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Green DJ, Chasland LC, Yeap BB, Naylor LH. Comparing the Impacts of Testosterone and Exercise on Lean Body Mass, Strength and Aerobic Fitness in Aging Men. SPORTS MEDICINE - OPEN 2024; 10:30. [PMID: 38563849 PMCID: PMC10987448 DOI: 10.1186/s40798-024-00703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Based on the largely untested premise that it is a restorative hormone that may reverse the detrimental impacts of aging, prescription of testosterone (T) has increased in recent decades despite no new clinical indications. It is apparent that middle-aged and older men with low-normal serum T levels are considering T supplementation as an anti-aging strategy. At the same time, there is evidence that physical activity (PA) is at historical lows in the Western world. In this review, we compare the impacts of T treatment aimed at achieving physiological T concentrations in middle-aged and older men, alongside the impacts of ecologically relevant forms of exercise training. The independent, and possible combined, effects of T and exercise therapy on physiological outcomes such as aerobic fitness, body composition and muscular strength are addressed. MAIN BODY Our findings suggest that both T treatment and exercise improve lean body mass in healthy older men. If improvement in lean body mass is the primary aim, then T treatment could be considered, and the combination of T and exercise may be more beneficial than either in isolation. In terms of muscle strength in older age, an exercise program is likely to be more beneficial than T treatment (where the dose is aimed at achieving physiological concentrations), and the addition of such T treatment does not provide further benefit beyond that of exercise alone. For aerobic fitness, T at doses aimed at achieving physiological concentrations has relatively modest impacts, particularly in comparison to exercise training, and there is limited evidence as to additive effects. Whilst higher doses of T, particularly by intramuscular injection, may have larger impacts on lean body mass and strength, this must be balanced against potential risks. CONCLUSION Knowing the impacts of T treatment and exercise on variables such as body composition, strength and aerobic fitness extends our understanding of the relative benefits of physiological and pharmacological interventions in aging men. Our review suggests that T has impacts on strength, body composition and aerobic fitness outcomes that are dependent upon dose, route of administration, and formulation. T treatment aimed at achieving physiological T concentrations in middle-aged and older men can improve lean body mass, whilst exercise training enhances lean body mass, aerobic fitness and strength. Men who are physically able to exercise safely should be encouraged to do so, not only in terms of building lean body mass, strength and aerobic fitness, but for the myriad health benefits that exercise training confers.
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Affiliation(s)
- Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia.
| | - Lauren C Chasland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, WA, 6009, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
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Matta RA, Farrage HM, Saedii AA, Abdelrahman MM. Male subclinical hypogonadism and late-onset hypergonadotrophic hypogonadism: mechanisms, endothelial function, and interplay between reproductive hormones, undercarboxylated osteocalcin, and endothelial dysfunction. Aging Male 2022; 25:72-87. [PMID: 35291927 DOI: 10.1080/13685538.2022.2049744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
BACKGROUND Pathogenesis and endothelial function in subclinical hypogonadism (SCH) remain unclear. Undercarboxylated osteocalcin (ucOC) participates in atherosclerosis and reproduction. We explored the underlying mechanisms and interplay of endothelial dysfunction, unOC and reproductive hormones in SCH and primary late-onset hypogonadism (LOH). METHODS In the SCH, LOH, and healthy eugonadal male groups, we measured serum unOC, calculated luteinizing hormone/testosterone (LH/T), LH.T product, and estradiol/T (E/T) as indicators of impaired Leydig cells, androgen sensitivity index (ASI), and aromatase activity, respectively (LH set-point regulators), and assessed flow-mediated dilation of the brachial artery (FMD%), carotid-intima media thickness (CIMT), and aortic stiffness (AS). RESULTS ↑LH/T, ↑ASI, ↓aromatase activity, normal T, follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) levels, ↑unOC, and enhanced atherosclerotic markers (↓FMD%, ↑CIMT, ↑AS) are characteristics of SCH. Testosterone was positively correlated with FMD% in SCH. The independent predictors were: SHBG and LH for FMD% and CIMT, respectively, and LH/T, ucOC, FSH, estradiol, and E/T ratio for AS in the LOH group; and LH for FMD% & AS and LH and LH/T for CIMT in all study subjects. CONCLUSIONS SCH is a distinct clinical entity characterized by impaired androgen sensitivity and aromatase activity, compensatory elevated unOC, endothelial dysfunction, and anti-atherogenic role of testosterone.
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Affiliation(s)
- Ragaa Abedelshaheed Matta
- Diabetes and Endocrinology Unit, Department of Internal Medicine, Faculty of Medicine, Minia University, Minia, Egypt
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3
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Corona G, Vena W, Pizzocaro A, Giagulli VA, Francomano D, Rastrelli G, Mazziotti G, Aversa A, Isidori AM, Pivonello R, Vignozzi L, Mannucci E, Maggi M, Ferlin A. Testosterone supplementation and bone parameters: a systematic review and meta-analysis study. J Endocrinol Invest 2022; 45:911-926. [PMID: 35041193 DOI: 10.1007/s40618-021-01702-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The role of testosterone (T) replacement therapy (TRT) in subjects with late onset hypogonadism is still the object of an intense debate. METHODS All observational studies and placebo-controlled or -uncontrolled randomized trials (RCTs) comparing the effect of TRT on different bone parameters were considered. RESULTS Out of 349 articles, 36 were considered, including 3103 individuals with a mean trial duration of 66.6 weeks. TRT improves areal bone mineral density (aBMD) at the spine and femoral neck levels in observational studies, whereas placebo-controlled RTCs showed a positive effect of TRT only at lumber spine and when trials included only hypogonadal patients at baseline (total testosterone < 12 nM). The effects on aBMD were more evident in subjects with lower T levels at baseline and increased as a function of trial duration and a higher prevalence of diabetic subjects. Either T or estradiol increase at endpoint contributed to aBMD improvement. TRT was associated with a significant reduction of bone resorption markers in observational but not in controlled studies. CONCLUSION TRT is able to inhibit bone resorption and increase bone mass, particularly at the lumbar spine level and when the duration is long enough to allow the anabolic effect of T and estrogens on bone metabolism to take place.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - W Vena
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - V A Giagulli
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - D Francomano
- Unit of Internal Medicine and Endocrinology, Madonna Delle Grazie Hospital, Velletri, Rome, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - G Mazziotti
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome-Policlinico Umberto I Hospital, Rome, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - E Mannucci
- Department of Diabetology, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
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Stefani WA. Commentary on: A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryolipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients. Aesthet Surg J 2021; 41:942-943. [PMID: 33956082 DOI: 10.1093/asj/sjab219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tallis J, Shelley S, Degens H, Hill C. Age-Related Skeletal Muscle Dysfunction Is Aggravated by Obesity: An Investigation of Contractile Function, Implications and Treatment. Biomolecules 2021; 11:372. [PMID: 33801275 PMCID: PMC8000988 DOI: 10.3390/biom11030372] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
Obesity is a global epidemic and coupled with the unprecedented growth of the world's older adult population, a growing number of individuals are both old and obese. Whilst both ageing and obesity are associated with an increased prevalence of chronic health conditions and a substantial economic burden, evidence suggests that the coincident effects exacerbate negative health outcomes. A significant contributor to such detrimental effects may be the reduction in the contractile performance of skeletal muscle, given that poor muscle function is related to chronic disease, poor quality of life and all-cause mortality. Whilst the effects of ageing and obesity independently on skeletal muscle function have been investigated, the combined effects are yet to be thoroughly explored. Given the importance of skeletal muscle to whole-body health and physical function, the present study sought to provide a review of the literature to: (1) summarise the effect of obesity on the age-induced reduction in skeletal muscle contractile function; (2) understand whether obesity effects on skeletal muscle are similar in young and old muscle; (3) consider the consequences of these changes to whole-body functional performance; (4) outline important future work along with the potential for targeted intervention strategies to mitigate potential detrimental effects.
