The rate of change in declining steroid hormones: a new parameter of healthy aging in men?

A literature review on Epimedium, a medicinal plant with promising slow aging properties

Ethnopharmacological relevance

Aging is related to many factors, such as genes, oxidative damage, metabolic abnormalities, immune regulation and sex hormones. This article reviews the pharmacological mechanism of Epimedium on slow aging from six aspects: gene regulation, antioxidant, the regulation of metabolism, the modulation of the immune system, the regulation of sex hormone, and clinical efficacy.Aim of the studyThrough literature review, to discover the potential pharmacological mechanism of Epimedium for slow aging.

Materials and methods

We reviewed the literature on the applications of Epimedium in multiple systems and the potential underlying mechanisms with systematic and comprehensive illustrations. The review includes the following aspects: gene regulation, antioxidant, the regulation of metabolism, the modulation of the immune system, the regulation of sex hormone, clinical efficacy and safety.

Results

The slow aging active components of Epimedium may be flavonoids, such as Epimedins A, B, C and icariin The slow aging effect of Epimedium may be related to gene regulation, antioxidant, the regulation of metabolism, the modulation of the immune system, and the regulation of sex hormone. No severe adverse reaction has been reported.

Conclusions

Epimedium has potential slow aging effect and been widely used in the clinic for aging-related diseases in the real world in China; however, large-scale studies are still needed.

Testosterone Replacement Therapy in the Treatment of Depression

BACKGROUND

Depression is a common disorder that affects millions globally and is linked to reduced quality of life and mortality. Its pathophysiology is complex and there are several forms of treatment proposed in the literature with differing side effect profiles. Many patients do not respond to treatment which warrants augmentation with other treatments and the investigation of novel treatments. One of these treatments includes testosterone therapy which evidence suggests might improve depressed mood in older patients with low levels of testosterone and helps restore physical impairments caused by age-related hormonal changes.

OBJECTIVE

The objective of this review is to synthesize information regarding clinical depression, its treatment options, and the efficacy and safety of testosterone treatment for the treatment of depression.

METHODS

This review utilized comprehensive secondary and tertiary data analysis across many academic databases and published work pertaining to the topic of interest.

RESULTS

Within some subpopulations such as men with dysthymic disorder, treatment resistant depression, or low testosterone levels, testosterone administration yielded positive results in the treatment of depression. Additionally, rodent models have shown that administering testosterone to gonadectomized male animals reduces symptoms of depression. Conversely, some studies have found no difference in depressive symptoms after treatment with testosterone when compared with placebo. It was also noted that over administration of testosterone is associated with multiple adverse effects and complications.

CONCLUSION

The current evidence provides mixed conclusions on the effectiveness of testosterone therapy for treating depression. More research is needed in adult men to see if declining testosterone levels directly influence the development of depression.

A meta-analysis of the association between male dimorphism and fitness outcomes in humans

Humans are sexually dimorphic: men and women differ in body build and composition, craniofacial structure, and voice pitch, likely mediated in part by developmental testosterone. Sexual selection hypotheses posit that, ancestrally, more 'masculine' men may have acquired more mates and/or sired more viable offspring. Thus far, however, evidence for either association is unclear. Here, we meta-analyze the relationships between six masculine traits and mating/reproductive outcomes (96 studies, 474 effects, N = 177,044). Voice pitch, height, and testosterone all predicted mating; however, strength/muscularity was the strongest and only consistent predictor of both mating and reproduction. Facial masculinity and digit ratios did not significantly predict either. There was no clear evidence for any effects of masculinity on offspring viability. Our findings support arguments that strength/muscularity may be sexually selected in humans, but cast doubt regarding selection for other forms of masculinity and highlight the need to increase tests of evolutionary hypotheses outside of industrialized populations.

The Role of Sex Hormones on Bone Mineral Density, Marrow Adiposity, and Muscle Adiposity in Middle-Aged and Older Men

PURPOSE

The etiology of age-related bone loss is less clear in men. This study is aimed to observe the variations of endogenous sex hormone concentrations with increasing of age in men, and investigate their relations to bone mass, marrow adiposity, and muscle adiposity.

METHODS

A total of 199 community-dwelling Chinese men (aged 41 to 82 years) were included and measured of serum total estradiol, total testosterone, and follicle-stimulating hormone (FSH) concentrations by enzyme-linked immunosorbent assay (ELISA). Vertebral trabecular volumetric bone mineral density (vBMD) was measured by quantitative computed tomography for all participants, and vertebral marrow fat content and erector muscle fat content were quantified by Chemistry-shift-encoding magnetic resonance imaging in 62 participants.

RESULTS

In this population, FSH concentration increased (p < 0.001) gradually with aging. Lower vBMD was independently associated with higher FSH concentration (β = -0.216, p < 0.001), but not with total estradiol or total testosterone. For each standard deviation increase in FSH there was a 50% higher risk of an individual having osteopenia or osteoporosis (vBMD < 120 mg/cm³). Marrow fat content and erector muscle fat content were greater in osteopenic and osteoporotic men, but there were no associations with sex hormones concentrations.

