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Livingston M, Heald AH. Adult Male Hypogonadism: A Laboratory Medicine Perspective on Its Diagnosis and Management. Diagnostics (Basel) 2023; 13:3650. [PMID: 38132234 PMCID: PMC10743125 DOI: 10.3390/diagnostics13243650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. In this review, we have highlighted factors, both biological and analytical, that introduce variation into the measurement of serum T concentrations in men; these need to be considered when requesting T levels and interpreting results. There is an ongoing need for analytical standardisation of T assays and harmonisation of pre- and post-analytical laboratory practices, particularly in relation to the laboratory reference intervals provided to clinicians. Further, there is a need to share with service users the most up-to-date and evidence-based action thresholds for serum T as recommended in the literature. Estimation of free testosterone may be helpful. Causes of secondary hypogonadism should be considered. A comprehensive approach is required in the management of male hypogonadism, including lifestyle modification as well as medication where appropriate. The goal of treatment is the resolution of symptoms as well as the optimisation of metabolic, cardiovascular, and bone health. The advice of an endocrinologist should be sought when there is doubt about the cause and appropriate management of the hypogonadism.
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Affiliation(s)
- Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
- School of Medicine and Clinical Practice, The University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, Manchester University, Manchester M13 9PL, UK;
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford M6 8HD, UK
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Heald A, Cook MJ, Antonio L, Tournoy J, Ghaffari P, Mannan F, Fachim H, Vanderschueren D, Laing I, Hackett G, Casanueva FF, Huhtaniemi IT, Maggi M, Rastrelli G, Slowikowska-Hilczer J, Wu F, O'Neill TW. Number of CAG repeats and mortality in middle aged and older men. Clin Endocrinol (Oxf) 2023; 99:559-565. [PMID: 37718889 DOI: 10.1111/cen.14962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023]
Abstract
DESIGN The androgen receptor (AR) mediates peripheral effects of testosterone. Previous data suggests an association between the number of CAG repeats in exon-1 of the AR gene and AR transcriptional activity. The aim of this analysis was to determine the association between the number of AR CAG repeats and all-cause mortality in men and the influence of testosterone level on the association. PATIENTS AND MEASUREMENTS Follow-up data to 27 January 2018 were available for men aged 40-79 years recruited across six countries of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios (HR)/95% confidence intervals (CI). RESULTS One thousand nine hundred and seventy-seven men were followed up. Mean baseline age was 60 ± 11.1 years. Mean duration of follow-up was 12.2 years. At follow up 25.1% of men had died. CAG repeat length ranged from 6 to 39, with the highest proportion of CAG repeat number at 21 repeats (16.4%). In a multivariable model, compared to men with 22-23 AR CAG repeats: for men with <22 and >23 AR CAG HR, 95% CI for mortality were, <22 CAG repeats 1.17 (0.93-1.49) and >23 CAG repeats 1.14 (0.88-1.47). In a post-hoc analysis, the association was significant for men in the lowest tertile of baseline testosterone (<14.2 nmol/L) with >23 CAG repeats: in the adjusted model for <22 and >23 CAG repeats, respectively, 1.49 (0.97-2.27) and 1.68 (1.06-2.67) versus 22-23 repeats. CONCLUSIONS Our European-wide cohort data overall found no association of androgen receptor CAG repeat number and mortality in men. However, post hoc analysis suggested that an association might be present in men with lower baseline testosterone concentrations, which merits further investigation.