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Affiliation(s)
- Jason Tallis
- Centre for Applied Biological and Exercise Sciences, Alison Gingell Building, Coventry University, Priory Street, Coventry CV15FB, UK;
| | - Sharn Shelley
- Centre for Applied Biological and Exercise Sciences, Alison Gingell Building, Coventry University, Priory Street, Coventry CV15FB, UK;
| | - Hans Degens
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Cameron Hill
- Randall Centre for Cell and Molecular Biophysics, New Hunt’s House, Guy’s Campus, King’s College London, London SE1 1UL, UK;
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Shin WC, Jang JH, Seo HE, Suh KT, Moon NH. Prevalence and clinical impact of sarcopenia in osteoporotic hip fracture: Single center retrospective cohort study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:27-33. [PMID: 32175894 DOI: 10.5152/j.aott.2020.01.476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study aimed to identify the prevalence of sarcopenia in patients with osteoporotic hip fractures, investigate the anthropometric differences between sarcopenic and non-sarcopenic patients, and evaluate and compare the surgical outcomes between the two groups. METHODS The study included 135 patients (35 men and 100 women; mean age: 74.1 years (range; 25-96)) who received surgical treatment for hip fracture between March 2014 and October 2016 and underwent whole-body dual-energy X-ray absorptiometry (DEXA). The skeletal muscle mass index (SMI) for diagnosis of sarcopenia was measured using whole-body DEXA. The following data were collected to compare the preoperative details of the sarcopenic and non-sarcopenic groups: SMI, age, sex, type of fracture, type of operation, BMI, obesity, American society of Anesthesiologists (ASA) class, pre-injury mobility score, BMD, and follow-up period. We compared clinical outcomes, including Harris Hip Score (HSS) and the walking ability at the last follow-up visit and radiologic outcomes, including non-union and the time to union. RESULTS The average HHS and Parker's mobility score at the last follow-up were 81.7 and 6.9 in the sarcopenic group, and 77.6 and 6.3 in the non-sarcopenic group, respectively (p=0.149 and 0.122). Non-union was identified 0 (0%) in sarcopenic group and 4 (10%) in non-sarcopenic group (p=0.288). The mean union timer of the patients in the sarcopenia group was 4.0 months and that of patients in the non-sarcopenic group was 4.4 months (p=0.210). Multiple regression analysis did not show any significant association between sarcopenia and postoperative surgical outcomes, including HHS, mobility score at the last follow up, non-union, and time to union. CONCLUSION Although the present study showed that the prevalence of sarcopenia in hip fracture patients was 45.9% (62/135), there was no clinical association between sarcopenia and postoperative. Based on these results, the clinical impact of sarcopenia may be confined to increased risk of hip fracture occurrence and surgical outcomes of hip fracture may not be affected by sarcopenia. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
- Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University, Yangsan Hospital, Busan, Korea
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Han Eol Seo
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University, Yangsan Hospital, Busan, Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Korea
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7
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Ghanim H, Dhindsa S, Green K, Abuaysheh S, Batra M, Makdissi A, Chaudhuri A, Dandona P. Increase in Osteocalcin Following Testosterone Therapy in Men With Type 2 Diabetes and Subnormal Free Testosterone. J Endocr Soc 2019; 3:1617-1630. [PMID: 31403089 PMCID: PMC6682410 DOI: 10.1210/js.2018-00426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023] Open
Abstract
Context One-third of men with type 2 diabetes have subnormal free testosterone concentrations. We evaluated the following: (i) whether bone mineral density (BMD) and bone strength are affected by gonadal status in type 2 diabetes and (ii) the effect of testosterone replacement on markers of osteoblast and osteoclast activity. Design This is a secondary analysis of a previously completed, randomized, placebo-controlled trial. Ninety-four men with type 2 diabetes were recruited; 44 had subnormal free testosterone concentrations. Men with subnormal free testosterone concentrations were randomized to receive intramuscular injections of testosterone or placebo every 2 weeks for 22 weeks. Dual energy X-ray absorptiometry scans were performed at baseline and at 23 weeks. Results Men with subnormal free testosterone had similar BMD compared with men with normal free testosterone. However, bone strength indices were lower in men with subnormal free testosterone. BMD was related to free estradiol concentrations (r = 0.37, P = 0.004 at hip), whereas bone strength was related to free testosterone concentrations (r = 0.41, P < 0.001). Testosterone replacement increased osteocalcin concentrations [mean change (95% CI), 3.52 (0.45, 6.59), P = 0.008]. C-Terminal telopeptide (CTx) concentrations also increased at 15 weeks but reverted to baseline following that. There were no changes in other bone turnover markers or BMD. Conclusion We conclude that testosterone replacement resulted in an increase in osteocalcin and a transient increase in CTx, indicating an increase in osteoblastic activity and transient increase in bone breakdown. Therefore, a major action of testosterone is to increase bone turnover in men with type 2 diabetes.
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Affiliation(s)
- Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York.,Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, St. Louis, Missouri
| | - Kelly Green
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
| | - Sanaa Abuaysheh
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
| | - Manav Batra
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
| | - Antoine Makdissi
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
| | - Ajay Chaudhuri
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, Williamsville, New York
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8
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Junjie W, Dongsheng H, Lei S, Hongzhuo L, Changying S. Testosterone Replacement Therapy Has Limited Effect on Increasing Bone Mass Density in Older Men: a Meta-analysis. Curr Pharm Des 2019; 25:73-84. [DOI: 10.2174/1381612825666190206223244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 11/22/2022]
Abstract
Background:
Testosterone insufficiency may play a role in age-related decreases in bone mass density
(BMD) and osteoporosis in aging men. Testosterone replacement therapy (T therapy) seems to be a simple and
convenient way to increase BMD and improve the condition of osteoporosis.
Objective:
To evaluate the effects of T therapy in increasing BMD among older men with low serum testosterone
concentrations.
Methods:
A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane Central databases
was undertaken for randomized controlled trials (RCTs) on the effect of T therapy on osteoporosis in aging men.
Primary outcome measures were the change in BMD, bone turnover markers, prostate symptoms, body composition,
metabolic and endocrine system markers. The final search was performed in October 2018.
Results:
Seven RCTs were included. A total of 800 patients met the inclusion criteria. T therapy did not significantly
reverse the trend toward decreasing BMD in the spine, femoral neck, Ward’s triangle and the whole body,
with the exception of the trochanter and total hip. In addition, T therapy increased prostate size, lean mass, sex
hormone levels; reduced HDL concentration; and had no statistical effect on prostate symptoms, body composition,
serum hormones and metabolism.
Conclusion:
T therapy is not effective in increasing BMD in older men. In addition, it has limited effects on
prostate-specific antigen (PSA), the International Prostate Symptom Score (IPSS), body mass index (BMI), fat
mass, parathyroid hormone (PTH), 25-VitD and lipid metabolism, although it can increase prostate size, lean
mass, and sex hormone levels, and reduce glucose levels and HDL concentrations.
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Affiliation(s)
- Wang Junjie
- Changzhi Medical College, address: No. 161, Jiefangdong Street, Changzhi, Shanxi, 046000, China
| | - Hao Dongsheng
- Changzhi Medical College, address: No. 161, Jiefangdong Street, Changzhi, Shanxi, 046000, China
| | - Sun Lei
- Changzhi Medical College, address: No. 161, Jiefangdong Street, Changzhi, Shanxi, 046000, China
| | - Li Hongzhuo
- Changzhi Medical College, address: No. 161, Jiefangdong Street, Changzhi, Shanxi, 046000, China
| | - Sun Changying
- Changzhi Medical College, address: No. 161, Jiefangdong Street, Changzhi, Shanxi, 046000, China
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MERIGGIOLA MCRISTINA, MARCOVINA SANTICA, PAULSEN CALVIN, BREMNER WILLIAMJ. Testosterone enanthate at a dose of 200 mg/week decreases HDL-cholesterol levels in healthy men. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/ijan.1995.18.5.237] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Coen PM, Musci RV, Hinkley JM, Miller BF. Mitochondria as a Target for Mitigating Sarcopenia. Front Physiol 2019; 9:1883. [PMID: 30687111 PMCID: PMC6335344 DOI: 10.3389/fphys.2018.01883] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022] Open
Abstract
Sarcopenia is the loss of muscle mass, strength, and physical function that is characteristic of aging. The progression of sarcopenia is gradual but may be accelerated by periods of muscle loss during physical inactivity secondary to illness or injury. The loss of mobility and independence and increased comorbidities associated with sarcopenia represent a major healthcare challenge for older adults. Mitochondrial dysfunction and impaired proteostatic mechanisms are important contributors to the complex etiology of sarcopenia. As such, interventions that target improving mitochondrial function and proteostatic maintenance could mitigate or treat sarcopenia. Exercise is currently the only effective option to treat sarcopenia and does so, in part, by improving mitochondrial energetics and protein turnover. Exercise interventions also serve as a discovery tool to identify molecular targets for development of alternative therapies to treat sarcopenia. In summary, we review the evidence linking mitochondria and proteostatic maintenance to sarcopenia and discuss the therapeutic potential of interventions addressing these two factors to mitigate sarcopenia.
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Affiliation(s)
- Paul M Coen
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, United States
| | - Robert V Musci
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - J Matthew Hinkley
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, United States
| | - Benjamin F Miller
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
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Tchernof A, Brochu D, Maltais‐Payette I, Mansour MF, Marchand GB, Carreau A, Kapeluto J. Androgens and the Regulation of Adiposity and Body Fat Distribution in Humans. Compr Physiol 2018; 8:1253-1290. [DOI: 10.1002/cphy.c170009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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12
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Khalil R, Kim NR, Jardi F, Vanderschueren D, Claessens F, Decallonne B. Sex steroids and the kidney: role in renal calcium and phosphate handling. Mol Cell Endocrinol 2018; 465:61-72. [PMID: 29155307 DOI: 10.1016/j.mce.2017.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 12/16/2022]
Abstract
Calcium and phosphate are vital for the organism and constitute essential components of the skeleton. Serum levels are tightly hormonally regulated and maintained by exchange with three major sources: the intestines, the kidney and the bone. The effects of sex steroids on the bone have been extensively studied and it is well known that sex steroid deficiency induces bone loss, indirectly influencing renal calcium and phosphate homeostasis. However, it is unknown whether sex steroids also directly regulate renal calcium and phosphate handling, hereby potentially indirectly impacting on bone. The presence of androgen receptors (AR) and estrogen receptors (ER) in both human and rodent kidney, although their exact localization within the kidney remains debated, supports direct effects. Estrogens stimulate renal calcium reabsorption as well as phosphate excretion, while the effects of androgens are less clear. Many of the studies performed with regard to renal calcium and/or phosphate homeostasis do not correct for the calcium and phosphate fluxes from the bone and intestines, which complicates the differentiation between the direct effects of sex steroids on renal calcium and phosphate handling and the indirect effects via the bone and intestines. The objective of this study is to review the literature and current insight of the role of sex steroids in calcium and phosphate handling in the kidney.
