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Coelingh Bennink HJT, Prowse A, Egberts JFM, Debruyne FMJ, Huhtaniemi IT, Tombal B. The Loss of Estradiol by Androgen Deprivation in Prostate Cancer Patients Shows the Importance of Estrogens in Males. J Endocr Soc 2024; 8:bvae107. [PMID: 38883397 PMCID: PMC11177789 DOI: 10.1210/jendso/bvae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Indexed: 06/18/2024] Open
Abstract
The role of estradiol (E2; an estrogen) in men needs to be more appreciated. In this review, we address the clinical situations that allow the study of the clinical consequences of E2 deficiency in men and discuss the effects of restoration of levels of this reproductive steroid hormone. In men with advanced prostate cancer (PCa) undergoing androgen deprivation therapy (ADT), E2 is suppressed along with testosterone, leading to side effects affecting the quality of life. These include hot flashes, arthralgia, fatigue, mood changes, cognition problems, weight gain, bone loss, and increased risk of cardiovascular disease. Transdermal E2 alone for ADT has shown equivalent testosterone suppression compared to gonadotropin-releasing hormone (GnRH) agonists while also preventing estrogen-deficiency side effects, including hot flashes and bone loss. Co-treatment of ADT with fetal estrogen estetrol (E4) has shown significant improvements of estrogen-deficiency symptoms. These observations emphasize the need to raise awareness of the importance of estrogens in men among clinicians and the lay public.
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Affiliation(s)
| | - Amanda Prowse
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | - Jan F M Egberts
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | | | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Imperial College London, London SW7 2AZ, UK
| | - Bertrand Tombal
- Division of Urology, University Clinic Saint-Luc, 1200 Brussels, Belgium
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2
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Shah SS, Kanani EAM, Kharat SK, Shah PS, Shah RM. Evaluation of the Incidence of Low Testosterone Levels in Young Male Adults with Moderate to Severe Obesity-Single-Centre Study from India. Obes Surg 2024; 34:836-840. [PMID: 38282174 DOI: 10.1007/s11695-024-07075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE With the increase in obesity epidemic among Asians, it is necessary to evaluate the impact of obesity on this population. Low testosterone levels are known to be associated with obesity. This is the 1st study from Asia to evaluate incidence and magnitude of hypotestosteronemia in young adults with BMI more than 32.5 kg/m2 defined as moderate to severe obesity in Asians. MATERIALS AND METHODS One hundred thirty-four male patients with BMI more than 32.5 kg/m2, between 18 and 30 years old who visited a single bariatric facility between 2017 and 2020, were evaluated with BMI, total and free testosterone levels and clinical features of gynecomastia, hypogonadism, and thinning of pubic and armpit hair. Statistical analysis was performed using SPSS, Spearman's correlation coefficient, and ANOVA test. RESULTS 60.4% of patients (84/134) had low testosterone levels (< 300 ng/dl) and 23.9% (32/134) had levels between 300 and 400 ng/dl. 89.6% patients (120/134 had gynecomastia, 60.4% (81/134) had thinning of pubic and arm pit hair, and 62.7% (84/134) had hypogonadism. Testosterone levels showed a decreasing trend with increasing BMI, but it was not statistically significant. CONCLUSION Obesity is one of the important etiologies of hypotestosteronemia and its manifestations in young adults. The actual incidence may be significantly higher than what is reported in the literature. High-quality research is required to address questions of diagnosis and best treatment options.
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Affiliation(s)
- Shashank S Shah
- Laparo Obeso Centre (LOC Healthcare LLP), University of Bergen, Pune, India
| | | | | | - Poonam S Shah
- Laparo Obeso Centre (LOC Healthcare LLP), University of Bergen, Pune, India
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Marriott RJ, Murray K, Adams RJ, Antonio L, Ballantyne CM, Bauer DC, Bhasin S, Biggs ML, Cawthon PM, Couper DJ, Dobs AS, Flicker L, Handelsman DJ, Hankey GJ, Hannemann A, Haring R, Hsu B, Karlsson M, Martin SA, Matsumoto AM, Mellström D, Ohlsson C, O'Neill TW, Orwoll ES, Quartagno M, Shores MM, Steveling A, Tivesten Å, Travison TG, Vanderschueren D, Wittert GA, Wu FCW, Yeap BB. Factors Associated With Circulating Sex Hormones in Men : Individual Participant Data Meta-analyses. Ann Intern Med 2023; 176:1221-1234. [PMID: 37639720 PMCID: PMC10995451 DOI: 10.7326/m23-0342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Various factors modulate circulating testosterone in men, affecting interpretation of testosterone measurements. PURPOSE To clarify factors associated with variations in sex hormone concentrations. DATA SOURCES Systematic literature searches (to July 2019). STUDY SELECTION Prospective cohort studies of community-dwelling men with total testosterone measured using mass spectrometry. DATA EXTRACTION Individual participant data (IPD) (9 studies; n = 21 074) and aggregate data (2 studies; n = 4075). Sociodemographic, lifestyle, and health factors and concentrations of total testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone, and estradiol were extracted. DATA SYNTHESIS Two-stage random-effects IPD meta-analyses found a nonlinear association of testosterone with age, with negligible change among men aged 17 to 70 years (change per SD increase about the midpoint, -0.27 nmol/L [-7.8 ng/dL] [CI, -0.71 to 0.18 nmol/L {-20.5 to 5.2 ng/dL}]) and decreasing testosterone levels with age for men older than 70 years (-1.55 nmol/L [-44.7 ng/dL] [CI, -2.05 to -1.06 nmol/L {-59.1 to -30.6 ng/dL}]). Testosterone was inversely associated with body mass index (BMI) (change per SD increase, -2.42 nmol/L [-69.7 ng/dL] [CI, -2.70 to -2.13 nmol/L {-77.8 to -61.4 ng/dL}]). Testosterone concentrations were lower for men who were married (mean difference, -0.57 nmol/L [-16.4 ng/dL] [CI, -0.89 to -0.26 nmol/L {-25.6 to -7.5 ng/dL}]); undertook at most 75 minutes of vigorous physical activity per week (-0.51 nmol/L [-14.7 ng/dL] [CI, -0.90 to -0.13 nmol/L {-25.9 to -3.7 ng/dL}]); were former smokers (-0.34 nmol/L [-9.8 ng/dL] [CI, -0.55 to -0.12 nmol/L {-15.9 to -3.5 ng/dL}]); or had hypertension (-0.53 nmol/L [-15.3 ng/dL] [CI, -0.82 to -0.24 nmol/L {-23.6 to -6.9 ng/dL}]), cardiovascular disease (-0.35 nmol/L [-10.1 ng/dL] [CI, -0.55 to -0.15 nmol/L {-15.9 to -4.3 ng/dL}]), cancer (-1.39 nmol/L [-40.1 ng/dL] [CI, -1.79 to -0.99 nmol/L {-51.6 to -28.5 ng/dL}]), or diabetes (-1.43 nmol/L [-41.2 ng/dL] [CI, -1.65 to -1.22 nmol/L {-47.6 to -35.2 ng/dL}]). Sex hormone-binding globulin was directly associated with age and inversely associated with BMI. Luteinizing hormone was directly associated with age in men older than 70 years. LIMITATION Cross-sectional analysis, heterogeneity between studies and in timing of blood sampling, and imputation for missing data. CONCLUSION Multiple factors are associated with variation in male testosterone, SHBG, and LH concentrations. Reduced testosterone and increased LH concentrations may indicate impaired testicular function after age 70 years. Interpretation of individual testosterone measurements should account particularly for age older than 70 years, obesity, diabetes, and cancer. PRIMARY FUNDING SOURCE Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).
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Affiliation(s)
- Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia (R.J.A.)
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (L.A., D.V.)
| | | | - Douglas C Bauer
- General Internal Medicine, University of California, San Francisco, San Francisco, California (D.C.B.)
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.B.)
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (M.L.B.)
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California (P.M.C.)
| | - David J Couper
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (D.J.C.)
| | - Adrian S Dobs
- School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland (A.S.D.)
| | - Leon Flicker
- Medical School and Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia (L.F.)
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia (D.J.H.)
| | - Graeme J Hankey
- Medical School, University of Western Australia, and Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia (G.J.H.)
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, and DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany (A.H.)
| | - Robin Haring
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and Faculty of Applied Public Health, European University of Applied Sciences, Rostock, Germany (R.H.)
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia (B.H.)
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden (M.K.)
| | - Sean A Martin
- Australian Institute of Family Studies, Southbank, Victoria, Australia (S.A.M.)
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington (A.M.M.)
| | - Dan Mellström
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Göteborg, Sweden (D.M., C.O.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Göteborg, Sweden (D.M., C.O.)
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester and National Institute for Health and Care Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom (T.W.O.)
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon (E.S.O.)
| | - Matteo Quartagno
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom (M.Q.)
| | - Molly M Shores
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington (M.M.S.)
| | - Antje Steveling
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany (A.S.)
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden (Å.T.)
| | - Thomas G Travison
- Brigham and Women's Hospital and Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (T.G.T.)
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (L.A., D.V.)
| | - Gary A Wittert
- Freemasons Centre for Male Health & Wellbeing, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia (G.A.W.)
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom (F.C.W.W.)
| | - Bu B Yeap
- Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Perth, Australia (B.B.Y.)
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Jasuja R, Pencina KM, Spencer DJ, Peng L, Privat F, Dhillo W, Jayasena C, Hayes F, Yeap BB, Matsumoto AM, Bhasin S. Reference intervals for free testosterone in adult men measured using a standardized equilibrium dialysis procedure. Andrology 2023; 11:125-133. [PMID: 36251328 DOI: 10.1111/andr.13310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Free testosterone (FT) determination may be helpful in evaluating men suspected of testosterone deficiency especially in conditions with altered binding-protein concentrations. However, methods for measuring FT by equilibrium dialysis and reference intervals vary among laboratories. OBJECTIVE To determine reference intervals for FT in healthy, nonobese men by age groups as well as in healthy young men, 19-39 years, using a standardized equilibrium dialysis procedure METHODS: We measured FT in 145 healthy, nonobese men, 19 years or older, using a standardized equilibrium dialysis method performed for 16-h at 37°C using undiluted serum and dialysis buffer that mimicked the ionic composition of human plasma. FT in dialysate was measured using a CDC-certified liquid chromatography tandem mass spectrometry assay. RESULTS In healthy nonobese men, the 2.5th, 10th, 50th, 90th, and 97.5th percentile values for FT were 66, 91, 141, 240, and 309 pg/ml, respectively; corresponding values for men, 19-39 years, were 120, 128, 190, 274, and 368 pg/ml, respectively. FT levels by age groups exhibit the expected age-related decline. FT levels were negatively associated with body mass index, age, and sex hormone-binding globulin (SHBG) levels. Percent FT was lower in middle-aged and older men than young men adjusting for SHBG level. DISCUSSION Further studies are needed to determine how these reference intervals apply to the diagnosis of androgen deficiency in clinical populations and in men of different races and ethnicities in different geographic regions. CONCLUSION Reference intervals for free FT levels (normative range 66-309 pg/ml [229-1072 pmol/L] in all men and 120-368 pg/ml [415-1274 pmol/L] in men, 19-39 years), measured using a standardized equilibrium dialysis method in healthy nonobese men, provide a rational basis for categorizing FT levels. These intervals require further validation in other populations, in relation to outcomes, and in randomized trials.