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Affiliation(s)
- Adrian Heald
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Michael J Cook
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Leen Antonio
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, Gerontology and Geriatrics Unit, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Parisa Ghaffari
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Fahmida Mannan
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Helene Fachim
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Dirk Vanderschueren
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Ian Laing
- Department of Biochemistry, Royal Preston Hospital, Preston, UK
| | | | - Felipe F Casanueva
- Department of Medicine, Santiagode Compostela University, Complejo Hospitalario Universitariode Santiago (CHUS), CIBER de Fisiopatología Obesidady Nutricion (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Ilpo T Huhtaniemi
- Department of Metabolism, Institute of Reproductive and Developmental, Digestion and Reproduction, Imperial College London, London, UK
| | - Mario Maggi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | | | - Fred Wu
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
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Heald A, Cook M, Antonio L, Vanderschueren D, Javed A, Fachim H, Hackett G, Wu F, O'Neill T. The number of androgen receptor CAG repeats and mortality in men. Aging Male 2022; 25:167-172. [PMID: 35652888 DOI: 10.1080/13685538.2022.2061452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The androgen receptor (AR) mediates peripheral effects of testosterone. Evidence suggests that the number of CAG repeats in exon-1 of the AR gene negatively correlates with AR transcriptional activity. The aim of this analysis was to determine the association between CAG repeat number and mortality in men. METHODS Men aged 40-79 years were recruited from primary care for participation in the UK arm of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios(HR)/95% confidence intervals (CI). RESULTS 312 men were followed up. The mean baseline age was 59.5 years. At follow up, 85/312(27%) men had died. CAG repeat length ranged from 14 to 39, with the highest proportion of CAG repeat number at 21 repeats(16.4%). In a multivariable model, using men with CAG repeat numbers of 22-23 as the reference, men with a lower number of CAG repeats(<22) showed a trend for a higher mortality in the follow-up period (HR 1.46 (0.75, 2.81)) as did men with higher number of repeats (>23) (1.37 (0.65, 2.91)). CONCLUSION Our data suggest that CAG repeat number may partially influence the risk of mortality in men. Further larger studies are required to quantify the effect.
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Affiliation(s)
- Adrian Heald
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Michael Cook
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | - Leen Antonio
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Ahmed Javed
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Helene Fachim
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | | | - Fred Wu
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester, UK
| | - Terence O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Javaroni V. Editorial Comment: Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer. Int Braz J Urol 2021; 48:188-195. [PMID: 34735092 PMCID: PMC8691234 DOI: 10.1590/s1677-5538.ibju.2022.01.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Valter Javaroni
- Departamento de Andrologia, Hospital Federal do Andaraí, Rio de Janeiro, RJ, Brasil
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Guilherme JPLF, V Shikhova Y, R Dondukovskaya R, A Topanova A, A Semenova E, V Astratenkova I, Ahmetov II. Androgen receptor gene microsatellite polymorphism is associated with muscle mass and strength in bodybuilders and power athlete status. Ann Hum Biol 2021; 48:142-149. [PMID: 33900145 DOI: 10.1080/03014460.2021.1919204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The androgen receptor (AR) gene contains a polymorphic trinucleotide (CAG) microsatellite repeat sequence (short or long alleles) that has been associated with fat-free mass in untrained men, which needs to be replicated in athletic cohorts. AIM The purpose of this study was to explore the AR (CAG)n polymorphism in trained individuals. SUBJECTS AND METHODS A total of 61 professional bodybuilders (40 males, 21 females), 73 elite male sprinters and weightlifters and 186 male controls were enrolled in this study. The influence of the AR (CAG)n polymorphism on muscle mass and strength was assessed in bodybuilders, while the frequencies of AR (CAG)n alleles were compared between power athletes and non-athletes. RESULTS The polymorphism was associated with anthropometric and strength measurements in bodybuilders of both genders. Those with ≥21 CAG repeats (i.e. carriers of long alleles) exhibited greater (p < 0.05) body mass index, absolute muscle mass, arm/thigh circumference and upper/lower limb strength compared to those with <21 CAG repeats. Furthermore, carriers of ≥21 CAG repeats were more frequent among power athletes compared to controls (p = 0.0076). CONCLUSIONS Long alleles of the AR (CAG)n polymorphism were associated with greater muscle mass and strength in bodybuilders, and power athlete status.