CONCLUSION

In summary, FSH but not total estradiol or total testosterone is related to vertebral trabecular vBMD in middle-aged and older Chinese men. Neither marrow adiposity nor muscle adiposity is associated with sex hormones.

Depressive symptoms are not associated with long-term integrated testosterone concentrations in hair

OBJECTIVES

The association between depressive symptomatology and endogenous testosterone levels is inconclusive. Large inter- and intra-individual testosterone differences suggest point measurements from saliva or serum to be inadequate to map basal testosterone concentrations highlighting the potential for long-term integrated testosterone levels from hair.

METHODS

Using data from a prospective cohort study, a total of 578 participants (74% female) provided complete data on depressive symptomatology, clinical features, and hair samples for quantification of testosterone concentrations at baseline. Available data of three annual follow-up examinations were used for longitudinal analyses.

RESULTS

Correlation analysis showed in both, men and women, hair testosterone across all the four time points not to be significantly related to depressive symptoms. Examined clinical features were not associated with testosterone levels, except for having a current diagnosis of a psychological disorder, which was associated with reduced testosterone levels in men, but not in women. Acceptable model fit for an autoregressive cross-lagged panel analysis emerged only for the female subsample suggesting inverse cross-relations for the prediction of testosterone by depressive symptomatology and vice versa.

CONCLUSIONS

Findings from this study add to the literature by showing no association between long-term integrated testosterone in hair and depressive symptomatology in men and women.

Reduced renal function may explain the higher prevalence of hyperuricemia in older people

This study aimed to investigate the contribution of renal dysfunction to enhanced hyperuricemia prevalence in older people. A cohort of 13,288 Chinese people aged between 40 and 95 years were recruited from January to May 2019. Serum uric acid concentration and estimated glomerular filtration rate [eGFR] were measured. The associations between age or eGFR and serum uric acid or hyperuricemia were analyzed using linear or binary logistic regression adjusting for risk factors. Uric acid concentration and prevalence of hyperuricemia were greater in older participants. Adjustment for reduced renal function (eGFR < 60 mL/min/1.73 m²) eliminated the associations between older age and higher uric acid concentration and between older age and higher prevalence of hyperuricemia diagnosis, whereas adjustment for other risk factors did not change those associations. Lower eGFR was associated with higher uric acid concentration both before (β = - 0.296, P < 0.001) and after adjustment for age (β = - 0.313, P < 0.001). Reduced renal function was associated with hyperuricemia diagnosis both before (odds ratio, OR, 3.64; 95% CI 3.10-4.28; P < 0.001) and after adjustment for age (adjusted OR, 3.82; 95% CI 3.22-4.54; P < 0.001). Mean serum uric acid and prevalence of hyperuricemia were higher in people with eGFR < 60 mL/min/1.73 m² than those with eGFR ≥ 60 mL/min/1.73 m². The prevalence of reduced renal function increased with older age (P < 0.001). This study suggests that reduced renal function can explain the increased uric acid levels and hyperuricemia diagnoses in older people.

Fatherhood Is Associated with Increased Infidelity and Moderates the Link between Relationship Satisfaction and Infidelity

Background: Relationship satisfaction has been identified as an important factor in terms of extradyadic sexual involvement. However, in men, fatherhood might be associated with infidelity by leading to changes in relationship satisfaction and the social life of parents. To date, no study has focused on the association of fatherhood and infidelity, nor the influence of fatherhood on the association between relationship satisfaction and infidelity. Methods: Using a cross-sectional design, 137 fathers and 116 non-fathers were assessed regarding relationship satisfaction, infidelity, and potential confounds. Results: Significantly more fathers reported having been unfaithful in the current relationship than non-fathers (30.7% vs. 17.2%). Fathers also reported longer relationship duration, higher relationship satisfaction, and lower neuroticism than non-fathers. Furthermore, fatherhood moderated the association between relationship satisfaction and infidelity insofar that only in non-fathers reduced relationship satisfaction was associated with infidelity. Conclusions: The results suggest that fatherhood increases the risk of engaging in extradyadic sexual activities and moderates the link between relationship satisfaction and infidelity. However, results need to be interpreted with caution due to the cross-sectional study design and the lack of information about the specific time point of the infidelity incident(s).

