independent replications. The genetic studies performed so far emphasize the complexity of male infertility as a presumably polygenetic trait amended by environmental, lifestyle or occupational factors.
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Affiliation(s)
- Frank Tüttelmann
- Institute of Reproductive Medicine of the University, Domagkstrasse 11, D-48129 Münster, Germany
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The androgen receptor and prostate cancer: A role for sexual selection and sexual conflict? Med Hypotheses 2008; 70:435-43. [DOI: 10.1016/j.mehy.2007.04.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 04/16/2007] [Indexed: 11/20/2022]
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Westerveld H, Visser L, Tanck M, van der Veen F, Repping S. CAG repeat length variation in the Androgen Receptor gene is not associated with spermatogenic failure. Fertil Steril 2008; 89:253-9. [PMID: 17889867 DOI: 10.1016/j.fertnstert.2007.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 02/02/2007] [Accepted: 02/02/2007] [Indexed: 11/19/2022]
Abstract
Previous association studies that described the effect of an enlarged CAG repeat length in the Androgen Receptor (AR) gene on spermatogenesis could not prove or refute a true association because of methodological weaknesses. Here, we clearly show that there is no association between CAG repeat length variation and semen quality.
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Affiliation(s)
- Henrike Westerveld
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands.
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Davis-Dao CA, Tuazon ED, Sokol RZ, Cortessis VK. Male infertility and variation in CAG repeat length in the androgen receptor gene: a meta-analysis. J Clin Endocrinol Metab 2007; 92:4319-26. [PMID: 17684052 DOI: 10.1210/jc.2007-1110] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Many studies have investigated the association between male infertility and trinucleotide repeat polymorphisms in the androgen receptor (AR) gene, but no comprehensive meta-analysis of all published studies has been conducted. OBJECTIVE Our goals were to summarize published data on associations between AR CAG and GGC repeat lengths and male infertility and investigate sources of variation between study results. DATA SOURCES We searched for reports published before October 2006 using Medline, PubMed, and Web of Science. STUDY SELECTION All selected studies included the following: a case group with infertility as measured by semen parameters, a control group of known or presumed fertile men, and measurement of CAG and/or GGC repeat lengths among cases and controls. Thirty-nine reports were selected based on these criteria, and 33 were ultimately included in the meta-analysis. DATA EXTRACTION One investigator extracted data on sample size, mean and sd of trinucleotide repeat length, and study characteristics. DATA SYNTHESIS Estimates of the standardized mean difference (95% confidence interval) were 0.19 (0.09-0.29) for the 33 studies and 0.31 (0.14-0.47) for a subset of 13 studies that used more stringent case and control selection criteria. Thus, in both groups, cases had statistically significantly longer CAG repeat length than controls. Publication date appeared to be a significant source of variation between studies. CONCLUSIONS This meta-analysis provides support for an association between increased androgen receptor CAG length and idiopathic male infertility, suggesting that even subtle disruptions in the androgen axis may compromise male fertility.
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Affiliation(s)
- Carol A Davis-Dao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, MC-9175, Los Angeles, California 90033, USA
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Zitzmann M, Nieschlag E. Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men. J Clin Endocrinol Metab 2007; 92:3844-53. [PMID: 17635942 DOI: 10.1210/jc.2007-0620] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A reliable form of androgen substitution therapy regarding kinetics, tolerance, and restoration of androgenicity is paramount in hypogonadal men. Intramuscular injection of the long-acting ester testosterone undecanoate (TU) offers a new modality. OBJECTIVE The objective of the study was to assess the safety of TU regarding metabolic and pharmacogenetic confounders. DESIGN This was a longitudinal one-arm open observation trial. A minimum of five individual assessments was a prerequisite. Putative modulators of safety parameters entering regression models were nadir and/or delta total testosterone concentrations, body mass index, androgen receptor (AR) gene CAG repeat length, and age. SETTING The study was conducted at an andrological outpatient clinic. PATIENTS Patients included 66 hypogonadal men (mean age 38 +/- 9.9 yr). MAIN OUTCOME MEASURES A total of 515 data time points each related to prostate, erythropoiesis, lipoproteins, and circulation during 118 treatment-years with 1000 mg TU at 10- to 14-wk intervals. RESULTS Testosterone substitution resulted in significant decrements of serum levels of low-density lipoprotein-cholesterol, resting diastolic and systolic blood pressure, and heart rate. Erythropoiesis was stimulated and concentrations of high-density lipoproteincholesterol increased. Parameters remained stable after four injections. No adverse effects regarding the prostate were observed. Significantly increased hematocrit greater than 50% was predicted by enhanced androgen action (shorter AR CAG repeats per higher testosterone levels). However, insufficient androgen action (longer AR CAG repeats per lower testosterone levels) caused pathological safety parameters (high blood pressure, adverse lipid profiles). In addition, a body mass index 30 kg/m(2) or greater represents a clinically relevant factor for the occurrence of all pathological safety parameters. Risk calculations for obese patients and nonlinear pharmacogenetic models to tailor androgen substitution are presented. CONCLUSIONS Testosterone substitution with im TU is generally well tolerated. Modifications of androgen action are due to both AR CAG repeats and testosterone levels. Adverse observations are mostly seen in obese patients.