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Affiliation(s)
- João Paulo L F Guilherme
- Laboratory of Applied Nutrition and Metabolism, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Yulia V Shikhova
- Sports Genetics Laboratory, St Petersburg Research Institute of Physical Culture, St Petersburg, Russia
| | - Rimma R Dondukovskaya
- Sports Genetics Laboratory, St Petersburg Research Institute of Physical Culture, St Petersburg, Russia.,Weider College of Fitness and Bodybuilding, St Petersburg, Russia
| | - Alexandra A Topanova
- Sports Genetics Laboratory, St Petersburg Research Institute of Physical Culture, St Petersburg, Russia.,Institute of Medical Education, Almazov National Medical Research Centre, St Petersburg, Russia
| | - Ekaterina A Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia.,Sport Technology Research Center, Volga Region State University of Physical Culture, Sport and Tourism, Kazan, Russia
| | - Irina V Astratenkova
- Sports Genetics Laboratory, St Petersburg Research Institute of Physical Culture, St Petersburg, Russia.,Department of Physiology, St Petersburg State University, St Petersburg, Russia
| | - Ildus I Ahmetov
- Sports Genetics Laboratory, St Petersburg Research Institute of Physical Culture, St Petersburg, Russia.,Department of Physical Education, Plekhanov Russian University of Economics, Moscow, Russia.,Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Genetic Variation in the Androgen Receptor Modifies the Association Between Testosterone and Vitality in Middle-Aged Men. J Sex Med 2020; 17:2351-2361. [PMID: 33011098 DOI: 10.1016/j.jsxm.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Low vitality is a common symptom of testosterone deficiency; however, clinical trial results remain inconclusive regarding the responsiveness of this symptom to hormone replacement. AIM The aim of the present study was to determine if the relationship between circulating testosterone levels and vitality would be moderated by the CAG repeat length in the androgen receptor (AR) gene, which influences the receptor's sensitivity to testosterone. METHODS We examined 676 men in the Vietnam Era Twin Study of Aging when they were, on average, 55.4 years old (SD = 2.5). Salivary testosterone levels were measured by using 3 samples collected at waking on 3 nonconsecutive days. The average testosterone level was classified as low, normal, or high based on 1-SD cutoffs. Analyses were conducted using multilevel, mixed linear models, which accounted for the nonindependence of the twin data, and adjusted for the effects of age, ethnicity, BMI, chronic health conditions, depressive symptoms, and sleep quality. OUTCOMES Vitality was measured using the 36-item Short Form (SF-36) vitality subscale. RESULTS We observed a significant interaction between salivary testosterone and the AR-CAG repeat length. When the repeat length was short, men with low testosterone had significantly lower vitality. As the AR-CAG repeat length increased, the magnitude of the testosterone effect decreased. CLINICAL TRANSLATION The observed interaction between testosterone and variation in the AR gene suggests that men with more sensitive ARs, as indicated by a shorter AR-CAG repeat, are more likely to experience symptoms of age-related testosterone deficiency. STRENGTHS & LIMITATIONS Strengths of the present study include our use of a large community-based sample, the use of multiple testosterone measurements, and the availability of a comprehensive set of covariates that may impact the association of interest. Limitations include the homogeneous nature of the sample with respect to ethnicity, the brevity of the 36-item Short Form vitality subscale, and our inability to establish change in testosterone levels because of the cross-sectional nature of data. CONCLUSIONS The association between testosterone and vitality appears to be clinically meaningful and is in part dependent on variation in the AR gene. Panizzon MS, Bree K, Hsieh T-C, et al. Genetic Variation in the Androgen Receptor Modifies the Association Between Testosterone and Vitality in Middle-Aged Men. J Sex Med 2020;17:2351-2361.