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Affiliation(s)
- Ravi Jasuja
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karol M Pencina
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Spencer
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liming Peng
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabiola Privat
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Waljit Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London Faculty of Medicine, Hammersmith Hospital, London, UK
| | - Channa Jayasena
- Section of Investigative Medicine, Imperial College London Faculty of Medicine, Hammersmith Hospital, London, UK
| | - Frances Hayes
- Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bu B Yeap
- Medical School, University of Western Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Appiah D, Luitel S, Nwabuo CC, Ebong I, Winters SJ. Low endogenous estradiol levels are associated with elevated risk of cardiovascular disease mortality in young and middle-aged men in the United States. Atherosclerosis 2022; 361:34-40. [PMID: 36210243 DOI: 10.1016/j.atherosclerosis.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/18/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Evidence for the association of total estradiol (E2) with cardiovascular disease (CVD) in young men is limited. We investigated the association of total E2 or free estradiol (FE2) and CVD mortality in a nationally representative multiracial sample of young and middle-aged men in the United States. METHODS Data were from 954 men without CVD, cancer, diabetes and not on androgen therapy or taking anabolic steroids, who participated in the National Health and Nutrition Examination Survey (1988-1991), for whom E2 was measured, and were followed for mortality through to 2015. Fasting serum levels of E2 were measured using competitive electrochemiluminescence immunoassays. Free estradiol was estimated from the levels of estradiol, sex hormone binding globulin, and albumin. International Classification of Diseases codes were used to define CVD mortality. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS The average age of participants at baseline was 35.7 ± 11.6 years, with 11% and 6% reporting Black and Hispanic race and ethnicity, respectively. During a median follow-up of 25.2 years, 40 CVD deaths were recorded. Controlling for baseline demographic and CVD risk factors, and total testosterone levels, a 1 standard deviation decrement in log E2 (HR: 2.33, 95%CI: 1.11-5.00) or FE2 (HR: 1.89, 95%CI: 1.01-3.57) was associated with elevated risk of CVD mortality. This elevated risk was largely limited to non-Hispanic White men. CONCLUSIONS In this study, low levels of E2 or FE2 were associated with elevated risk of CVD mortality.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Sujata Luitel
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chike C Nwabuo
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Imo Ebong
- Division of Cardiovascular Sciences, University of California, Davis, Sacramento, CA, USA
| | - Stephen J Winters
- Division of Endocrinology, Metabolism and Diabetes, University of Louisville, Louisville, KY, USA
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Huhtaniemi IT, Wu FCW. Ageing male (part I): Pathophysiology and diagnosis of functional hypogonadism. Best Pract Res Clin Endocrinol Metab 2022; 36:101622. [PMID: 35210191 DOI: 10.1016/j.beem.2022.101622] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This narrative review summarizes key points of the pathogenesis and diagnosis of the ageing-related decline of testosterone (T) in men. The condition is commonly termed late-onset hypogonadism (LOH), but because it is more often caused by other factors than chronological ageing (obesity and other comorbidities), a more appropriate term is functional hypogonadism (FH). Unlike the classical organic hypogonadism, no anatomical or genetic aberrations are found in FH, and the suppression of T is milder. Moreover, FH can be reversible if the underlying cause (e.g. obesity, chronic disease) is removed/treated. Low serum total T in connection with more specific hypogonadism-associated symptoms (primarily sexual) form the basis of the diagnosis of FH. When T concentrations are borderline, the accuracy of diagnosis can be improved by assessment of free or calculated free T, especially when suppressed SHBG levels (usually related to obesity) are likely. Current data indicate that FH (low T and sexual symptoms) is not a common condition, and it is detectable in about 2% of community-dwelling men aged 40-80 years.
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Affiliation(s)
- Ilpo T Huhtaniemi
- Department of Digestion, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Hammersmith Campus, Imperial College London, London W12 0NN, UK.
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK
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The 3,4-Quinones of Estrone and Estradiol Are the Initiators of Cancer whereas Resveratrol and N-acetylcysteine Are the Preventers. Int J Mol Sci 2021; 22:ijms22158238. [PMID: 34361004 PMCID: PMC8347442 DOI: 10.3390/ijms22158238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
This article reviews evidence suggesting that a common mechanism of initiation leads to the development of many prevalent types of cancer. Endogenous estrogens, in the form of catechol estrogen-3,4-quinones, play a central role in this pathway of cancer initiation. The catechol estrogen-3,4-quinones react with specific purine bases in DNA to form depurinating estrogen-DNA adducts that generate apurinic sites. The apurinic sites can then lead to cancer-causing mutations. The process of cancer initiation has been demonstrated using results from test tube reactions, cultured mammalian cells, and human subjects. Increased amounts of estrogen-DNA adducts are found not only in people with several different types of cancer but also in women at high risk for breast cancer, indicating that the formation of adducts is on the pathway to cancer initiation. Two compounds, resveratrol, and N-acetylcysteine, are particularly good at preventing the formation of estrogen-DNA adducts in humans and are, thus, potential cancer-prevention compounds.
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8
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Yeap BB, Marriott RJ, Antonio L, Bhasin S, Dobs AS, Dwivedi G, Flicker L, Matsumoto AM, Ohlsson C, Orwoll ES, Raj S, Reid CM, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Sociodemographic, lifestyle and medical influences on serum testosterone and sex hormone-binding globulin in men from UK Biobank. Clin Endocrinol (Oxf) 2021; 94:290-302. [PMID: 32979890 DOI: 10.1111/cen.14342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Serum testosterone concentrations are affected by factors unrelated to hypothalamo-pituitary-testicular axis pathology. We evaluated the impact of sociodemographic, lifestyle and medical factors, on serum testosterone and sex hormone-binding globulin (SHBG) in men aged 40-69 years. DESIGN Cross-sectional analysis of 208,677 community-dwelling men from the UK Biobank. MEASUREMENTS We analysed associations of different factors with serum testosterone and SHBG (immunoassays) and calculated free testosterone (cFT), using smoothed centile plots, linear mixed models and effect size estimates. RESULTS Median (interquartile range) for serum testosterone was 11.6 (9.4-14.1) nmol/L, SHBG 36.9 (27.9-48.1) nmol/L and cFT 213 (178-255) pmol/L. Age and BMI were inversely associated with testosterone and cFT, while SHBG was associated with age and inversely with BMI (all P < .001). Living with a partner, (South) Asian ethnicity, never or previous smoker and some medical conditions were associated with lower testosterone. Poultry or fish eater, and higher physical activity were associated with higher testosterone (all P < .001). Testosterone was lowered by ~0.5 nmol/L across ages, ~1.5 nmol/L for BMI 30 vs 25 kg/m2 , ~2 nmol/L for (South) Asian ethnicity, living with partner, college/university qualifications, low red meat eater, insufficient physical activity and 0.3-1.0 nmol/L with cardiovascular disease or diabetes. Different combinations of these factors varied serum testosterone by ~4 nmol/L, SHBG by ~30 nmol/L and cFT by ~60 pmol/L. CONCLUSIONS The identified modifiable risk factors support lifestyle-based interventions in men with low testosterone concentrations. Considering sociodemographic, lifestyle and medical factors facilitates more personalized interpretation of testosterone testing results with respect to existing reference ranges.
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adrian S Dobs
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Girish Dwivedi
- Medical School, University of Western Australia, Perth, WA, Australia
- Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, WA, Australia
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric S Orwoll
- Oregon Health and Science University, Portland, OR, United States
| | - Suchitra Raj
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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9
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Kramer BL. The molecularization of race in testosterone research. BIOSOCIETIES 2020. [DOI: 10.1057/s41292-020-00200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Giagulli VA, Castellana M, Lisco G, Triggiani V. Critical evaluation of different available guidelines for late‐onset hypogonadism. Andrology 2020; 8:1628-1641. [DOI: 10.1111/andr.12850] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Vito Angelo Giagulli
- Interdisciplinary Department of Medicine‐Section of Internal Medicine Geriatrics, Endocrinology and Rare Diseases School of Medicine University of Bari “Aldo Moro” Bari Italy
- Outpatients Clinic of Endocrinology and Metabolic Disease Conversano Hospital Bari Italy
| | - Marco Castellana
- National Institute of Gastroenterology "Saverio de Bellis" Research Hospital Bari Italy
| | - Giuseppe Lisco
- Hospital Unit of Endocrinology Perrino Hospital Brindisi Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine‐Section of Internal Medicine Geriatrics, Endocrinology and Rare Diseases School of Medicine University of Bari “Aldo Moro” Bari Italy
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11
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12
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Zhang H, Basit A, Wolford C, Chen KF, Gaedigk A, Lin YS, Leeder JS, Prasad B. Normalized Testosterone Glucuronide as a Potential Urinary Biomarker for Highly Variable UGT2B17 in Children 7-18 Years. Clin Pharmacol Ther 2020; 107:1149-1158. [PMID: 31900930 DOI: 10.1002/cpt.1764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/17/2019] [Indexed: 12/25/2022]
Abstract
UDP-glucuronosyltransferase 2B17 (UGT2B17) is a highly variable androgen-metabolizing and drug-metabolizing enzyme. UGT2B17 exhibits a unique ontogeny profile characterized by a dramatic increase in hepatic protein expression from prepubertal age to adulthood. Age, sex, copy number variation (CNV), and single nucleotide polymorphisms only explain 26% of variability in protein expression, highlighting the need for a phenotypic biomarker for predicting interindividual variability in glucuronidation of UGT2B17 substrates. Here, we propose testosterone glucuronide (TG) normalized by androsterone glucuronide (TG/AG) as a urinary UGT2B17 biomarker, and examine the associations among urinary TG/AG and age, sex, and CNV. We performed targeted metabolomics of 12 androgen conjugates with liquid-chromatography tandem mass spectrometry in 63 pediatric subjects ages 7-18 years followed over 7 visits in 3 years. Consistent with the reported developmental trajectory of UGT2B17 protein expression, urinary TG/AG is significantly associated with age, sex, and CNV. In conclusion, TG/AG shows promise as a phenotypic urinary UGT2B17 biomarker.
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Affiliation(s)
- Haeyoung Zhang
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Abdul Basit
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Chris Wolford
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Kuan-Fu Chen
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Yvonne S Lin
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - J Steven Leeder
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Bhagwat Prasad
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
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Kaufman JM, Lapauw B, Mahmoud A, T'Sjoen G, Huhtaniemi IT. Aging and the Male Reproductive System. Endocr Rev 2019; 40:906-972. [PMID: 30888401 DOI: 10.1210/er.2018-00178] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022]
Abstract
This narrative review presents an overview of current knowledge on fertility and reproductive hormone changes in aging men, the factors driving and modulating these changes, their clinical consequences, and the benefits and risks of testosterone (T) therapy. Aging is accompanied by moderate decline of gamete quality and fertility. Population mean levels show a mild total T decline, an SHBG increase, a steeper free T decline, and a moderate LH increase with important contribution of comorbidities (e.g., obesity) to these changes. Sexual symptoms and lower hematocrit are associated with low T and are partly responsive to T therapy. The relationship of serum T with body composition and metabolic health is bidirectional; limited beneficial effects of T therapy on body composition have only marginal effects on metabolic health and physical function. Skeletal changes are associated primarily with estradiol and SHBG. Cognitive decline is not consistently linked to low T and is not improved by T therapy. Although limited evidence links moderate androgen decline with depressive symptoms, T therapy has small beneficial effects on mood, depressive symptoms, and vitality in elderly patients with low T. Suboptimal T (and/or DHT) has been associated with increased risk of stroke, but not of ischemic heart disease, whereas an association with mortality probably reflects that low T is a marker of poor health. Globally, neither severity of clinical consequences attributable to low T nor the nature and magnitude of beneficial treatment effects justify the concept of some broadly applied "T replacement therapy" in older men with low T. Moreover, long-term safety of T therapy is not established.