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Affiliation(s)
- Rougin Khalil
- Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49 Box 902, Belgium.
| | - Na Ri Kim
- Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49 Box 902, Belgium
| | - Ferran Jardi
- Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49 Box 902, Belgium
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49 Box 902, Belgium
| | - Frank Claessens
- Molecular Endocrinology, KU Leuven, Herestraat 49 Box 901, Belgium
| | - Brigitte Decallonne
- Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49 Box 902, Belgium
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Abstract
The sexual behaviour of older people is more often the target of jocularity or ridicule than the subject of serious scientific research. As a consequence, relatively little is known about the sexual behaviour of the over-65s and such information as is available shows a polarisation according to gender, male sexual behaviour and dysfunction being viewed very much in the light of physical problems, whereas women's sexual behaviour revolves around attitudes towards sexuality and the psychological effects of ageing. This review will address the biological changes associated with ageing, the psychological and social concomitants, the prevalence of sexual dysfunction, its aetiological factors, and the management of common sexual problems including those found in an institutional setting.
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Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2017; 6:86-105. [PMID: 29128268 DOI: 10.1016/j.sxmr.2017.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Testosterone (T) deficiency (TD; hypogonadism) has deleterious effects on men's health; negatively affects glycometabolic and cardiometabolic functions, body composition, and bone mineral density; contributes to anemia and sexual dysfunction; and lowers quality of life. T therapy (TTh) has been used for the past 8 decades to treat TD, with positive effects on signs and symptoms of TD. AIM To summarize the health benefits of TTh in men with TD. METHODS A comprehensive literature search was carried out using PubMed, articles relevant to TTh were accessed and evaluated, and a comprehensive summary was synthesized. MAIN OUTCOME MEASURES Improvements in signs and symptoms of TD reported in observational studies, registries, clinical trials, and meta-analyses were reviewed and summarized. RESULTS A large body of evidence provides significant valuable information pertaining to the therapeutic value of TTh in men with TD. TTh in men with TD provides real health benefits for bone mineral density, anemia, sexual function, glycometabolic and cardiometabolic function, and improvements in body composition, anthropometric parameters, and quality of life. CONCLUSION TTh in the physiologic range for men with TD is a safe and effective therapeutic modality and imparts great benefits on men's health and quality of life. Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2018;6:86-105.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boson, MA, USA.
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Abstract
Sarcopenia is defined as low muscle function (walking speed or grip strength) in the presence of low muscle mass. A simple screening test-the SARC-F-is available to identify persons with sarcopenia. The major endocrine causes of sarcopenia are diabetes mellitus and male hypogonadism. Other causes are decreased physical activity, loss of motor neuron units, weight loss, inflammatory cytokines, reduced blood flow to muscles, very low 25(OH) vitamin D levels, and decreased growth hormone and insulin-like growth factor 1. Treatment for sarcopenia includes resistance and aerobic exercise, leucine-enriched essential amino acids, and vitamin D. In hypogonadal males, testosterone improves muscle mass, strength, and function. Selective androgen receptor molecules and anti-myostatin activin II receptor molecules are under development as possible treatments for sarcopenia. ABBREVIATIONS COPD = chronic obstructive pulmonary disease DHEA = dehydroepiandrosterone IGF-1 = insulin-like growth factor 1 GH = growth hormone mTOR = mammalian target of rapamycin SARM = selective androgen receptor molecule.
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Intramuscular Anabolic Signaling and Endocrine Response Following Resistance Exercise: Implications for Muscle Hypertrophy. Sports Med 2017; 46:671-85. [PMID: 26666743 DOI: 10.1007/s40279-015-0450-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Maintaining skeletal muscle mass and function is critical for disease prevention, mobility and quality of life, and whole-body metabolism. Resistance exercise is known to be a major regulator for promoting muscle protein synthesis and muscle mass accretion. Manipulation of exercise intensity, volume, and rest elicit specific muscular adaptations that can maximize the magnitude of muscle growth. The stimulus of muscle contraction that occurs during differing intensities of resistance exercise results in varying biochemical responses regulating the rate of protein synthesis, known as mechanotransduction. At the cellular level, skeletal muscle adaptation appears to be the result of the cumulative effects of transient changes in gene expression following acute bouts of exercise. Thus, maximizing the resistance exercise-induced anabolic response produces the greatest potential for hypertrophic adaptation with training. The mechanisms involved in converting mechanical signals into the molecular events that control muscle growth are not completely understood; however, skeletal muscle protein synthesis appears to be regulated by the multi-protein phosphorylation cascade, mTORC1 (mammalian/mechanistic target of rapamycin complex 1). The purpose of this review is to examine the physiological response to resistance exercise, with particular emphasis on the endocrine response and intramuscular anabolic signaling through mTORC1. It appears that resistance exercise protocols that maximize muscle fiber recruitment, time-under-tension, and metabolic stress will contribute to maximizing intramuscular anabolic signaling; however, the resistance exercise parameters for maximizing the anabolic response remain unclear.
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Abstract
Undernutrition is defined as a state induced by nutrient deficiency that may be improved solely by administration of nutrients. By this definition, provision of adequate protein and energy sources should reverse the clinical presentation and correct the problem. However, a large number of patients who seem to be undernourished fail to respond to refeeding. A developing understanding of the acute-phase inflammatory response to illness and the role of cytokines in the pathophysiology of chronic illness has challenged the current diagnostic paradigm of undernutrition. In the presence of adequate food, weight loss is most often due to cytokine-associated cachexia and anorexia. Failure of appetite, or anorexia, may play a role in involuntary weight loss. Intervention for involuntary weight loss should aim first at the provision of adequate calories and protein, often in the form of high-density nutrition supplements. However, cytokine-mediated cachexia is remarkably resistant to hypercaloric feeding. With continued weight loss, the use of an orexigenic drug should be considered. Orexigenic drugs have been demonstrated to improve appetite and produce weight gain. The mechanism is unknown but may relate to suppression of proinflammatory cytokines. General guidelines for the use of orexigenic agents are presented. Although much work remains to be done, anticytokine drugs seem to be a promising avenue for the treatment of involuntary weight loss.
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Affiliation(s)
- David R Thomas
- Division of Geriatric Medicine, St Louis Universit Health Sciences Center, St Louis, MO, USA.
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Onasanya O, Iyer G, Lucas E, Lin D, Singh S, Alexander GC. Association between exogenous testosterone and cardiovascular events: an overview of systematic reviews. Lancet Diabetes Endocrinol 2016; 4:943-956. [PMID: 27669646 DOI: 10.1016/s2213-8587(16)30215-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 01/02/2023]
Abstract
Given the conflicting evidence regarding the association between exogenous testosterone and cardiovascular events, we systematically assessed published systematic reviews for evidence of the association between exogenous testosterone and cardiovascular events. We searched PubMed, MEDLINE, Embase, Cochrane Collaboration Clinical Trials, ClinicalTrials.gov, and the US Food and Drug Administration website for systematic reviews of randomised controlled trials published up to July 19, 2016. Two independent reviewers screened 954 full texts from 29 335 abstracts to identify systematic reviews of randomised controlled trials in which the cardiovascular effects of exogenous testosterone on men aged 18 years or older were examined. We extracted data for study characteristics, analytic methods, and key findings, and applied the AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklist to assess methodological quality of each review. Our primary outcome measure was the direction and magnitude of association between exogenous testosterone and cardiovascular events. We identified seven reviews and meta-analyses, which had substantial clinical heterogeneity, differing statistical methods, and variable methodological quality and quality of data abstraction. AMSTAR scores ranged from 3 to 9 out of 11. Six systematic reviews that each included a meta-analysis showed no significant association between exogenous testosterone and cardiovascular events, with summary estimates ranging from 1·07 to 1·82 and imprecise confidence intervals. Two of these six meta-analyses showed increased risk in subgroup analyses of oral testosterone and men aged 65 years or older during their first treatment year. One meta-analysis showed a significant association between exogenous testosterone and cardiovascular events, in men aged 18 years or older generally, with a summary estimate of 1·54 (95% CI 1·09-2·18). Our optimal information size analysis showed that any randomised controlled trial aiming to detect a true difference in cardiovascular risk between treatment groups receiving exogenous testosterone and their controls (with a two-sided p value of 0·05 and a power of 80%) would require at least 17 664 participants in each trial group. Therefore, given the challenge of adequately powering clinical trials for rare outcomes, rigorous observational studies are needed to clarify the association between testosterone-replacement therapy and major adverse cardiovascular outcomes.
