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Nieschlag E, Forti G, Wu F, Toppari J, Krausz C. History of the European Academy of Andrology. Andrology 2022; 10 Suppl 2:4-9. [DOI: 10.1111/andr.13244] [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] [Indexed: 11/30/2022]
Affiliation(s)
- Eberhard Nieschlag
- Centre of Reproductive Medicine and Andrology University Hospital Münster Münster Germany
| | - Gianni Forti
- Professor Emeritus of Endocrinology, Department of Experimental and Clinical Biomedical Sciences “Mario Serio” University of Florence Florence Italy
| | - Frederick Wu
- Emeritus Professor of Medicine and Endocrinology Division of Endocrinology Diabetes & Gastroenterology School of Medical Sciences Faculty of Biology Medicine and Health University of Manchester Manchester UK
| | - Jorma Toppari
- Institute of Biomedicine Research Centre for Integrative Physiology and Pharmacology, and Centre for Population Health Research University of Turku Turku Finland
- Department of Pediatrics Turku University Hospital Turku Finland
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio” University of Florence Italy
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Overman MJ, Pendleton N, O'Neill TW, Bartfai G, Casanueva FF, Forti G, Rastrelli G, Giwercman A, Han TS, Huhtaniemi IT, Slowikowska-Hilczer J, Lean ME, Punab M, Lee DM, Antonio L, Gielen E, Rutter MK, Vanderschueren D, Wu FC, Tournoy J. