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Dehghanbanadaki H, Jimbo M, Fendereski K, Kunisaki J, Horns JJ, Ramsay JM, Gross KX, Pastuszak AW, Hotaling JM. Transgenerational effects of paternal exposures: the role of germline de novo mutations. Andrology 2024. [PMID: 38396220 DOI: 10.1111/andr.13609] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/02/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Germline de novo mutations (DNMs) refer to spontaneous mutations arising during gametogenesis, resulting in genetic changes within germ cells that are subsequently transmitted to the next generation. While the impact of maternal exposures on germline DNMs has been extensively studied, more recent studies have begun to highlight the increasing importance of the effects of paternal factors. In this review, we have summarized the existing literature on how various exposures experienced by fathers affect the germline DNM burden in their spermatozoa, as well as their consequences for semen analysis parameters, pregnancy outcomes, and offspring health. A growing body of literature supports the conclusion that advanced paternal age (APA) correlates with a higher germline DNM rate in offspring. Furthermore, lifestyle choices, environmental toxins, assisted reproductive techniques (ART), and chemotherapy are associated with the accumulation of paternal DNMs in spermatozoa, with deleterious consequences for pregnancy outcomes and offspring health. Ultimately, our review highlights the clear importance of the germline DNM mode of inheritance, and the current understanding of how this is affected by various paternal factors. In addition, we explore conflicting reports or gaps of knowledge that should be addressed in future research.
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Affiliation(s)
- Hojat Dehghanbanadaki
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Masaya Jimbo
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Kiarad Fendereski
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Jason Kunisaki
- Department of Human Genetics, University of Utah, Salt Lake City, Utah, USA
| | - Joshua J Horns
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Joemy M Ramsay
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Kelli X Gross
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
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2
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Allen-Brady KL, Christensen MB, Sandberg AD, Pastuszak AW. Significant familial clustering of Peyronie's disease in close and distant relatives. Andrology 2022; 10:1361-1367. [PMID: 35770847 PMCID: PMC9481671 DOI: 10.1111/andr.13223] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peyronie's disease (PD) has previously been observed to co-aggregate in a small number of first-degree relative pairs (e.g., father-son). However, the familial aggregation of PD in more distant relatives, as well as the aggregation of Dupuytren's disease (DD) in probands and relatives, has not been thoroughly investigated. OBJECTIVE This study explored the evidence for familial clustering of PD and DD in close and distant relatives. MATERIALS AND METHODS The Utah Population Database, which includes genealogy information linked to electronic medical records (available since 1995), was used to identify men and their relatives with PD and DD based on ICD9/10 codes. All cases were required to have high-quality genealogy data. We estimated relative risk (RR) of PD and DD in first- through fifth-degree relatives compared to matched population rates of disease. We also investigated the average relatedness of cases compared to the average relatedness of sets of matched controls. Outcome measures include estimation of relative risk and excessive relatedness as measured by a Genealogical Index of Familiality (GIF) analysis. RESULTS We analyzed 307 individuals with PD, and their first- through fifth-degree relatives. Approximately 0.12% of the population had PD, 95% of these were diagnosed over the age of 30 years (age range: 10-92 years), and 1.3% of PD probands had a comorbid diagnosis of DD. RR estimates for PD were significant for first- and fifth-degree relatives. RR estimates for DD were significant only for probands. The average relatedness of cases was significantly greater than matched controls, even after removing first- and second-degree relatives. We also found that 74.9% of identified PD probands belonged to pedigrees with a statistical excess of PD. CONCLUSION Despite the low prevalence of PD in our healthcare records, the results provide evidence that support a genetic contribution to at least a subset of PD cases.
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Affiliation(s)
- Kristina L Allen-Brady
- Genetic Epidemiology, Department of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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3
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Twitchell DK, Christensen MB, Hackett G, Morgentaler A, Saad F, Pastuszak AW. Examining Male Predominance of Severe COVID-19 Outcomes: A Systematic Review. Androg Clin Res Ther 2022; 3:41-53. [PMID: 36199281 PMCID: PMC9527649 DOI: 10.1089/andro.2022.0006] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 05/26/2023]
Abstract
Although not universal, many epidemiological data sources signal that a higher proportion of males than females with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections have adverse outcomes, such as intensive care unit (ICU) admission and death. Though likely multifactorial, the various hypotheses that have been proposed as underlying factors behind this trend are related to greater smoking prevalence among males, testosterone (T) deficiency causing an inflammatory storm, androgen-driven pathogenesis of SARS-CoV-2, a protective effect of estrogen in females, and inborn errors of cytokine immunity. This review aims at examining the evidence and at assessing the likelihood that the factors being investigated are contributory to the reported trend of male predominance of severe COVID-19 cases. Sources were obtained using the PubMed database and were selected based on their relevance to one of the primary hypotheses attempting to explain the strong male sex bias of severe SARS-CoV-2 infections. Emphasis was placed on meta-analyses and population-based studies. Sources are current through February 22, 2022. A severe COVID-19 case or outcome is defined in this review as a progression of the SARS-CoV-2 virus that results in either admission to an ICU for management of symptoms and clinical stabilization or which leads to death. Although the trend of male predominance of severe COVID-19 cases is likely multifactorial, the hypothesis of T deficiency causing an inflammatory storm has support from many studies with limited conflicting evidence. An inborn error in cytokine immunity is also well supported, but it needs more studies to add support to the hypothesis. The immunologic protective effect of estrogen is supported by multiple studies, but it also has conflicting evidence. It appears less likely that the trend is caused solely by an increased prevalence of smoking among males or an androgen-driven pathogenesis, based on the extent of conflicting evidence.
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Affiliation(s)
| | - Michael B. Christensen
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Geoffrey Hackett
- Department of Men's Health, Little Aston Hospital, Sutton Coldfield, United Kingdom
| | - Abraham Morgentaler
- Division of Urology, Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Farid Saad
- Department of Men's Health Research, Gulf Medical University, Ajman, UAE
| | - Alexander W. Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Patel DP, Cheng PJ, Hanson HA, Smith KR, Aston KI, Pastuszak AW, Hotaling JM. Seasonal variation in semen quality is not associated with fecundity in the Utah Population Database. Andrologia 2022; 54:e14515. [PMID: 35768958 DOI: 10.1111/and.14515] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/06/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022] Open
Abstract
We determine whether a suspected seasonal variability in semen quality affect subsequent live birth rates. This is a retrospective, cohort analysis of men who provided semen analyses as part of fertility workup through a large andrology lab between 1996 and 2013 and corresponding birth rates using the Utah Population Database (UPDB). Semen parameters were analysed including total motile count (TMC), total sperm count, sperm concentration and progressive motility. Corresponding live births reflect those born in the state of Utah and were derived from birth certificate data available in the UPDB. Descriptive statistics were reported along with linear regression analysis with mixed effected models to test for an interaction between seasonal variation in semen quality and birth rates, accounting for age at the time of the semen analysis and abstinence time. A total of 11,929 patients and 14,765 semen samples were included. Only 3597 men (39% of men) had one or more values outside the World Health Organization reference range for their semen parameters. Linear regression demonstrated a consistent U-shaped relationship between TMC, total sperm count, and sperm concentration and season, with spring and winter yielding the highest values with a decline in the summer and fall. 7319 of these males had recorded live births for a total of 13,502 live births during the study period after a median follow-up of 7.2 years (IQR: 3.9-11.0). We did not find a significant interaction between specific semen parameters for a specific season and subsequent live births. Semen quality was the highest in the spring and winter, however there was no interaction between seasonal variability in semen quality and subsequent births. This is one of the largest studies describing seasonal variation in semen quality in humans.
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Affiliation(s)
- Darshan P Patel
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Philip J Cheng
- IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey, USA
| | - Heidi A Hanson
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA.,Computational Science and Engineering, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
| | - Ken R Smith
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah, USA
| | - Kenneth I Aston
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
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Patel DP, Horns JJ, Pastuszak AW, Hsieh TC, Yafi FA, Hotaling JM. Hypogonadism associated with higher rate of penile prosthesis infection: An Analysis of United States claims data. Urology 2022; 167:132-137. [PMID: 35768026 DOI: 10.1016/j.urology.2022.06.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand the relationship between hypogonadism and penile prosthesis infection risk. METHODS We performed a retrospective analysis using IBM MarketScan™ Commercial Claims and Encounters database. We identified men with ED diagnosis who underwent penile prosthesis placement from 1/1/2008 to 12/31/2017. Comorbidities and risk factors were identified along with a diagnosis of hypogonadism. After placement of penile prosthesis, men were followed until date of surgery of penile prosthesis explant due to infection. Cox proportional hazards models from time of penile prosthesis surgery to date of infection adjusting for various known confounding factors were run. RESULTS We identified 16,660 men who had received penile prosthesis during the study period. 4,832 (29.0%) men had a hypogonadism diagnosis at the time of their initial surgery date. There were 421 (2.5%) device infections requiring explanation. Descriptively, a higher percentage of infections were noted for removal and replacement surgeries compared to primary implants. Hypogonadism was independently associated with a 25.8% higher risk of penile prosthesis infection (HR: 1.258, 95% CI: 1.024-1.546). Among those men who received testosterone therapy for hypogonadism (prescription data within 0-30 days and within 0-90 days of their initial implant surgery), the effect of hypogonadism on infection risk was no longer significant. CONCLUSIONS Untreated hypogonadism was associated with a 26% higher risk of penile prosthesis infection. This association was most pronounced in men undergoing removal and replacement surgery, which likely drives this association. This suggests a possible benefit to testosterone therapy in testosterone deficient men prior to penile implant, specifically in men undergoing revision.
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Affiliation(s)
- Darshan P Patel
- Department of Urology, University of California San Diego, La Jolla, CA, USA.
| | - Joshua J Horns
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA; Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA.
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA, USA.
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Orange, CA, USA.
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
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6
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Moghalu OI, Das R, Horns J, Campbell A, Hotaling JM, Pastuszak AW. Trends in treatment of Peyronie's disease in adult men in the United States from 2008 to 2017-results from an encounter and claims database. Int J Impot Res 2022; 34:280-288. [PMID: 33828265 PMCID: PMC8494877 DOI: 10.1038/s41443-021-00430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
Treatments for Peyronie's Disease (PD) include oral medications, intralesional injections, and surgery. Collagenase Clostridium histolyticum (CCh) is the only FDA-approved treatment for PD. We sought to examine current trends in treatment of PD across the United States. Using data in the MarketScan Database, we conducted a retrospective study of men with PD in the United States. Cases were identified by ICD-9 and 10 codes, and treatments were identified using NDC and CPT codes. Treatment rates were analyzed using a linear regression model, and a Cox proportional hazard function test was performed for time-to-treatment analysis. About 27.8% of men with PD were treated within a year of diagnosis. The annual treatment rate increased from 23.2 to 35.4%, and intralesional injection was the most used treatment. Over the study period, the percentage of men receiving treatment with oral medication increased from 0.66 to 20.5%, while the use of intralesional injection and surgery decreased. Increased odds of treatment were observed in men 45-54 years (odds ratio [OR] 1.35; 95% confidence interval [CI], 1.21-1.50; p = 0) and in the southern region (OR 1.48; 95% CI, 1.39-1.56; p = 0). Trends in treatment of PD have changed over time. Intralesional injection remains the most used treatment option for men with PD.
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Affiliation(s)
- Odinachi I Moghalu
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America.
| | - Rupam Das
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
| | - Joshua Horns
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
| | - Alexander Campbell
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
| | - James M Hotaling
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Utah Center for Reproductive Medicine, Salt Lake City, Utah, United States of America
| | - Alexander W Pastuszak
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, Utah, United States of America
- Utah Center for Reproductive Medicine, Salt Lake City, Utah, United States of America
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7
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Lo SP, Hsieh TC, Pastuszak AW, Hotaling JM, Patel DP. Effects of SARS CoV-2, COVID-19, and its vaccines on male sexual health and reproduction: where do we stand? Int J Impot Res 2022; 34:138-144. [PMID: 34707243 PMCID: PMC8548269 DOI: 10.1038/s41443-021-00483-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered, there have been questions surrounding the effects of coronavirus disease 2019 (COVID-19), and more recently the COVID-19 vaccine, on men's health and fertility. Significant research has been conducted to study viral tropism, potential causes for gender susceptibility, the impact of COVID-19 on male sexual function in the acute and recovery phases, and the effects of the virus on male reproductive organs and hormones. This review provides a recent assessment of the literature regarding the impact of COVID-19 and its vaccine on male sexual health and reproduction.
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Affiliation(s)
- Sharon P Lo
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Darshan P Patel
- Department of Urology, University of California San Diego, La Jolla, CA, USA.
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8
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Pastuszak AW, Patel DP, Jenkins LC, Hsieh TC, Yafi FA, Mumford SL, Mulhall JP, Hotaling JM. A Call for Quality: Substandard Research in Male Sexual and Reproductive Medicine During the COVID-19 Pandemic. J Sex Med 2022; 19:1-4. [PMID: 34844887 PMCID: PMC8556583 DOI: 10.1016/j.jsxm.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Darshan P Patel
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | | | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
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9
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Moghalu OI, Das R, Horns J, Campbell A, Hotaling JM, Pastuszak AW. Regional variation in the incidence and prevalence of Peyronie's disease in the United States-results from an encounters and claims database. Int J Impot Res 2022; 34:64-70. [PMID: 33024286 PMCID: PMC8021604 DOI: 10.1038/s41443-020-00363-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Abstract
In recent years there have been more studies dedicated to Peyronie's disease (PD). However, prevalence and incidence are likely underestimated, with limited information on regional variation in the rate of diagnosis. In this study, we sought to estimate age and regional variation of the annual incidence and prevalence of PD in the United States. We reviewed data from the IBM MarketScan™ Claims and Encounters database between 2008-2017 for men ≥18 years. Inclusion required ≥1 medical claim with PD, identified by ICD-9 and ICD-10 codes or ≥1 claim for intralesional injection for PD, identified by Current Procedure Terminology (CPT) code. Overall average annual incidence was estimated at 20.9 cases per 100,000, with the highest rate of 41.6 cases per 100,000 observed in men 55-64 years (RR = 8.2; p < 0.0001). Geographically, the highest incidence rate was observed in the South (23.9 cases per 100,000 men; RR = 1.30; p < 0.0001). Across all ages, overall prevalence of PD showed a general upward trend, from 0.052% in 2008 to 0.096% in 2017. Our findings suggest men in the southern U.S. are diagnosed more with PD compared to other regions. Identification of associated factors may allow for a more proactive approach to diagnosis and management.
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Affiliation(s)
- Odinachi I Moghalu
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT, USA.
| | - Rupam Das
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT, USA
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, UT, USA
| | - Joshua Horns
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT, USA
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, UT, USA
| | - Alexander Campbell
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT, USA
- Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, UT, USA
| | - James M Hotaling
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT, USA
- Utah Center for Reproductive Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT, USA
- Utah Center for Reproductive Medicine, Salt Lake City, UT, USA
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10
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Jørgensen N, Lamb DJ, Levine H, Pastuszak AW, Sigalos JT, Swan SH, Eisenberg ML. Are worldwide sperm counts declining? Fertil Steril 2021; 116:1457-1463. [PMID: 34836581 DOI: 10.1016/j.fertnstert.2021.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Niels Jørgensen
- University Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Dolores J Lamb
- Department of Urology, Weill Cornell Medical College, New York, New York; Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, New York; Center for Reproductive Genomics, Weill Cornell Medical College, New York, New York
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health Science Center, Salt Lake City, Utah
| | - John T Sigalos
- Department of Urology, University of California Los Angeles, Los Angeles, California
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; Department of Urology, Stanford University School of Medicine, Stanford, California.