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ahmed Mahmoud
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ilpo Tapani Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.,Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
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14
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Montagna G, Balestra S, D'Aurizio F, Romanelli F, Benagli C, Tozzoli R, Risch L, Giovanella L, Imperiali M. Establishing normal values of total testosterone in adult healthy men by the use of four immunometric methods and liquid chromatography-mass spectrometry. Clin Chem Lab Med 2019; 56:1936-1944. [PMID: 29746252 DOI: 10.1515/cclm-2017-1201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The total testosterone (T) cutoffs clinically adopted to define late-onset hypogonadism (LOH) do not consider the differences that exist between different analytical platforms, nor do they consider the body mass index (BMI) or age of the patient. We aimed at providing method, age and BMI-specific normal values for total T in European healthy men. METHODS A total of 351 eugonadal healthy men were recruited, and total T was measured with four automated immunometric assays (IMAs): ARCHITECT i1000SR (Abbott), UniCel DxI800 (Beckman Coulter), Cobas e601 (Roche), IMMULITE 2000 (Siemens) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Reference ranges (RRs) were calculated for each method. RESULTS Passing and Bablok regression analysis and Bland-Altman plot showed an acceptable agreement between Abbott and LC-MS/MS, but a poor one between LC-MS/MS and the other IMAs. Age-specific T concentrations in non-obese (BMI <29.9 kg/m2) men were greater than in all men. The total T normal range, in non-obese men aged 18-39 years, measured with LC-MS/MS was 9.038-41.310 nmol/L. RRs calculated with LC-MS/MS statistically differed from the ones calculated with all individual IMAs, except Abbott and among all IMAs. Statistically significant differences for both upper and lower reference limits between our RRs and the ones provided by the manufacturers were also noticed. CONCLUSIONS We calculated normal ranges in a non-obese cohort of European men, aged 18-39 years, with four commercially available IMAs and LC-MS/MS and found statistically significant differences according to the analytical method used. Method-specific reference values can increase the accuracy of LOH diagnosis and should be standardly used.
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Affiliation(s)
- Giacomo Montagna
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
| | - Samuela Balestra
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Francesco Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Cinzia Benagli
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Renato Tozzoli
- Clinical Pathology Service, Regional Hospital, Pordenone, Italy
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland.,Institute of Clinical Chemistry, University of Bern, Bern, Switzerland.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Luca Giovanella
- Clinic for Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Integrated Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland, Phone: +41 91 811 86 72, Fax: +41 91 811 82 50
| | - Mauro Imperiali
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Anupam B, Shivaprasad C, Sridevi A, Aiswarya Y, Gautham K, Ramdas B, Kejal S. Association of total and calculated free testosterone with androgen deficiency symptoms in patients with type 2 diabetes. Int J Impot Res 2019; 32:289-296. [PMID: 31000814 DOI: 10.1038/s41443-019-0144-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 12/13/2022]
Abstract
The Androgen Deficiency in the Aging Male (ADAM) questionnaire is commonly used to screen type 2 diabetes mellitus (T2DM) patients for androgen deficiency symptoms, but the association of low total (TT) and free testosterone (FT) levels with divergent responses to the ADAM questionnaire remains unclear. The aim of this study was to assess the predictive ability of TT and calculated FT (cFT) levels for accurately classifying ADAM status. We recruited 70 patients each with positive (group A) and negative (group B) responses to the ADAM questionnaire and 70 age-matched healthy controls (group C) (mean age, 50.5 years); serum levels of TT were estimated and cFT were estimated using Vermeulen equation. Hypogonadism was defined as the presence of symptoms (positive ADAM score) along with TT level < 300 ng/dL or calculated (cFT) <6.35 ng/dL. BMI was highest in group A (P < 0.05), followed by groups B and C. Group A had longer diabetes durations (P < 0.05) and higher fasting plasma glucose (FPG) and HbA1c levels than group B (P < 0.001). TT levels and cFT were significantly lower in Group A than in the other two groups. In group A, 51 (73%) men had low TT levels (<300 ng/dL) and 48 (69%) had low cFT (<6.35 ng/dL). TT levels < 300 ng/dL had higher sensitivity and specificity (73 and 96%, respectively) than cFT < 6.35 ng/dL (69 and 90%, respectively) for predicting ADAM status. Multivariate-adjusted logistic regression showed that diabetes duration, HbA1c level, and BMI predicted low TT levels, whereas diabetes duration and HbA1c and high-density lipoprotein levels were significant predictors of low cFT. TT levels were a better predictor of ADAM responses than cFT in male T2DM patients. Our results suggest that TT level is better than cFT for diagnosing hypogonadism in T2DM patients when equilibrium dialysis is not feasible.
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Affiliation(s)
- Biswas Anupam
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Channabasappa Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
| | - Atluri Sridevi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Yalamanchi Aiswarya
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Kolla Gautham
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Barure Ramdas
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Shah Kejal
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
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16
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Minooee S, Ramezani Tehrani F, Rahmati M, Amanollahi Soudmand S, Tohidi M, Sabet Z, Azizi F. The association between serum total testosterone and progression of hyperglycemia: a 15‐year prospective cohort study. Andrology 2019; 7:148-155. [DOI: 10.1111/andr.12568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/21/2018] [Accepted: 11/02/2018] [Indexed: 02/03/2023]
Affiliation(s)
- S. Minooee
- Reproductive Endocrinology Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical SciencesTehran I.R. Iran
| | - F. Ramezani Tehrani
- Reproductive Endocrinology Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical SciencesTehran I.R. Iran
| | - M. Rahmati
- Reproductive Endocrinology Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical SciencesTehran I.R. Iran
- Department of Epidemiology and Biostatistics School of Public Health Tehran University of Medical Sciences Tehran I.R. Iran
| | | | - M. Tohidi
- Prevention of Metabolic Disorders Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical SciencesTehran I.R.Iran
| | - Z. Sabet
- Endocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran I.R. Iran
| | - F. Azizi
- Endocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences Tehran I.R. Iran
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Ha Chung B, Horie S, Chiong E. The incidence, mortality, and risk factors of prostate cancer in Asian men. Prostate Int 2018; 7:1-8. [PMID: 30937291 PMCID: PMC6424686 DOI: 10.1016/j.prnil.2018.11.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/07/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023] Open
Abstract
The objective of this review was to describe the epidemiology and risk factors of prostate cancer (PCa) in Asian populations. English language publications published over the last 10 years covering studies on the incidence, mortality, and risk factors of PCa in Asia were reviewed. The incidence of PCa in Asia is rising but is still significantly lower than that in Western countries. Studies in Asia indicated that the consumption of red meat, fat, dairy, and eggs was associated with a higher risk for PCa. Age and family history were also found to be risk factors. The emergence of genetic data indicates that different genetic backgrounds between Asian and Western populations play a role in the observed differences in PCa incidence. The lower incidence of PCa in Asian men than in Western men may in part be due to a lack of systematic prostate-specific antigen screening, but environmental and genetic factors also play a role.
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Affiliation(s)
- Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, 2 Chome-1-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - Edmund Chiong
- Department of Urology, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore
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18
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Yeap BB, Page ST, Grossmann M. Testosterone treatment in older men: clinical implications and unresolved questions from the Testosterone Trials. Lancet Diabetes Endocrinol 2018; 6:659-672. [PMID: 30017800 DOI: 10.1016/s2213-8587(17)30416-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 10/28/2022]
Abstract
A decrease in the concentration of circulating testosterone in many older men is a biomarker and possibly a rectifiable contributing factor to ill health. Low circulating testosterone concentration has been associated with cardiovascular disease, reduced cognition, fracture risk, and anaemia. However, randomised placebo-controlled trials are essential to clarify the benefits and possible risks of testosterone treatment in men without hypothalamic, pituitary, or testicular disease. The Testosterone Trials (T-Trials) were a coordinated set of trials that, following a screening-to-enrolment ratio of 65:1, randomly assigned 790 men aged 65 years or older who had a baseline testosterone concentration of less than 9·54 nmol/L and symptoms consistent with hypogonadism, but no recognisable hypothalamic-pituitary-testicular axis pathology, to daily transdermal testosterone or placebo for 12 months. In the main trial, testosterone treatment resulted in a modest benefit for sexual function, whereas the other primary outcomes of vitality and physical function were not met. Data from concomitant substudies raised a possible concern over changes in coronary plaque volume, showed a neutral effect on memory and other cognitive functions, and revealed improvements in volumetric bone mineral density and anaemia. Although insufficient to alter the existing clinical equipoise, the T-Trials provided substantial new data on organ-specific outcomes for testosterone treatment in older men. Further clinical trials are necessary to determine whether testosterone treatment will translate into patient-valued health outcomes and to clarify effects on the cardiovascular system.
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Affiliation(s)
- Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Stephanie T Page
- Division of Metabolism and Endocrinology, University of Washington, Seattle, WA, USA.
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
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19
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Defeudis G, Mazzilli R, Gianfrilli D, Lenzi A, Isidori AM. The CATCH checklist to investigate adult-onset hypogonadism. Andrology 2018; 6:665-679. [PMID: 29888533 DOI: 10.1111/andr.12506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 12/18/2022]
Abstract
Adult-onset hypogonadism is a syndrome often underdiagnosed, undertreated, or incompletely explored. There are various reasons for this: firstly, undefined age range of men in whom testosterone levels should be investigated and then no definitive serum cutoff point for the diagnosis of hypogonadism; and finally, variable and non-specific signs and symptoms; men and physicians do not pay adequate attention to sexual health. All these factors make the diagnostic criteria for hypogonadism controversial. The evaluation of the clinical features and causes of this syndrome, its link with age, the role of testosterone and other hormone levels, and the presence of any comorbidities are all useful factors in the investigation of this population. The purpose of this manuscript, after an accurate analysis of current literature, is to facilitate the diagnosis of hypogonadism in men through the use of the CATCH acronym and a checklist to offer a practical diagnostic tool for daily clinical practice. A narrative review of the relevant literature regarding the diagnosis of late-onset hypogonadism or adult-onset hypogonadism was performed. PubMed database was used to retrieve articles published on this topic. A useful new acronym CATCH (Clinical features [symptoms] and Causes, Age, Testosterone level, Comorbidities, and Hormones) and a practical checklist to facilitate the evaluation of hypogonadism in aging men were used. The evaluation of the clinical features and causes of hypogonadism, the link with age, the role of Testosterone and other hormones, and the evaluation of comorbidities are important in investigating adult-onset hypogonadism. The CATCH checklist could be helpful for clinicians for an early diagnosis of both hypogonadism and associated comorbidities. We suggest the use of this acronym to advocate the investigation of declining testosterone in aging men.