Age-Related Alterations in Endocrine Markers Do Not Match Changes in Psychosocial Measures: Findings From the Men's Health 40+ Longitudinal Study

While life expectancy continues to increase, aging can bring several distinct endocrine and psychosocial changes. The study aimed to investigate the interplay between biopsychosocial factors of healthy aging in specifically healthy aging men. Ninety-seven healthy aging men were investigated at two time points spanning 4 years. Participants completed questionnaires measuring several psychosocial dimensions and gave saliva samples for hormone quantification during a laboratory appointment. The study applied a random intercept mixed-model approach. Age-related changes were found in most endocrine markers (cortisol, testosterone, dehydroepiandrosterone-sulfate, and progesterone), except for estradiol. Psychosocial measures remained stable, except for increased social support. Further, changes in endocrine and psychosocial measures were independent of each other. The results suggest that in healthy aging men, age-related endocrine changes occur, but do not necessarily determine a change in psychosocial measures. Potentially, preventive interventions can be derived from these results.

A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males

Ashwagandha ( Withania somnifera) is a herb commonly used in Ayurvedic medicine to promote youthful vigor, enhance muscle strength and endurance, and improve overall health. In this 16-week, randomized, double-blind, placebo-controlled, crossover study, its effects on fatigue, vigor, and steroid hormones in aging men were investigated. Overweight men aged 40-70 years, with mild fatigue, were given a placebo or an ashwagandha extract (Shoden beads, delivering 21 mg of withanolide glycosides a day) for 8 weeks. Outcome measures included the Profile of Mood States, Short Form (POMS-SF), Aging Males' Symptoms (AMS) questionnaire, and salivary levels of DHEA-S, testosterone, cortisol, and estradiol. Fifty-seven participants were enrolled, with 50 people completing the first 8-week period of the trial and 43 completing all 16 weeks. Improvements in fatigue, vigor, and sexual and psychological well-being were reported over time, with no statistically significant between-group differences. Ashwagandha intake was associated with an 18% greater increase in DHEA-S ( p = .005) and 14.7% greater increase in testosterone ( p = .010) compared to the placebo. There were no significant between-group differences in cortisol and estradiol. In conclusion, the intake of a standardized ashwagandha extract (Shoden beads) for 8 weeks was associated with increased levels of DHEA-S and testosterone, although no significant between-group differences were found in cortisol, estradiol, fatigue, vigor, or sexual well-being. Further studies with larger sample sizes are required to substantiate the current findings.

Optimization of mass spectrometry settings for steroidomic analysis in young and old killifish

Steroids are essential structural components of cell membranes that organize lipid rafts and modulate membrane fluidity. They can also act as signalling molecules that work through nuclear and G protein–coupled receptors to impact health and disease. Notably, changes in steroid levels have been implicated in metabolic, cardiovascular and neurodegenerative diseases, but how alterations in the steroid pool affect ageing is less well understood. One of the major challenges in steroidomic analysis is the ability to simultaneously detect and distinguish various steroids due to low in vivo concentrations and naturally occurring stereoisomers. Here, we established such a method to study the mass spectrometry behaviour of nine sterols/steroids and related molecules (cholesterol precursors: squalene, lanosterol; sterol metabolites; 7 Dehydrocholesterol, 24, 25 and 27 Hydroxycholesterol; and steroids: progesterone, testosterone, and corticosterone) during ageing in the African turquoise killifish, a new model for studying vertebrate longevity. We find that levels of all tested steroids change significantly with age in multiple tissues, suggesting that specific steroids could be used as biomarkers of ageing. These findings pave the way for use of Nothobranchius furzeri as a novel model organism to unravel the role of sterols/steroids in ageing and age-related diseases.

The Relation Between Steroid Secretion Patterns and the Androgen Receptor Gene Polymorphism on Physical Health and Psychological Well-Being-Longitudinal Findings From the Men's Health 40+ Study

Research is increasingly focusing on promoting healthy aging and the related extension of the health span by targeting crucial biological processes responsible for age-related conditions. While age-related gradual changes in steroid hormones such as testosterone, estradiol, or cortisol are well described in men, their interactions among each other or with genetic markers have not been sufficiently investigated with regard to physical health or psychological well-being. More specifically, the examination of age-related alterations in hormone interactions and the androgen receptor polymorphism, which modulates androgen action on target cells, in relation to physical health and psychological well-being represents a promising avenue for research on healthy aging in men. A total of 97 healthy aging men provided complete data on psychometric health measures as well as hormonal and genetic parameters at baseline and a 4-year follow-up assessment. Fasting saliva samples were taken at 8:00 am under standardized laboratory conditions, while the androgen receptor gene polymorphism was analyzed from dried blood spots. Longitudinal analyses revealed that psychological well-being and physical health remained stable over time. Analyses indicated that E2 moderated the course of psychological well-being, while the androgen receptor gene polymorphism moderated the course of physical health. Further, T was a strong predictor of physical health. These results suggest that the hypothalamic-pituitary-gonadal (HPG) axis might be important for the maintenance of psychological well-being in men, while physical health depends more on interindividual differences in the androgen receptor gene and T.