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Androgen receptor-reduced sensitivity is associated with increased mortality and poorer glycaemia in men with type 2 diabetes mellitus: a prospective cohort study. Cardiovasc Endocrinol Metab 2020; 10:37-44. [PMID: 33634254 DOI: 10.1097/xce.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
Introduction Hypogonadism is associated with poorer glycaemic outcomes/increased all-cause and cardiovascular morbidity/mortality in type 2 diabetes mellitus (T2DM). Increasing CAG repeat number within exon-1 of the androgen receptor (AR) gene is associated with increased AR resistance/insulin resistance. Methods We determined in a long-term 14-year follow-up cohort of 423 T2DM Caucasian men, the association between baseline androgen status/CAG repeat number (by PCR then Sequenom sequencing) and metabolic/cardiovascular outcomes. Results Metabolic outcomes: Lower total testosterone was associated with higher BMI (kg/m2) at 14-year-follow-up: regression coefficient -0.30 (95% confidence interval -0.445 to -0.157), P = 0.0001. The range of CAG repeat number was 9-29 repeats. Higher CAG repeat number in exon-1 of the AR gene was associated with higher follow-up HbA1c2016 - each unit increase in CAG repeat-associated with an increment of 0.1% in HbA1C2016 (P = 0.04), independent of baseline testosterone. Cardiovascular outcomes and mortality: At an average of 14-year-follow-up, 55.8% of hypogonadal men had died vs 36.1% of eugonadal men (P = 0.001). There was a 'u' shaped relation between number of CAG repeats and mortality. Twenty-one CAG repeats were associated with an up to nearly 50% lower mortality rate than <21 CAG repeats and >21 CAG repeats - independent of baseline testosterone level. Conclusion A higher number of CAG repeats at the AR gene associates with higher future HbA1c. There was a 'u' shaped relation between CAG repeat number and mortality rate. Determination of CAG repeat number may become part of assessment of androgen status/its consequences for men with T2DM.
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Owens SJ, Weickert TW, Purves-Tyson TD, Ji E, White C, Galletly C, Liu D, O'Donnell M, Shannon Weickert C. Sex-Specific Associations of Androgen Receptor CAG Trinucleotide Repeat Length and of Raloxifene Treatment with Testosterone Levels and Perceived Stress in Schizophrenia. MOLECULAR NEUROPSYCHIATRY 2019; 5:28-41. [PMID: 31019916 PMCID: PMC6465742 DOI: 10.1159/000495062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022]
Abstract
Lower testosterone levels are associated with greater negative symptoms in men with schizophrenia. Testosterone signals via androgen receptor (AR). A functional variant in the AR gene (CAG trinucleotide repeat polymorphism) is associated with circulating testosterone and mood-related symptoms in healthy people. Raloxifene increases testosterone in healthy males and reduces symptom severity and improves cognition in schizophrenia; however, whether raloxifene increases testosterone in men with schizophrenia is unknown. We assessed the interaction of a functional AR gene variant and adjunctive raloxifene on peripheral testosterone and symptom severity in schizophrenia. Patients with schizophrenia (59 males and 38 females) participated in a randomized, double-blind, placebo-controlled, crossover trial of adjunctive raloxifene (120 mg/day). Healthy adults (46 males and 41 females) were used for baseline comparison. Baseline circulating testosterone was decreased in male patients compared to male controls and positively correlated with CAG repeat length in male controls and female patients. Male patients with short, compared to long, CAG repeat length had higher stress scores. Raloxifene treatment increased testosterone in male patients, but was unrelated to AR CAG repeat length, suggesting that raloxifene's effects may not depend on AR activity. Sex-specific alterations of the relationship between AR CAG repeat length and testosterone suggest that altered AR activity may impact perceived stress in men with schizophrenia.