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Affiliation(s)
- Michael Zitzmann
- Institute of Reproductive Medicine, University Clinics, Muenster D-48149, Germany
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Crabbe P, Bogaert V, De Bacquer D, Goemaere S, Zmierczak H, Kaufman JM. Part of the interindividual variation in serum testosterone levels in healthy men reflects differences in androgen sensitivity and feedback set point: contribution of the androgen receptor polyglutamine tract polymorphism. J Clin Endocrinol Metab 2007; 92:3604-10. [PMID: 17579205 DOI: 10.1210/jc.2007-0117] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT There is a large interindividual variation in serum (free) testosterone (FT) levels in men, underlain in part by genetic components. OBJECTIVE The objective of the study was to explore the hypothesis that this variability results in part from differences in androgen sensitivity and feedback loop set point and assess the role of the androgen receptor (AR) polyglutamine tract polymorphism encoded by a CAG repeat of variable length in exon 1 of the AR gene. DESIGN/SETTING/PARTICIPANTS We performed a cross-sectional analysis in two independent populations of healthy men, consisting of 2322 men aged 35-59 yr (Belstress study) and 358 men aged 25-45 yr (Siblos study), respectively. MAIN OUTCOME MEASURES Serum hormonal levels and the AR gene CAG repeat length were determined. RESULTS In the Belstress population, serum testosterone and calculated FT showed a positive linear association with LH (P < 0.001). In the 200 men with lowest FT, CAG repeat number was lower than in the 200 men with highest FT (P = 0.004). As studied in a larger subset of the population consisting of 857 men covering the whole FT range, FT increased progressively with CAG repeat length (P = 0.003). These findings of a positive relation of FT with both LH and CAG repeat length were confirmed in the Siblos study population (both P < or = 0.001). Difference in FT between extreme quartiles of CAG repeat was 10 and 14% in the Belstress and Siblos study, respectively. In both study populations, CAG repeat length was also positively associated with serum total testosterone (P < or = 0.004). CONCLUSIONS The data support the view that between-subject variability in serum FT in healthy men is underlain in part by differences in androgen sensitivity and feedback set point, with a contributory role of AR polymorphism. These findings have potential implications for the interpretation of epidemiological studies, diagnosis of hypogonadism, and pharmacogenetics of androgen treatment in men.
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Affiliation(s)
- P Crabbe
- Department of Endocrinology, 9K12 I.E., Ghent University Hospital, 9000 Ghent, Belgium
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Abstract
The etiopathogenesis of testicular failure remains unknown in about half of the cases and is referred to as "idiopathic infertility". "Idiopathic" testicular failure is of probable genetic origin since the number of genes involved in human spermatogenesis is likely thousands and only a small proportion of them have been identified and screened in infertile men. In parallel with studies aimed to identify mutations with a clear cause-effect relationship in spermatogenesis candidate genes, there is an increasing interest towards genetic susceptibility factors to male infertility. Despite many efforts, only a few clinically relevant polymorphisms have been identified. This is mainly related to the multifactorial nature of male infertility and to the inappropriate study design of the majority of the studies. The most promising polymorphisms are in genes involved in the endocrine regulation of spermatogenesis and on the Y chromosome, the "gr/gr" deletions. Polymorphisms are generally considered as co-factors. Their final effect on testis function and fertility is probably modulated by the genetic background of each individual and/or by the presence of certain environmental factors. In this review, recent findings concerning some of the most widely studied polymorphisms and male infertility will be discussed.