Do dehydroepiandrosterone, progesterone, and testosterone influence women's depression and anxiety levels? Evidence from hair-based hormonal measures of 2105 rural Indian women

Depressive and anxiety disorders substantially contribute to the global burden of disease, particularly in poor countries. Higher prevalence rates for both disorders among women indicate sex hormones may be integrated in the pathophysiology of these disorders. The Kshetriya Gramin Financial Services study surveyed a random sample of 4160 households across 876 villages in rural Tamil Nadu, India. An interviewer-administered questionnaire was conducted to quantify depressive (K6-D) and anxiety (K6-A) symptoms. Alongside, hair samples for sex hormone profiling were collected from a subsample of 2105 women aged 18-85 years. Importantly, 5.9%, 14.8%, and 46.3% of samples contained non-detectable hormone levels for dehydroepiandrosterone, progesterone, and testosterone, respectively. Our primary analysis imputes values for the non-detectable sample and we check robustness of results when non-detectable values are dropped. In this cohort of women from rural India, higher depressive symptomatology is associated with lower levels of dehydroepiandrosterone and higher depressive and anxiety symptoms are associated with higher levels of testosterone. Progesterone shows no clear association with either depressive or anxiety symptoms. These results support a potential protective effect of higher endogenous dehydroepiandrosterone levels. An important caveat on the potential negative effect of hair testosterone levels on women's mental health is that the testosterone analysis is sensitive to how non-detectable values are treated.

Higher testosterone levels are associated with unfaithful behavior in men

BACKGROUND

Infidelity in romantic relationships is a common, but severe issue often causing breakup and severe psychological impairment. Higher levels of testosterone are related to mating-behavior, sexual desire, and infidelity in men with sexual dysfunctions. Previous studies, have insufficiently addressed the potential role of testosterone in infidelity in healthy men.

METHODS

A sample of 224 middle-aged self-reporting healthy men being currently in a relationship completed questionnaires on relationship characteristics, infidelity, and provided overnight-fasting saliva samples for testosterone quantification.

RESULTS

In the sample, 37.5% men answered having been unfaithful in the current relationship, while 29% were identified as fulfilling criteria for a sexual dysfunction. Adjusting for covariates, a significant positive association for the frequency of unfaithful behavior and testosterone levels emerged. Subsample analysis indicates a positive association between testosterone and infidelity only to be present in men without sexual dysfunction.

CONCLUSION

Unfaithful behavior in males is associated with higher testosterone levels.

Steroid secretion in healthy aging

Nowadays, people spend a considerable amount of their lives as older adults, but this longer lifespan is often accompanied by an increase in chronic conditions and disease, resulting in reduced quality of life and unprecedented societal and economic burden. Healthy aging is therefore increasingly recognized as a healthcare priority. Physical and mental adaptations to changes over the life course, and the maintenance of well-being, represent pivotal challenges in healthy aging. To capture the complexity of healthy aging, we propose a specific phenotype based on body composition, cognition, mood, and sexual function as indicators of different dimensions of healthy aging. With increasing age, sex hormones as well as glucocorticoids undergo significant alterations, and different patterns emerge for women and men. This review describes age-related patterns of change for women and men, and sheds light on the underlying mechanisms. Furthermore, an overview is provided of the challenges for healthy aging resulting from these age-related steroid alterations. While clinical practice guidelines recommend hormonal treatment only in the case of consistently low hormone levels and symptoms of hormone deficiency, physical exercise and a healthy lifestyle emerge as preventive strategies which can counter age-related hormonal changes and at best prevent chronic conditions.

Testosterone and Dehydroepiandrosterone Treatment in Ageing Men: Are We All Set?

Although demographic statistics show that populations around the world are rapidly ageing, this rising life expectancy is accompanied by an increase in the number of people living with age-related chronic conditions, such as frailty, cognitive decline, depression, or sexual dysfunction. In men, a progressive decline in androgens occurs with increasing age, and low androgen levels are associated with age-related chronic conditions. However, androgen administration studies are inconclusive, showing differing results according to the androgen used (testosterone [T], dehydroepiandrosterone [DHEA]), the group of men examined (younger vs. older; eugonadal vs. hypogonadal) and the conditions studied (frailty, cognitive decline, depression, sexual dysfunction). In this review, the current state for the use of T and DHEA therapy in men for the age-related conditions is examined. Due to the progressive age-related decline in androgens leading to a higher rate of older men having low androgen levels, the effects of androgen treatment in elderly males will be of particular interest in this review. Dose-response relationships, the role of potential moderators, and the androgen treatment-related risk for adverse events will be discussed. Studies have suggested that T treatment - more so than DHEA treatment - may be an effective therapy against age-related chronic conditions in men with low T levels; especially older men. Such conditions include frailty, depression, or sexual dysfunction. However, T treatment does not emerge as an effective therapy against cognitive decline. Nevertheless, more high-quality, randomised controlled trials using T treatment for age-related chronic conditions are necessary if further conclusions are to be made.

Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis

IMPORTANCE

Countering depressive disorders is a public health priority. Currently, antidepressants are the first-line treatment, although they show modest effects. In men, testosterone treatment is a controversial alternative or adjunct treatment option.

OBJECTIVES

To examine the association of testosterone treatment with alleviation of depressive symptoms in men and to clarify moderating effects of testosterone status, depression status, age, treatment duration, and dosage.

DATA SOURCES

English-language studies published in peer-reviewed journals identified from PubMed/Medline, Embase, Scopus, PsychINFO, and the Cochrane Controlled Trials Register from database inception to March 5, 2018, using the search terms testosterone, mood, administration, dosage, adverse effects, deficiency, standards, therapeutic use, therapy, treatment, and supplementation.

STUDY SELECTION

Randomized placebo-controlled clinical trials (RCTs) of testosterone treatment that together cover a broad age range and hypogonadal or eugonadal men reporting depressive symptoms on psychometrically validated depression scales.

DATA EXTRACTION AND SYNTHESIS

Of 7690 identified records, 469 were evaluated against full study inclusion criteria after removing duplicates, reviews, and studies that did not examine male patients or testosterone. Quality assessment and data extraction from the remaining 27 RCTs were performed.

MAIN OUTCOMES AND MEASURES

Primary outcomes were testosterone treatment effectiveness (standardized score difference after treatment), efficacy (proportion of patients who responded to testosterone treatment with a score reduction of 50% or greater), and acceptability (proportion of patients who withdrew for any reason).

RESULTS

Random-effects meta-analysis of 27 RCTs including 1890 men suggested that testosterone treatment is associated with a significant reduction in depressive symptoms compared with placebo (Hedges g, 0.21; 95% CI, 0.10-0.32), showing an efficacy of odds ratio (OR), 2.30 (95% CI, 1.30-4.06). There was no significant difference between acceptability of testosterone treatment and placebo (OR, 0.79; 95% CI, 0.61-1.01). Meta-regression models suggested significant interactions for testosterone treatment with dosage and symptom variability at baseline. In the most conservative bias scenario, testosterone treatment remained significant whenever dosages greater than 0.5 g/wk were administered and symptom variability was kept low.

CONCLUSIONS AND RELEVANCE

Testosterone treatment appears to be effective and efficacious in reducing depressive symptoms in men, particularly when higher-dosage regimens were applied in carefully selected samples. However, given the heterogeneity of the included RCTs, more preregistered trials are needed that explicitly examine depression as the primary end point and consider relevant moderators.

The poly-omics of ageing through individual-based metabolic modelling

BACKGROUND

Ageing can be classified in two different ways, chronological ageing and biological ageing. While chronological age is a measure of the time that has passed since birth, biological (also known as transcriptomic) ageing is defined by how time and the environment affect an individual in comparison to other individuals of the same chronological age. Recent research studies have shown that transcriptomic age is associated with certain genes, and that each of those genes has an effect size. Using these effect sizes we can calculate the transcriptomic age of an individual from their age-associated gene expression levels. The limitation of this approach is that it does not consider how these changes in gene expression affect the metabolism of individuals and hence their observable cellular phenotype.

RESULTS

We propose a method based on poly-omic constraint-based models and machine learning in order to further the understanding of transcriptomic ageing. We use normalised CD4 T-cell gene expression data from peripheral blood mononuclear cells in 499 healthy individuals to create individual metabolic models. These models are then combined with a transcriptomic age predictor and chronological age to provide new insights into the differences between transcriptomic and chronological ageing. As a result, we propose a novel metabolic age predictor.

CONCLUSIONS

We show that our poly-omic predictors provide a more detailed analysis of transcriptomic ageing compared to gene-based approaches, and represent a basis for furthering our knowledge of the ageing mechanisms in human cells.

MR-10 Enhances Men's Health by Improving Endogenous Male Sex Hormone Generation

Although there is a clear need for improving men's health, treatment with suitable natural substances has not yet been well established. Previously, it was reported that MR-10, a novel complex of Korean dandelion and rooibos found by screening many natural products, improved sperm generation and activity. Here, the ability of MR-10 to increase testosterone levels and enhance men's health was tested. Treatment with MR-10 (400 mg/day) for a month significantly increased levels of free testosterone, total testosterone, and the testosterone precursor dehydroepiandrosterone by 22%, 14%, and 32%, respectively, in clinical studies. Also, men's health in terms of mental, physical, and sexual aspects, as determined by using the clinical questionnaires Androgen Deficiency of Aging Men and Aging Males' Symptoms, was improved. Furthermore, the safety of MR-10 was determined by testing levels of prostate-specific antigen, glutamic oxaloacetic transaminase, and glutamic pyruvate transaminase; and the lack of changes due to MR-10 treatment supports the safety of MR-10. In conclusion, this study suggests that MR-10 is a safe and effective natural product improving men's sexual health.