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Affiliation(s)
- Samantha J. Owens
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas W. Weickert
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Tertia D. Purves-Tyson
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Ellen Ji
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher White
- Department of Endocrinology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Maryanne O'Donnell
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Cynthia Shannon Weickert
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, New York, USA
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Wong PW, Lee HM, Lau ESH, Lim C, Ma RCW, Kong APS, Chan JCN, Luk AOY. Interactive effects of testosterone and the androgen receptor CAG repeat length polymorphism on cardiovascular-renal events and mortality in men with diabetes. Diabetes Metab Res Rev 2019; 35:e3081. [PMID: 30261555 DOI: 10.1002/dmrr.3081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 12/28/2022]
Abstract
AIM Current evidence relating testosterone to cardiovascular disease and mortality is inconclusive. Cellular effects of testosterone are mediated by androgen receptor and longer receptor gene CAG repeat length correlates with reduced transcriptional activity. We investigated the independent and interactive association of total testosterone and CAG repeat length with incident cardiovascular disease (CVD), chronic kidney disease (CKD) and mortality in Chinese men with type 2 diabetes. MATERIALS AND METHODS From March 2008 and February 2009, 474 men with diabetes underwent structured clinical assessment including genotyping for CAG repeat length. Patients were followed for new-onset CVD, CKD defined by estimated glomerular filtration rate <60 mL/min/1.73m2 , and death until 31 May 2015. RESULTS In this cohort (mean age: 58.6 years, disease duration: 15.4 years), CAG repeat number ranged from 11 to 32 with median of 23, and 9.3% had low testosterone. Over follow-up of 5.8 years, 49 (10.3%) men had CVD, 139 (29.3%) had CKD, and 43 (9.1%) died. In multivariate Cox regression adjusted for age, duration of diabetes, and cardiometabolic risk factors, both total testosterone and interaction term of total testosterone × CAG repeat were associated with all-cause death with respective hazard ratios 1.63 (P = 0.002) and 0.98 (P = 0.004). Total testosterone and CAG repeat were not related to incident CVD or CKD. CONCLUSIONS Among men with type 2 diabetes, high total testosterone was associated with increased mortality in the presence of shorter CAG repeat length but decreased mortality in those with long CAG repeats.
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Affiliation(s)
- Poon-Wing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - Heung-Man Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Cadmon Lim
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
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Ryan CP, Georgiev AV, McDade TW, Gettler LT, Eisenberg DTA, Rzhetskaya M, Agustin SS, Hayes MG, Kuzawa CW. Androgen receptor polyglutamine repeat length (AR‐CAGn) modulates the effect of testosterone on androgen‐associated somatic traits in Filipino young adult men. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 163:317-327. [DOI: 10.1002/ajpa.23208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/16/2017] [Accepted: 02/25/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Calen P. Ryan
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
| | | | - Thomas W. McDade
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
- Institute for Policy ResearchNorthwestern UniversityEvanston Illinois
| | - Lee T. Gettler
- Department of AnthropologyUniversity of Notre DameNotre Dame Indiana
- The Eck Institute for Global HealthUniversity of Notre DameNotre Dame Indiana
| | - Dan T. A. Eisenberg
- Department of AnthropologyUniversity of WashingtonSeattle Washington
- Center for Studies in Demography and EcologyUniversity of WashingtonSeattle Washington
| | - Margarita Rzhetskaya
- Division of EndocrinologyMetabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineChicago Illinois
| | - Sonny S. Agustin
- USC‐Office of Population Studies FoundationUniversity of San CarlosCebu City Philippines
| | - M. Geoffrey Hayes
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
- Division of EndocrinologyMetabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of MedicineChicago Illinois
- Center for Genetic MedicineNorthwestern University Feinberg School of MedicineChicago Illinois
| | - Christopher W. Kuzawa
- Department of AnthropologyNorthwestern UniversityEvanston Illinois
- Institute for Policy ResearchNorthwestern UniversityEvanston Illinois
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Sung J, Song YM. Genetic effects on serum testosterone and sex hormone-binding globulin in men: a Korean twin and family study. Asian J Androl 2016; 18:786-90. [PMID: 26486061 PMCID: PMC5000805 DOI: 10.4103/1008-682x.164923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/07/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
We conducted a community-based cross-sectional study to evaluate the role of genetics in determining the individual difference in total testosterone and sex hormone-binding globulin levels. Study participants comprised 730 Korean men consisting of 142 pairs of monozygotic twins, 191 pairs of siblings, and 259 father-offspring pairs from 270 families who participated in the Healthy Twin study. Serum concentration of total testosterone and sex hormone-binding globulin were measured by chemiluminescence immunoassay, and free testosterone and bioavailable testosterone were calculated using Vermeulen's method. Quantitative genetic analysis based on a variance decomposition model showed that the heritability of total testosterone, free testosterone, bioavailable testosterone, and sex hormone-binding globulin were 0.56, 0.45, 0.44, and 0.69, respectively after accounting for age and body mass index. Proportions of variance explained by age and body mass index varied across different traits, from 8% for total testosterone to 31% for sex hormone-binding globulin. Bivariate analysis showed a high degree of additive genetic correlation (ρG = 0.67) and a moderate degree of individual-specific environmental correlation (ρE = 0.42) between total testosterone and sex hormone-binding globulin. The findings confirmed the important role of genetics in determining the individually different levels of testosterone and sex hormone-binding globulin during adulthood in Korean men as found in non-Asian populations, which may suggest that common biologic control for determining testosterone level directly or indirectly through binding protein are largely shared among different populations.