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Affiliation(s)
- G Defeudis
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.,Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - R Mazzilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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20
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Eriksson AL, Perry JRB, Coviello AD, Delgado GE, Ferrucci L, Hoffman AR, Huhtaniemi IT, Ikram MA, Karlsson MK, Kleber ME, Laughlin GA, Liu Y, Lorentzon M, Lunetta KL, Mellström D, Murabito JM, Murray A, Nethander M, Nielson CM, Prokopenko I, Pye SR, Raffel LJ, Rivadeneira F, Srikanth P, Stolk L, Teumer A, Travison TG, Uitterlinden AG, Vaidya D, Vanderschueren D, Zmuda JM, März W, Orwoll ES, Ouyang P, Vandenput L, Wu FCW, de Jong FH, Bhasin S, Kiel DP, Ohlsson C. Genetic Determinants of Circulating Estrogen Levels and Evidence of a Causal Effect of Estradiol on Bone Density in Men. J Clin Endocrinol Metab 2018; 103:991-1004. [PMID: 29325096 PMCID: PMC5868407 DOI: 10.1210/jc.2017-02060] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/04/2018] [Indexed: 12/24/2022]
Abstract
Context Serum estradiol (E2) and estrone (E1) levels exhibit substantial heritability. Objective To investigate the genetic regulation of serum E2 and E1 in men. Design, Setting, and Participants Genome-wide association study in 11,097 men of European origin from nine epidemiological cohorts. Main Outcome Measures Genetic determinants of serum E2 and E1 levels. Results Variants in/near CYP19A1 demonstrated the strongest evidence for association with E2, resolving to three independent signals. Two additional independent signals were found on the X chromosome; FAMily with sequence similarity 9, member B (FAM9B), rs5934505 (P = 3.4 × 10-8) and Xq27.3, rs5951794 (P = 3.1 × 10-10). E1 signals were found in CYP19A1 (rs2899472, P = 5.5 × 10-23), in Tripartite motif containing 4 (TRIM4; rs17277546, P = 5.8 × 10-14), and CYP11B1/B2 (rs10093796, P = 1.2 × 10-8). E2 signals in CYP19A1 and FAM9B were associated with bone mineral density (BMD). Mendelian randomization analysis suggested a causal effect of serum E2 on BMD in men. A 1 pg/mL genetically increased E2 was associated with a 0.048 standard deviation increase in lumbar spine BMD (P = 2.8 × 10-12). In men and women combined, CYP19A1 alleles associated with higher E2 levels were associated with lower degrees of insulin resistance. Conclusions Our findings confirm that CYP19A1 is an important genetic regulator of E2 and E1 levels and strengthen the causal importance of E2 for bone health in men. We also report two independent loci on the X-chromosome for E2, and one locus each in TRIM4 and CYP11B1/B2, for E1.
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Affiliation(s)
- Anna L Eriksson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John R B Perry
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | | | - Graciela E Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, Gerontology Research Center, National Institute on Aging, Baltimore, Maryland
| | - Andrew R Hoffman
- Division of Endocrinology, Stanford University School of Medicine, Stanford, California
| | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, United Kingdom
- Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Magnus K Karlsson
- Department of Orthopaedics and Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gail A Laughlin
- Family Medicine and Public Health, University of California-San Diego, San Diego, California
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg and Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kathryn L Lunetta
- Boston University School of Public Health, Boston, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
| | - Dan Mellström
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg and Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Joanne M Murabito
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Anna Murray
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Maria Nethander
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carrie M Nielson
- School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Inga Prokopenko
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, United Kingdom
- Hammersmith Hospital, London, United Kingdom
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Leslie J Raffel
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Priya Srikanth
- School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Thomas G Travison
- Institute for Aging Research, Hebrew Senior Life and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dirk Vanderschueren
- Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Winfried März
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Eric S Orwoll
- Bone & Mineral Unit, Oregon Health & Science University, Portland, Oregon
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frederick C W Wu
- Andrology Research Unit, Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Frank H de Jong
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas P Kiel
- Framingham Heart Study, Framingham, Massachusetts
- Institute for Aging Research, Hebrew Senior Life and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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21
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Karakas C, Wang C, Deng F, Huang H, Wang D, Lee P. Molecular mechanisms involving prostate cancer racial disparity. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2017; 5:34-48. [PMID: 29181436 PMCID: PMC5698597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Prostate cancer (PCa) is the second leading cause of cancer-related deaths in the United States. The African (AA) descent has greater incidence and mortality rates of PCa as compared to Caucasian (CA) men. While socioeconomic differences across racial groups contribute to disparity in PCa, increasing evidence points that genetic and molecular alterations play important roles in racial disparities associated with PCa. In this review, we focus on genetic and molecular influences that contribute to racial disparity between AA and CA men including: androgen and estrogen receptor signaling pathways, growth factors, apoptotic proteins, genetic, genomic and epigenetic alterations. Future translational studies will identify prognostic and predictive biomarkers for AA PCa and assist in the development of new targeted-therapies specifically for AA men with PCa.
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Affiliation(s)
- Cansu Karakas
- Department of Pathology, New York University School of MedicineNew York, NY, USA
| | - Cassie Wang
- Department of Bioengineering, University of PennsylvaniaPennsylvania, PA, USA
| | - Fangming Deng
- Department of Pathology, New York University School of MedicineNew York, NY, USA
| | - Hongying Huang
- Department of Pathology, New York University School of MedicineNew York, NY, USA
| | - Dongwen Wang
- Department of Urology, First Hospital of Shanxi Medical UniversityTaiyuan, Shanxi, China
| | - Peng Lee
- Department of Pathology, New York University School of MedicineNew York, NY, USA
- Department of Urology, New York University School of MedicineNew York, NY, USA
- Department of New York Harbor Healthcare System, New York University School of MedicineNew York, NY, USA
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22
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Vandenput L, Mellström D, Laughlin GA, Cawthon PM, Cauley JA, Hoffman AR, Karlsson MK, Rosengren BE, Ljunggren Ö, Nethander M, Eriksson AL, Lorentzon M, Leung J, Kwok T, Orwoll ES, Ohlsson C. Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men: The International MrOS Study. J Bone Miner Res 2017; 32:1174-1181. [PMID: 28135013 PMCID: PMC5466469 DOI: 10.1002/jbmr.3088] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/19/2017] [Accepted: 01/25/2017] [Indexed: 01/24/2023]
Abstract
Fracture risk is determined by bone strength and the risk of falls. The relationship between serum sex steroids and bone strength parameters in men is well known, whereas the predictive value of sex steroids for falls is less studied. The aim of this study was to assess the associations between serum testosterone (T) and estradiol (E2) and the likelihood of falls. Older men (aged ≥65 years) from the United States (n = 1919), Sweden (n = 2495), and Hong Kong (n = 1469) participating in the Osteoporotic Fractures in Men Study had baseline T and E2 analyzed by mass spectrometry. Bioavailable (Bio) levels were calculated using mass action equations. Incident falls were ascertained every 4 months during a mean follow-up of 5.7 years. Associations between sex steroids and falls were estimated by generalized estimating equations. Fall rate was highest in the US and lowest in Hong Kong (US 0.50, Sweden 0.31, Hong Kong 0.12 fall reports/person/year). In the combined cohort of 5883 men, total T (odds ratio [OR] per SD increase = 0.88, 95% confidence interval [CI] 0.86-0.91) and BioT (OR = 0.86, 95% CI 0.83-0.88) were associated with incident falls in models adjusted for age and prevalent falls. These associations were only slightly attenuated after simultaneous adjustment for physical performance variables (total T: OR = 0.94, 95% CI 0.91-0.96; BioT: OR = 0.91, 95% CI 0.89-0.94). E2, BioE2, and sex hormone-binding globulin (SHBG) were not significantly associated with falls. Analyses in the individual cohorts showed that both total T and BioT were associated with falls in MrOS US and Sweden. No association was found in MrOS Hong Kong, and this may be attributable to environmental factors rather than ethnic differences because total T and BioT predicted falls in MrOS US Asians. In conclusion, low total T and BioT levels, but not E2 or SHBG, are associated with increased falls in older men. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gail A Laughlin
- Division of Epidemiology, Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Östen Ljunggren
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Maria Nethander
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna L Eriksson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Timothy Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Eric S Orwoll
- Bone and Mineral Unit, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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23
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Travison TG, Vesper HW, Orwoll E, Wu F, Kaufman JM, Wang Y, Lapauw B, Fiers T, Matsumoto AM, Bhasin S. Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe. J Clin Endocrinol Metab 2017; 102:1161-1173. [PMID: 28324103 PMCID: PMC5460736 DOI: 10.1210/jc.2016-2935] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
Background Reference ranges for testosterone are essential for making a diagnosis of hypogonadism in men. Objective To establish harmonized reference ranges for total testosterone in men that can be applied across laboratories by cross-calibrating assays to a reference method and standard. Population The 9054 community-dwelling men in cohort studies in the United States and Europe: Framingham Heart Study; European Male Aging Study; Osteoporotic Fractures in Men Study; and Male Sibling Study of Osteoporosis. Methods Testosterone concentrations in 100 participants in each of the four cohorts were measured using a reference method at Centers for Disease Control and Prevention (CDC). Generalized additive models and Bland-Altman analyses supported the use of normalizing equations for transformation between cohort-specific and CDC values. Normalizing equations, generated using Passing-Bablok regression, were used to generate harmonized values, which were used to derive standardized, age-specific reference ranges. Results Harmonization procedure reduced intercohort variation between testosterone measurements in men of similar ages. In healthy nonobese men, 19 to 39 years, harmonized 2.5th, 5th, 50th, 95th, and 97.5th percentile values were 264, 303, 531, 852, and 916 ng/dL, respectively. Age-specific harmonized testosterone concentrations in nonobese men were similar across cohorts and greater than in all men. Conclusion Harmonized normal range in a healthy nonobese population of European and American men, 19 to 39 years, is 264 to 916 ng/dL. A substantial proportion of intercohort variation in testosterone levels is due to assay differences. These data demonstrate the feasibility of generating harmonized reference ranges for testosterone that can be applied to assays, which have been calibrated to a reference method and calibrator.