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11
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Wright L, Hotaling J, Pastuszak AW. Response to the Letter-to-the-Editor: "Erectile Dysfunction and Treatment: An Analysis of Associated Chronic Health Conditions". Urology 2021; 160:231. [PMID: 34788665 DOI: 10.1016/j.urology.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Lindsey Wright
- Univeristy of Utah School of Medicine, Salt Lake City, UT, USA
| | - James Hotaling
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT USA; Department of Surgery, Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, UT, USA.
| | - Alexander W Pastuszak
- Department of Surgery, Division of Urology, University of Utah Health Science Center, Salt Lake City, UT USA
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12
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Patel DP, Meeks HT, Pastuszak AW, Hanson HA, Smith KR, Letourneau JM, Hotaling JM. Lower female partner live birth rate in male cancer survivors: An age-matched cohort analysis of the Utah Population Database. Andrologia 2021; 54:e14293. [PMID: 34734429 DOI: 10.1111/and.14293] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/29/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022] Open
Abstract
We determine the time to first live birth for female partners of males after a cancer diagnosis. Our group performed a retrospective, population-based, age-matched cohort study of Utah male residents diagnosed with cancer at age 18 years or later between 1956 and 2013 (exposed) matched to male Utah residents without cancer diagnosis (unexposed). Using stratified Cox proportional hazard models, we adjusted for race, ethnicity and number of live births prior to cancer diagnosis, to estimate the effect of time to a partner live birth following cancer diagnosis. Our study cohort included 19,303 men diagnosed with cancer (exposed) and 93,608 age-matched men without cancer diagnoses (unexposed). Exposed men were less likely to have a live birth prior to first cancer diagnosis (60.7% vs. 65.4%, p < 0.001) and after first cancer diagnosis (10.9% vs. 12.2%, p < 0.001) compared to unexposed men. Exposed men had a fertility hazard rate that was 31% lower after cancer diagnosis date than unexposed men (HR: 0.69; 95% CI: 0.65-0.72). This was most profound for men aged 18-30 years (HR: 0.59, 95% CI: 0.55-0.63). Male cancer survivors have a 31% lower female partner live birth rate after cancer diagnosis. These findings are important for patient counselling regarding fertility preservation at the time of cancer diagnosis.
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Affiliation(s)
- Darshan P Patel
- Department of Urology, University of California San Diego, La Jolla, California, USA
| | - Huong T Meeks
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Heidi A Hanson
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Ken R Smith
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah, USA
| | - Joseph M Letourneau
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
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13
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Pastuszak AW, Gittelman M, Tursi JP, Jaffe JS, Schofield D, Miner MM. Pharmacokinetics of testosterone therapies in relation to diurnal variation of serum testosterone levels as men age. Andrology 2021; 10:209-222. [PMID: 34510812 PMCID: PMC9293229 DOI: 10.1111/andr.13108] [Citation(s) in RCA: 3] [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: 04/12/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Background To improve symptoms associated with testosterone deficiency, many testosterone therapies are available that aim to restore serum testosterone (T) levels to the normal physiologic range. The magnitude, frequency, and duration between peak and trough T concentrations vary with route of administration, and none reflect normal endogenous daily diurnal T variations. Objective To compare pharmacokinetic profiles of serum T from approved T formulations with endogenous diurnal T variations in young and older men, and to consider whether there may be value in mimicking the diurnal T rhythmicity with exogenous testosterone therapies as men age. Materials and methods A literature search of studies examining the diurnal variation of endogenous T in healthy men and men with testosterone deficiency was performed using PubMed in January 2020. Additional searches for serum T pharmacokinetic profiles of various testosterone therapy formulations were also conducted. Prescribing information for various T formulations was also reviewed. Discussion and conclusion Endogenous diurnal T variation is well described and appears to be blunted naturally as men age. Men with testosterone deficiency lack diurnal T variation and exhibit a flatter T profile compared with eugonadal men. Some T replacement options provide intraday T level variations similar to normal circadian secretion, and others provide a flatter exposure profile reflective of depot release. Others provide profiles that exceed the frequency and physiologic range of the natural diurnal variation of T. All exogenous T replacement dosing targets an increase in average T levels to within the normal physiologic range and improves symptoms associated with low T, but no single testosterone therapy can exactly mimic the normal diurnal T patterns seen in younger men and the blunted circadian T secretion of older men.
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Affiliation(s)
| | - Marc Gittelman
- 21st Century Oncology, Uro-Medix/GenesisCare, Aventura, Florida, USA
| | | | | | | | - Martin M Miner
- Men's Health Center, Miriam Hospital, Providence, Rhode Island, USA
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14
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Keihani S, Verrilli LE, Zhang C, Presson AP, Hanson HA, Pastuszak AW, Johnstone EB, Hotaling JM. Semen parameter thresholds and time-to-conception in subfertile couples: how high is high enough? Hum Reprod 2021; 36:2121-2133. [PMID: 34097024 DOI: 10.1093/humrep/deab133] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 06/24/2020] [Revised: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION What thresholds for total sperm count, sperm concentration, progressive motility, and total progressive motile sperm count (TPMC) are associated with earlier time-to-conception in couples undergoing fertility evaluation? SUMMARY ANSWER Values well above the World Health Organization (WHO) references for total sperm count, concentration, and progressive motility, and values up to 100 million for TPMC were consistently associated with earlier time-to-conception and higher conception rates. WHAT IS KNOWN ALREADY Although individual semen parameters are generally not able to distinguish between fertile and infertile men, they can provide clinically useful information on time-to-pregnancy for counseling patients seeking fertility treatment. Compared to the conventional semen parameters, TPMC might be a better index for evaluating the severity of male infertility. STUDY DESIGN, SIZE, DURATION We used data from a longitudinal cohort study on subfertile men from 2002 to 2017 and included 6061 men with initial semen analysis (SA) in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Men from subfertile couples who underwent a SA within the study period were included, and 5-year follow-up data were collected to capture conception data. Couples were further categorized into two subgroups: natural conception (n = 5126), after separating those who achieved conception using ART or IUI; natural conception without major female factor (n = 3753), after separating those with severe female factor infertility diagnoses. TPMC was calculated by multiplying the semen volume (ml) by sperm concentration (million/ml) and the percentage of progressively motile sperm (%). Cox proportional hazard models were used to report hazard ratios (HRs) with 95% CIs before and after adjusting for male age, the number of previous children before the first SA, and income. Using the regression tree method, we calculated thresholds for total sperm count, sperm concentration, progressive motility, and TPMC to best differentiate those who were more likely to conceive within 5 years after first SA from those less likely to conceive. We also plotted continuous values of semen parameters in predicting 5-year conception rates and time-to-conception. MAIN RESULTS AND THE ROLE OF CHANCE Overall, the median time to conception was 22 months (95% CI: 21-23). A total of 3957 (65%) couples were known to have achieved conception within 5 years of the first SA. These patients were younger and had higher values of sperm concentration, progressive motility, and TPMC. In the overall cohort, a TPMC of 50 million best differentiated men who were more likely to father a child within 5 years. Partners of men with TPMC ≥50 million had a 45% greater chance of conception within 5 years in the adjusted model (HR: 1.45; 95% CI: 1.34-1.58) and achieved pregnancy earlier compared to those men with TPMC < 50 million (median 19 months (95% CI: 18-20) versus 36 months (95% CI: 32-41)). Similar results were observed in the natural conception cohort. For the natural conception cohort without major female factor, the TPMC cut-off was 20 million. In the visual assessment of the graphs for the continuous semen parameter values, 5-year conception rates and time-to-conception consistently plateaued at higher values of sperm concentration, total sperm count, progressive motility, and TPMC compared to the WHO reference levels and our calculated thresholds. For TPMC, values up to 100-150 million were still associated with a better conception rate and time-to-conception in the visual assessment of the curves. LIMITATIONS, REASONS FOR CAUTION There was limited information on female partners and potential for inaccuracies in capturing less severe female infertility diagnoses. Also we lacked details on assisted pregnancies achieved outside of our healthcare network (with possible miscoding as 'natural conception' in our cohort). We only used the initial SA and sperm morphology, another potentially important parameter, was not included in the analyses. We had no information on continuity of pregnancy attempts/intention, which could affect the time-to-conception data. Finally, most couples had been attempting conception for >12 months prior to initiating fertility treatment, so it is likely that we are underestimating time to conception. Importantly, our data might lack the generalizability to other populations. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that a TPMC threshold of 50 million sperm provided the best predictive power to estimate earlier time-to-conception in couples evaluated for male factor infertility. Higher values of sperm count, concentration and progressive motility beyond the WHO references were still associated with better conception rates and time-to-conception. This provides an opportunity to optimize semen parameters in those with semen values that are low but not abnormal according to the WHO reference values. These data can be used to better inform patients regarding their chances of conception per year when SA results are used for patient counseling. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Lauren E Verrilli
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Heidi A Hanson
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Erica B Johnstone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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15
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Pastuszak AW, Bush M, Curd L, Vijayan S, Priestley T, Xiang Q, Hu Y. Population Pharmacokinetic Modeling and Simulations to Evaluate a Potential Dose Regimen of Testosterone Undecanoate in Hypogonadal Males. J Clin Pharmacol 2021; 61:1618-1625. [PMID: 34269421 PMCID: PMC9290951 DOI: 10.1002/jcph.1939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
Intramuscular testosterone undecanoate is indicated as testosterone replacement in adult males with a deficiency in or absence of endogenous testosterone (hypogonadism). Intramuscular testosterone undecanoate 750 mg is approved to be administered at initiation and at 4 weeks, followed by a maintenance dose every 10 weeks. However, a more frequent maintenance regimen may improve symptom management of low testosterone at the end of each dosing interval. The current objective was to develop a population pharmacokinetic (PK) model for intramuscular testosterone undecanoate 750 mg and to perform PK simulations to assess the impact of an 8-week maintenance regimen on testosterone exposure. A 1-compartment model with first-order absorption and first-order elimination best described the PK of testosterone undecanoate. The model included time-dependent suppression and gradual recovery of endogenous testosterone production during testosterone undecanoate administration. Significant covariates included body weight and sex hormone binding globulin level. With the final PK model, simulations were performed to evaluate the impact of an 8-week versus a 10-week maintenance regimen on testosterone exposure. The 8-week testosterone undecanoate regimen had a predicted 11% increase in Cavg and Ctrough and a 5% increase in Cmax . This translated into an ≈10% increase in the percentage of patients predicted to have Ctrough >300 ng/dL, minimal change in the percentage of patients with Cavg in the normal range, and a low likelihood of Cmax >2500 ng/dL. These simulations suggest that more frequent administration of intramuscular testosterone undecanoate may be beneficial in some patients. Further clinical evaluation of an 8-week dose regimen is warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | | | | | | | - Yiqun Hu
- Endo Pharmaceuticals Inc., Malvern, PA, USA
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16
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Cheng PJ, Kim J, Craig JR, Alukal J, Pastuszak AW, Walsh TJ, Hotaling JM. "The Back-up Vasectomy Reversal." Simultaneous Sperm Retrieval and Vasectomy Reversal in the Couple With Advanced Maternal Age: A Cost-Effectiveness Analysis. Urology 2021; 153:175-180. [PMID: 33812879 DOI: 10.1016/j.urology.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/21/2021] [Accepted: 03/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of different fertility options in men who have undergone vasectomy in couples with a female of advanced maternal age (AMA). The options include vasectomy reversal (VR), sperm retrieval (SR) with in vitro fertilization (IVF), and the combination of VR and SR with IVF, which is a treatment pathway that has been understudied. MATERIALS AND METHODS Using TreeAge software, a model-based cost-utility analysis was performed estimating the cost per quality-adjusted life years (QALY) in couples with infertility due to vasectomy and advanced female age over a period of one year. The model stratified for female age (35-37, 38-40, >40) and evaluated four strategies: VR followed by natural conception (NC), SR with IVF, VR and SR followed by failed NC and then IVF, and VR and SR followed by failed IVF and then NC. QALY estimates and outcome probabilities were obtained from the literature and average patient charges were calculated from high-volume centers. RESULTS The most cost-effective fertility strategy was to undergo VR and try for NC (cost-per-QALY: $7,150 (35-37 y), $7,203 (38-40 y), and $7,367 (>40 y)). The second most cost-effective strategy was the "back-up vasectomy reversal": undergo VR and SR, attempt IVF and switch to NC if IVF fails. CONCLUSION In couples with a history of vasectomy and female of AMA, it is most cost-effective to undergo a VR. If the couple opts for SR for IVF, it is more cost-effective to undergo a concomitant VR than SR alone.
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Affiliation(s)
- Philip J Cheng
- Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ, Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology, and Reproductive Sciences.
| | - Jaewhan Kim
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - James R Craig
- Fontana Medical Center, Kaiser Permanente, Fontana, CA
| | - Joseph Alukal
- Department of Urology, Columbia University Medical Center, New York, NY
| | | | - Thomas J Walsh
- Department of Urology, University of Washington, Seattle, WA
| | - James M Hotaling
- Division of Urology, University of Utah, Salt Lake City, UT, Reproductive Medicine Associates of New Jersey
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17
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Dupree JM, Coward RM, Hsieh TC, Tanrikut C, Shin P, Mehta A, Hotaling JM, Pastuszak AW, Williams D, Alukal J, Lipshultz LI, Schlegel P, Walsh TJ, Eisenberg ML, Shin D, Honig S, Nagler HM, Samplaski M, Nangia AK, Sandlow J, Smith JF. The Impact of Physician Productivity Models on Access to Subspecialty Care: A White Paper From the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology. Urology 2021; 153:28-34. [PMID: 33484822 DOI: 10.1016/j.urology.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 01/25/2023]
Abstract
Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvantages of various physician productivity measurement systems for male infertility practices. We close with recommendations for measuring productivity that we hope urologists and administrators can use when creating productivity plans for male infertility practices.
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Affiliation(s)
- James M Dupree
- Department of Urology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC and UNC Fertility LLC, Raleigh NC
| | | | | | - Paul Shin
- Department of Urology, Shady Grove Fertility, Washington, DC
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | | | - Daniel Williams
- Department of Urology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI
| | - Joseph Alukal
- Department of Urology, Columbia University, New York, NY
| | | | - Peter Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY
| | - Thomas J Walsh
- Department of Urology, Men's Health Center at University of Washington Medical Center, Seattle, WA
| | - Michael L Eisenberg
- Department of Urology, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - David Shin
- Department of Urology, Hackensack Meridan School of Medicine, Nutley, NJ
| | - Stan Honig
- Department of Urology, Yale Urology, New Haven, CT
| | - Harris M Nagler
- Department of Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Mary Samplaski
- University of Southern California, Institute of Urology, Los Angeles, CA
| | - Ajay K Nangia
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Jay Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - James F Smith
- Department of Urology, University of California San Francisco, San Francisco, CA
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18
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Hanson BM, Kohn TP, Pastuszak AW, Scott RT, Cheng PJ, Hotaling JM. Round spermatid injection into human oocytes: a systematic review and meta-analysis. Asian J Androl 2021; 23:363-369. [PMID: 33565426 PMCID: PMC8269823 DOI: 10.4103/aja.aja_85_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.