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Affiliation(s)
- Oluwadamilola Onasanya
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geetha Iyer
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eleanor Lucas
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dora Lin
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonal Singh
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.
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Konaka H, Sugimoto K, Orikasa H, Iwamoto T, Takamura T, Takeda Y, Shigehara K, Iijima M, Koh E, Namiki M. Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: a multicenter randomized controlled trial in Japan (EARTH Study). Asian J Androl 2016; 18:25-34. [PMID: 25761833 PMCID: PMC4736352 DOI: 10.4103/1008-682x.148720] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Androgen replacement therapy (ART) efficacy on late-onset hypogonadism (LOH) has been widely investigated in Western countries; however, it remains controversial whether ART can improve health and prolong active lifestyles. We prospectively assessed long-term ART effects on the physical and mental statuses of aging men with LOH in Japan. The primary endpoint was health-related quality of life assessed by questionnaires. Secondary endpoints included glycemic control, lipid parameters, blood pressure, waist circumference, body composition, muscular strength, International Prostate Symptom Scores (IPSS), International Index of Erectile Function-5 (IIEF-5) scores, and serum prostate-specific antigen levels. Of the 1637 eligible volunteers, 334 patients > 40 years with LOH were randomly assigned to either the ART (n = 169) or control groups (n = 165). Fifty-two weeks after the initial treatment, ART significantly affected the role physical subdomain of the short form-36 health survey (SF-36) scale (P = 0.0318). ART was also associated with significant decreases in waist circumstance (P = 0.002) and serum triglyceride (TG) (P = 0.013) and with significant increases in whole-body and leg muscle mass volumes (P = 0.071 and 0.0108, respectively), serum hemoglobin (P < 0.001), IPSS voiding subscore (P = 0.0418), and the second question on IIEF-5 (P = 0.0049). There was no significant difference between the groups in terms of severe adverse events. In conclusion, in patients with LOH, long-term ART exerted beneficial effects on Role Physical subdomain of the SF-36 scale, serum TG, waist circumstance, muscle mass volume, voiding subscore of IPSS, and the second question of IIEF-5. We hope our study will contribute to the future development of this area.
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Affiliation(s)
- Hiroyuki Konaka
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
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Abstract
Sarcopenia is now clinically defined as a loss of muscle mass coupled with functional deterioration (either walking speed or distance or grip strength). Based on the FRAX studies suggesting that the questions without bone mineral density can be used to screen for osteoporosis, there is now a valid simple questionnaire to screen for sarcopenia, i.e., the SARC-F. Numerous factors have been implicated in the pathophysiology of sarcopenia. These include genetic factors, mitochondrial defects, decreased anabolic hormones (e.g., testosterone, vitamin D, growth hormone and insulin growth hormone-1), inflammatory cytokine excess, insulin resistance, decreased protein intake and activity, poor blood flow to muscle and deficiency of growth derived factor-11. Over the last decade, there has been a remarkable increase in our understanding of the molecular biology of muscle, resulting in a marked increase in potential future targets for the treatment of sarcopenia. At present, resistance exercise, protein supplementation, and vitamin D have been established as the basic treatment of sarcopenia. High-dose testosterone increases muscle power and function, but has a number of potentially limiting side effects. Other drugs in clinical development include selective androgen receptor molecules, ghrelin agonists, myostatin antibodies, activin IIR antagonists, angiotensin converting enzyme inhibitors, beta antagonists, and fast skeletal muscle troponin activators. As sarcopenia is a major predictor of frailty, hip fracture, disability, and mortality in older persons, the development of drugs to treat it is eagerly awaited.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO, 63104, USA.
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22
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Corona G, Giagulli VA, Maseroli E, Vignozzi L, Aversa A, Zitzmann M, Saad F, Mannucci E, Maggi M. THERAPY OF ENDOCRINE DISEASE: Testosterone supplementation and body composition: results from a meta-analysis study. Eur J Endocrinol 2016; 174:R99-116. [PMID: 26537862 DOI: 10.1530/eje-15-0262] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/19/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The role of testosterone (T) in regulating body composition is conflicting. Thus, our goal is to meta-analyse the effects of T supplementation (TS) on body composition and metabolic outcomes. METHODS All randomized controlled trials (RCTs) comparing the effect of TS on different endpoints were considered. RESULTS Overall, 59 trials were included in the study enrolling 3029 and 2049 patients in TS and control groups respectively. TS was associated with any significant modification in body weight, waist circumference and BMI. Conversely, TS was associated with a significant reduction in fat and with an increase in lean mass as well as with a reduction of fasting glycaemia and insulin resistance. The effect on fasting glycaemia was even higher in younger individuals and in those with metabolic diseases. When only RCTs enrolling hypogonadal (total T <12 mol/l) subjects were considered, a reduction of total cholesterol as well as triglyceride (TGs) levels were also detected. Conversely, an improvement in HDL cholesterol levels as well as in both systolic and diastolic blood pressure was not observed. CONCLUSION Our data suggest that TS is able to improve body composition and glycometabolic profile particularly in younger subjects and in those with metabolic disturbances. Specifically designed studies are urgently needed to confirm this point.
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Affiliation(s)
| | - Vito A Giagulli
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Elisa Maseroli
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Linda Vignozzi
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Antonio Aversa
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Michael Zitzmann
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Farid Saad
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Edoardo Mannucci
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
| | - Mario Maggi
- Endocrinology UnitMedical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, ItalyUnit of Metabolic Diseases and EndocrinologyConversano, ItalyAndrology and Sexual Medicine UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, ItalyDepartment of Experimental MedicineSapienza University of Rome, Rome, ItalyCentre for Reproductive Medicine and AndrologyMuenster, GermanyBayer PharmaGlobal Medical Affairs Andrology, Berlin, GermanySchool of MedicineGulf Medical University, Ajman, United Arab EmiratesDiabetes AgencyCareggi Hospital, Florence, Italy
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Ghayyoomi M, Soltani N, Nematbakhsh M, Moslemi F, Talebi A, Shirdavani S, Razmjoo F. The effect of an specific inducible NO synthase inhibitor, S-methylisothiourea hemisulfate on cisplatin-induced nephrotoxicity; gender-related differences. Adv Biomed Res 2015; 4:130. [PMID: 26322278 PMCID: PMC4544122 DOI: 10.4103/2277-9175.161223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/04/2014] [Indexed: 11/23/2022] Open
Abstract
Backgrounds: It has been previously demonstrated that the increase of nitric oxide (NO) level may promote cisplatin (CP)-induced nephrotoxicity. The aim of this study was to investigate the role of inducible NO synthase (iNOS) inhibitor to prevent CP-induced nephrotoxicity. Materials and Methods: Four groups of male and four groups of female rats were treated daily with vehicle, S-methylisothiourea hemisulfate (SMT) as a selective iNOS inhibitor (5 mg/kg/twice a day), CP (2.5 mg/kg/day), and CP + SMT for 6 days. Then, all animals were sacrificed and the serum levels of creatinine (Cr), blood urea nitrogen (BUN), nitrite, and malondialdehyde (MDA) were measured. The kidney was removed immediately for histopathological study. Results: Our results showed that inhibition of iNOS by SMT could make different response in male and female animals. SMT therapy in male animals decreased serum BUN, Cr, nitrite, and MDA levels; and it also protected kidney against CP-induced nephrotoxicity. Conclusion: It is concluded that decrease in NO production by SMT has a beneficial effect on reducing CP-induced nephrotoxicity in male. However, such beneficial effect was not observed in female animals.
