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Kalra S, Jacob J, Unnikrishnan AG, Bantwal G, Sahoo A, Sahay R, Jindal S, Agrawal MS, Kapoor N, Saboo B, Tiwaskar M, Kochhar K. Expert Opinion on the Diagnosis and Management of Male Hypogonadism in India. Int J Endocrinol 2023; 2023:4408697. [PMID: 36876281 PMCID: PMC9977550 DOI: 10.1155/2023/4408697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/24/2023] Open
Abstract
Male hypogonadism (MH) is a clinical and biochemical syndrome caused by inadequate synthesis of testosterone. Untreated MH can result in long-term effects, including metabolic, musculoskeletal, mood-related, and reproductive dysfunction. Among Indian men above 40 years of age, the prevalence of MH is 20%-29%. Among men with type 2 diabetes mellitus, 20.7% are found to have hypogonadism. However, due to suboptimal patient-physician communication, MH remains heavily underdiagnosed. For patients with confirmed hypogonadism (either primary or secondary testicular failure), testosterone replacement therapy (TRT) is recommended. Although various formulations exist, optimal TRT remains a considerable challenge as patients often need individually tailored therapeutic strategies. Other challenges include the absence of standardized guidelines on MH for the Indian population, inadequate physician education on MH diagnosis and referral to endocrinologists, and a lack of patient awareness of the long-term effects of MH in relation to comorbidities. Five nationwide advisory board meetings were convened to garner expert opinions on diagnosis, investigations, and available treatment options for MH, as well as the need for a person-centered approach. Experts' opinions have been formulated into a consensus document with the aim of improving the screening, diagnosis, and therapy of men living with hypogonadism.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India
| | - Jubbin Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana 141008, Punjab, India
| | | | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College, Bengaluru 560034, Karnataka, India
| | - Abhay Sahoo
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751003, Odisha, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad 500095, Telangana, India
| | - Sushil Jindal
- People's Medical College and Research Centre, Bhopal 462037, Madhya Pradesh, India
| | - Madhu Sudan Agrawal
- Department of Urology, Global Rainbow Hospita, l, Agra 282007, Uttar Pradesh, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore 632004, Tamil Nadu, India
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Banshi Saboo
- Department of Medicine, Dia Care, Ahmedabad 380015, Gujarat, India
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Mumbai 400068, Maharashtra, India
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PATNAIK N, MISHRA KG, PRADHAN NR. Effect of SA3X (Spilanthes acmella) Supplementation on Serum Testosterone Levels in Males with Erectile Dysfunction - A Parallel Double-Blind Randomized Controlled Trial. MAEDICA 2022; 17:869-877. [PMID: 36818267 PMCID: PMC9923073 DOI: 10.26574/maedica.2022.17.4.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Objectives:To determine whether SA3X (Spilanthes acmella) supplementation improves serum testosterone levels, in comparison with placebo, in participants with erectile dysfunction (ED) and low testosterone levels. Material and methods:This double-blind placebo-controlled parallel-group was conducted in Hyderabad, India, among male participants who were randomized to SA3X therapy or placebo (1:1) for three months. The change of serum testosterone levels from baseline to months 1, 2, 3 and 6 (three months after completion of the intervention) were assessed using a mixed model repeated measures analysis. Additional secondary outcomes were the change in the Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function (IIEF) and the duration of penile erection. Stratifying the effect of SA3X on testosterone levels was done to account for potential confounders and effect modifiers. Safety was evaluated. Results:The intention-to-treat population included 215 patients (105 - SA3X therapy; 110 - placebo). SA3X intervention increased the testosterone levels significantly (21.85 vs. 1.89 ng/dL; P<0.001) at the end of month 3. The elevated testosterone levels were maintained at month 6 (18.69 vs. 1.79; P<0.001) even after discontinuation of the intervention. The MSHQ scores, IIEF scores, and duration of penile erection also increased significantly in the SA3X group. Sensitivity analysis showed that the effect of SA3X on testosterone significantly differed by BMI, presence of comorbid conditions and intake of phosphodiesterase-5 inhibitors. Dysgeusia (7.61%) was the significant drug-related adverse effect. Conclusion:Supplementation with SA3X for people with ED and low testosterone is a safe option as it significantly increases testosterone levels along with erectile function.
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Affiliation(s)
- Nabnita PATNAIK
- Department of Obstetrics and Gynecology, AIIMS Bibinagar, Hyderabad, India
| | - Kumar Guru MISHRA
- Department of Community Medicine and Family Medicine, AIIMS Bibinagar, Hyderabad, India
| | - Nihar Ranjan PRADHAN
- Department of Vascular and Endovascular Surgery, Apollo Hospital, Hyderabad, Telangana, India
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Rajandram R, Koong JK, Quek KF, Lee EG, Razack AHA, Kuppusamy S. Ethnic differences in serum testosterone concentration among Malay, Chinese and Indian men: A cross-sectional study. Clin Endocrinol (Oxf) 2022; 97:303-309. [PMID: 35107834 DOI: 10.1111/cen.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate non-urological patients with multiple comorbidities for factors contributing towards differences in testosterone concentration in multiethnic Malaysian men. DESIGN An observational study. PATIENTS Sexually active men, ≥40 years, with no known urological problems, were recruited at the phlebotomy clinic at our centre. MEASUREMENTS A brief history along with latest fasting lipid profile and plasma glucose levels were obtained. An Aging Male Symptoms questionnaire was administered; waist circumference (WC) and serum testosterone concentration were measured. STATSTICAL ANALYSIS Analysis of testosterone concentration between Malay, Indian and Chinese men was performed. Statistical tests such as analysis of variance, χ2 test, univariate and multivariable regression were performed. Any p < .05 was noted as statistically significant. RESULTS Among the 604 participants analysed, mean testosterone concentration was significantly lower in Malays (15.1 ± 5.9 nmol/L) compared to the Chinese (17.0 ± 5.9 nmol/L) and Indian (16.1 ± 6.5 nmol/L) participants. The mean WC was also found to be higher among the Malays (96.1 ± 10.9 cm) compared to Chinese (92.6 ± 9.6 cm) and Indians (95.6 ± 9.9 cm). Testosterone concentration tended to be lower with higher age, but this was not statistically significant (p > .05). In the multivariable analysis only Malay ethnicity, WC ≥ 90 cm and low high-density lipoprotein (HDL) were associated with lower testosterone concentration. CONCLUSION In this study, Malaysian men of Malay origin had lower testosterone concentration compared with Indian and Chinese men. WC and low HDL were also associated with lower testosterone concentrations.