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Affiliation(s)
| | - Hubert W. Vesper
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341
| | - Eric Orwoll
- Oregon Health and Science University, Portland, Oregon 97239
| | - Frederick Wu
- Andrology Research Unit, Centre for Endocrinology and Diabetes, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9WL, United Kingdom
| | | | - Ying Wang
- Oregon Health and Science University, Portland, Oregon 97239
| | | | - Tom Fiers
- Department of Clinical Chemistry, Ghent University Hospital, Ghent B-9000, Belgium
| | - Alvin M. Matsumoto
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98108
| | - Shalender Bhasin
- Research Program in Men’s Health, Aging, and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
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24
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Orwoll ES, Lapidus J, Wang PY, Vandenput L, Hoffman AR, Fink HA, Laughlin GA, Nethander M, Ljunggren Ö, Kindmark A, Lorentzon M, Karlsson M, Mellström D, Kwok A, Khosla S, Kwok T, Ohlsson C. The Limited Clinical Utility of Testosterone, Estradiol, and Sex Hormone Binding Globulin Measurements in the Prediction of Fracture Risk and Bone Loss in Older Men. J Bone Miner Res 2017; 32:633-640. [PMID: 27753150 PMCID: PMC5896330 DOI: 10.1002/jbmr.3021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/05/2016] [Accepted: 10/16/2016] [Indexed: 01/08/2023]
Abstract
Measurement of serum testosterone (T) levels is recommended in the evaluation of osteoporosis in older men and estradiol (E2) and sex hormone binding globulin (SHBG) levels are associated with the rate of bone loss and fractures, but the clinical utility of sex steroid and SHBG measurements for the evaluation of osteoporosis in men has not been examined. To evaluate whether measurements of T, E2, and/or SHBG are useful for the prediction of fracture risk or the rate of bone loss in older men, we analyzed longitudinal data from 5487 community-based men participating in the Osteoporotic Fractures in Men (MrOS) study in the United States, Sweden, and Hong Kong. Serum T, E2, and SHBG levels were assessed at baseline; incident fractures were self-reported at 4-month intervals with radiographic verification (US), or ascertained via national health records (Sweden, Hong Kong). Rate of bone loss was assessed by serial measures of hip bone mineral density (BMD). We used receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to assess improvement in prediction. Mean age at baseline was 72 to 75 years and the prevalence of low T levels (<300 ng/dL) was 7.6% to 21.3% in the three cohorts. There were 619 incident major osteoporotic and 266 hip fractures during follow-up of approximately 10 years. Based on ROC curves, there were no improvements in fracture risk discrimination for any biochemical measure when added to models, including the Fracture Risk Assessment Tool (FRAX) with BMD. Although minor improvements in NRI were observed for the dichotomous parameters low bioavailable E2 (BioE2) (<11.4 pg/mL) and high SHBG (>59.1 nM), neither sex steroids nor SHBG provided clinically useful improvement in fracture risk discrimination. Similarly, they did not contribute to the prediction of BMD change. In conclusion, there is limited clinical utility of serum E2, T, and SHBG measures for the evaluation of osteoporosis risk in elderly men. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Eric S. Orwoll
- Division of Endocrinology, Diabetes, and Clinical Nutrition – Bone and Mineral Unit, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR 113, Portland, OR, USA 97239
| | - Jodi Lapidus
- Dept of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, OR
| | - Patty Y. Wang
- Bone and Mineral Unit, Dept of Medicine, Oregon Health & Science University, Portland, OR
| | - Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Howard A. Fink
- Geriatric Research Education & Clinical Center, VA Medical Center, Minneapolis, MN
- Dept of Medicine, University of Minnesota, Minneapolis, MN
| | - Gail A. Laughlin
- Division of Epidemiology, Dept of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA
| | - Maria Nethander
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Östen Ljunggren
- Dept of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Andreas Kindmark
- Dept of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research and Dept of Geriatric Medicine, Inst of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Dept of Clinical Sciences, Lund University
- Dept of Orthopaedics, Malmö University Hospital, Malmö, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research and Dept of Geriatric Medicine, Inst of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anthony Kwok
- Department of Orthopaedics and Traumatology, and Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong
| | | | - Timothy Kwok
- Jockey Club Centre for Osteoporosis Care and Control, and Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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Zhang HY, Cui J, Zhang Y, Wang ZL, Chong T, Wang ZM. Isoflavones and Prostate Cancer: A Review of Some Critical Issues. Chin Med J (Engl) 2017; 129:341-7. [PMID: 26831238 PMCID: PMC4799580 DOI: 10.4103/0366-6999.174488] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: The purpose of this review is to discuss some critical issues of isoflavones protective against the development of prostate cancer (PCa). Data Sources: Data cited in this review were obtained primarily from PubMed and Embase from 1975 to 2015. Study Selection: Articles were selected with the search terms “isoflavone”, “Phytoestrogen”, “soy”, “genistin”, and “PCa”. Results: Isoflavones do not play an important role on prostate-specific antigen levels reduction in PCa patients or healthy men. The effect of isoflavones on sex hormone levels and PCa risk may be determined by equol converting bacteria in the intestine, specific polymorphic variation and concentrations of isoflavones. The intake of various types of phytoestrogens with lower concentrations in the daily diet may produce synergistic effects against PCa. Moreover, prostate tissue may concentrate isoflavones to potentially anti-carcinogenic levels. In addition, it is noteworthy that isoflavones may act as an agonist in PCa. Conclusions: Isoflavones play a protective role against the development of PCa. However, careful consideration should be given when isoflavones are used in the prevention and treatment of PCa.
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Affiliation(s)
| | | | | | | | | | - Zi-Ming Wang
- Department of Urology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
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26
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Keevil BG, Clifton S, Tanton C, Macdowall W, Copas AJ, Lee D, Field N, Mitchell KR, Sonnenberg P, Bancroft J, Mercer CH, Johnson AM, Wellings K, Wu FCW. Distribution of Salivary Testosterone in Men and Women in a British General Population-Based Sample: The Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). J Endocr Soc 2017; 1:14-25. [PMID: 29264442 PMCID: PMC5677216 DOI: 10.1210/js.2016-1029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction: Measurement of salivary testosterone (Sal-T) to assess androgen status offers important potential advantages in epidemiological research. The utility of the method depends on the interpretation of the results against robustly determined population distributions, which are currently lacking. Aim: To determine age-specific Sal-T population distributions for men and women. Methods: Morning saliva samples were obtained from participants in the third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey of the British general population. Sal-T was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Linear and quantile regression analyses were used to determine the age-specific 2.5th and 97.5th percentiles for the general population (1675 men and 2453 women) and the population with health exclusions (1145 men and 1276 women). Results: In the general population, the mean Sal-T level in men decreased from 322.6 pmol/L at 18 years of age to 153.9 pmol/L at 69 years of age. In women, the decrease in the geometric mean Sal-T level was from 39.8 pmol/L at 18 years of age to 19.5 pmol/L at 74 years of age. The annual decrease varied with age, with an average of 1.0% to 1.4% in men and 1.3% to 1.5% in women. For women, the 2.5th percentile fell below the detection limit (<6.5 pmol/L) from age 52 years onward. The mean Sal-T level was approximately 6 times greater in men than in women, and this remained constant over the age range. The Sal-T level was lowest for men and highest for women in the summer. The results were similar for the general population with exclusions. Conclusions: To our knowledge, this is the first study to describe the sex- and age-specific distributions for Sal-T in a large representative population using a specific and sensitive LC-MS/MS technique. The present data can inform future population research by facilitating the interpretation of Sal-T results as a marker of androgen status.
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Affiliation(s)
- Brian G Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester, Manchester Academic Health Science Centre
| | - Soazig Clifton
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - Wendy Macdowall
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Andrew J Copas
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - David Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, and
| | - Nigel Field
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - Kirstin R Mitchell
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.,Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow G4 0SF, United Kingdom; and
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - John Bancroft
- Kinsey Institute, Indiana University, Bloomington, Indiana 47405
| | - Cath H Mercer
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London WC1E 6BT, United Kingdom
| | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Frederick C W Wu
- Andrology Research Unit, Manchester Centre of Endocrinology and Diabetes, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, United Kingdom
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27
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Trost LW, Mulhall JP. Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials. J Sex Med 2016; 13:1029-46. [PMID: 27209182 PMCID: PMC5516925 DOI: 10.1016/j.jsxm.2016.04.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Male hypogonadism is a common condition, with an increasing body of literature on diagnosis, implications, and management. Given the significant variability in testosterone (T) from a physiologic and assay perspective, a thorough understanding of factors affecting T values and study methodology is essential to interpret reported study outcomes appropriately. However, despite the large number of publications on T, there are no reference materials consolidating all relevant and potentially confounding factors necessary to interpret T studies appropriately. AIMS To create a resource document that reviews sources of T variability, free vs total T, assay techniques and questionnaires, and study methodology relevant to interpreting outcomes. METHODS A PubMed search was performed of all the T literature published on T variability, assay techniques, and T-specific questionnaires. Results were summarized in the context of their impact on interpreting T literature outcomes and methodology. MAIN OUTCOME MEASURES Effect of various factors on T variability and their relevance to study methodology and outcomes. RESULTS Several factors affect measured T levels, including aging, circadian rhythms, geography, genetics, lifestyle choices, comorbid conditions, and intraindividual daily variability. The utility of free T over total T is debatable and must be compared using appropriate threshold levels. Among various assay techniques, mass spectrometry and equilibrium dialysis are gold standards. Calculated empirical estimates of free T also are commonly used and accepted. Hypogonadism-specific questionnaires have limited utility in screening for hypogonadism, and their role as objective end points for quantifying symptoms remains unclear. Numerous aspects of study methodology can directly or indirectly affect reported outcomes, including design (randomized, prospective, retrospective), duration, populations studied (age, comorbid conditions), low T threshold, therapeutic agent used, objective measurements and end points selected, and statistical interpretation. CONCLUSION Critical appraisal of the T literature requires an understanding of numerous factors resulting in T variability, study design and methodology, and limitations of assay techniques and objective measurement scales.
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Affiliation(s)
- Landon W Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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28
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Vandenput L, Mellström D, Kindmark A, Johansson H, Lorentzon M, Leung J, Redlund-Johnell I, Rosengren BE, Karlsson MK, Wang YX, Kwok T, Ohlsson C. High Serum SHBG Predicts Incident Vertebral Fractures in Elderly Men. J Bone Miner Res 2016; 31:683-9. [PMID: 26391196 PMCID: PMC4832265 DOI: 10.1002/jbmr.2718] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 12/11/2022]
Abstract
Previous prospective cohort studies have shown that serum levels of sex steroids and sex hormone-binding globulin (SHBG) associate with nonvertebral fracture risk in men. The predictive value of sex hormones and SHBG for vertebral fracture risk specifically is, however, less studied. Elderly men (aged ≥ 65 years) from Sweden and Hong Kong participating in the Osteoporotic Fractures in Men (MrOS) study had baseline estradiol and testosterone analyzed by gas chromatography-mass spectrometry (GC-MS) and SHBG by immunoradiometric assay (IRMA). Incident clinical vertebral fractures (n = 242 cases) were evaluated in 4324 men during an average follow-up of 9.1 years. In a subsample of these men (n = 2256), spine X-rays were obtained at baseline and after an average follow-up of 4.3 years to identify incident radiographic vertebral fractures (n = 157 cases). The likelihood of incident clinical and radiographic vertebral fractures was estimated by Cox proportional hazards models and logistic regression models, respectively. Neither serum estradiol (hazard ratio [HR] per SD increase = 0.93, 95% confidence interval [CI] 0.80-1.08) nor testosterone (1.05, 0.91-1.21) predicted incident clinical vertebral fractures in age-adjusted models in the combined data set. High serum SHBG, however, associated with increased clinical vertebral fracture risk (1.24, 1.12-1.37). This association remained significant after further adjustment for FRAX with or without bone mineral density (BMD). SHBG also associated with increased incident radiographic vertebral fracture risk (combined data set; odds ratio [OR] per SD increase = 1.23, 95% CI 1.05-1.44). This association remained significant after adjustment for FRAX with or without BMD. In conclusion, high SHBG predicts incident clinical and radiographic vertebral fractures in elderly men and adds moderate information beyond FRAX with BMD for vertebral fracture risk prediction.
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Affiliation(s)
- Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Kindmark
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Helena Johansson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Inga Redlund-Johnell
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Yi-Xiang Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Timothy Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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29
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Cawthon PM, Shahnazari M, Orwoll ES, Lane NE. Osteoporosis in men: findings from the Osteoporotic Fractures in Men Study (MrOS). Ther Adv Musculoskelet Dis 2016; 8:15-27. [PMID: 26834847 DOI: 10.1177/1759720x15621227] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The lifespan of men is increasing and this is associated with an increased prevalence of osteoporosis in men. Osteoporosis increases the risk of bone fracture. Fractures are associated with increased disability and mortality, and public health problems. We review here the study of osteoporosis in men as obtained from a longitudinal cohort of community-based older men, the Osteoporotic Fractures in Men Study (MrOS).