Testosterone Pathway Genetic Polymorphisms in Relation to Primary Open-Angle Glaucoma: An Analysis in Two Large Datasets

Purpose

Sex hormones may be associated with primary open-angle glaucoma (POAG), although the mechanisms are unclear. We previously observed that gene variants involved with estrogen metabolism were collectively associated with POAG in women but not men; here we assessed gene variants related to testosterone metabolism collectively and POAG risk.

Methods

We used two datasets: one from the United States (3853 cases and 33,480 controls) and another from Australia (1155 cases and 1992 controls). Both datasets contained densely called genotypes imputed to the 1000 Genomes reference panel. We used pathway- and gene-based approaches with Pathway Analysis by Randomization Incorporating Structure (PARIS) software to assess the overall association between a panel of single nucleotide polymorphisms (SNPs) in testosterone metabolism genes and POAG. In sex-stratified analyses, we evaluated POAG overall and POAG subtypes defined by maximum IOP (high-tension [HTG] or normal tension glaucoma [NTG]).

Results

In the US dataset, the SNP panel was not associated with POAG (permuted P = 0.77), although there was an association in the Australian sample (permuted P = 0.018). In both datasets, the SNP panel was associated with POAG in men (permuted P ≤ 0.033) and not women (permuted P ≥ 0.42), but in gene-based analyses, there was no consistency on the main genes responsible for these findings. In both datasets, the testosterone pathway association with HTG was significant (permuted P ≤ 0.011), but again, gene-based analyses showed no consistent driver gene associations.

Conclusions

Collectively, testosterone metabolism pathway SNPs were consistently associated with the high-tension subtype of POAG in two datasets.

Lower birthweight and left-/mixed-handedness are associated with intensified age-related sex steroid decline in men. Findings from the Men's Health 40+ Study

In males, age‐related decline in free testosterone (T) and dehydroepiandrosterone (DHEA) by 2–3% per year has been reported. Estradiol (E2) and progesterone (P) seem to decrease as well, but to a lesser extent. Lower sex steroid levels in men have been related to physical and mental symptoms. Low birthweight and left‐/mixed‐handedness (L/MH) are indicators of an adverse fetal environment during pregnancy, and both have been linked to morbidity in later life. The aim of this study is to examine the relationship between lower birthweight as well as L/MH and age‐related sex steroid decline. In a cross‐sectional study design, saliva samples were collected under standardized conditions from healthy men for subsequent steroid hormone analysis using standard luminescence immunoassays. T (M = 67.57 pg/mL), DHEA (M = 247.91 pg/mL), E2 (M = 1.29 pg/mL), and P (M = 28.20 pg/mL) have been quantified leading to a final sample of 256 men providing complete data on sex hormones (M_Age=57.8; SD_Age = 10.8). Information on participants’ birthweight was obtained from birth reports (N = 134), and participants were asked about their handedness (right‐handed, left‐handed, mixed‐handed) (N = 256). Multivariate‐adjusted linear regression models relating each sex hormone individually and the principal component of declining steroid hormones (DSH)—an integrated hormonal parameter—with handedness and birthweight did not identify significant associations except for handedness and E2. Moderation analysis using robust regression accounting for bias due to influential data points detected a significant association between age and DSH for handedness (β = −0.0314, p = 0.040) but only a trend for birthweight (β = 0.0309, p = 0.073). For lower birthweight, a trend toward intensified age‐related sex steroid decline in men was observed, while for L/MH, a significant association with intensified age‐related sex steroid decline was identified. These results indicate that L/MH and potentially also lower birthweight might be considered as early risk factors for endocrine health in later life.

Emotions and Steroid Secretion in Aging Men: A Multi-Study Report

Although aging increases the risk of cognitive and socioemotional deterioration, it has also been shown to be accompanied by an increase in experienced positive emotions and a decrease in negative emotions. Steroid hormones and age-related alterations in secretion patterns have been suggested to play a crucial role in these age-related changes in emotional experience. Importantly, previous studies identified effects of neuroactive hormones on age-related alterations in emotional experience, which vary by sex and depression levels. Therefore, in three independent cross-sectional studies including a total of 776 men, we examined age-related differences in emotional experience and subsequently the moderation effect of steroid hormones. Sample one consisted of 271 self-reporting healthy (SRH) men aged between 40 and 75 years, while sample two comprised 121 men in the identical age range but only including vitally exhausted (VE) men. Sample three included 384 men aged between 25 and 78 years who reported having fathered (FA) at least one child. For the SRH men, age was negatively associated with anxiety symptoms and aggression, while negative trends emerged for depressive symptoms. In VE men, age was negatively associated with depressive symptoms and positively associated with aggression and positive emotions. For FA men, anxiety symptoms and aggression were negatively associated with age. Age trends of steroid hormones and identified moderation effects are reported. However, with adjustment for multiple comparisons, most of the significant associations fade and the reported associations need to be regarded as exploratory starting points for the further investigation of age-related alterations in emotional experience and their relation to steroid secretion. Overall, the results indicate that salivary cortisol might be a moderator of the association between age and symptoms of anxiety for SRH and VE men, while salivary testosterone seems to moderate the association between age and symptoms of anxiety or depression in VE and FA men, respectively. Both hair cortisol and progesterone seem to influence age-related alterations in anger experience. Age-related alterations in the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-gonadal (HPG) axis emerge as promising avenues to further investigate the decrease in experienced negative emotions in aging men.