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Affiliation(s)
- Joohon Sung
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul 151-742, South Korea
- Institute of Health Environment, Seoul National University, Seoul 151-742, South Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center and Center for Clinical Research, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
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12
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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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13
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Abstract
Metabolic syndrome (MetS) is a growing health concern worldwide. Initially a point of interest in cardiovascular events, the cluster of HTN, obesity, dyslipidemia, and insulin resistance known as MetS has become associated with a variety of other disease processes, including androgen deficiency and late-onset hypogonadism (LOH). Men with MetS are at a higher risk of developing androgen deficiency, and routine screening of testosterone (T) is advised in this population. The pathophysiology of androgen deficiency in MetS is multifactorial, and consists of inflammatory, enzymatic, and endocrine derangements. Many options for the concomitant treatment of both disorders exist. Direct treatment of MetS, whether by diet, exercise, or surgery, may improve T levels. Conversely, testosterone replacement therapy (TRT) has been shown to improve MetS parameters in multiple randomized controlled trials (RTCs).
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Affiliation(s)
- Ashley G Winter
- 1 James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY 10065, USA ; 2 Department of Urology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Fujun Zhao
- 1 James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY 10065, USA ; 2 Department of Urology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Richard K Lee
- 1 James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY 10065, USA ; 2 Department of Urology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 20080, China
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14
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Tirabassi G, Cignarelli A, Perrini S, delli Muti N, Furlani G, Gallo M, Pallotti F, Paoli D, Giorgino F, Lombardo F, Gandini L, Lenzi A, Balercia G. Influence of CAG Repeat Polymorphism on the Targets of Testosterone Action. Int J Endocrinol 2015; 2015:298107. [PMID: 26421011 PMCID: PMC4572434 DOI: 10.1155/2015/298107] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/09/2015] [Indexed: 01/11/2023] Open
Abstract
In the last decade, ample evidence has demonstrated the growing importance of androgen receptor (AR) CAG repeat polymorphism in andrology. This genetic parameter is able to condition the peripheral effects of testosterone and therefore to influence male sexual function and fertility, cardiovascular risk, body composition, bone metabolism, the risk of prostate and testicular cancer, the psychiatric status, and the onset of neurodegenerative disorders. In this review, we extensively discuss the literature data and identify a role for AR CAG repeat polymorphism in conditioning the systemic testosterone effects. In particular, our main purpose was to provide an updated text able to shed light on the many and often contradictory findings reporting an influence of CAG repeat polymorphism on the targets of testosterone action.