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Affiliation(s)
| | - Mohammad Shahnazari
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy E Lane
- UC Davis Health System, 4625 2nd Avenue, Suite 2006, Sacramento, CA 95817, USA
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Xu X, Chen X, Hu H, Dailey AB, Odedina FT. WITHDRAWN: Current opinion in the role of testosterone in the development of prostate cancer: A dynamic model. Med Hypotheses 2016. [DOI: 10.1016/j.mehy.2015.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Handelsman DJ, Yeap B, Flicker L, Martin S, Wittert GA, Ly LP. Age-specific population centiles for androgen status in men. Eur J Endocrinol 2015; 173:809-17. [PMID: 26385186 DOI: 10.1530/eje-15-0380] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/18/2015] [Indexed: 01/14/2023]
Abstract
AIM The age-specific population profiles in men of circulating testosterone and its two bioactive metabolites dihydrotestosterone (DHT) and estradiol (E2) across the adult lifespan and its determinants are not well described. OBJECTIVE Our objective was to deduce smoothed age-specific centiles of circulating testosterone, DHT, and E2 in men using pooled data from population-based studies in three Australian cities from liquid chromatography-mass spectrometry steroid measurements in a single laboratory. DESIGN, SETTING, AND PARTICIPANTS We pooled data of 10 904 serum samples (serum testosterone, DHT, E2, age, height, and weight) from observational population-based studies in three major cities across Australia. MAIN OUTCOME MEASURES Age-specific smoothed centiles for serum testosterone, DHT, and E2 in men aged 35-100 years were deduced by large sample data analysis methods. RESULTS We found that serum testosterone, DHT, and E2 decline gradually from ages 35 onwards with a more marked decline after 80 years of age. Higher weight, BMI, and body surface area as well as shorter stature are associated with reduced serum testosterone, DHT, and E2. CONCLUSIONS Among Australian men, there is a gradual progressive population-wide decline in androgen status during male aging until the age of 80 years after which there is a more marked decline. Obesity and short stature are associated with reduced androgen status. Research into the age-related decline in androgen status should focus on the progressive accumulation of age-related comorbidities to better inform optimal clinical trial design.
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Affiliation(s)
| | - B Yeap
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
| | - L Flicker
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
| | - S Martin
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
| | - G A Wittert
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
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Vesper HW, Wang Y, Vidal M, Botelho JC, Caudill SP. Serum Total Testosterone Concentrations in the US Household Population from the NHANES 2011-2012 Study Population. Clin Chem 2015; 61:1495-504. [PMID: 26510959 DOI: 10.1373/clinchem.2015.245969] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Limited information is available about testosterone concentrations representative of the general US population, especially children, women, and non-Hispanic Asians. METHODS We obtained nationally representative data for total testosterone (totalT), measured with standardized LC-MS/MS, for the US population age 6 years and older from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). We analyzed 6746 serum samples and calculated the geometric means, distribution percentiles, and covariate-adjusted geometric means by age, sex, and race/ethnicity. RESULTS The 10th-90th percentiles of totalT values in adults (≥20 years) was 150-698 ng/dL (5.20-24.2 nmol/L) in men, 7.1-49.8 ng/dL (0.25-1.73 nmol/L) in women, and 1.0-9.5 ng/dL (0.04-0.33 nmol/L) in children (6-10 years old). Differences among race/ethnic groups existed in children and men: covariate-adjusted totalT values in non-Hispanic Asians were highest among children (58% compared to non-Hispanic black children) and lowest among men (12% compared to Mexican-American men). Covariate-adjusted totalT values in men were higher at age 55-60 years compared to ages 35 and 80 years, a pattern different from that observed in previous NHANES cycles. CONCLUSIONS TotalT patterns were different among age groups in men compared with previous NHANES cycles. Covariate-adjusted totalT values peaked at age 55-60 years in men, which appeared to be consistent with the increased use of exogenous testosterone. Differences among race/ethnic groups existed and appeared more pronounced in children than adults.
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Affiliation(s)
| | - Yuesong Wang
- Division of Laboratory Sciences, CDC, Atlanta, GA
| | - Meghan Vidal
- Division of Laboratory Sciences, CDC, Atlanta, GA
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Xu X, Chen X, Hu H, Dailey AB, Taylor BD. Current opinion on the role of testosterone in the development of prostate cancer: a dynamic model. BMC Cancer 2015; 15:806. [PMID: 26502956 PMCID: PMC4623905 DOI: 10.1186/s12885-015-1833-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 10/19/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Since the landmark study conducted by Huggins and Hodges in 1941, a failure to distinguish between the role of testosterone in prostate cancer development and progression has led to the prevailing opinion that high levels of testosterone increase the risk of prostate cancer. To date, this claim remains unproven. PRESENTATION OF THE HYPOTHESIS We present a novel dynamic mode of the relationship between testosterone and prostate cancer by hypothesizing that the magnitude of age-related declines in testosterone, rather than a static level of testosterone measured at a single point, may trigger and promote the development of prostate cancer. TESTING THE HYPOTHESIS Although not easily testable currently, prospective cohort studies with population-representative samples and repeated measurements of testosterone or retrospective cohorts with stored blood samples from different ages are warranted in future to test the hypothesis. IMPLICATIONS OF THE HYPOTHESIS Our dynamic model can satisfactorily explain the observed age patterns of prostate cancer incidence, the apparent conflicts in epidemiological findings on testosterone and risk of prostate cancer, racial disparities in prostate cancer incidence, risk factors associated with prostate cancer, and the role of testosterone in prostate cancer progression. Our dynamic model may also have implications for testosterone replacement therapy.
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Affiliation(s)
- Xiaohui Xu
- Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M Health Science Center, 205A SRPH Administration Building | MS 1266, 212 Adriance Lab Road, College Station, TX, 77843-1266, USA.
| | - Xinguang Chen
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Amy B Dailey
- Health Sciences Department, Gettysburg College, Gettysburg, PA, USA.
| | - Brandie D Taylor
- Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M Health Science Center, 205A SRPH Administration Building | MS 1266, 212 Adriance Lab Road, College Station, TX, 77843-1266, USA.
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Handelsman DJ, Sikaris K, Ly LP. Estimating age-specific trends in circulating testosterone and sex hormone-binding globulin in males and females across the lifespan. Ann Clin Biochem 2015; 53:377-84. [PMID: 26438522 DOI: 10.1177/0004563215610589] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Age-specific trends of serum testosterone and sex hormone-binding globulin across the full lifespan have not been reported. METHODS We deduced age-specific trends in serum testosterone and sex hormone-binding globulin in males and females between ages 10 and 90 from a large sample of consecutive results from a single large pathology laboratory. Coded results of 110,712 consecutive blood samples requesting serum testosterone over seven years (2007-2013) comprising blood testosterone, sex hormone-binding globulin and calculated free testosterone together with gender and age were analysed create smoothed age-specific centiles (2.5%, 5%, 25%, 50%, 75%, 95%, 97.5%) for males and females. RESULTS These identified the pubertal increases in serum testosterone in males peaking at 20 years of age and remaining stable thereafter until the eighth decade. In females, circulating testosterone peaked in late adolescence and declined gradually over the next two decades but remained stable across menopause and beyond. After early childhood, serum sex hormone-binding globulin declines to a nadir in males at the age of 20 years and remains stable till the sixth decade with a gradual, progressive rise thereafter. In females, the sex hormone-binding globulin nadir is reached earlier with levels rising gradually and progressively with age thereafter and accelerating after the age of 70 years. Females also exhibit a second sex hormone-binding globulin peak during reproductive ages reflected only in upper centiles due to effects of pregnancy and oral contraceptive use in a significant minority of females. CONCLUSIONS This large sample of clinical data provides a comprehensive profile of androgen status across the lifespan from early adolescence to late old age.
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Affiliation(s)
- David J Handelsman
- Andrology Department, Concord Hospital, NSW, Australia ANZAC Research Institute, University of Sydney, Concord Hospital, NSW, Australia
| | - Ken Sikaris
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - Lam P Ly
- Andrology Department, Concord Hospital, NSW, Australia
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Kim C, Cushman M, Kleindorfer D, Lisabeth L, Redberg RF, Safford MM. A review of the relationships between endogenous sex steroids and incident ischemic stroke and coronary heart disease events. Curr Cardiol Rev 2015; 11:252-60. [PMID: 25563292 PMCID: PMC4558357 DOI: 10.2174/1573403x1103150515110749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/22/2014] [Accepted: 12/25/2014] [Indexed: 12/22/2022] Open
Abstract
For decades, it has been recognized that men have a higher age-adjusted risk of ischemic cardiovascular (CVD) events compared to women, thus generating hypotheses that sex steroids contribute to CVD risk. Potential mechanisms include genomic and non-genomic effects of sex steroids as well as mediation through classic CVD risk factors and obesity. However, results from randomized studies suggest that sex steroid supplementation in men and women do not result in improved CVD outcomes and may increase CVD risk. In contrast, prospective observations from endogenous sex steroid studies, i.e. among participants not using sex steroids, have suggested the opposite relationship. We reviewed the findings of prospective observational studies in men (17 studies) and women (8 studies) that examined endogenous sex steroids and CVD risk. These studies suggested a lack of association or that lower levels of testosterone or dihydrotestosterone are associated with higher CVD risk in both men and women. Higher, rather than lower, estradiol levels were associated with higher CVD risk in women. There were several significant gaps in the literature. First, it is unclear whether more sensitive measures of sex steroid levels might detect significant differences. Second, there are few prospective studies in women. Similarly, no studies report outcomes for high-risk groups such as African-Americans and Hispanics. Finally, few studies report upon ischemic coronary disease as opposed to ischemic stroke separately, although relationships between sex steroids and CVD may vary by vascular bed. Future investigations need to examine high risk groups and to distinguish between subtypes of CVD.
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Affiliation(s)
- Catherine Kim
- 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, USA.
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Wang Q, Rangiah K, Mesaros C, Snyder NW, Vachani A, Song H, Blair IA. Ultrasensitive quantification of serum estrogens in postmenopausal women and older men by liquid chromatography-tandem mass spectrometry. Steroids 2015; 96:140-52. [PMID: 25637677 PMCID: PMC4369926 DOI: 10.1016/j.steroids.2015.01.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/21/2022]
Abstract
An ultrasensitive stable isotope dilution liquid chromatography-tandem mass spectrometry method (LC-MS/MS) was developed and validated for multiplexed quantitative analysis of six unconjugated and conjugated estrogens in human serum. The quantification utilized a new derivatization procedure, which formed analytes as pre-ionized N-methyl pyridinium-3-sulfonyl (NMPS) derivatives. This method required only 0.1mL of human serum, yet was capable of simultaneously quantifying six estrogens within 20min. The lower limit of quantitation (LLOQ) for estradiol (E2), 16α-hydroxy (OH)-E2, 4-methoxy (MeO)-E2 and 2-MeO-E2 was 1fg on column, and was 10fg on column for 4-OH-E2 and 2-OH-E2. All analytes demonstrated a linear response from 0.5 to 200pg/mL (5-2000pg/mL for 4-OH-E2 and 2-OH-E2). Using this validated method, the estrogen levels in human serum samples from 20 female patients and 20 male patients were analyzed and compared. The levels found for unconjugated serum E2 from postmenopausal women (mean 2.7pg/mL) were very similar to those obtained by highly sensitive gas chromatography-mass spectrometry (GC-MS) methodology. However, the level obtained in serum from older men (mean 9.5pg/mL) was lower than has been reported previously by both GC-MS and LC-MS procedures. The total (unconjugated+conjugated) 4-MeO-E2 levels were significantly higher in female samples compared with males (p<0.05). The enhanced sensitivity offered by the present method will allow for a more specific analysis of estrogens and their metabolites. Our observations might suggest that the level of total 4-MeO-E2 could be a potential biomarker for breast cancer cases.
