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Xu Z, Chen X, Zhou H, Ren C, Wang Q, Pan Y, Liu L, Liu X. An updated systematic review and meta-analysis of the effects of testosterone replacement therapy on erectile function and prostate. Front Endocrinol (Lausanne) 2024; 15:1335146. [PMID: 38344665 PMCID: PMC10853420 DOI: 10.3389/fendo.2024.1335146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Testosterone replacement therapy (TRT) is a generally accepted method treating for aging-related late-onset hypogonadism (LOH). However, the efficacy and safety of TRT remain controversial. An updated systematic review and meta-analysis aimed to determine the effectiveness and security of TRT treating for LOH. Methods Randomized controlled trials (RCTs) of TRT for LOH were searched in the databases of Pubmed, Embase, Clinicaltrials.gov and Cochrane from 1990 to 2023 and an updated meta-analysis was conducted. Results The results of 28 RCTs involving 3461 patients were included and scrutinized in this analysis. Among these, 11 RCTs were of long-term duration (≥12 months), while 18 RCTs were short-term studies (<12 months) comparing TRT with a placebo. TRT modalities comprised injection, oral administration, and transdermal administration. International Index of Erectile Function (IIEF) (Weighted Mean difference (WMD) 3.26; 95%; 95% confidence interval (CI) 1.65-4.88; P<0.0001) was obviously improved in the TRT group. International Prostate Symptom Score (IPSS) (WMD 0.00; 95% CI -0.45-0.45; P=1.0), Prostate Volume (PV) (WMD 0.38; 95% CI -0.64-1.41; P=0.46), Maximum Flow Rate (Qmax) (WMD 1.86; 95% CI -0.98-4.69; P=0.20), Postvoid Residual Urine Volume (PVR) (WMD 3.20; 95% CI -5.87-12.28; P=0.49) and Prostate-Specific Antigen (PSA) (WMD 0.08; 95% CI -0.00-0.17; P=0.06) were not significantly statistical between two groups. Conclusion This meta-analysis reveals that TRT could improve the IIEF score of hypogonadal men without detriment to the IPSS score, PV, Qmax, PVR and PSA regardless of the administration method or duration of treatment.The meta-analysis was registered at PROSPERO (CRD42023413434).
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Affiliation(s)
- Zhunan Xu
- Department of Urology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Xiangyu Chen
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hang Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Congzhe Ren
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qihua Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Shin D, Jeon SH, Piao J, Park HJ, Tian WJ, Moon DG, Ahn ST, Jeon KH, Zhu GQ, Park I, Park HJ, Bae WJ, Cho HJ, Hong SH, Kim SW. Efficacy and Safety of Maca ( Lepidium meyenii) in Patients with Symptoms of Late-Onset Hypogonadism: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. World J Mens Health 2023:41.e11. [PMID: 36593713 DOI: 10.5534/wjmh.220112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/17/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluated the efficacy and safety of gelatinized Maca (Lepidium meyenii) for eugonadal patients with late onset hypogonadism symptoms (LOH). MATERIALS AND METHODS Participants were instructed to receive 1,000 mg of Maca or placebo, two pills at a time, three times per day for 12 weeks before food intake. To evaluate the efficacy of the drug, Aging Males' Symptoms scale (AMS), Androgen Deficiency in the Aging Males (ADAM), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF) questionnaires, serologic tests (total testosterone and free testosterone, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride), body weight, and waist circumference were assessed at 4 and 12 weeks after treatment. RESULTS A total of 80 participants were enrolled and randomly assigned to Maca treated group (n=41) or the placebo group (n=39). AMS, IIEF, and IPSS were significantly (p<0.05) improved in Maca treated group than in the placebo group. ADAM positive rate was also significantly (p<0.0001) decreased in Maca treated group. CONCLUSIONS Maca may be considered an effective and safe treatment for eugonadal patients with late onset hypogonadism symptoms.