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Affiliation(s)
- Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Sebastio Perrini
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola delli Muti
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Giorgio Furlani
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Mariagrazia Gallo
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Pallotti
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Donatella Paoli
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Lombardo
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Loredana Gandini
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Andrea Lenzi
- Laboratory of Seminology-Sperm Bank, Department of Experimental Medicine, University of Rome “La Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
- *Giancarlo Balercia:
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15
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Rudolph A, Shi H, Försti A, Hoffmeister M, Sainz J, Jansen L, Hemminki K, Brenner H, Chang-Claude J. Repeat polymorphisms in ESR2 and AR and colorectal cancer risk and prognosis: results from a German population-based case-control study. BMC Cancer 2014; 14:817. [PMID: 25376484 PMCID: PMC4232639 DOI: 10.1186/1471-2407-14-817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/27/2014] [Indexed: 02/08/2023] Open
Abstract
Background Evidence has accumulated which suggests that sex steroids influence colorectal cancer development and progression. We therefore assessed the association of repeat polymorphisms in the estrogen receptor β gene (ESR2) and the androgen receptor gene (AR) with colorectal cancer risk and prognosis. Methods The ESR2 CA and AR CAG repeat polymorphisms were genotyped in 1798 cases (746 female, 1052 male) and 1810 controls (732 female, 1078 male), matched for sex, age and county of residence. Colorectal cancer risk associations overall and specific for gender were evaluated using multivariate logistic regression models adjusted for sex, county of residence and age. Associations with overall and disease-specific survival were evaluated using Cox proportional hazard models adjusted for established prognostic factors (diagnosis of other cancer after colorectal cancer diagnosis, detection by screening, treatment with adjuvant chemotherapy, tumour extent, nodal status, distant metastasis, body mass index, age at diagnosis and year of diagnosis) and stratified for grade of differentiation. Heterogeneity in gender specific associations was assessed by comparing models with and without a multiplicative interaction term by means of a likelihood ratio test. Results The average number of ESR2 CA repeats was associated with a small 5% increase in colorectal cancer risk (OR = 1.05, 95% CI 1.01-1.10) without significant heterogeneity according to gender or tumoural ESR2 expression. We found no indication for an association between the AR CAG repeat polymorphisms and risk of colorectal cancer. The ESR2 CA and AR CAG repeat polymorphisms were not associated with overall survival or disease specific survival after colorectal cancer diagnosis. Conclusions Higher numbers of ESR2 CA repeats are potentially associated with a small increase in colorectal cancer risk. Our study does not support an association between colorectal cancer prognosis and the investigated repeat polymorphisms. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-817) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
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16
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Vandenput L, Ohlsson C. Genome-wide association studies on serum sex steroid levels. Mol Cell Endocrinol 2014; 382:758-766. [PMID: 23541950 DOI: 10.1016/j.mce.2013.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 11/21/2022]
Abstract
Even though the levels of circulating sex steroid hormones are to a large extent heritable, their genetic determinants are largely unknown. With the advent of genome-wide association studies (GWAS), much progress has been made and several genetic loci have been identified to be associated with serum levels of dehydroepiandrosterone sulfate, testosterone and sex hormone-binding globulin. The variants identified so far only explain a small amount of the overall heritability, but may help to elucidate the role of sex steroid hormones in common disorders such as hypogonadism, type 2 diabetes and hormone-sensitive cancers. This review provides an overview of the current state of knowledge of the genetic determinants of sex steroid hormones, with a focus on recent GWAS and brief directions for elucidating the remaining heritability.
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Affiliation(s)
- Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Schneider G, Zitzmann M, Gromoll J, Ladwig KH, Berger K. The relation between sex hormone levels, the androgen receptor CAGn-polymorphism and depression and mortality in older men in a community study. Psychoneuroendocrinology 2013; 38:2083-90. [PMID: 23602133 DOI: 10.1016/j.psyneuen.2013.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sex hormones levels and the androgen receptor CAGn polymorphism have been shown to be involved in depressed mood in aging men. But the few prior studies found inconsistent results on the role of both factors. METHODS 186 male participants aged ≥65 years from the community based Memory and Morbidity in Augsburg Elderly (MEMO) Study underwent a physical examination, and a medical interview including two scales (Center for Epidemiologic Studies Depression Scale (CES-D); Activities of Daily Living Scale (ADL). Testosterone, SHBG and LH levels were measured and the androgen receptor CAGn polymorphism was genotyped. χ(2), Mann-Whitney U-test, Pearson's correlations and multivariable linear and logistic regression were used in the analysis. RESULTS Higher depressive scores were significantly associated with higher SHBG-levels (beta coefficient 0.25, p<0.001). SHBG alone explained 8% of variance of the CES-D depression score. Mortality at 10 years follow-up was predicted by higher SHBG levels, higher ADL-scores, older age, current smoking and the depression score at baseline. This model explained 35% of the variance of mortality. The number of CAG repeats was neither related to depression scores nor to mortality. CONCLUSIONS We found positive associations between SHBG levels and old age male depression as well as mortality. Whether SHBG has a testosterone independent effect in this context should be investigated further.