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Affiliation(s)
- Qingqing Wang
- Center of Excellence in Environmental Toxicology and Penn SRP Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Kannan Rangiah
- Center of Excellence in Environmental Toxicology and Penn SRP Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; NCBS, Center for Cellular and Molecular Platforms, Bangalore, India
| | - Clementina Mesaros
- Center of Excellence in Environmental Toxicology and Penn SRP Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Nathaniel W Snyder
- Center of Excellence in Environmental Toxicology and Penn SRP Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Anil Vachani
- Center of Excellence in Environmental Toxicology and Penn SRP Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
| | - Haifeng Song
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Ian A Blair
- Center of Excellence in Environmental Toxicology and Penn SRP Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
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Fui MNT, Dupuis P, Grossmann M. Lowered testosterone in male obesity: mechanisms, morbidity and management. Asian J Androl 2014; 16:223-31. [PMID: 24407187 PMCID: PMC3955331 DOI: 10.4103/1008-682x.122365] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With increasing modernization and urbanization of Asia, much of the future focus of the obesity epidemic will be in the Asian region. Low testosterone levels are frequently encountered in obese men who do not otherwise have a recognizable hypothalamic-pituitary-testicular (HPT) axis pathology. Moderate obesity predominantly decreases total testosterone due to insulin resistance-associated reductions in sex hormone binding globulin. More severe obesity is additionally associated with reductions in free testosterone levels due to suppression of the HPT axis. Low testosterone by itself leads to increasing adiposity, creating a self-perpetuating cycle of metabolic complications. Obesity-associated hypotestosteronemia is a functional, non-permanent state, which can be reversible, but this requires substantial weight loss. While testosterone treatment can lead to moderate reductions in fat mass, obesity by itself, in the absence of symptomatic androgen deficiency, is not an established indication for testosterone therapy. Testosterone therapy may lead to a worsening of untreated sleep apnea and compromise fertility. Whether testosterone therapy augments diet- and exercise-induced weight loss requires evaluation in adequately designed randomized controlled clinical trials.
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Affiliation(s)
| | | | - Mathis Grossmann
- Department of Medicine Austin Health, University of Melbourne, Melbourne; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
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Cheung KKT, Luk AOY, So WY, Ma RCW, Kong APS, Chow FCC, Chan JCN. Testosterone level in men with type 2 diabetes mellitus and related metabolic effects: A review of current evidence. J Diabetes Investig 2014; 6:112-23. [PMID: 25802717 PMCID: PMC4364844 DOI: 10.1111/jdi.12288] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 12/20/2022] Open
Abstract
A significant proportion of patients with type 2 diabetes mellitus have a low testosterone level relative to reference ranges based on healthy young men. Only a small number of these patients suffer from classical hypogonadism as a result of recognizable hypothalamic-pituitary-gonadal axis pathology. The cut-off value of the serum testosterone level in men without obvious hypothalamic-pituitary-gonadal axis pathology is controversial. It is unclear to what extent a low serum testosterone level causally leads to type 2 diabetes and/or the metabolic syndrome. From a theoretical standpoint, there can be complex interactions among the hypothalamic-pituitary-gonadal axis, body composition and insulin resistance, which can be further influenced by intrinsic and extrinsic factors to give rise to metabolic syndrome, glucose intolerance, and low-grade inflammation to increase the risk of cardiovascular disease. Although a low serum testosterone level frequently coexists with cardiometabolic risk factors and might serve as a biomarker, more studies are required to clarify the causal, mediating or modifying roles of low serum testosterone level in the development of adverse clinical outcomes. Currently, there are insufficient randomized clinical trial data to evaluate the effects of testosterone replacement therapy on meaningful clinical outcomes. The risk-to-benefit ratio of testosterone therapy in high-risk subjects, such as those with type 2 diabetes, also requires elucidation. The present article aims to review the current evidence on low serum testosterone levels in patients with type 2 diabetes, and its implications on cardiovascular risk factors, metabolic syndrome and adverse clinical outcomes.
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Affiliation(s)
- Kitty Kit Ting Cheung
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Andrea On Yan Luk
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Wing Yee So
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Francis Chun Chung Chow
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital New Territories, Hong Kong SAR, China
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Tivesten Å, Vandenput L, Carlzon D, Nilsson M, Karlsson MK, Ljunggren Ö, Barrett-Connor E, Mellström D, Ohlsson C. Dehydroepiandrosterone and its Sulfate Predict the 5-Year Risk of Coronary Heart Disease Events in Elderly Men. J Am Coll Cardiol 2014; 64:1801-10. [DOI: 10.1016/j.jacc.2014.05.076] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
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Hu H, Odedina FT, Reams RR, Lissaker CTK, Xu X. Racial Differences in Age-Related Variations of Testosterone Levels Among US Males: Potential Implications for Prostate Cancer and Personalized Medication. J Racial Ethn Health Disparities 2014; 2:69-76. [PMID: 26863244 DOI: 10.1007/s40615-014-0049-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/07/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
AIM The magnitude of the age-related declines in testosterone rather than levels measured at single point in time may be related to the genesis of prostate cancer (PCa). We examined age-related variations of testosterone levels among black and white males, which may provide important insights into racial disparities in PCa incidence and mortality. METHOD We analyzed data from the 1999-2004 National Health and Nutritional Examination Survey to compare age-related variations in the testosterone levels of 355 black and 631 white males. RESULT Overall, between the ages of 12 and 15, black males had lower testosterone levels than white males. Testosterone levels increased rapidly with age and reached higher and earlier peak levels in black males compared to white males at 20-30 years of age. After reaching a peak level, testosterone levels declined earlier in blacks than in whites. Further analyses showed that black males had considerably higher levels of testosterone compared to white males aged 20-39 years after adjusting for covariates, including age, body mass index, cigarette smoking, physical activity, and waist circumference; however, no statistically significant differences were observed between the groups at any other age. CONCLUSION Our study revealed that testosterone levels in black males decrease substantially with increasing age compared to those in white males. This rapid drop in testosterone levels may contribute to racial disparities in PCa. Our findings also suggest that personalized medication for hormone replacement therapy may be necessary to avoid sudden drops in testosterone levels, particularly for black males.
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Affiliation(s)
- Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Folakemi T Odedina
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Romonia R Reams
- Division of Basic Pharmaceutical Sciences, College of Pharmacy & Pharmaceutical Sciences, Florida A& M University, Tallahassee, FL, USA
| | - Claudia T K Lissaker
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Xiaohui Xu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
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Systematic Literature Review of the Epidemiology of Nongenetic Forms of Hypogonadism in Adult Males. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/190347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study summarizes the literature on the prevalence, incidence, and proportion of patients receiving treatment for male hypogonadism and a systematic literature search was performed for articles published in the last 20 years. Of the 97 studies identified, 96 examined the prevalence, 2 examined the incidence, and 4 examined the proportion of males with hypogonadism patients receiving treatment. Based on studies conducted in Europe and USA, the prevalence of hypogonadism in the general population ranged from 2.1% to 12.8% of middle-aged to older men, with an estimated incidence of 12 new cases per 1,000 person-years. Prevalence was higher among patients with comorbid conditions, such as type 2 diabetes mellitus and obesity. Approximately 10–12% of men with hypogonadism were receiving testosterone treatment. This literature review suggests that there is potentially a significant burden of hypogonadism in the general population. Burden seems to increase with age and in the presence of certain disease conditions. Data suggests that many hypogonadal men who may benefit from testosterone replacement are not receiving treatment. This may be the result of underdiagnosis of the disease, lack of awareness by patients or physicians, irregularities surrounding the diagnostic criteria, and deficiency of long-term safety studies.
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Cauley JA, Chalhoub D, Kassem AM, Fuleihan GEH. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 2014; 10:338-51. [PMID: 24751883 DOI: 10.1038/nrendo.2014.51] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Osteoporotic fractures are a major worldwide epidemic. Here, we review global variability, ethnic differences and secular changes in osteoporotic fractures. Worldwide, age-standardized incidence rates of hip fracture vary >200-fold in women and >140-fold in men when comparing the country in which incidence rates are the highest with that in which they are the lowest. Median age-standardized rates are highest in North America and Europe, followed by Asia, Middle East, Oceania, Latin America and Africa. Globally, rates of hip fracture are greater in women than in men, with an average ratio of ∼2:1. The incidence of radiographic vertebral fractures is much higher than that of hip fractures, whereas the incidence rates of clinical vertebral fractures mirror hip fracture rates in most countries. Methodological challenges of defining and ascertaining vertebral fractures limit the interpretation of these data. Secular declines in hip fracture rates have been reported in populations from North America, Europe and Oceania. These declines are especially notable in women, suggesting that reproductive factors might contribute to this reduction. By contrast, hip fracture rates are increasing in parts of Asia and Latin America. Global indicators of health, education and socioeconomic status are positively correlated with fracture rates suggesting that lifestyles in developed countries might contribute to hip fracture. Improvements in fracture assessment, in particular for nonhip fractures, and identification of factors that contribute to this variability might substantially influence our understanding of osteoporotic fracture aetiology and provide new avenues for prevention.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree A510, Pittsburgh, PA 15261, USA
| | - Didier Chalhoub
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree A510, Pittsburgh, PA 15261, USA
| | - Ahmed M Kassem
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree A510, Pittsburgh, PA 15261, USA
| | - Ghada El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, WHO Collaborating Centre for Metabolic Bone Disorders, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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Ritchey J, Zhang H, Karmaus W, Steck SE, Sabo-Attwood T. "Linearity assessment methods for sex steroid hormones and carrier proteins among men in the National Health and Nutrition Examination Survey (NHANES III)". Steroids 2014; 82:23-8. [PMID: 24412759 DOI: 10.1016/j.steroids.2013.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/12/2013] [Accepted: 12/30/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION It has been hypothesized that racial disparities among several diseases are explained by differences in testosterone (T), 17-β estradiol (E), sex hormone binding globulin (SHBG) and albumin (A) levels, yet epidemiologic results have been mixed. Statistical advice regarding appropriate adjustment methods for carrier proteins of sex steroid hormones in the literature is scant. Therefore, we investigated different adjustment methods for carrier proteins. METHODS Data for 1496 men, >17 years from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-91 were used to analyze linearity between sex hormones and carrier proteins by examining correlation, plots, and regression models. The statistical importance of age, body mass index (BMI), and race/ethnicity were examined for changes in results by the adjustment method. RESULTS T was weakly correlated with SHBG and A (r-squared, 0.25, 0.13, respectively) and E was weakly negatively correlated with A (p<0.0001), but not SHBG (p<0.1799). Based on the model residual plots and r-squared, the categorical model performed better than linear models. Regression coefficients for age, BMI, and race/ethnicity groups using quotient (e.g., T/A and E/A) models differed from continuous and categorical models. CONCLUSION Choosing an appropriate adjustment for carrier proteins is important to prevent bias in analyses and inconsistency in findings across studies. Linearity between variables should not be assumed when adjusting models, and should be conducted and reported. An independent categorical carrier protein variable is recommended in analysis exploring factors predicting sex hormone levels, although statistical testing should always be employed.