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Affiliation(s)
- Dongho Shin
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Jeon
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Junjie Piao
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hyo Jung Park
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Wen Jie Tian
- Department of Urology, The Second Hospital of Jilin University, Chang Chun, China
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Hwa Jeon
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
| | - Guan Qun Zhu
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ilbum Park
- Yuhan Care Co., Ltd., Yuhan Care R&D Center, Yongin, Korea
| | - Hyun-Je Park
- Yuhan Care Co., Ltd., Yuhan Natural Product R&D Center, Andong, Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea.,Green Medicine Co., Ltd, Busan, Korea.
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Kim JW, Bae YD, Ahn ST, Kim JW, Kim JJ, Moon DG. Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population. Sex Med 2018; 6:203-209. [PMID: 29706560 PMCID: PMC6085405 DOI: 10.1016/j.esxm.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/21/2018] [Accepted: 04/01/2018] [Indexed: 01/02/2023] Open
Abstract
Background Testosterone action is mediated through the androgen receptor (AR), whose sensitivity is influenced by the AR CAG repeat polymorphism. However, the relation between late-onset hypogonadism (LOH) and AR CAG repeat length is unclear and studies of Asian populations are limited. Aim To investigate the relation between AR CAG repeat length and LOH in Korean men. Methods 263 Korean men (mean age = 63.43 ± 10.9 years) were enrolled from 2014 to 2015. LOH diagnosis was based on a serum testosterone level lower than 3.5 ng/mL and positive androgen deficiency according to the Aging Males’ Symptom Scale (AMS). Total testosterone levels and answers to the LOH-related questionnaire were analyzed. Outcomes The relation between AR CAG repeat length and LOH was determined. Results Mean CAG repeat length was 22.1 ± 4.6 and mean serum testosterone levels were 2.6 ± 0.7 and 6.0 ± 2.0 ng/mL in men with and without LOH, respectively. Men with LOH showed significantly longer AR CAG repeat lengths than men without LOH (26.1 vs 21.6, P < .001). Longer CAG repeat lengths were correlated with higher AMS total scores (r = 0.454, P = .001) and AMS psychotic, somatic, and sexual sub-scores (r = 0.276, 0.246, and 0.571, P = .006, .007, .001, respectively) and significantly lower 5-item International Index of Erectile Function scores (r = −0.261, P = .001). Multivariate analysis showed that patient age and CAG repeat length were independently associated with LOH (odds ratio = 1.05 and 1.29, P = .041 and <.001, respectively). Clinical Implications A longer CAG repeat length is associated with LOH symptoms and LOH. Strengths and Limitations Associations between CAG repeats and LOH were verified in Korean patients. Moreover, a longer CAG repeat length was shown to be an independent risk factor for LOH. Limitations included the small number of LOH patients studied and that other sex hormone-associated factors were not measured. Conclusions AR CAG repeat length was associated with LOH prevalence and clinical symptoms in this Korean male population. Thus, it is important to measure CAG repeat length for patients with LOH symptoms with normal testosterone levels. Kim JW, Bae YD, Ahn ST, et al. Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population. Sex Med 2018;6:203–209.
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Affiliation(s)
- Jong Wook Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Young Dae Bae
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Jin Wook Kim
- Institute of Regenerative Medicine, Korea University, Seoul, Korea; Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea; Institute of Regenerative Medicine, Korea University, Seoul, Korea.
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Anaissie J, DeLay KJ, Wang W, Hatzichristodoulou G, Hellstrom WJ. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol 2017; 6:183-191. [PMID: 28540225 PMCID: PMC5422691 DOI: 10.21037/tau.2016.11.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The global prevalence of testosterone deficiency (TD) ranges from 10–40%. The actual diagnosis of TD is controversial, as a wide range of total testosterone (TT) thresholds are used for diagnosis (200–400 ng/dL), and physicians differ in their emphasis placed on clinical symptoms. There are also significant global differences in the prescription patterns of testosterone replacement therapy (TRT). In the United States, prescription of TRT is significantly higher than the rest of the world, increasing 3-fold over the last 10 years and more so in eugonadal men. The majority of treating physicians emphasizes clinical symptomology of TD over laboratory values, and up to one-fourth of their patients do not even have serum testosterone levels. There are significant inter-physician differences in willingness to prescribe TRT in the setting of prostate cancer. Data is scarce on testosterone prescribing patterns in Africa, Asia, and the Middle East. More literature is needed to better characterize how physicians from different regions diagnose TD.