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Affiliation(s)
- Brent M Hanson
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA
| | - Taylor P Kohn
- Department of Urology, The Brady Urological Institute at Johns Hopkins University, Baltimore, MD 21287, USA
| | - Alexander W Pastuszak
- Department of Surgery, University of Utah Center for Reconstructive Urology and Men's Health, Salt Lake City, UT 84108, USA
| | - Richard T Scott
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA
| | - Philip J Cheng
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA.,Department of Surgery, University of Utah Center for Reconstructive Urology and Men's Health, Salt Lake City, UT 84108, USA
| | - James M Hotaling
- Department of Reproductive Endocrinology and Infertility, IVI-Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ 07920, USA.,Department of Surgery, University of Utah Center for Reconstructive Urology and Men's Health, Salt Lake City, UT 84108, USA
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19
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Khera M, Miner M, Jaffe J, Pastuszak AW. Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk. J Sex Med 2020; 18:83-98. [PMID: 33317996 DOI: 10.1016/j.jsxm.2020.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/01/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment of "adult-onset hypogonadism" (AOH) with exogenous testosterone therapy (TTh) to raise serum testosterone (T) levels may influence cardiovascular (CV) risk factors in patients with AOH, whereas low endogenous T levels are associated with an increased CV risk and mortality. AIM To critically evaluate studies reporting increased CV risk associated with TTh and to provide an overview of the risks and benefits of restoring T levels through exogenous TTh. METHODS A review of publications focusing on the association between TTh and increased CV risk was conducted, and the study methodologies and conclusions of each were critically evaluated. Further, recent clinical and epidemiological studies associating AOH or TTh with a change in CV risk, and pertinent hematologic and vascular effects noted in animal studies and in vitro, as well as in clinical practice were also reviewed. OUTCOMES A review of the literature shows that untreated testosterone deficiency and/or low T is associated with an increase in CV risk and adverse outcomes, with numerous studies and meta-analyses to support a positive association between exogenous TTh and an improvement in CV risk factors in men with AOH. RESULTS Numerous studies in the literature demonstrate the positive benefits of using TTh; however, since 2013, some publications have suggested a link to increased CV risk associated with TTh. A number of these studies retrospectively analyzed insurance claims databases using diagnosis codes, procedures codes, and prescription information. Many reviews published since have pointed out the methodological flaws and debatable conclusions of these studies. CLINICAL IMPLICATIONS A careful assessment of the patient's current health status and CV risk factors should be weighed against the benefits and possible risks resulting from TTh, and consideration should be given to deferring treatment pending resolution or stabilization of CV disease or risk factors. STRENGTHS & LIMITATIONS In this review, we provide an in-depth analysis of studies reporting increased CV risk with TTh. Many of the studies were not well-designed, randomized, double-blind, prospective clinical trials but rather post hoc analyses of cohort data. These studies may reflect bias in how treatment and nontreatment decisions are made or reflect conclusions based on widely cited methodological flaws. CONCLUSION Appropriate patient selection supported by low pre-treatment T levels and monitoring T levels during treatment with the goal of achieving and maintaining physiologic levels all contribute to the safe and effective use of TTh in men with AOH. Khera M, Miner M, Jaffe J, et al. Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk. J Sex med 2021;18:83-98.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | - Martin Miner
- Clinical Professor of Family Medicine and Urology, Brown University, Providence, RI, USA
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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20
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Abstract
INTRODUCTION Testosterone prescriptions have increased dramatically in recent years, largely because of changes in expert guidelines. Concerns have been raised that testosterone therapy (TTh) may be associated with an increased incidence of conditions such as cardiovascular (CV) disease, thromboembolic events, obstructive sleep apnea (OSA), benign prostatic hyperplasia (BPH), and prostate cancer (PCa) and also may be a beneficial therapy in the management of prediabetes. As such, considerable debate remains regarding which hypogonadal populations are appropriate candidates for TTh. OBJECTIVES This systematic review aims to affirm or refute, using the most current evidence, the published concerns surrounding TTh and its potential increased risk of conditions such as CV disease, thromboembolic events, OSA, urolithiasis, BPH, and PCa, as well as its role as a potential tool for managing prediabetes. METHODS A systematic review of literature surrounding TTh and its impact on increasing risk for the adverse conditions mentioned previously was performed. 62 publications were selected for inclusion based on their relevance to the effects and risks of TTh. Evidence is current through December 2019. RESULTS Evidence demonstrates that positive associations exist between TTh and OSA, erythrocytosis, as well as urolithiasis. TTh may potentially be used to treat hypogonadal men with prediabetes. While low testosterone is positively correlated with adverse CV events, TTh in hypogonadal men either has no effect or decreases such risk. TTh is likely not associated with increased risk of PCa incidence or recurrence. CONCLUSIONS Despite historical beliefs that TTh increases the risk of CV disease, thromboembolic events, BPH, and PCa, recent evidence suggests that TTh conveys less risk than previously perceived. While caution should continue to be exercised, evidence suggests that TTh is a reasonable treatment option in many hypogonadal men who were previously excluded from TTh based on risk factors and prior health histories. Twitchell DK, Pastuszak AW, Khera M. Controversies in Testosterone Therapy. Sex Med Rev 2021;9:149-159.
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Affiliation(s)
| | | | - Mohit Khera
- Department of Urology - Baylor College of Medicine, Houston, TX, USA.
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21
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Patel DP, Horns JJ, Kinnear S, Hanson HA, Gross KX, Pastuszak AW, Smith KR, Hotaling J. INCREASED RISK FOR CONGENITAL MALFORMATIONS IN RELATIVES OF MEN WITH POOR SEMEN QUALITY: EVIDENCE FROM THE UTAH POPULATION DATABASE (UPDB). Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. Erectile Dysfunction and Peyronie’s Disease: Genetic Diseases? Eur Urol Focus 2020; 6:572-574. [DOI: 10.1016/j.euf.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023]
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23
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Keihani S, Wright LN, Alder NJ, Jiang J, Cheng PJ, Stoddard GJ, Pastuszak AW, Deibert CM, Hotaling JM. Baseline Gonadotropin Levels and Testosterone Response in Hypogonadal Men Treated With Clomiphene Citrate. Urology 2020; 142:119-124. [PMID: 32353397 DOI: 10.1016/j.urology.2020.04.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of baseline gonadotropins in predicting the biochemical response to clomiphene citrate (CC) treatment. METHODS We conducted a retrospective review of data from hypogonadal men treated with CC in 2 high-volume fertility centers between 2013 and 2018. Patient age, body mass index, and baseline hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], and total testosterone [TT]) were obtained. Response to treatment was measured as changes in TT levels within 6 months of initiating CC treatment. Linear regression models adjusted for age, body mass index, and time on CC therapy were fitted to assess the associations between baseline LH and FSH levels with treatment response. RESULTS A total of 332 men with mean ± standard deviation age of 36.2 ± 8.2 years were included. Median time to initial follow-up was 6 weeks (25th-75th interquartile range [IQR]: 4-9 weeks). TT levels increased significantly on CC treatment (mean change: 329.2 ng/dL, 95% CI: 307.4-351.0) with 73% of men having at least 200 ng/dL increase over baseline TT levels. In univariable linear regression models, only age was significantly associated with TT response. Neither the baseline LH nor FSH significantly predicted TT response in linear regression models. CONCLUSION CC treatment results in significant increases in testosterone levels in most men. Baseline gonadotropins are not strong predictors for treatment response to CC. Adequate biochemical response with CC trial can be expected in most patients with normal or slightly elevated baseline gonadotropin levels.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | - Lindsey N Wright
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Nathan J Alder
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jinfeng Jiang
- Division of Urologic Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | | | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
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24
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Abstract
This article aims to define the optimal endocrine workup of male factor infertility, including evaluation and treatment of men who have previously been on exogenous testosterone or anabolic steroids. Future directions include the expansion of genetic testing for infertility to include endocrine gene products.
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Affiliation(s)
- Sarah C McGriff
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Eric M Lo
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, 3 North 1900 East, Salt Lake City, UT 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, 3 North 1900 East, Salt Lake City, UT 84132, USA.
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Balasubramanian A, Kohn TP, Santiago JE, Sigalos JT, Kirby EW, Hockenberry MS, Pickett SM, Pastuszak AW, Lipshultz LI. AUTHOR REPLY. Urology 2020; 138:58-59. [PMID: 32252955 DOI: 10.1016/j.urology.2019.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/31/2019] [Indexed: 10/24/2022]
Affiliation(s)
| | - Taylor P Kohn
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - John T Sigalos
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - E Will Kirby
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Mark S Hockenberry
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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Balasubramanian A, Kohn TP, Santiago JE, Sigalos JT, Kirby EW, Hockenberry MS, Pickett SM, Pastuszak AW, Lipshultz LI. Increased Risk of Hypogonadal Symptoms in Shift Workers With Shift Work Sleep Disorder. Urology 2020; 138:52-59. [DOI: 10.1016/j.urology.2019.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 01/31/2023]
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Gondokusumo JC, Butaney M, Balasubramanian A, Beilan JA, Tatem AJ, Thirumavalavan N, Pastuszak AW, Lipshultz LI. The use of scrotal ultrasound in the evaluation of varicoceles: A survey study of reproductive specialists. Can Urol Assoc J 2020; 14:E358-E362. [PMID: 32209215 DOI: 10.5489/cuaj.6147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urologists use ultrasound in the male infertility workup to evaluate scrotal contents and objectively identify varicoceles if their presence is questionable on physical examination. We assessed practice patterns and diagnostic criteria of male reproductive urologists using ultrasound to evaluate varicoceles. METHODS An anonymous online survey was sent to the Society for Male Reproduction and Urology (SMRU) members. We queried respondents about ultrasonographic criteria and ultrasound techniques employed in varicocele evaluation. Chi-squared was used to determine association between categorical variables. RESULTS In total, 110/320 (34.4%) SMRU members responded. Sixty percent of respondents (66/110) reported performing scrotal ultrasound; 92.4 % (61/66) were attending urologists and 87.9% (58/66) completed an andrology fellowship. A total of 37.9% (25/66) performed their own ultrasound, while the remainder had ultrasound performed by an alternate practitioner. Among those performing their own ultrasound, 95.5% (21/22) measured varicocele venous diameter compared to 76% (29/38) when another practitioner performed the ultrasound. Venous diameter used to define a varicocele ranged from 2-4 mm. Although 80% (49/61) of respondents assessed retrograde flow during ultrasound, only 52.5% reported that retrograde flow was required for varicocele diagnosis. Almost all (60/61) indicated they would fix palpable varicoceles in patients with abnormal semen parameters. Fewer (42.6%, 26/61) respondents stated they would repair varicoceles found exclusively on ultrasound. CONCLUSIONS Ultrasound is commonly employed by male reproductive urologists to diagnose varicoceles. We identified that practitioners use various ultrasonographic criteria and techniques for varicocele diagnosis. Study limitations include recall bias and high degree of specialization among respondents.