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Affiliation(s)
- Mansooreh Ghayyoomi
- Department of Physiology, Hormozgan University of Medical Sciences, Bandar Abbas, Isfahan, Iran ; Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Isfahan, Iran ; Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nepton Soltani
- Department of Physiology, Hormozgan University of Medical Sciences, Bandar Abbas, Isfahan, Iran ; Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Isfahan, Iran
| | - Mehdi Nematbakhsh
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Physiology Isfahan University of Medical Sciences, Isfahan, Iran ; Isfahan MN Institute of Basic and Applied Sciences Research, Isfahan, Iran
| | - Fatemeh Moslemi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ardeshir Talebi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Clinical Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Shirdavani
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Razmjoo
- Department of Physiology, Hormozgan University of Medical Sciences, Bandar Abbas, Isfahan, Iran
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Pastuszak AW, Gomez LP, Scovell JM, Khera M, Lamb DJ, Lipshultz LI. Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen. Sex Med 2015; 3:165-73. [PMID: 26468380 PMCID: PMC4599554 DOI: 10.1002/sm2.76] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Numerous testosterone (T) formulations are available, each with differing effects on serum parameters. Aim The aim of this study was to compare the long-term effects of topical, injectable, and implantable pellet T formulations in hypogonadal men. Methods Retrospective review of hypogonadal men treated with a single T formulation was performed: 47 men on T gels, 57 on injectable T, and 74 on T pellets were identified. Total T (TT), calculated free T (FT), estradiol (E), hemoglobin (Hgb), hematocrit (Hct), prostate-specific antigen (PSA), total cholesterol (Tchol), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were evaluated at baseline and every 3–6 months for 3 years. Serum parameters were compared using a mixed model linear regression for repeated measures. Main Outcome Measures Effects of topical, injectable, and pellet T formulations on serum hormone levels, Hgb, Hct, lipid parameters and PSA. Results Men in the injectable T group were younger (42.5 ± 12.3 years) than in the gel (54.1 ± 9.8 years) or pellet groups (53.8 ± 13.0 years), and baseline FT, Hgb, and Hct were higher in the injectable T group than in gel or pellet groups. Increases in TT and FT were observed throughout follow-up in all groups. Increases in E were observed at in all T groups and throughout follow-up in injectable and gel groups. No PSA increases were observed. Erythrocytosis (Hct > 50%) was more common with injectable T (66.7%) than with T gels (12.8%) or pellets (35.1%, P < 0.0001). Transient changes in cholesterol, TG, and LDL were observed, and no significant changes were seen in HDL for any group. Conclusions All T formulations increase serum T and FT. More significant increases in E occur with injectable T and T gels. Changes in Hgb and Hct are most significant with injectable T, and effects on lipids are variable and inconsistent. Selection of T formulations must account for individual patient preferences and the effects of each formulation.
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Affiliation(s)
- Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
| | - Lissette P Gomez
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
| | - Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Dolores J Lamb
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA ; Department of Cell Biology, Baylor College of Medicine Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine Houston, TX, USA ; Center for Reproductive Medicine, Baylor College of Medicine Houston, TX, USA
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25
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Isidori AM, Balercia G, Calogero AE, Corona G, Ferlin A, Francavilla S, Santi D, Maggi M. Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Invest 2015; 38:103-12. [PMID: 25384570 PMCID: PMC4282686 DOI: 10.1007/s40618-014-0155-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 08/06/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We developed clinical practice guidelines to assess the individual risk-benefit profile of androgen replacement therapy in adult male hypogonadism (HG), defined by the presence of specific signs and symptoms and serum testosterone (T) below 12 nmol/L. PARTICIPANTS The task force consisted of eight clinicians experienced in treating HG, selected by the Italian Society of Endocrinology (SIE). The authors received no corporate funding or remuneration. CONSENSUS PROCESS Consensus was guided by a systematic review of controlled trials conducted on men with a mean T < 12 nmol/L and by interactive discussions. The guidelines were reviewed and sequentially approved by the SIE Guidelines Commission and Executive Committee. CONCLUSIONS We recommend T supplementation (TS) for adult men with severely reduced T levels (T < 8 nmol/L) to improve body composition and sexual function. We suggest that TS be offered to subjects with T < 12 nmol/L to improve glycaemic control, lipid profile, sexual function, bone mineral density, muscle mass and depressive symptoms, once major contraindications have been ruled out. We suggest that lifestyle changes and other available interventions (e.g. for erectile dysfunction) be suggested prior to TS. We suggest that TS should be combined with currently available treatments for individuals at high risk for complications, such as those with osteoporosis and/or metabolic disorders. We recommend against using TS to improve cardiac outcome and limited mobility. We recommend against using TS in men with prostate cancer, unstable cardiovascular conditions or elevated haematocrit. The task force places a high value on the timely treatment of younger and middle-aged subjects to prevent the long-term consequences of hypoandrogenism.
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Affiliation(s)
- A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Balercia
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - A E Calogero
- Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | - G Corona
- Medical Department Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - A Ferlin
- Department of Medicine, University of Padua, Padua, Italy
| | - S Francavilla
- Department of Life, Health and Environment Sciences, Andrology, and Epidemiology, University of L'Aquila, L'Aquila, Italy
| | - D Santi
- Department of Biosciences, Metabolism and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Firenze, Italy.
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26
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Maggio M, De Vita F, Fisichella A, Lauretani F, Ticinesi A, Ceresini G, Cappola A, Ferrucci L, Ceda GP. The Role of the Multiple Hormonal Dysregulation in the Onset of "Anemia of Aging": Focus on Testosterone, IGF-1, and Thyroid Hormones. Int J Endocrinol 2015; 2015:292574. [PMID: 26779261 PMCID: PMC4686706 DOI: 10.1155/2015/292574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022] Open
Abstract
Anemia is a multifactorial condition whose prevalence increases in both sexes after the fifth decade of life. It is a highly represented phenomenon in older adults and in one-third of cases is "unexplained." Ageing process is also characterized by a "multiple hormonal dysregulation" with disruption in gonadal, adrenal, and somatotropic axes. Experimental studies suggest that anabolic hormones such as testosterone, IGF-1, and thyroid hormones are able to increase erythroid mass, erythropoietin synthesis, and iron bioavailability, underlining a potential role of multiple hormonal changes in the anemia of aging. Epidemiological data more consistently support an association between lower testosterone and anemia in adult-older individuals. Low IGF-1 has been especially associated with anemia in the pediatric population and in a wide range of disorders. There is also evidence of an association between thyroid hormones and abnormalities in hematological parameters under overt thyroid and euthyroid conditions, with limited data on subclinical statuses. Although RCTs have shown beneficial effects, stronger for testosterone and the GH-IGF-1 axis and less evident for thyroid hormones, in improving different hematological parameters, there is no clear evidence for the usefulness of hormonal treatment in improving anemia in older subjects. Thus, more clinical and research efforts are needed to investigate the hormonal contribution to anemia in the older individuals.
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Affiliation(s)
- Marcello Maggio
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
- *Marcello Maggio:
| | - Francesca De Vita
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
| | - Alberto Fisichella
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
| | - Fulvio Lauretani
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
| | - Andrea Ticinesi
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
| | - Anne Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health (NIH), Baltimore, MD 21201, USA
| | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, 43126 Parma, Italy
- Geriatric Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy
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O'Connell MDL, Wu FCW. Androgen effects on skeletal muscle: implications for the development and management of frailty. Asian J Androl 2014; 16:203-12. [PMID: 24457838 PMCID: PMC3955329 DOI: 10.4103/1008-682x.122581] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well–tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs) suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies.
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Affiliation(s)
| | - Frederick C W Wu
- Andrology Research Unit, Institute of Human Development, Centre for Endocrinology and Diabetes, University of Manchester, Manchester, United Kingdom
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To Treat or Not to Treat with Testosterone Replacement Therapy: a Contemporary Review of Management of Late-Onset Hypogonadism and Critical Issues Related to Prostate Cancer. Curr Urol Rep 2014; 15:422. [DOI: 10.1007/s11934-014-0422-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muscle wasting in hemodialysis patients: new therapeutic strategies for resolving an old problem. ScientificWorldJournal 2013; 2013:643954. [PMID: 24382946 PMCID: PMC3870868 DOI: 10.1155/2013/643954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 10/28/2013] [Indexed: 01/01/2023] Open
Abstract
Muscle wasting has long been recognized as a major clinical problem in hemodialysis (HD) patients. In addition to its impact on quality of life, muscle wasting has been proven to be associated with increased mortality rates. Identification of the molecular mechanisms underlying muscle wasting in HD patients provides opportunities to resolve this clinical problem. Several signaling pathways and humeral factors have been reported to be involved in the pathogenic mechanisms of muscle wasting in HD patients, including ubiquitin-proteasome system, caspase-3, insulin/insulin-like growth factor-1 (IGF-1) signaling, endogenous glucocorticoids, metabolic acidosis, inflammation, and sex hormones. Targeting the aforementioned crucial signaling and molecules to suppress protein degradation and augment muscle strength has been extensively investigated in HD patients. In addition to exercise training, administration of megestrol acetate has been proven to be effective in improving anorexia and muscle wasting in HD patients. Correction of metabolic acidosis through sodium bicarbonate supplements can decrease muscle protein degradation and hormone therapy with nandrolone decanoate has been reported to increase muscle mass. Although thiazolidinedione has been shown to improve insulin sensitivity, its role in the treatment of muscle wasting remains unclear. This review paper focuses on the molecular pathways and potential new therapeutic approaches to muscle wasting in HD patients.