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Affiliation(s)
- James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kent J DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - William Wang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Wayne J Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Lee CP, Chen Y, Jiang KH, Chu CL, Hsu SC, Chen JL, Chen CY. The prevalence and correlates of the positive Androgen Deficiency in the Aging Male (ADAM) questionnaire among psychiatric outpatients: a cross-sectional survey of 176 men in a general hospital in Taiwan. Neuropsychiatr Dis Treat 2015; 11:185-9. [PMID: 25653527 PMCID: PMC4309773 DOI: 10.2147/ndt.s75701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Androgen Deficiency in the Aging Male (ADAM) questionnaire is widely used to screen for late-onset hypogonadism. The positive response to the ADAM questionnaire (positive ADAM) has been associated with depression and poorer quality of life in a number of studies. It is unclear whether there is any value of the ADAM questionnaire in psychiatric populations. In this study, we aimed to determine the utility of the ADAM questionnaire in a convenient sample of male psychiatric outpatients. METHODS One hundred and seventy-six men (mean age: 54.3 years; standard deviation: 10.7 years; range: 40-80 years) completed the ADAM questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Aging Males' Symptoms (AMS) scale. Anxiety was defined as a HADS anxiety subscore ≥8; depression as a HADS depression subscore ≥8; and moderate/severe impairment of health-related quality of life (HQoL) as AMS ≥37. ADAM, anxiety, and depression was used to model the moderate/severe impairment of HQoL. RESULTS One hundred and sixty-four (93%) men had positive ADAM. Positive ADAM was associated with a lower body mass index (P<0.05) and moderate/severe impairment of HQoL (P<0.001), but was not associated with anxiety or depression (P>0.05). Positive ADAM was associated with five symptoms of the AMS scale: "decline of one's feeling of general well-being", "depressive mood", and three sexual symptoms. In regression analysis, positive ADAM was associated with increased risk of moderate/severe impairment of HQoL (unadjusted odds ratio 20.1, 95% confidence interval 3.77-372, P<0.01), which remained significant with covariates of anxiety and depression (adjusted odds ratio 15.6, 95% confidence interval 2.52-309, P<0.05). CONCLUSION The ADAM questionnaire can be used to screen the sexual symptoms but not depression/anxiety in male psychiatric outpatients. Positive ADAM may indicate moderate/severe impairment of HQoL.
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Affiliation(s)
- Chin-Pang Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, Taiwan ; Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan
| | - Yu Chen
- Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan ; Department of Urology, Chang Gung Memorial Hospital, Linkou, Taiwan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Hao Jiang
- Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan ; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Lin Chu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, Taiwan ; Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, Taiwan ; Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiun-Liang Chen
- Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan ; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yen Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan, Taiwan ; Men's Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Kang S, Park HJ, Park NC. Serum total testosterone level and identification of late-onset hypogonadism: a community-based study. Korean J Urol 2013; 54:619-23. [PMID: 24044097 PMCID: PMC3773593 DOI: 10.4111/kju.2013.54.9.619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/26/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Late-onset hypogonadism (LOH) in aging males is a clinical and biochemical syndrome characterized by a decline in serum testosterone levels. LOH results in various physical and mental disabilities. We evaluated the relationship between serum testosterone levels and symptoms of LOH. MATERIALS AND METHODS During an andropause screening program, we examined responses to the Saint Louis university androgen deficiency in aging males (ADAM) questionnaire and results on the International Index of Erectile Function (IIEF-5) in terms of clinical symptoms and evaluated serum total testosterone levels for a biochemical diagnosis of LOH in healthy community-living volunteers aged over 40 years. RESULTS The mean age of the 534 men was 59.1 years (range, 40 to 79 years), and their mean serum testosterone level was 464.1±171.9 ng/dL. The serum testosterone level decreased significantly with age. There was a 92.5% positive response rate to the ADAM questionnaire. The percentage of patients whose serum testosterone level was <350 ng/dL among those with a positive response to the ADAM questionnaire was 25.6% (137 patients). The mean serum testosterone level among patients with a positive or negative ADAM questionnaire was 472.4±198.5 ng/dL and 487.3±165.7 ng/dL, respectively (p>0.05). There was no significant correlation between IIEF-5 scores and serum testosterone levels. CONCLUSIONS Among men over 40 years of age, 25.6% met the clinical and biochemical diagnostic criteria for LOH. There was no relationship between serum testosterone levels and symptoms of LOH.
