Relationship between symptoms of androgen deficiency and psychological factors and quality of life among Chinese men

Androgen regulation of behavioral stress responses and the hypothalamic-pituitary-adrenal axis

Testosterone is a powerful steroid hormone that can impact the brain and behavior in various ways, including regulating behavioral and neuroendocrine (hypothalamic-pituitary-adrenal (HPA) axis) stress responses. Early in life androgens can act to alter development of brain regions associated with stress regulation, which ultimately impacts the display of stress responses later in life. Adult circulating androgens can also influence the expression of distinct genes and proteins that regulate stress responses. These changes in the brain are hypothesized to underlie the potent effects of androgens in regulating behaviors related to stress and stress-induced activation of the HPA axis. Androgens can induce alterations in these functions through direct binding to the androgen receptor (AR) or following conversion to estrogens and subsequent binding to estrogen receptors including estrogen receptor alpha (ERα), beta (ERβ), and G protein-coupled estrogen receptor 1 (GPER1). In this review, we focus on the role of androgens in regulating behavioral and neuroendocrine stress responses at different stages of the lifespan and the sex hormone receptors involved in regulating these effects. We also review the specific brain regions and cell phenotypes upon which androgens are proposed to act to regulate stress responses with an emphasis on hypothalamic and extended amygdala subregions. This knowledge of androgen effects on these neural systems is critical for understanding how sex hormones regulate stress responses.

Effects of Unripe Black Raspberry Extract Supplementation on Male Climacteric Syndrome and Voiding Dysfunction: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial

Male climacteric syndrome (MCS) is a medical condition that can affect middle-aged men whose testosterone levels begin to decline considerably. These symptoms may include fatigue, decreased libido, mood swings, and disturbed sleep. MCS can be managed with lifestyle modifications and testosterone replacement. However, testosterone therapy may cause number of side effects, including an increased risk of cardiovascular issues. This study aims to evaluate the efficacy and safety of unripe black raspberry extract (BRE) against MCS and voiding dysfunction in men with andropause symptoms. A total of 30 subjects were enrolled and randomly assigned to the BRE group (n = 15) or the placebo group (n = 15). Participants were supplemented with 4800 mg BRE or placebo twice daily for 12 weeks. The impact of BRE was assessed using the Aging Male's Symptoms (AMS scale), International Prostate Symptom Score (IPSS) and the IPSS quality of life index (IPSS-QoL). Additionally, male sex hormones, lipid profiles, and anthropometric indices were assessed 6 and 12 weeks after treatment. The AMS scores did not differ significantly between the two groups. In the BRE group, the total IPSS and IPSS-QoL scores decreased significantly after 12 weeks compared to baseline (p < 0.05), but there was no significant difference compared to the placebo group. However, a significant difference was observed in the IPSS voiding symptoms sub-score compared to the placebo group. Furthermore, LDL-C and TC levels were also significantly lower in the BRE group than in the placebo group (p < 0.05). Collectively, the study provides strong evidence supporting the safety of BRE as a functional food and its supplementation potentially enhances lipid metabolism and alleviates MCS and dysuria symptoms, limiting the development of BPH.

The severity of hypogonadism symptoms and its risk factors among male employees of Tehran University of Medical Sciences

OBJECTIVES

The current study was conducted to examine the severity of hypogonadism symptoms and their risk factors among the male employees of Tehran University of Medical Sciences (TUMS).

METHODS

This cross-sectional study was conducted on 80 male employees aged 40-60 years, with hypogonadism, at TUMS. The participants were selected through census sampling. The data collection tools included the demographic questionnaire and the Aging Male Symptoms (AMS) questionnaire. The participants first completed the demographic questionnaire and then the AMS questionnaire. SPSS statistical software version 22 (Chicago, IL) was used to analyze the data, and one-way ANOVA tests, Pearson's correlation coefficient, and stepwise multivariate logistic regression were applied.

RESULTS

Based on our findings, the mean overall score of hypogonadism symptoms was 41.71 ± 9.20. Based on Pearson's correlation coefficient results, there was a statistically significant association between the severity of hypogonadism symptoms and age (p < .001). Furthermore, there were significant associations between the economic status, cigarette consumption and hours of sleep and the severity of hypogonadism symptoms (p < .001).

CONCLUSIONS

The current study's results showed that certain factors can affect hypogonadism in males. Thus, it is important to reduce the severity of hypogonadism symptoms and to modify the factors related to this phenomenon.