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Affiliation(s)
- Jabez C Gondokusumo
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Mohit Butaney
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | | | - Jonathan A Beilan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Alexander J Tatem
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Nannan Thirumavalavan
- University Hospitals Urology Institute Case Western Reserve University, Cleveland, OH, United States
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
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Balasubramanian A, Thirumavalavan N, Srivatsav A, Yu J, Lipshultz LI, Pastuszak AW. Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements. J Sex Med 2020; 16:203-212. [PMID: 30770069 DOI: 10.1016/j.jsxm.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/22/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Testosterone-boosting supplements (T-Boosters) are prominently featured on Amazon.com, with numerous dedicated pages and claims that they "naturally" increase testosterone levels. AIM To evaluate the highest rated and frequently reviewed T-Boosters on Amazon.com to facilitate patient counseling regarding marketing myths, T-Booster formulations, and evidence for efficacy and safety. METHODS The Amazon marketplace was queried using the key words "testosterone" + "booster," with default search settings and ranking items based on relevance. The top 5 T-Boosters identified on July 22, 2018, were reviewed based on price, ratings, reviews, manufacturer details, and ingredients. Consumer reviews were categorized using core themes in the Androgen Deficiency in the Aging Male (ADAM) questionnaire as a proxy to understand T-Booster efficacy and reanalyzed after filtration of untrustworthy comments using ReviewMeta.com, a proprietary Amazon customer review analysis software. MAIN OUTCOME MEASURES Quantitative and qualitative evaluation of T-Boosters on Amazon.com was performed. RESULTS The top 5 T-Boosters had an average ± SD of 2,761 ± 5,112 reviews and a rating of 4.56 ± 0.25 stars. 19 unique ingredients were identified across these T-Boosters, and literature review revealed 191 studies involving the 10 most common ingredients, of which 19% involved human subjects, 53% animal models, 15% in vitro studies, and 12% case reports or review articles. Among 37 human studies, 30% observed an increase in T levels, 3% a decrease, 46% no effect, and 22% were indeterminate. Analysis of top customer reviews from the first 2 pages of reviews for each supplement revealed differences in the ADAM score before and after ReviewMeta.com filtration. After filtration, there was a 91% decrease in users reporting increased libido, a 59% decrease in reports of increased energy, a 93% decrease in reports of improved strength/endurance, a 60% decrease in reports of improved erections, an elimination of reports of improved work performance, a 67% decrease in reports of improved sleep, and an 89% decrease in reports of improved sports ability. CLINICAL IMPLICATIONS Our study can serve as a guide for providers to counsel patients about the efficacy of popular online T-Boosters as well as the prevalence of disingenuous reviews associated with these products on online marketplaces like Amazon.com. STRENGTHS & LIMITATIONS Strengths include the novel approach to assess consumers' perceptions and satisfaction of T-Boosters, as well as summary information that clinicians can provide patients. Limitations include selection bias, a small number of supplements analyzed, and the proprietary nature of the Amazon review analysis software. CONCLUSION T-Boosters are easily available online. Our investigation revealed that limited human studies have evaluated T-Boosters, resulting in no definitive findings of efficacy. In the absence of additional human studies, patients should be cautioned before considering T-Boosters, given the availability of highly effective therapies approved by the Food and Drug Administration. Balasubramanian A, Thirumavalavan N, Srivatsav A, et al. Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements. J Sex Med 2019;16:203-212.
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Affiliation(s)
| | - Nannan Thirumavalavan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Justin Yu
- Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Department of Surgery-Urology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Pastuszak AW, Hu Y, Freid JD. Occurrence of Pulmonary Oil Microembolism After Testosterone Undecanoate Injection: A Postmarketing Safety Analysis. Sex Med 2020; 8:237-242. [PMID: 32184081 PMCID: PMC7261689 DOI: 10.1016/j.esxm.2020.01.009] [Citation(s) in RCA: 4] [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: 09/30/2019] [Revised: 01/10/2020] [Accepted: 01/30/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The Aveed Risk Evaluation and Mitigation Strategy program was instituted because of potential risk of pulmonary oil microembolism (POME) and/or anaphylaxis after intramuscular injection of Aveed (testosterone undecanoate), indicated for treatment of adult male patients with congenital or acquired primary hypogonadism or hypogonadotropic hypogonadism. AIM To analyze the reporting rate of POME associated with testosterone undecanoate administration (750 mg/3 mL) during postmarketing surveillance. METHODS The Endo Pharmaceuticals Inc database was searched for POME reports occurring from testosterone undecanoate approval on March 5, 2014, through June 30, 2018. Each case was reviewed and adjudicated by a drug safety physician to confirm the reported event had predefined clinical characteristics consistent with POME. OUTCOMES Annual rate and clinical features of spontaneously reported POME cases were characterized. RESULTS During the 4.3-year period, 90,092 doses of intramuscular testosterone undecanoate were distributed via an Aveed Risk Evaluation and Mitigation Strategy program to health-care professionals for patient treatment. Of 633 individual case safety reports in the Endo Pharmaceuticals Inc safety database, 28 spontaneously reported adverse events were classified as POME, for a yearly spontaneously reported adverse event per-injection rate of <0.1%. Most (21/22) events resolved, and of those with a resolution time reported, most (13/17) resolved in ≤30 minutes. More than 60% (13/21) of patients required no medical intervention (ie, the POME event resolved spontaneously). One fatality was reported 18 months after a documented POME event and appeared unrelated to the reported testosterone undecanoate injection or subsequent injections after the POME event. In 3 out of 4 POME cases with symptoms serious enough to require an emergency room visit, issues with injection technique or dosing were identified as a potential contributing factor. CLINICAL IMPLICATIONS Injection technique and proper product usage are key elements in the prevention of POME events. STRENGTHS & LIMITATIONS The reported rate of POME events was determined from a real-world clinical practice patient population; however, postmarketing safety data typically are underreported and retrospective in nature. CONCLUSION POME events appear to be rare, with resolution occurring quickly without medical intervention in most cases. Pastuszak AW, Hu Y, Freid JD. Occurrence of Pulmonary Oil Microembolism After Testosterone Undecanoate Injection: A Postmarketing Safety Analysis. Sex Med 2020;8:237-242.
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Affiliation(s)
- Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Yiqun Hu
- Medical Affairs, Endo Pharmaceuticals Inc, Malvern, PA, USA
| | - Jeffrey D Freid
- Pharmacovigilance and Risk Management, Endo Pharmaceuticals Inc, Malvern, PA, USA
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Affiliation(s)
- Jacob R Basilius
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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31
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Sinha DK, Balasubramanian A, Tatem AJ, Rivera-Mirabal J, Yu J, Kovac J, Pastuszak AW, Lipshultz LI. Beyond the androgen receptor: the role of growth hormone secretagogues in the modern management of body composition in hypogonadal males. Transl Androl Urol 2020; 9:S149-S159. [PMID: 32257855 PMCID: PMC7108996 DOI: 10.21037/tau.2019.11.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/16/2022] Open
Abstract
Male hypogonadism is an increasingly prevalent clinical condition that affects patients’ quality of life and overall health. Obesity and metabolic syndrome can both cause and result from hypogonadism. Although testosterone remains the gold standard for hypogonadism management, its benefits are not always conserved across different populations, especially with regards to changes in body composition. Partially in response to this, growth hormone secretagogues (GHS) have emerged as a potential novel adjunctive therapy for some of the symptoms of hypogonadism, although current data on their clinical efficacy largely remain lacking. The present review examines the existing literature on the use of GHS and explores their potential complementary role in the management of hypogonadal and eugonadal males with metabolic syndrome or subclinical hypogonadism (SH). The GHS that will be discussed include sermorelin, growth hormone-releasing peptides (GHRP)-2, GHRP-6, ibutamoren, and ipamorelin. All are potent GH and IGF-1 stimulators that can significantly improve body composition while ameliorating specific hypogonadal symptoms including fat gain and muscular atrophy. However, a paucity of data examining the clinical effects of these compounds currently limits our understanding of GHS’ role in the treatment of men with hypogonadism, but does open opportunities for future investigation.