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Wickramatilake CM, Mohideen MR, Pathirana C. Association of serum testosterone with lipid abnormalities in patients with angiographically proven coronary artery disease. Indian J Endocrinol Metab 2013; 17:1061-1065. [PMID: 24381885 PMCID: PMC3872686 DOI: 10.4103/2230-8210.122624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Low testosterone levels are associated with an atherogenic lipid profile and may contribute to the pathogenesis of atherosclerosis. AIMS Our study aimed to investigate the relationship between serum total testosterone (TT) levels and lipid profile in angiographically confirmed coronary artery disease (CAD) in men. SETTINGS AND DESIGN This is a case-control hospital-based study at Teaching Hospital, Karapitiya, Galle, Sri Lanka. MATERIALS AND METHODS Two hundred and six men, 103 with angiographically proven CAD and 103 healthy men as a control group were studied. The serum levels of TT and lipids were assessed. STATISTICAL ANALYSIS Data were analyzed using Minitab software (version 15 for Windows). RESULTS THE MEAN CONCENTRATIONS OF LIPID PARAMETERS OF PATIENTS AND CONTROLS WERE AS FOLLOWS: Serum total cholesterol (TCh), 5.9 ± 2.8 vs. 5.2 ± 1.6 mmol/l (P = 0.022), low-density lipoprotein cholesterol (LDL-Ch), 3.9 ± 1.2 vs. 3.1 ± 0.5 mmol/l (P = 0.001), high-density lipoprotein cholesterol (HDL-Ch), 1.1 ± 0.5 vs. 1.4 ± 0.6 mmol/l (P = 0.001), and TGs, 2.0 ± 1.0 vs. 1.5 ± 0.8 mmol/l (P = 0.001); lipid levels were significantly different between the two groups. The mean levels of TT in the patients and controls were 11.4 ± 2.7 vs. 18.1 ± 7.2 nmol/l (P = 0.001), significantly different. Among CAD patients, a significant positive association was found between testosterone and HDL-Ch (r = 0.623, P = 0.001), whereas a negative association was found with LDL-Ch (r = -0.579, P = 0.001). CONCLUSIONS Low levels of TT in men with CAD that appear together with an atherogenic lipid milieu may be involved in the pathogenesis of CAD. The observed association between testosterone and HDL-Ch suggests a protective effect of the hormone.
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Affiliation(s)
| | | | - Chitra Pathirana
- Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Abstract
Frailty is now a definable clinical syndrome with a simple screening test. Age-related changes in hormones play a major role in the development of frailty by reducing muscle mass and strength (sarcopenia). Selective Androgen Receptor Molecules and ghrelin agonists are being developed to treat sarcopenia. The role of Activin Type IIB soluble receptors and Follistatin-like 3 mimetics is less certain because of side effects. Exercise (resistance and aerobic), vitamin D and protein supplementation, and reduction of polypharmacy are keys to the treatment of frailty.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
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Morley JE. Hypogonadism, testosterone, and nursing home residents. J Am Med Dir Assoc 2013; 14:381-3. [PMID: 23647780 DOI: 10.1016/j.jamda.2013.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 01/10/2023]
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Abstract
Numerous alterations in hormonal secretion occur with aging. In general, these tend towards a disintegration of the normal cyclic secretory patterns resulting in lower total circulating levels. In addition, declines in receptors and postreceptor function further decreases the ability of the hormonal orchestra to maintain coordinated function throughout the organism. Clues to some of these age-related changes in humans may come from the study of simpler organisms where regulatory systems are known to modulate the aging process. In particular, the interactions among the environment, hormones, and insulin receptor genes have led to new insights into the genetic control of longevity and the development of syndrome X.
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Affiliation(s)
- W A Banks
- Division of Geriatric Medicine, Saint Louis University Medical School, 915 N. Grand Blvd., St. Louis, MO 63106 ; Geriatric Research, Education and Clinical Center, St. Louis VAMC, St. Louis, MO 63125
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Xu L, Freeman G, Cowling BJ, Schooling CM. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med 2013; 11:108. [PMID: 23597181 PMCID: PMC3648456 DOI: 10.1186/1741-7015-11-108] [Citation(s) in RCA: 377] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/15/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Testosterone therapy is increasingly promoted. No randomized placebo-controlled trial has been implemented to assess the effect of testosterone therapy on cardiovascular events, although very high levels of androgens are thought to promote cardiovascular disease. METHODS A systematic review and meta-analysis was conducted of placebo-controlled randomized trials of testosterone therapy among men lasting 12+ weeks reporting cardiovascular-related events. We searched PubMed through the end of 2012 using "("testosterone" or "androgen") and trial and ("random*")" with the selection limited to studies of men in English, supplemented by a bibliographic search of the World Health Organization trial registry. Two reviewers independently searched, selected and assessed study quality with differences resolved by consensus. Two statisticians independently abstracted and analyzed data, using random or fixed effects models, as appropriate, with inverse variance weighting. RESULTS Of 1,882 studies identified 27 trials were eligible including 2,994, mainly older, men who experienced 180 cardiovascular-related events. Testosterone therapy increased the risk of a cardiovascular-related event (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.09 to 2.18). The effect of testosterone therapy varied with source of funding (P-value for interaction 0.03), but not with baseline testosterone level (P-value for interaction 0.70). In trials not funded by the pharmaceutical industry the risk of a cardiovascular-related event on testosterone therapy was greater (OR 2.06, 95% CI 1.34 to 3.17) than in pharmaceutical industry funded trials (OR 0.89, 95% CI 0.50 to 1.60). CONCLUSIONS The effects of testosterone on cardiovascular-related events varied with source of funding. Nevertheless, overall and particularly in trials not funded by the pharmaceutical industry, exogenous testosterone increased the risk of cardiovascular-related events, with corresponding implications for the use of testosterone therapy.
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Affiliation(s)
- Lin Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China
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Sah C, Aridogan IA, Izol V, Erdogan S, Doran S. Effects of Long-term Administration of the Antiaging Hormone Dehydroepiandrosterone Sulfate on Rat Prostates and Testes as Androgen-Dependent Organs. Korean J Urol 2013; 54:199-203. [PMID: 23524493 PMCID: PMC3604575 DOI: 10.4111/kju.2013.54.3.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 07/25/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to determine the effects of the long-term use of dehydroepiandrosterone sulfate (DHEAS) on rat prostates and testes as well as on serum testosterone and DHEAS levels. Materials and Methods Thirty male rats aged 4 to 5 months were studied. A DHEAS suspension of 5 mg/kg per rat was administered orally to the 15 rats in the experimental group 5 times a week, whereas saline was administered concurrently to the 15 rats in the control group. Intracardiac blood samples were drawn to determine hormone levels, and histological samples of prostate and testes were evaluated under light microscopy. Results At the end of the 6-month study period, histological examinations performed on prostate preparations showed that the atrophy score of the experimental group was significantly lower than the scores of the sham and control groups (p<0.001 and p<0.001, respectively). The serum total testosterone and DHEAS levels of the rats in the study group were significantly increased (p<0.001). Conclusions In our study, we determined that the long-term use of DHEAS does not have any detrimental effects on the prostate or the testis; on the contrary, it protects the prostate from atrophy, which is imperative for the continuation of fertility as well as for increasing serum testosterone and DHEAS levels.
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Affiliation(s)
- Cem Sah
- Department of Urology, University of Cukurova Faculty of Medicine, Adana, Turkey
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White JP, Gao S, Puppa MJ, Sato S, Welle SL, Carson JA. Testosterone regulation of Akt/mTORC1/FoxO3a signaling in skeletal muscle. Mol Cell Endocrinol 2013; 365:174-86. [PMID: 23116773 PMCID: PMC3529800 DOI: 10.1016/j.mce.2012.10.019] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 09/14/2012] [Accepted: 10/18/2012] [Indexed: 01/07/2023]
Abstract
Low endogenous testosterone production, known as hypogonadism is commonly associated with conditions inducing muscle wasting. Akt signaling can control skeletal muscle mass through mTOR regulation of protein synthesis and FoxO regulation of protein degradation, and this pathway has been previously identified as a target of androgen signaling. However, the testosterone sensitivity of Akt/mTOR signaling requires further understanding in order to grasp the significance of varied testosterone levels seen with wasting disease on muscle protein turnover regulation. Therefore, the purpose of this study is to determine the effect of androgen availability on muscle Akt/mTORC1/FoxO3a regulation in skeletal muscle and cultured C(2)C(12) myotubes. C57BL/6 mice were either castrated for 42 days or castrated and treated with the nandrolone decanoate (ND) (6 mg/kg bw/wk). Testosterone loss (TL) significantly decreased volitional grip strength, body weight, and gastrocnemius (GAS) muscle mass, and ND reversed these changes. Related to muscle mass regulation, TL decreased muscle IGF-1 mRNA, the rate of myofibrillar protein synthesis, Akt phosphorylation, and the phosphorylation of Akt targets, GSK3β, PRAS40 and FoxO3a. TL induced expression of FoxO transcriptional targets, MuRF1, atrogin1 and REDD1. Muscle AMPK and raptor phosphorylation, mTOR inhibitors, were not altered by low testosterone. ND restored IGF-1 expression and Akt/mTORC1 signaling while repressing expression of FoxO transcriptional targets. Testosterone (T) sensitivity of Akt/mTORC1 signaling was examined in C(2)C(12) myotubes, and mTOR phosphorylation was induced independent of Akt activation at low T concentrations, while a higher T concentration was required to activate Akt signaling. Interestingly, low concentration T was sufficient to amplify myotube mTOR and Akt signaling after 24 h of T withdrawal, demonstrating the potential in cultured myotubes for a T initiated positive feedback mechanism to amplify Akt/mTOR signaling. In summary, androgen withdrawal decreases muscle myofibrillar protein synthesis through Akt/mTORC1 signaling, which is independent of AMPK activation, and readily reversible by anabolic steroid administration. Acute Akt activation in C(2)C(12) myotubes is sensitive to a high concentration of testosterone, and low concentrations of testosterone can activate mTOR signaling independent of Akt.