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Affiliation(s)
- Csilla Krausz
- Andrology Unit, Department of Clinical Physiopathology, Viale Pieraccini, 6 Firenze, Italy.
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40
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Abstract
Androgen receptor (AR) gene has been extensively studied in diverse clinical conditions. In addition to the point mutations, trinucleotide repeat (CAG and GGN) length polymorphisms have been an additional subject of interest and controversy among geneticists. The polymorphic variations in triplet repeats have been associated with a number of disorders, but at the same time contradictory findings have also been reported. Further, studies on the same disorder in different populations have generated different results. Therefore, combined analysis or review of the published studies has been of much value to extract information on the significance of variations in the gene in various clinical conditions. AR genetics has been reviewed extensively but until now review articles have focused on individual clinical categories such as androgen insensitivity, male infertility, prostate cancer, and so on. We have made the first effort to review most the aspects of AR genetics. The impact of androgens in various disorders and polymorphic variations in the AR gene is the main focus of this review. Additionally, the correlations observed in various studies have been discussed in the light of in vitro evidences available for the effect of AR gene variations on the action of androgens.
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MESH Headings
- Androgen-Insensitivity Syndrome/genetics
- Androgen-Insensitivity Syndrome/physiopathology
- Bone Diseases, Metabolic/genetics
- Bone Diseases, Metabolic/physiopathology
- Breast Neoplasms/genetics
- Breast Neoplasms/physiopathology
- Cognition Disorders/genetics
- Cognition Disorders/physiopathology
- Digestive System Diseases/genetics
- Digestive System Diseases/physiopathology
- Female
- Genital Neoplasms, Female/genetics
- Genital Neoplasms, Female/physiopathology
- Genital Neoplasms, Male/genetics
- Genital Neoplasms, Male/physiopathology
- Humans
- Infertility, Male/genetics
- Male
- Muscular Atrophy, Spinal/genetics
- Muscular Atrophy, Spinal/physiopathology
- Phenotype
- Point Mutation
- Polycystic Ovary Syndrome/genetics
- Polycystic Ovary Syndrome/physiopathology
- Polymorphism, Genetic
- Pre-Eclampsia/genetics
- Pre-Eclampsia/physiopathology
- Pregnancy
- Receptors, Androgen/genetics
- Receptors, Androgen/physiology
- Schizophrenia/genetics
- Schizophrenia/physiopathology
- Testosterone/deficiency
- Trinucleotide Repeats
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Affiliation(s)
- Singh Rajender
- Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad 500007, India
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41
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Zitzmann M. Mechanisms of Disease: pharmacogenetics of testosterone therapy in hypogonadal men. ACTA ACUST UNITED AC 2007; 4:161-6. [PMID: 17347661 DOI: 10.1038/ncpuro0706] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 11/28/2006] [Indexed: 11/09/2022]
Abstract
A defective, mutated androgen receptor may lead to variable phenotypes of androgen insensitivity in humans. Also, the CAG repeat polymorphism in exon 1 of the androgen receptor gene modulates androgen effects; in vitro, transcription of androgen-dependent target genes is attenuated with increasing length of triplet residues. Clinically, the CAG repeat polymorphism causes significant modulations of androgenicity in various tissues and psychological traits in healthy eugonadal men: the longer the repeat tracts, the less pronounced is the androgen effect when individuals with similar testosterone concentrations are compared. Furthermore, as effects of testosterone substitution are markedly influenced by the number of CAG repeats, the pharmacogenetic implications of this polymorphism are likely to have a significant role in future testosterone treatment of hypogonadal men. Thresholds at which testosterone treatment should be initiated, as well as androgen dosage, might be tailored according to the receptor polymorphism.
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Affiliation(s)
- Michael Zitzmann
- Institute of Reproductive Medicine, Domagkstr. 11, D-48149 Münster, Germany.
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