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Affiliation(s)
| | | | | | | | - Justin Yu
- Baylor College of Medicine, Houston, TX, USA
| | - Jason Kovac
- Men's Health Center, Urology of Indiana, Greenwood, IN, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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32
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Abstract
Sleep has increasingly been found to play a role in the overall health of an individual, but sleep quality has also been decreasing with the invasion of technology into the bedroom, “always-on” lifestyles, and increasing demands on one’s time when awake. We have herein reviewed the literature to assess the impact of sleep on erectile dysfunction, lower urinary tract symptoms, hypogonadal symptoms, low testosterone, and male infertility. We find that erectile dysfunction, lower urinary tract symptoms, and hypogonadal symptoms all have a linear relationship with sleep, as worse symptoms occur with poorer sleep. Male infertility, interestingly, has an inverse U-shaped relation to sleep in which men with too little and too much sleep seem to be more at risk for infertility than those with 7–8 hours of sleep. Finally, the literature has not demonstrated a significant clinical relationship between hypogonadal symptoms or testosterone levels and sleep. Overall, a large number of men experience poor quality sleep. Given the impact that poor sleep can have on general health and men’s health, in particular, screening for poor sleep quality and recommending interventions to improve sleep are becoming imperative during clinical evaluation and treatment.
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Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nora M Haney
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Lipshultz LI, Pastuszak AW. Men's health: a rapidly changing landscape of healthcare delivery and treatment. Transl Androl Urol 2020; 9:S114-S115. [PMID: 32257851 PMCID: PMC7108980 DOI: 10.21037/tau.2019.12.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Department of Surgery, Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Abstract
Selective androgen receptor modulators (SARMs) are small molecule drugs that function as either androgen receptor (AR) agonists or antagonists. Variability in AR regulatory proteins in target tissues permits SARMs to selectively elicit anabolic benefits while eschewing the pitfalls of traditional androgen therapy. SARMs have few side effects and excellent oral and transdermal bioavailability and may, therefore, represent viable alternatives to current androgen therapies. SARMs have been studied as possible therapies for many conditions, including osteoporosis, Alzheimer’s disease, breast cancer, stress urinary incontinence (SUI), prostate cancer (PCa), benign prostatic hyperplasia (BPH), male contraception, hypogonadism, Duchenne muscular dystrophy (DMD), and sarcopenia/muscle wasting/cancer cachexia. While there are no indications for SARMs currently approved by the Food and Drug Administration (FDA), many potential applications are still being explored, and results are promising. In this review, we examine the literature assessing the use of SARMS for a number of indications.
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Affiliation(s)
| | - Larry I Lipshultz
- Scott Department of Urology.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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35
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Balasubramanian A, Yu J, Srivatsav A, Spitz A, Eisenberg ML, Thirumavalavan N, McBride JA, Lipshultz LI, Pastuszak AW. A review of the evolving landscape between the consumer Internet and men's health. Transl Androl Urol 2020; 9:S123-S134. [PMID: 32257853 PMCID: PMC7108985 DOI: 10.21037/tau.2019.09.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/30/2022] Open
Abstract
Internet adoption continues to increase as broadband access and mobile connectivity penetrate developing global markets. Alongside increasing adoption, the Internet continues to evolve and usher in new modes of user interaction. Social media and search engines have facilitated the emergence of the participatory web, in which users are able to contribute content, form online communities, and disseminate information. This participatory web is reshaping the patient-physician relationship as patients are able to search for medical information, directly engage with healthcare practitioners through social media, and make therapeutic decisions via online marketplaces. The ability for patients to self-diagnose and self-treat is highly relevant to andrology, given that men have a baseline reluctance to visit healthcare providers. Furthermore, men’s health issues such as erectile dysfunction and male infertility are stigmatized, with men turning to the Internet for guidance. The focus of this review is to survey the academic literature that evaluates the quality of online content for four common men’s health conditions: hypogonadism, male infertility, erectile dysfunction, and Peyronie’s disease.
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Affiliation(s)
| | - Justin Yu
- Baylor College of Medicine, Houston, TX, USA
| | | | - Aaron Spitz
- Department of Urology, University of California-Irvine, Orange County Urology Associates, Laguna Hills, CA, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Nannan Thirumavalavan
- University Hospitals Urology Institute/Case Western Reserve University, Cleveland, OH, USA
| | - J Abram McBride
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Keihani S, Alder NJ, Cheng PJ, Stoddard GJ, Pastuszak AW, Hotaling JM. Obesity and Baseline Estradiol Levels Are Independent Predictors for Initiation of Anastrozole in Hypogonadal Men on Clomiphene Citrate. World J Mens Health 2020; 38:582-590. [PMID: 32202084 PMCID: PMC7502320 DOI: 10.5534/wjmh.190160] [Citation(s) in RCA: 3] [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: 12/06/2019] [Revised: 01/02/2020] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the conversion rate from clomiphene citrate (CC) monotherapy to combination CC+anastrozole (AZ) therapy in hypogonadal men and the predictors associated with the initiation of AZ. MATERIALS AND METHODS A retrospective review of records from hypogonadal men treated with CC in a single fertility center was performed from 2013 to 2018. Patient age, body mass index (BMI), blood pressure, and reproductive hormones were obtained at baseline. Obesity was defined as BMI≥30 kg/m². Cox proportional hazards models were used to identify predictors of switching to combination CC+AZ therapy. RESULTS A total of 318 men on CC were included. Median (interquartile range) age was 34 years (30-39 years) and patients were followed for a median of 9 months (4-17 months). Of these, 97 (30.5%) were started on CC+AZ therapy. These patients had higher baseline BMI and estradiol, which in multivariable regression were significant predictors for switching to CC+AZ therapy. A threshold of 18.5 pg/mL for baseline estradiol provided the highest accuracy for predicting the addition of AZ after adjusting for baseline BMI and total testosterone levels. CONCLUSIONS In our practice, following CC monotherapy, 30% of men were initiated on CC+AZ. Obesity (BMI≥30 kg/m²) and baseline estradiol ≥18.5 pg/mL can predict the conversion to combination therapy with addition of AZ. This information can be used to counsel patients and also help to identify patients who can be started on combination therapy upfront.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Nathan J Alder
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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37
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Patel DP, Jenkins TG, Aston KI, Guo J, Pastuszak AW, Hanson HA, Hotaling JM. Harnessing the full potential of reproductive genetics and epigenetics for male infertility in the era of "big data". Fertil Steril 2020; 113:478-488. [PMID: 32089255 DOI: 10.1016/j.fertnstert.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
The complexity of male reproductive impairment has hampered characterization of the underlying genetic causes of male infertility. However, in the last 20 years, more powerful and affordable tools to interrogate the genetic and epigenetic determinants of male infertility have accelerated the number of new discoveries in the characterization of male infertility. With this explosion of new data, integration in a systems-based approach-including complete phenotypic information-to male infertility is imperative. We briefly review the current understanding of genetic and epigenetic causes of male infertility and how findings may be translated into a practical component for the diagnosis and treatment of male infertility.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Tim G Jenkins
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah; Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah
| | - Kenneth I Aston
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jingtao Guo
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah; Department of Oncological Sciences and Huntsman Cancer Institute, Howard Hughes Medical Institute, University of Utah, Salt Lake City, Utah
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Heidi A Hanson
- Department of Surgery and Population Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - James M Hotaling
- Division of Urology, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah.