Emotional Support, Depressive Symptoms, and Age-Related Alterations in Male Body Composition: Cross-Sectional Findings from the Men's Health 40+ Study

More depressive symptoms and low emotional support have been related to worse body composition. Body composition significantly deteriorates in aging men. Therefore, we aimed to examine whether high emotional support and low depressive symptoms are associated with better body composition and a decelerated age-related deterioration of body composition in aging men. A cross-sectional analysis including 269 self-reporting healthy men aged between 40 and 75 years living in the German-speaking part of Switzerland was conducted. Participants completed questionnaires on emotional support and depressive symptoms. The depression screening instrument was used to form a group with low (N = 225) and moderate (N = 44) depressive symptoms. Body mass index (BMI) and waist-to-hip ratio (WHR) were measured, and cell proportion (CP), fat mass (FM), and water balance (WB) were obtained using bioelectrical impedance analysis. Age-related associations emerged for WHR, CP, FM, and WB, but not for BMI. Emotional support was negatively associated with BMI, WHR, and WB, and only trend-wise with CP and FM. Group comparisons revealed that more depressive symptoms were associated with lower levels of CP and higher levels of WB. Both emotional support and depressive symptoms were significant moderators of the association between age and specific measures of body composition such as CP, FM, and WB. However, after correction for multiple testing for moderation analyses only the moderation effects of depressive symptoms on the association between age and WB and CP remained significant. Low depressive symptoms were associated with a better body composition as well as a decelerated decline in body composition and the role of emotional support acting as a buffer against age-related deterioration of body composition merits further investigation.

Are Psychosocial Resources Associated With Perceived Facial Aging in Men?

Background: Looking younger than actual age has been related to a variety of health outcomes. Optimism, self-esteem, and relationship satisfaction are important psychosocial resources for mental health. Little is known about their relation with a younger facial appearance. Objective: This study analyzed whether these psychosocial resources are associated with a younger facial appearance and if their effects were mediated through mental health. Method: A sample of N = 223 self-reporting healthy men aged 40 to 75 years filled in questionnaires to assess optimism (Life Orientation Test–Revised), self-esteem (Multidimensional Self-Esteem Scale), relationship satisfaction (Relationship Assessment Scale), and mental health (Short-Form Health Survey). Five female raters estimated the visual age of each participant from a frontal face photograph. Results: Looking younger (compared with chronological age) was correlated with optimism, relationship satisfaction, and mental health. Mediation analyses and structural equation modeling indicated that mental health mediated the association between each psychosocial resource and a younger appearance. Discussion: The results emphasize the importance of promoting psychosocial resources and mental health in men 40+ for the maintenance of good health and the deceleration of facial aging.

No Difference in Mood and Quality of Life in DHEA-S Deficient Adults with Addison's Disease vs. Type 2 Diabetes Patients with Normal DHEA-S Levels: Implications for Management of These Conditions

Patients with Addison's disease have relatively high rates of depression and anxiety symptoms compared with population-based reference samples. Addison's disease results in deficiency of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S). There is considerable debate about the specific effects of DHEA deficiency on energy level and mood. We measured emotional well-being in 16 patients with Addison's disease and a group of 16 hospital attendees with type 2 diabetes. Participants completed the General Health Questionnaire-28 (GHQ-28), the Hospital Anxiety and Depression Scale (HADS), the World Health Organization's quality of life assessment (WHOQOL-BREF) and the Holmes-Rahe life event scale. DHEA-S was low in Addison's patients (Addison's men: 0.5 ± 0.1 μmol/l [normal range: 2.1-10.8] compared with diabetes men: 3.2 ± 1.2 μmol/l; Addison's women: 0.4 ± 0.01 μmol/l [normal range: 1.0-11.5] compared with diabetes women: 2.2 ± 0.71 μmol/l). Testosterone levels were similar in both groups studied. There were no differences in emotional well-being and quality of life (QOL) between patients with Addison's disease and Type 2 Diabetes Mellitus as measured by GHQ-28 (Addison's: 22.4 ± 2.6, Diabetes: 19.6 ± 2.7), HADS Depression (Addison's: 5.4 ± 0.9, Diabetes: 4.5 ± 1.4), HADS Anxiety and WHOQOL-BREF. There were no gender differences in affective symptomatology within the Addison's group. Life event scores were above average in both groups (Addison's: 195 ± 39.6, Diabetes: 131 ± 43.8), but not significant for difference between groups as was GHQ-28 total score. Both groups scored highly on the GHQ-28 and the life event scale, indicative of poorer health perceptions than the general population. This could be due to the chronicity of both disorders. We have not identified any specific effects of DHEA-S deficiency on mood or QOL.