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Affiliation(s)
- Sungmin Kang
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Abstract
Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men's sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care.
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Clapauch R, Braga DJDC, Marinheiro LP, Buksman S, Schrank Y. Risk of late-onset hypogonadism (andropause) in Brazilian men over 50 years of age with osteoporosis: usefulness of screening questionnaires. ACTA ACUST UNITED AC 2009; 52:1439-47. [PMID: 19197451 DOI: 10.1590/s0004-27302008000900006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 10/23/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the relative risk of late-onset hypogonadism in men with osteoporosis and the usefulness of screening questionnaires. METHODS We correlated the Aging Male's Symptoms (AMS), Androgen Deficiency in Aging Male (ADAM) and International Index of Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone density, paired by age and ethnicity). RESULTS Hypogonadism presented in 25% of the osteoporotic and in 12.2 % of normal bone density men (OR 2.08; IC95%: 1.14-3.79) and was associated with ADAM first question (low libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels. CONCLUSION Hypogonadism was 2.08 times more prevalent in osteoporotic men. The symptom that best correlated with late-onset hypogonadism was low libido (ADAM 1 positive).
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Affiliation(s)
- Ruth Clapauch
- Division of Female Endocrinology and Andrology, Endocrinology Sector, Hospital da Lagoa, Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, RJ, Brazil
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Blümel JE, Chedraui P, Gili SA, Navarro A, Valenzuela K, Vallejo S. Is the Androgen Deficiency of Aging Men (ADAM) questionnaire useful for the screening of partial androgenic deficiency of aging men? Maturitas 2009; 63:365-8. [PMID: 19481382 DOI: 10.1016/j.maturitas.2009.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/13/2009] [Accepted: 04/25/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Androgen serum levels significantly decrease in older men, causing quality of life impairment and increasing the risk of chronic disease. This disorder is defined as PADAM (Partial Androgen Deficiency of Aging Men). OBJECTIVE To evaluate a PADAM screening tool and determine the prevalence of this disorder in healthy adult men. METHODS This was a cross-sectional study in which 96 men aged 40 or more of the South Metropolitan Region of Santiago de Chile were surveyed with the Androgen Deficiency of Aging Men (ADAM) questionnaire of the Saint Louis University and sampled for the serum determination of total testosterone, sexual hormone binding globulin (SHBG) and albumin. Also free and bioavailable testosterone were calculated. PADAM was considered present if items 1 or 7 or any 3 other questions of the ADAM questionnaire were positive. An available testosterone of <198.4 ng/dL was used as a gold standard for the diagnosis of PADAM. RESULTS A total of 78 men (81.3%) were identified as possible PADAM according to the ADAM questionnaire. Total testosterone levels fell from 503.6+/-180.1 ng/dL in men aged 40 to 54 years to 382.1+/-247.3 in those >70 years; however this was not statistically significant (ANOVA, p=0.06). In the same age groups, SHBG significantly increased (31.0+/-15.0 to 47.5+/-15.0 nmol/L, p<0.001) whereas free and available testosterone significantly decreased (10.6+/-3.2 to 6.4+/-3.6 ng/dL and 266.6+/-81.2 to 152.2+/-97.6 ng/dL, respectively, p<0.0001). Overall (n=96), available testosterone confirmed PADAM diagnosis in 27 cases (28.1%). The ADAM tool rendered a 83.3% sensitivity and 19.7% specificity in the detection of PADAM. Item 1 (decreased sexual desire) was a better predictor of hypogonadism than the complete questionnaire (63.3% sensitivity and 66.7% specificity). CONCLUSION In this series, in accordance to available testosterone, the prevalence of PADAM was determined to be high, in which the ADAM questionnaire rendered a low diagnostic efficiency. PADAM diagnosis could be clinically suspected when symptoms of sexual dysfunction are present.