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38
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Lo EM, Balasubramanian A, Pastuszak AW, Khera M. Bipolar Androgen Therapy in Prostate Cancer (Update). J Sex Med 2020; 17:831-834. [PMID: 32033864 DOI: 10.1016/j.jsxm.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/12/2019] [Accepted: 12/21/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Eric M Lo
- Baylor College of Medicine, Houston, TX, USA
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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39
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Jenkins TG, James ER, Aston KI, Salas-Huetos A, Pastuszak AW, Smith KR, Hanson HA, Hotaling JM, Carrell DT. Age-associated sperm DNA methylation patterns do not directly persist trans-generationally. Epigenetics Chromatin 2019; 12:74. [PMID: 31856899 PMCID: PMC6921445 DOI: 10.1186/s13072-019-0323-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background The impact of aging on the sperm methylome is well understood. However, the direct, subsequent impact on offspring and the role of altered sperm DNA methylation alterations in this process remain poorly understood. The well-defined impact of aging on sperm DNA methylation represents an excellent opportunity to trace the direct, transgenerational transmission of these signals. Results We utilized the Illumina MethylationEPIC array to analyze the sperm of 16 patients with older (> 40 years of age) paternal grandfathers (‘old grand paternal age’ patients; OGPA) and 16 patients with younger (< 25 years of age) grandfathers (‘young grand paternal age’ patients; YGPA) identified through the Subfertility Health Assisted Reproduction and the Environment (SHARE) cohort to investigate differences in DNA methylation. No differentially methylated regions were identified between the OGPA and YGPA groups. Further, when assessing only the sites previously shown to be altered by age, no statistically significant differences between OGPA and YGPA were identified. This was true even despite the lower bar for significance after removing multiple comparison correction in a targeted approach. Interestingly though, in an analysis of the 140 loci known to have decreased methylation with age, the majority (~ 72%) had lower methylation in OGPA compared to YGPA though the differences were extremely small (~ 1.5%). Conclusions This study suggests that the robust and consistent age-associated methylation alterations seen in human sperm are ‘reset’ during large-scale epigenetic reprograming processes and are not directly inherited trans-generationally (over two generations). An extremely small trend was present between the YGPA and OGPA groups that resemble the aging pattern in older sperm. However, this trend was not significant and was so small that, if real, is almost certainly biologically inert.
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Affiliation(s)
- Timothy G Jenkins
- Department of Physiology and Developmental Biology, Brigham Young University Provo, Life Sciences Building 4005, Provo, UT, 84602, USA. .,Andrology and IVF Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Emma R James
- Andrology and IVF Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kenneth I Aston
- Andrology and IVF Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Albert Salas-Huetos
- Andrology and IVF Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ken R Smith
- Department of Population Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Heidi A Hanson
- Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Population Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James M Hotaling
- Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Douglas T Carrell
- Andrology and IVF Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Surgery (Urology Division), University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Garg D, Meeks HD, Johnstone E, Pastuszak AW, Berga SL, Smith KR, Hotaling J, Letourneau JM. Cancer treatment is associated with a measurable decrease in live births in a large, population-based study. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Garg D, Kohn TP, Pastuszak AW, Letourneau JM, Hotaling J. The potential impact of newer chemotherapy regimens on future fertility in men and women treated for lymphoma. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Patel DP, Meeks HD, Pastuszak AW, Smith KR, Hotaling J. Lower total motile count is associated with smaller historic intergenerational family size: a pedigree analysis from the Utah Population Database (UPDB). Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Garg D, Meeks HD, Johnstone E, Pastuszak AW, Berga SL, Smith KR, Hotaling J, Letourneau JM. Describing live births after cancer treatments: when do patients conceive and how many children do they have? a population-based study in the Western United States. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Balasubramanian A, Thirumavalavan N, Bates JN, Wang EK, Hsieh A, Pathak US, Payne K, Pastuszak AW, Lipshultz LI. Significant delays in evaluation of male partner amongst infertile couples. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Garg D, Meeks HD, Johnstone E, Pastuszak AW, Berga SL, Smith KR, Hotaling J, Letourneau JM. Pregnancy outcomes among cancer survivors: a population-based analysis. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Srivatsav A, Balasubramanian A, Butaney M, Thirumavalavan N, McBride JA, Gondokusumo J, Pastuszak AW, Lipshultz L. Patient Attitudes Toward Testicular Prosthesis Placement After Orchiectomy. Am J Mens Health 2019; 13:1557988319861019. [PMID: 31359823 PMCID: PMC6685124 DOI: 10.1177/1557988319861019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/18/2022] Open
Abstract
Orchiectomy is the standard of care for many testicular conditions. Testicular prosthesis placement (TPP) can mitigate psychosocial burden, restore self-image, and improve quality of life for patients requiring orchiectomy. Limited data exist regarding patient attitudes and counseling on TPP in the United States. The objective of this study was to characterize patient experiences after TPP, rationale for pursuing/declining TPP, and satisfaction levels. Patients with a history of urologic conditions warranting orchiectomy were identified and sent an anonymous survey addressing demographics, pre/post counseling, attitudes toward TPP, satisfaction rates, and postoperative complications. Sixteen percent (76/480) of patients completed the survey. Of these, 50.8% (32/63) undergoing orchiectomy were counseled by their surgeon about TPP, and 22.2% (14/63) received a prosthesis. The most common reasons for declining TPP included lack of concern for cosmetic appearance and lack of counseling. Leading reasons for pursuing TPP included improving self-confidence and cosmetic appearance. Although 71% (10/14) of patients were satisfied with TPP, they did highlight areas for improvement. Twenty percent (2/10) felt their implant was too high, 60% (6/10) felt their implant was too firm, 10% (1/10) endorsed discomfort during sex, and 30% (3/10) felt that TPP did not match their size expectations. Despite these findings, 71% (10/14) reported that they would have TPP again and 79% (11/14) would recommend TPP to others. TPP improves body image and quality of life following orchiectomy. Provider counseling plays an important role in influencing a patient’s decision to undergo TPP. Areas of improvement include implant positioning and more effective replication of testicular consistency.
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Affiliation(s)
| | | | - Mohit Butaney
- 2 Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Nannan Thirumavalavan
- 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,4 Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - J Abram McBride
- 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,4 Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Alexander W Pastuszak
- 5 Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Larry Lipshultz
- 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,4 Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Abstract
INTRODUCTION Menopausal hormone therapy (MHT) has proven an effective treatment for the amelioration of symptoms of menopause. The idea that a substance was the missing factor in a woman's body after menopause dates to the 1800s, when cow ovarian tissue was injected into German women in a successful attempt to reverse the sexual symptoms of menopause. The early 1900s saw the rise of commercialized menopause "treatments" that ranged in substance and even theoretical efficacy. The role of estrogen was first accurately described in Guinea pigs in 1917 by Dr. Papanicolaou. AIM To tell the detailed history of how estrogen was discovered and the controversy surrounding MHT. METHODS A literature search was conducted using PubMed to identify relevant studies and historical documents regarding the history of estrogen therapy. RESULTS The history of estrogen supplementation and its controversies are interesting stories and relevant to today's ongoing investigation into hormone replacement. CONCLUSION The controversy of MHT remained until the first randomized trials examining MHT in the early 1990s that suggested MHT is cardioprotective in postmenopausal women, although this conclusion was contradicted in subsequent trials. In the present day, MHT is approved only for short-term use for the symptomatic treatment of menopause. Kohn GE, Rodriguez KM, Hotaling J, et al. The History of Estrogen Therapy. Sex Med Rev 2019;7:416-421.
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Affiliation(s)
| | | | - James Hotaling
- Department of Surgery-Urology, University of Utah, Salt Lake City, UT, USA
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Abstract
PURPOSE OF REVIEW To review novel, non-surgical therapies for erectile dysfunction (ED). RECENT FINDINGS Recently, a landmark study identified the SIM1 locus, involved in the leptin-melanocortin pathway, as an independent risk factor for ED and a potential target for novel therapies. The recent literature otherwise has focused on low-intensity shock wave therapy (LiSWT), with several randomized trials and meta-analyses suggesting therapeutic efficacy. There are few novel oral agents for ED. There is growing evidence suggesting efficacy of intracavernosal stem cells therapy and low-intensity shock wave therapy (LiSWT), although these therapies are still investigational. A better understanding of the pathophysiologic spectrum of ED will offer new opportunities for novel, non-surgical therapies for ED.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA.
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Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease. World J Urol 2019; 38:253-261. [PMID: 31190155 DOI: 10.1007/s00345-019-02815-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023] Open
Abstract
Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA.
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Abstract
Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and in vitro maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.
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Affiliation(s)
- Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Isak A Goodwin
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
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