Concurrent training protocol for men with androgen deficiency in the aging male: a randomized clinical trial

BACKGROUND

The androgen deficiency in the aging male (ADAM) affects physical, sexual, and psychological aspects with characteristics symptoms of middle-aged men. The practice of regular physical activity and physical exercise can attenuate these symptoms. The aim of this randomized clinical trial is to propose a physical exercise protocol based on concurrent training for middle-aged men with ADAM.

METHOD

Randomized clinical trial with a 6-month intervention will randomly divided into two groups: experimental group (EG) and control group (CG). Four evaluations will be carried out, (1) pre-intervention; (2) in the first month of intervention; (3) in the third month of intervention; (4) post-intervention, evaluating: physical, psychological, sexual, and hormonal aspects. The intervention protocol with concurrent training will have duration of 6 months; frequency of 3 times weekly, with 60 min per session. The two-way ANOVA test will be used for the inter-group and intra-group comparisons with repeated measurements, and also Sydak's comparison test.

CONCLUSION

This protocol was developed with the intent of easing the symptoms of ADAM. In addition, it is believed that the concurrent training protocol could be capable to recover hormonal, physical, psychological, and sexual aspect of middle-aged men with ADAM.

Debate position: cognition and mood are not improved in men administered exogenous testosterone therapy

PURPOSE OF REVIEW

The purpose of this article is to provide an overview of the increasing evidence suggesting that exogenous testosterone therapy is not associated with improvements in cognition or mood. This article is part of a series, in this issue, in which authors are assigned opinion pieces on controversial topics pertaining to testosterone replacement.

RECENT FINDINGS

Testosterone is increasingly being prescribed. Particularly in the setting of recent data suggestive of possible cardiovascular risk associated with its use; a clear understanding of the domains of health that improve with exogenous testosterone use is important. Data on endogenous and exogenous testosterone with cognition and mood are mixed, likely partly related to methodological differences of type of testosterone, patient population, and dosing.

SUMMARY

Overall, available data are not suggestive of a clear benefit of testosterone supplementation in multiple domains of cognition and in mood. Supraphysiologic testosterone has been associated with adverse psychological outcomes, albeit not uniformly in studies.

The prevalence and correlates of the positive Androgen Deficiency in the Aging Male (ADAM) questionnaire among psychiatric outpatients: a cross-sectional survey of 176 men in a general hospital in Taiwan

INTRODUCTION

The Androgen Deficiency in the Aging Male (ADAM) questionnaire is widely used to screen for late-onset hypogonadism. The positive response to the ADAM questionnaire (positive ADAM) has been associated with depression and poorer quality of life in a number of studies. It is unclear whether there is any value of the ADAM questionnaire in psychiatric populations. In this study, we aimed to determine the utility of the ADAM questionnaire in a convenient sample of male psychiatric outpatients.

METHODS

One hundred and seventy-six men (mean age: 54.3 years; standard deviation: 10.7 years; range: 40-80 years) completed the ADAM questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Aging Males' Symptoms (AMS) scale. Anxiety was defined as a HADS anxiety subscore ≥8; depression as a HADS depression subscore ≥8; and moderate/severe impairment of health-related quality of life (HQoL) as AMS ≥37. ADAM, anxiety, and depression was used to model the moderate/severe impairment of HQoL.

RESULTS

One hundred and sixty-four (93%) men had positive ADAM. Positive ADAM was associated with a lower body mass index (P<0.05) and moderate/severe impairment of HQoL (P<0.001), but was not associated with anxiety or depression (P>0.05). Positive ADAM was associated with five symptoms of the AMS scale: "decline of one's feeling of general well-being", "depressive mood", and three sexual symptoms. In regression analysis, positive ADAM was associated with increased risk of moderate/severe impairment of HQoL (unadjusted odds ratio 20.1, 95% confidence interval 3.77-372, P<0.01), which remained significant with covariates of anxiety and depression (adjusted odds ratio 15.6, 95% confidence interval 2.52-309, P<0.05).

CONCLUSION

The ADAM questionnaire can be used to screen the sexual symptoms but not depression/anxiety in male psychiatric outpatients. Positive ADAM may indicate moderate/severe impairment of HQoL.

Partial androgen deficiency, depression, and testosterone supplementation in aging men

The aim of this review was to summarize current knowledge on the correlation between depressive symptoms with a syndrome called partial androgen deficiency of the aging male (PADAM) and on the potential benefits of testosterone (T) treatment on mood. Despite, the causative nature of the relationship between low T levels and depression is uncertain, many hypogonadal men suffer from depression and vice versa several depressed patients are affected by hypogonadism. Supplementation with testosterone failed to show sound evidence of effectiveness in the treatment of depression. Nevertheless, testosterone supplementation has proved to be effective on some domains significant for the quality of life of aged patients with PADAM (sexual function and cognitive functions, muscular strengths).