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Affiliation(s)
- Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jun K Koong
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
- Division of Urology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kia F Quek
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Eng G Lee
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Azad H A Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shanggar Kuppusamy
- Department of Surgery, Faculty of Medicine, University of Malaya, Universiti Malaya, Kuala Lumpur, Malaysia
- Division of Urology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
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Anupam B, Shivaprasad C, Vijaya S, Sridevi A, Aiswarya Y, Nikhil K. Prevalence of hypogonadism in patients with type 2 diabetes mellitus among the Indian population. Diabetes Metab Syndr 2020; 14:1299-1304. [PMID: 32755825 DOI: 10.1016/j.dsx.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine the prevalence of hypogonadism among Indian men with and without type 2 diabetes mellitus (T2DM) and evaluate its association with various metabolic parameters. METHODS One hundred fifty consecutive men with T2DM, aged 25-70 years, and one hundred age-matched healthy men without diabetes were included. The free testosterone (FT) level was calculated using the total testosterone (TT), sex hormone-binding globulin (SHBG), and albumin levels in serum. Patients with a calculated FT level <6.35 ng/dL and a positive response on the androgen deficiency in aging male questionnaire (ADAM) were diagnosed with hypogonadism. RESULTS The prevalence of hypogonadism was 17.3% and 10% in men with and without T2DM, respectively. The body mass index (BMI) and the mean levels of follicle-stimulating hormone (FSH), TT, SHBG, Triglycerides (TG), and FT were significantly different between the groups. The mean BMI and TG levels were significantly higher in patients with T2DM than in those without. Both groups showed a significant negative correlation between the BMI and SHBG level. CONCLUSION The hypogonadism prevalence was higher in patients with T2DM than in those without, although the difference did not reach statistical significance.
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Shamim MO, Ali Khan FM, Arshad R. Association between serum total testosterone and Body Mass Index in middle aged healthy men. Pak J Med Sci 2015; 31:355-9. [PMID: 26101490 PMCID: PMC4476341 DOI: 10.12669/pjms.312.6130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/06/2015] [Accepted: 01/14/2015] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine correlation of serum total testosterone with body mass index (BMI) and waist hip ratio (WHR) in healthy adult males. Methods: A cross sectional study was conducted on 200 nonsmoker healthy males (aged 30-50 years) university employees. They were selected by convenience sampling technique after a detailed medical history and clinical examination including BMI and Waist Hip Ratio (WHR) calculation. Blood sampling was carried out to measure serum total testosterone (TT) using facilities of Chemiluminescence assay (CLIA) technique in Dow Chemical Laboratory. Independent sample T test was used for mean comparisons of BMI and WHR in between low and normal testosterone groups. (Subjects having < 9.7 nmol/L of total testosterone in blood were placed in low testosterone group and subjects having ≥ 9.7 nmol/L of total testosterone in blood were placed in normal testosterone group). Correlation of testosterone with BMI and WHR was analyzed by Pearson Correlation. Results: Mean (± SD) age of the subjects included in this study was 38.7 (± 6.563) years mean (± SD) total testosterone was 15.92 (±6.322)nmol/L. The mean (± SD) BMI, and WHR were 24.95 (±3.828) kg/m2 and 0.946 (±0.0474) respectively. Statistically significant differences were observed in the mean values of BMI and WHR for the two groups of testosterone. Significant inverse correlation of serum total testosterone with BMI(r = -0.311, p = 0.000) was recorded in this study. However testosterone was not significantly correlated with waist/hip ratio.(r = -0.126, p = 0.076) Conclusion: Middle age men working at DUHS who have low level of serum total testosterone are more obese than individuals with normal total testosterone level.
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Affiliation(s)
- Muhammad Omar Shamim
- Dr. Muhammad Omar Shamim, MBBS, MPhil. Assistant Professor, Physiology Department, Islam Medical College, Pasrur Road, Sialkot, Pakistan
| | - Farooq Munfaet Ali Khan
- Dr. Farooq Munfaet Ali Khan, MBBS, MPhil. Assistant Professor, Physiology Department, Mohtarma Benazir Bhutto Shaheed Medical College, MirPur, Azad Jammu Kashmir, Pakistan
| | - Rabia Arshad
- Dr. Rabia Arshad, MBBS, M. Phil. Assistant Professor, Pharmacology Department, Sir Syed College of Medical Sciences, Clifton Karachi, Pakistan
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