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Affiliation(s)
- Juan E Blümel
- Facultad Medicina, Universidad de Chile, Santiago de Chile, Chile
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Langham S, Maggi M, Schulman C, Quinton R, Uhl‐Hochgraeber K. Health‐Related Quality of Life Instruments in Studies of Adult Men with Testosterone Deficiency Syndrome: A Critical Assessment. J Sex Med 2008; 5:2842-52. [DOI: 10.1111/j.1743-6109.2008.01015.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liao C, Chiang H. Erectile dysfunction, testosterone deficiency, metabolic syndrome and prostatic disease in Taiwan. Journal of Men's Health 2008; 5:289-296. [DOI: 10.1016/j.jomh.2008.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Liu CC, Wu WJ, Lee YC, Wang CJ, Ke HL, Li WM, Hsiao HL, Yeh HC, Li CC, Chou YH, Huang CH, Huang SP. The prevalence of and risk factors for androgen deficiency in aging Taiwanese men. J Sex Med 2008; 6:936-946. [PMID: 19210712 DOI: 10.1111/j.1743-6109.2008.01171.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Androgen deficiency in aging men has attracted much medical interest. Most studies on androgen deficiency have been conducted in Caucasian populations, and data from other ethnicities are lacking. AIM To evaluate the prevalence of and risk factors for androgen deficiency and symptomatic androgen deficiency in Taiwanese men over 40 years old. METHODS From August 2007 to April 2008, a free health screening was conducted by a medical center in Kaohsiung, Taiwan, and 819 men participated in this health screening. All participants completed a health questionnaire, received a detailed physical examination, and blood samples were drawn between 8:00 and 12:00 am. MAIN OUTCOME MEASURES Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms of androgen deficiency were assessed using the Androgen Deficiency in the Aging Male (ADAM) questionnaire. RESULTS Seven hundred thirty-four men who met the inclusion criteria (mean age 57.4 +/- 6.7 years; range: 43-87 years) were included in this study. The prevalence of androgen deficiency was 24.1% based on the criterion of TT level < 300 ng/dL, and 16.6% based on the criterion of both TT < 300 ng/dL and FT < 5 ng/dL. The prevalence of symptomatic androgen deficiency was 12.0%. Both prevalence of androgen deficiency and symptomatic androgen deficiency increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency. CONCLUSIONS In a sample of aging Taiwanese men, a substantial proportion had androgen deficiency and symptomatic androgen deficiency, and the prevalence increased with age. Older age, obesity, and diabetes mellitus were independent risk factors for androgen deficiency and symptomatic androgen deficiency. Those potentially modifiable risk factors like obesity and diabetes mellitus should be prevented to maintain normal testosterone levels during aging in men.
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Affiliation(s)
- Chia-Chu Liu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Chin Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chii-Jye Wang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsi-Lin Hsiao
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yii-Her Chou
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hsiung Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Pin Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;; Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
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18
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Abstract
The diagnosis of late life hypogonadism is controversial. For the purposes of discussion, it is suggested that treatment of late life hypogonadism requires the presence of symptoms, a low level of circulating free or bioavailable testosterone level and a positive response to treatment. While this may appear to be a radical proposal, we believe it represents the most rigorous scientific approach to the diagnosis of late life hypogonadism at the present time.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University Medical Center, 1402 South Grand Boulevard, Saint Louis, MO 63104, USA.
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