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MESH Headings
- Adenylate Kinase/metabolism
- Androgens/pharmacology
- Animals
- Cell Line
- Enzyme Activation
- Forkhead Box Protein O3
- Forkhead Transcription Factors/metabolism
- Gene Expression
- Insulin-Like Growth Factor I/genetics
- Insulin-Like Growth Factor I/metabolism
- Male
- Mechanistic Target of Rapamycin Complex 1
- Mice
- Mice, Inbred C57BL
- Multiprotein Complexes
- Muscle Fibers, Skeletal/drug effects
- Muscle Fibers, Skeletal/metabolism
- Muscle Fibers, Skeletal/physiology
- Muscle Strength
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/physiology
- Nandrolone/analogs & derivatives
- Nandrolone/pharmacology
- Nandrolone Decanoate
- Orchiectomy
- Phosphorylation
- Protein Processing, Post-Translational
- Proteins/metabolism
- Proto-Oncogene Proteins c-akt/metabolism
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Signal Transduction
- TOR Serine-Threonine Kinases
- Testosterone/physiology
- Transcriptional Activation
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Affiliation(s)
- James P. White
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Song Gao
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Melissa J. Puppa
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Shuichi Sato
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Stephen L. Welle
- Department of Medicine, University of Rochester Medical School, Rochester, NY
| | - James A. Carson
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
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Abstract
INTRODUCTION The Framingham risk score predicts a patient's 10-year risk of developing cardiovascular disease. Many risk factors included in its calculation influence or are influenced by circulating testosterone. To investigate the possible association between testosterone and cardiovascular risk, as defined by the Framingham score, a Veterans Affairs (VA) database was analyzed. METHODS A retrospective chart review was performed. Inclusion criteria were male sex and age ≥ 20 years. Exclusion criteria included pre-existing cardiovascular disease, stroke, and diabetes. Data were collected on veterans who had total plasma testosterone checked in the year 2008. RESULTS The study included 1,479 patients (mean age 61 years). Framingham score was negatively associated with both total testosterone (p < 0.0001) and free testosterone (p = 0.0003). There was a positive association between total testosterone and high-density lipoprotein and negative associations between total testosterone and body mass index (BMI), total cholesterol, triglycerides, and blood pressure medication use. Free testosterone was positively associated with total cholesterol, low-density lipoprotein, and current smoking status and negatively associated with age, BMI, and blood pressure medication use. The BMI was not associated with Framingham score. CONCLUSIONS Lower plasma testosterone may suggest the presence of cardiovascular risk factors and potentially increased risk for heart disease.
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Affiliation(s)
- Brandon Chock
- Veterans Affairs Northern California Health Care System (VANCHCS), Martinez, CA, USA.
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Blomberg Jensen M. Vitamin D metabolism, sex hormones, and male reproductive function. Reproduction 2012; 144:135-52. [DOI: 10.1530/rep-12-0064] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The spectrum of vitamin D (VD)-mediated effects has expanded in recent years, and VD is now recognized as a versatile signaling molecule rather than being solely a regulator of bone health and calcium homeostasis. One of the recently identified target areas of VD is male reproductive function. The VD receptor (VDR) and the VD metabolizing enzyme expression studies documented the presence of this system in the testes, mature spermatozoa, and ejaculatory tract, suggesting that both systemic and local VD metabolism may influence male reproductive function. However, it is still debated which cell is the main VD target in the testis and to what extent VD is important for sex hormone production and function of spermatozoa. This review summarizes descriptive studies on testicular VD metabolism and spatial distribution of VDR and the VD metabolizing enzymes in the mammalian testes and discusses mechanistic and association studies conducted in animals and humans. The reviewed evidence suggests some effects of VD on estrogen and testosterone biosynthesis and implicates involvement of both systemic and local VD metabolism in the regulation of male fertility potential.
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Giannoulis MG, Martin FC, Nair KS, Umpleby AM, Sonksen P. Hormone replacement therapy and physical function in healthy older men. Time to talk hormones? Endocr Rev 2012; 33:314-77. [PMID: 22433122 PMCID: PMC5393154 DOI: 10.1210/er.2012-1002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Improving physical function and mobility in a continuously expanding elderly population emerges as a high priority of medicine today. Muscle mass, strength/power, and maximal exercise capacity are major determinants of physical function, and all decline with aging. This contributes to the incidence of frailty and disability observed in older men. Furthermore, it facilitates the accumulation of body fat and development of insulin resistance. Muscle adaptation to exercise is strongly influenced by anabolic endocrine hormones and local load-sensitive autocrine/paracrine growth factors. GH, IGF-I, and testosterone (T) are directly involved in muscle adaptation to exercise because they promote muscle protein synthesis, whereas T and locally expressed IGF-I have been reported to activate muscle stem cells. Although exercise programs improve physical function, in the long-term most older men fail to comply. The GH/IGF-I axis and T levels decline markedly with aging, whereas accumulating evidence supports their indispensable role in maintaining physical function integrity. Several studies have reported that the administration of T improves lean body mass and maximal voluntary strength in healthy older men. On the other hand, most studies have shown that administration of GH alone failed to improve muscle strength despite amelioration of the detrimental somatic changes of aging. Both GH and T are anabolic agents that promote muscle protein synthesis and hypertrophy but work through separate mechanisms, and the combined administration of GH and T, albeit in only a few studies, has resulted in greater efficacy than either hormone alone. Although it is clear that this combined approach is effective, this review concludes that further studies are needed to assess the long-term efficacy and safety of combined hormone replacement therapy in older men before the medical rationale of prescribing hormone replacement therapy for combating the sarcopenia of aging can be established.
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Affiliation(s)
| | - Finbarr C. Martin
- Guy's and St. Thomas' National Health Service Foundation Trust (F.C.M.), and Institute of Gerontology (F.C.M.), King's College, London WC2R 2LS, United Kingdom
| | | | - A. Margot Umpleby
- Department of Human Metabolism, Diabetes, and Metabolic Medicine (A.M.U.), Postgraduate Medical School, University of Surrey, Guildford GU2 7WG, United Kingdom
| | - Peter Sonksen
- St. Thomas' Hospital and King's College (P.S.), London SE1 7EW, United Kingdom; and Southampton University (P.S.), SO17 1BJ, Southampton, United Kingdom
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Stahlman J, Britto M, Fitzpatrick S, McWhirter C, Testino SA, Brennan JJ, Zumbrunnen TL. Effects of skin washing on systemic absorption of testosterone in hypogonadal males after administration of 1.62% testosterone gel. Curr Med Res Opin 2012; 28:271-9. [PMID: 22185431 DOI: 10.1185/03007995.2011.652256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The impact of washing on the pharmacokinetics, systemic absorption and residual testosterone on the skin after application of a 1.62% testosterone gel was investigated in an open-label, randomized, three-way crossover study in hypogonadal men. RESEARCH DESIGN AND METHODS Twenty-four hypogonadal men (total testosterone <300 ng/dL) applied 5 g of 1.62% gel (81 mg testosterone) once daily to the shoulders/upper arms for 7 days during each of three consecutive treatment periods. On the 7th dosing day of each period, the skin was washed (soap/water) at one of the following times: 2, 6, or 10 hours post-dose. Pharmacokinetic serum samples were collected at baseline, and on days 6 (no washing) and 7 (with washing) of each treatment period. Skin stripping for determination of residual testosterone was also performed on days 6 and 7. A single location on the application site was stripped a total of 10 times. Testosterone was extracted from the tape strips using ethanol, and concentrations were determined using high performance liquid chromatography with diode array detection (HPLC-UV). MAIN OUTCOME MEASURES Testosterone C(max), AUC(0-24), average concentration over the dosing interval (C(av)), and safety were assessed. RESULTS Washing at 2 and 6 hours caused a 10-14% decrease in AUC(0-24) and C(av), but not C(max). Washing 10 hours after gel application had no effect on C(max), AUC(0-24), or C(av). Skin washing decreased the mean amount of testosterone remaining on the skin surface by at least 81%. CONCLUSIONS Washing the site of gel application as soon as 2 hours after application had little impact on bioavailability and was effective in reducing residual testosterone on the skin. This finding may be important to prevent secondary transfer. STUDY LIMITATIONS The experimental conditions using uniform timing and procedures for dose administration and washing may not fully reflect real world circumstances. CLINICAL TRIAL REGISTRATION NCT NUMBERS: Study was not registered (first subject enrolled 22 December 2006).