Psychobiological Protective Factors Modifying the Association Between Age and Sexual Health in Men: Findings From the Men's Health 40+ Study

Sexual health severely decreases with age. For males older than 40 years, erectile dysfunction (ED) is the most common sexual disorder. Although physical and psychological risk factors for ED have been identified, protective factors are yet to be determined. To date, no study has examined endocrine and psychosocial factors in parallel with regard to their modifying effect on the age-related increase in ED. Two hundred and seventy-one self-reporting healthy men aged between 40 and 75 years provided both psychometric data on sexual function and a set of potential psychosocial protective factors, and saliva samples for the analysis of steroid hormones and proinflammatory cytokines. Around 35% of the participants reported at least a mild form of ED. Direct associations with ED were identified for perceived general health, emotional support, relationship quality, intimacy motivation but not for steroid hormones or proinflammatory markers. Moderation analyses for the association between age and ED revealed positive effects for testosterone (T), dehydroepiandrosterone (DHEA), perceived general health, emotional support, intimacy motivation, and a negative effect for interleukin-6 (all p < .05; f² > .17). Group differences between older men with and without ED emerged for T, DHEA, and psychometric measures such as perceived general health, emotional support, satisfaction with life, and intimacy motivation (all p < .05; d > .3). Both psychosocial and endocrine parameters moderated the association between age and sexual health. Perceived general health, emotional support, intimacy motivation, and relationship quality emerged as psychosocial protective factors against ED. Higher T and DHEA and lower interleukin-6 levels also buffered against an age-related increase in ED.

Bipolar Spectrum Disorders in Male Youth: The Interplay between Symptom Severity, Inflammation, Steroid Secretion, and Body Composition

The morbidity and societal burden of youth bipolar spectrum disorders (BSD) are high. These disorders are multisystemic in that adult populations there are clear interactions with inflammatory processes and steroidal physiological systems. There are much less data concerning these areas of study in youth populations with BSD. This is surprising given the association of youth-onset BSD with puberty and its associated physiological changes. In this mini-review, we overview the theoretical role of inflammatory processes and steroidal physiological systems in youth BSD, describe the greater literature in adult populations, detail the literature in youth populations when available, and overview current proposed molecular mechanistic pathways and interaction effects based on the available data. We also attend to the interplay of this complex system with body composition and weight gain, an especially important consideration in relation to the role of second generation antipsychotics as the first line treatment for youth with BSD in major clinical guidelines. A developmental model of early onset BSD for boys is hypothesized with pubertal hormonal changes increasing risk for first (hypo-)manic/depressive episode. The dramatic androgen rise during puberty might be relevant for first onset of BSD in boys. A shift from general hypercortisolism driven by glucocorticoid resistance to hypocortisolism with further disease progression is assumed, while increased levels of inflammation are functionally associated with endocrine dysregulation. The interacting role of overweight body habitus and obesity in youth with BSD further indicates leptin resistance to be a central moderator of the dynamic neurobiology of BSD in youth. The intent of this mini-review is to advance our knowledge of youth BSD as multisystemic disorders with important contributions from endocrinology and immunology based on a developmental perspective. This knowledge can influence current clinical care and more importantly inform future research.

Neuroendocrinology of a Male-Specific Pattern for Depression Linked to Alcohol Use Disorder and Suicidal Behavior

Epidemiological studies show low rates of diagnosed depression in men compared to women. At the same time, high rates of alcohol use disorders (AUDs) and completed suicide are found among men. These data suggest that a male-specific pattern for depression may exist that is linked to AUDs and suicidal behavior. To date, no underlying neuroendocrine model for this specific pattern of male depression has been suggested. In this paper, we integrate findings related to this specific pattern of depression with underlying steroid secretion patterns, polymorphisms, and methylation profiles of key genes in order to detail an original neuroendocrine model of male-specific depression. Low circulating levels of sex steroids seem to increase the vulnerability for male depression, while concomitant high levels of glucocorticoids further intensify this vulnerability. Interactions of hypothalamus-pituitary-gonadal (HPG) and hypothalamus-pituitary-adrenocortical (HPA) axis-related hormones seem to be highly relevant for a male-specific pattern of depression linked to AUDs and suicidal behavior. Moreover, genetic variants and the epigenetic profiles of the androgen receptor gene, well-known depression related genes, and HPA axis-related genes were shown to further interact with men's steroid secretion and thus may further contribute to the proposed male-specific pattern for depression. This mini-review points out the multilevel interactions between the HPG and HPA axis for a male-specific pattern of depression linked to AUDs and suicidal behavior. An integration of multilevel interactions within the three-hit concept of vulnerability and resilience concludes the review.