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Affiliation(s)
- Jamie Ritchey
- University of South Carolina, Department of Epidemiology and Biostatistics, 800 Sumter Street, Columbia, SC 29208, United States; Inter Tribal Council of Arizona, Tribal Epidemiology Center, 2214 N Central Ave., Phoenix, AZ 85004, United States.
| | - Hongmei Zhang
- University of South Carolina, Department of Epidemiology and Biostatistics, 800 Sumter Street, Columbia, SC 29208, United States
| | - Wilfried Karmaus
- University of South Carolina, Department of Epidemiology and Biostatistics, 800 Sumter Street, Columbia, SC 29208, United States; University of Memphis, School of Public Health, Division of Epidemiology, Biostatistics, and Environmental Health, 301 Robinson Hall, Memphis, TN 38152, United States
| | - Susan E Steck
- University of South Carolina, Department of Epidemiology and Biostatistics, 800 Sumter Street, Columbia, SC 29208, United States
| | - Tara Sabo-Attwood
- University of Florida, Department of Environmental and Global Health, PO Box 100188, HPNP Building, Room 2150, Gainesville, FL 32610, United States
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Tan RB, Guay AT, Hellstrom WJ. Clinical Use of Aromatase Inhibitors in Adult Males. Sex Med Rev 2014; 2:79-90. [DOI: 10.1002/smrj.23] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Richard A, Rohrmann S, Zhang L, Eichholzer M, Basaria S, Selvin E, Dobs AS, Kanarek N, Menke A, Nelson WG, Platz EA. Racial variation in sex steroid hormone concentration in black and white men: a meta-analysis. Andrology 2014; 2:428-35. [PMID: 24648111 DOI: 10.1111/j.2047-2927.2014.00206.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/28/2014] [Accepted: 02/16/2014] [Indexed: 11/29/2022]
Abstract
Sex steroid hormones are associated with chronic diseases and mortality with risk associations that differ between racial and ethnic groups. However, it is currently unclear whether sex steroid hormone levels differ between black and white men. The aim of this study was to assess racial variation in circulating testosterone, free testosterone, sex hormone-binding globulin (SHBG) and estradiol levels in men. We searched PubMed for articles comparing circulating hormones in black and white men. A meta-analysis was performed using weighted mean differences (WMD) to compare hormones levels between black and white men. Fifteen eligible studies were identified; three did not report adjusted means. After age adjustment, free testosterone levels were significantly higher in black than in white men (WMD = 4.07 pg/mL, 95% CI 1.26, 6.88). Depending on the free testosterone concentration in white men, this WMD translates into a racial difference ranging from 2.5 to 4.9%. Total testosterone (WMD = 0.10 ng/mL, 95% CI -0.02, 0.22), estradiol (WMD = 0.67 pg/mL, 95% CI -0.04, 1.38) and SHBG (WMD = -0.45 nmol/L, 95% CI -1.75, 0.85) concentrations did not differ comparing blacks with whites. After adjustment for age, black men have a modestly but significantly 2.5 to 4.9% higher free testosterone level than white men. Based on previous studies on effects of sex steroid hormones on risk of chronic diseases or mortality, this modest difference is unlikely to explain racial differences in disease risk.
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Affiliation(s)
- A Richard
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
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Travison TG, Zhuang WV, Lunetta KL, Karasik D, Bhasin S, Kiel DP, Coviello AD, Murabito JM. The heritability of circulating testosterone, oestradiol, oestrone and sex hormone binding globulin concentrations in men: the Framingham Heart Study. Clin Endocrinol (Oxf) 2014; 80:277-82. [PMID: 23746309 PMCID: PMC3825765 DOI: 10.1111/cen.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 01/29/2013] [Accepted: 06/02/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Circulating testosterone, oestradiol and oestrone concentrations vary considerably between men. Although a substantial proportion of this variation may be attributed to morbidity and behavioural factors, these cannot account for its entirety, suggesting genetic inheritance as a potential additional determinant. The analysis described here was intended to estimate the heritability of male circulating total testosterone (TT), calculated free testosterone (cFT), oestrone (E1), oestradiol (E2) and sex hormone binding globulin (SHBG), along with the genetic correlation between these factors. DESIGN Cross-sectional, observational analysis of data from male members of the Offspring and Generation 3 cohorts of the Framingham Heart Study. Data were collected in the years 1998-2005. PARTICIPANTS A total of 3367 community-dwelling men contributed to the analysis, including 1066 father/son and 1284 brother pairs among other family relationships. MEASUREMENTS Levels of serum sex steroids (TT, E1 and E2) were measured by liquid chromatography-tandem mass spectrometry, SHBG by immunofluorometric assay and cFT by mass action equation. Heritability was obtained using variance components analysis with adjustment for covariates including age, diabetes mellitus, body mass index and smoking status. RESULTS Age-adjusted heritability estimates were 0·19, 0·40, 0·40, 0·30 and 0·41 for cFT, TT, E1, E2 and SHBG, respectively. Adjustment for covariates did not substantially attenuate these estimates; SHBG-adjusted TT results were similar to those obtained for cFT. Genetic correlation coefficients (ρG ) indicated substantial genetic association between TT and cFT (ρG = 0·68), between TT and SHBG (pG = 0·87), between E1 and E2 (ρG = 0·46) and between TT and E2 (ρG = 0·48). CONCLUSION Circulating testosterone, oestradiol and oestrone concentrations exhibit substantial heritability in adult men. Significant genetic association between testosterone and oestrogen levels suggests shared genetic pathways.
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Affiliation(s)
- T G Travison
- Research Program on Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA
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Vandenput L, Ohlsson C. Genome-wide association studies on serum sex steroid levels. Mol Cell Endocrinol 2014; 382:758-766. [PMID: 23541950 DOI: 10.1016/j.mce.2013.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 11/21/2022]
Abstract
Even though the levels of circulating sex steroid hormones are to a large extent heritable, their genetic determinants are largely unknown. With the advent of genome-wide association studies (GWAS), much progress has been made and several genetic loci have been identified to be associated with serum levels of dehydroepiandrosterone sulfate, testosterone and sex hormone-binding globulin. The variants identified so far only explain a small amount of the overall heritability, but may help to elucidate the role of sex steroid hormones in common disorders such as hypogonadism, type 2 diabetes and hormone-sensitive cancers. This review provides an overview of the current state of knowledge of the genetic determinants of sex steroid hormones, with a focus on recent GWAS and brief directions for elucidating the remaining heritability.
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Affiliation(s)
- Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Veldhuis JD, Bondar OP, Dyer RB, Trushin SA, Klee EW, Singh RJ, Klee GG. Immunological and mass spectrometric assays of SHBG: consistent and inconsistent metabolic associations in healthy men. J Clin Endocrinol Metab 2014; 99:184-93. [PMID: 24203061 PMCID: PMC3879680 DOI: 10.1210/jc.2013-2642] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT SHBG concentrations correlate inconsistently with metabolic parameters. HYPOTHESIS SHBG assay platforms contribute to nonuniformities according to the literature. DESIGN The design of the study was a noninterventional quantification of SHBG by two immuno- and two mass spectrometric assays and abdominal visceral fat by computed tomography scan. SETTING The study was conducted at the Center for Translational Science Activities. PARTICIPANTS Healthy men (n=120) aged 18-80 years with a body mass index of 20-43 kg/m2 participated I the study. OUTCOMES Outcomes of the study included a correlation of log SHBG with age, metabolic surrogates [body mass index, albumin, glucose, insulin, abdominal (total and visceral) fat, homeostasis model assessment insulin resistance index], sex steroids (estrone, 17β-estradiol, T, and dihydrotestosterone by mass spectrometry), and adipocytokines (IL-1β, IL-6, IL-8, IL-10 and IL-12, TNF-α, and adiponectin). RESULTS By univariate regression, age (P<10(-4)), dihydrotestosterone (P<10(-4)), T (P≤.00022), and adiponectin (P≤.0084) were positive correlates, and insulin and homeostasis model assessment insulin resistance index were negative correlates (P≤.0060) of SHBG in all four assays. Stepwise multivariate analysis unveiled that age and T together could explain 38.1%-52.5% of the statistical variance in SHBG in all assays (P<10(-11)). Multivariate regression without sex steroids unveiled that age (P<10(-5)) and insulin (P<10(-3)) are jointly associated with SHBG levels in the four assays with overall R2=0.215-0.293 and P<10(-6). In one immunological SHBG assay each, abdominal visceral fat and adiponectin were weak multivariates also. CONCLUSION Immunological and mass spectrometric SHBG assays yield both consistent and inconsistent correlations with key metabolic variables in healthy men, thereby potentially explaining earlier inconsistencies in the literature.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit (J.D.V.), Mayo School of Graduate Medical Education Center for Translational Science Activities, Immunochemical Laboratory (R.B.D.), and Departments of Neurology (S.A.T.) and Laboratory Medicine and Pathology (J.D.V., O.P.B., E.W.K., R.J.S., G.G.K.), Mayo Clinic, Rochester, Minnesota 55905
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Hwang HJ, Kim YS, Sunwoo S, Yu BY, Bae WK, Park JS, Park YJ, Park YK, Yang YJ, Kim CM, Hong JH. Prevalence and Correlates of Late-Onset Hypogonadism Among Korean Men Aged 40 Years or Older in Primary Care. JOURNAL OF MENS HEALTH 2013. [DOI: 10.1089/jomh.2013.1505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Xu L, Au Yeung SL, Kavikondala S, Leung GM, Schooling CM. Testosterone concentrations in young healthy US versus Chinese men. Am J Hum Biol 2013; 26:99-102. [PMID: 24254402 DOI: 10.1002/ajhb.22482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/24/2013] [Accepted: 10/26/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Previous small studies examining differences in testosterone concentrations by ethnicity found mixed results for Caucasians and Chinese men, which might be confounded by age differences and living standards. The aim of the present study is to examine the differences in total, free, and bioavailable testosterone concentrations between healthy young men from the United States (US) and from the most economically developed part of China, i.e., Hong Kong (HK). METHODS Cross-sectional analysis based on 365 young men from the Third National Health and Nutrition examination Survey (NHANES III) in the US and 299 Chinese men recruited from university students. All participants were aged from 18 to 29 years. Main outcome measures were total testosterone (TT) and calculated bioavailable testosterone (Bio T) and free testosterone (FT). RESULTS In both US and Chinese men, TT, FT, and Bio T concentration peaked at 20-24 years of age, at 23.19, 0.49, and 12.23 nmol/l in US men, and 20.72, 0.48 and 12.59 nmol/l in Chinese men, respectively. Among those aged 18-24 years, after adjusting for age, US men had higher TT (mean, 95% confidence interval: 21.64, 21.31-21.99 versus 20.20, 20.12-20.28 nmol/l), but not FT (0.47, 0.47-0.48 versus 0.47, 0.47-0.47 nmol/l) or Bio T (11.90, 11.83-11.97 versus 12.39, 12.35-12.42 nmol/l) than Chinese men. CONCLUSIONS TT, but not FT or Bio T concentrations are lower in young healthy Chinese men than US men. These differences apparent in young men may be important in understanding different patterns of diseases between Western and Asian populations.
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Affiliation(s)
- L Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
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