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Di Sante S, Conners WP, Morgentaler A. Influence of Baseline Serum Testosterone on Changes in Body Composition in Response to Testosterone Therapy. J Sex Med 2012; 9:585-93. [DOI: 10.1111/j.1743-6109.2011.02557.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Cattabiani C, Basaria S, Ceda GP, Luci M, Vignali A, Lauretani F, Valenti G, Volpi R, Maggio M. Relationship between testosterone deficiency and cardiovascular risk and mortality in adult men. J Endocrinol Invest 2012; 35:104-20. [PMID: 22082684 DOI: 10.3275/8061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Classic male hypogonadism is associated with known adverse effects including decreased libido, erectile dysfunction, osteoporosis, and changes in body composition. Recently, we have come to appreciate that reduction in serum testosterone (T) levels resulting from aging or chronic disease or androgen deprivation therapy (ADT) have consequences similar to those seen in classic male hypogonadism which include increased fat mass, decreased lean body mass, decreased muscle strength, and sexual dysfunction. These data suggest that low T levels may represent a newly recognized cardiometabolic risk factor. Therefore, we carried out a careful review of the literature, focusing on major turning points of research and studies which gave more important and controversial contribution to the cardiovascular role of T. Observational studies and clinical trials investigating the relationship between T levels and cardiovascular disease and mortality were identified byMedline search. The results were synthesized, tabulated, and interpreted. The aim of this review is to discuss the association between low T levels and adverse metabolic profile such as insulin resistance, metabolic syndrome, and diabetes. We will also investigate the potential mechanisms by which male hypogonadism, especially age related or induced by ADT, may increase cardio-metabolic risk. Finally we will detail the emerging relationship between low T and mortality in men addressing also the reverse hypothesis that low T has a protective role by turning off T-dependent functions.
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Affiliation(s)
- C Cattabiani
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy
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Abstract
Cardiovascular disease remains the leading cause of death in most of the developed world despite advances in both prevention and treatment. At the same time, the incidence rates of cardiovascular disease differ greatly between the genders, with men more likely than women to manifest ischemic heart disease. This observation has prompted new research initiatives to explain the discrepancy in heart disease prevalence and incidence between the sexes. Whether androgens affect cardiovascular disease adversely remains a contentious issue, with some data pointing to a deleterious effect of androgens on lipid profiles, and other studies revealing androgens' possible benefits on cardiovascular function. This review will examine the relationship between the endogenous production of androgen as well as the exogenous replacement of testosterone in men and the possible links to cardiovascular disease. The role of testosterone in male cardiovascular health is not completely understood, and additional studies are needed to explain its effect on atherosclerosis and its complications.
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Rolland Y, Onder G, Morley JE, Gillette-Guyonet S, Abellan van Kan G, Vellas B. Current and future pharmacologic treatment of sarcopenia. Clin Geriatr Med 2011; 27:423-47. [PMID: 21824556 DOI: 10.1016/j.cger.2011.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcopenia is a complex multifactorial condition that can by treated with multimodal approaches. No pharmacologic agent to prevent or treat sarcopenia has been as efficacious as exercise (mainly resistance training) in combination with nutritional intervention (adequate protein and energy intake). However, performing resistance training sessions and following nutritional advice can be challenging, especially for frail, sarcopenic, elderly patients, and results remain only partial. Therefore, new pharmacologic agents may substantially reduce the functional decline in older people. This article reviews the new pharmacologic agents currently being assessed for treating sarcopenia.
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Affiliation(s)
- Yves Rolland
- Inserm U1027, University of Toulouse III, Avenue Jules Guesdes, France.
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Auyeung TW, Lee JSW, Kwok T, Leung J, Ohlsson C, Vandenput L, Leung PC, Woo J. Testosterone but not estradiol level is positively related to muscle strength and physical performance independent of muscle mass: a cross-sectional study in 1489 older men. Eur J Endocrinol 2011; 164:811-7. [PMID: 21346095 DOI: 10.1530/eje-10-0952] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the relationship between different measures of testosterone and estradiol (E(2)), muscle mass, muscle strength, and physical performance; and to test whether the association of sex hormone level with muscle strength and physical performance was independent of muscle mass. DESIGN AND METHODS A cross-sectional survey on 1489 community-dwelling men older than 64 years of age. Serum levels of testosterone and E(2) were measured by mass spectrometry, and sex hormone-binding globulin (SHBG) levels were measured by immunoradioassay. Muscle mass was examined by dual-energy X-ray absorptiometry and physical performance was assessed by hand-grip strength, gait speed, step length and chair-stand test. RESULTS Appendicular skeletal mass (ASM) was positively associated with total testosterone (TT; P<0.001), free testosterone (FT; P<0.001), and total E(2) (P<0.001) but not with free E(2) (P=0.102). After adjustment for age, serum SHBG and relative ASM, both TT and FT were significantly associated with grip strength, narrow-walk speed and the composite neuromuscular score. Higher total E(2), but not free E(2) was associated with lower grip strength (P<0.05) after adjustment for age, FT, SHBG and relative ASM. CONCLUSIONS Testosterone level was related to both muscle mass, strength and physical performance. Total E(2) level, though related to muscle mass positively, affected muscle strength adversely in older men.
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Affiliation(s)
- Tung Wai Auyeung
- The S H Ho Centre of Gerontology and Geriatrics, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.
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Rolland Y, Dupuy C, Abellan van Kan G, Gillette S, Vellas B. Treatment strategies for sarcopenia and frailty. Med Clin North Am 2011; 95:427-38, ix. [PMID: 21549870 DOI: 10.1016/j.mcna.2011.02.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sarcopenia is the key feature of frailty in older people and a major determinant of adverse health outcomes such as functional limitations and disability. Resistance training and adequate protein and energy intake are the key strategies for the management of sarcopenia. Management of weight loss and resistance training are the most relevant protective countermeasures to slow down the decline of muscle mass and muscle strength. The quality of amino acids in the diet is an important factor for stimulating protein synthesis. Vitamin D deficiency should be treated, and new pharmacologic approaches for sarcopenia are currently assessed.
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Affiliation(s)
- Yves Rolland
- Inserm U1027, F-31073, Avenue Jules Guesdes, University of Toulouse III, F-31073, France.
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Abstract
The prevalence of osteoporosis is estimated to be 18% in men, but 30% of all fractures occur in men. With age, men experience a gradual decline in testosterone production and bone density. The rate of trabecular bone loss in the lumbar spine in men over age 50 can be double the rate of loss in men under age 50. Endogenous testosterone, estradiol, and their metabolites play a role in maintaining bone health, but their specific effects on bone turnover have been difficult to elucidate. Recently, large cohort studies have provided more detailed information confirming estrogen’s associations and further characterizing the effect of endogenous testosterone and its metabolites on bone mineral density and fractures. Very few clinical trials have assessed the impact of testosterone replacement therapy (TRT) on bone density and fractures in men. The few studies that have been conducted are generally small and not robust enough to show the true treatment effect of TRT and adequately determine its safety. In the absence of data on patient outcomes, it is important for pharmacists to understand the impact of drug therapy on biomarkers and surrogate markers of disease for optimal pharmacotherapy selection and monitoring.
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Affiliation(s)
- Andrew C. Martin
- Pharmacy Practice, Union University School of Pharmacy, Jackson, TN, USA
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Kenny AM, Kleppinger A, Annis K, Rathier M, Browner B, Judge JO, McGee D. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty. J Am Geriatr Soc 2010; 58:1134-43. [PMID: 20722847 DOI: 10.1111/j.1532-5415.2010.02865.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the effects of testosterone supplementation on bone, body composition, muscle, physical function, and safety in older men. DESIGN Double-blind, randomized, placebo-controlled trial. SETTING A major medical institution. PARTICIPANTS One hundred thirty-one men (mean age 77.1 +/- 7.6) with low testosterone, history of fracture, or bone mineral density (BMD) T-score less than -2.0 and frailty. INTERVENTION Participants received 5 mg/d of testosterone or placebo for 12 to 24 months; all received calcium (1500 mg/d diet and supplement) and cholecalciferol (1,000 IU/d). MEASUREMENTS BMD of hip, lumbar spine, and mid-radius; body composition; sex hormones, calcium-regulating hormones; bone turnover markers; strength; physical performance; and safety parameters. RESULTS Ninety-nine men (75.6%) completed 12 months, and 62 (47.3%) completed end therapy (mean 23 months; range 16-24 months for 62 who completed therapy). Study adherence was 54%, with 40% of subjects maintaining 70% or greater adherence. Testosterone and bioavailable testosterone levels at 12 months were 583 ng/dL and 157 ng/dL, respectively, in the treatment group. BMD on testosterone increased 1.4% at the femoral neck and 3.2% at the lumbar spine (P=.005) and decreased 1.3% at the mid-radius (P<.001). There was an increase in lean mass and a decrease in fat mass in the testosterone group but no differences in strength or physical performance. There were no differences in safety parameters. CONCLUSION Older, frail men receiving testosterone replacement increased testosterone levels and had favorable changes in body composition, modest changes in axial BMD, and no substantial changes in physical function.
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Affiliation(s)
- Anne M Kenny
- Center on Aging, MC-5215, University of Connecticut Health Center, Farmington, CT 06030, USA.
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