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Affiliation(s)
- Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University of Muenster, Muenster, Germany.
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18
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Abstract
PURPOSE OF REVIEW To review recent data concerning the relationship between endogenous testosterone and lipids as well as testosterone replacement therapy and lipids. To describe the effects of sex hormones on cardiovascular disease (CVD) that may act via serum lipids. RECENT FINDINGS Low endogenous testosterone is associated with high low-density lipoprotein and low high-density lipoprotein in both cross-sectional and prospective observational studies. Exogenous testosterone administration is associated with decreased high-density lipoprotein coupled with beneficial decreases in low-density lipoprotein and total cholesterol. The overall impact of testosterone administration on CVD is still unclear, with mixed safety results from recent randomized controlled trials. SUMMARY There may be CVD risk reduction benefits, including an improved lipid profile, from testosterone administration in hypogonadal men. The overall effect of testosterone on CVD risk has not been definitively determined.
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Affiliation(s)
- Anne K Monroe
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Maryland, USA
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19
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Tirabassi G, delli Muti N, Corona G, Maggi M, Balercia G. Androgen Receptor Gene CAG Repeat Polymorphism Regulates the Metabolic Effects of Testosterone Replacement Therapy in Male Postsurgical Hypogonadotropic Hypogonadism. Int J Endocrinol 2013; 2013:816740. [PMID: 24454369 PMCID: PMC3876679 DOI: 10.1155/2013/816740] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/04/2013] [Indexed: 11/26/2022] Open
Abstract
Aim. To evaluate the independent role of androgen receptor (AR) gene CAG repeat polymorphism on metabolic effects of testosterone replacement therapy (TRT) in male postsurgical hypogonadotropic hypogonadism, a condition frequently associated with hypopituitarism and in which the TRT-related metabolic effects are combined with those deriving from concomitant administration of metabolically active pituitary-function replacement therapies. Methods. 15 men affected by postsurgical hypogonadotropic hypogonadism were evaluated before and after TRT. Cardiovascular risk factors (CVRFs), pituitary-dependent hormones, and AR gene CAG repeat polymorphism were considered. Results. Testosterone, insulin-like growth factor 1 (IGF-1), and estradiol were the only hormones, which varied significantly between the two phases. All CVRFs significantly improved after TRT. The number of CAG triplets was positively and significantly correlated with all the variations (Δ-) of CVRFs (except for a significant negative correlation with Δ-high-density lipoprotein); the opposite occurred between the latter and Δ-testosterone. No correlation between Δ-IGF-1 or estradiol and Δ-CVRFs was found. At multiple linear regression, after correction for Δ-testosterone, nearly all the associations between the number of CAG triplets and Δ-CVRFs were confirmed. Conclusions. In male postsurgical hypogonadotropic hypogonadism, shorter AR gene CAG tract length seems to yield greater metabolic improvement after TRT, independently of the effects of concomitant pituitary-function replacement therapies.
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Affiliation(s)
- Giacomo Tirabassi
- Andrology Unit, Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Nicola delli Muti
- Andrology Unit, Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Giovanni Corona
- Endocrinology Unit, Azienda Usl di Bologna, Maggiore-Bellaria Hospital, Bologna, Italy
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Mario Maggi
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Giancarlo Balercia
- Andrology Unit, Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, 60126 Ancona, Italy
- *Giancarlo Balercia:
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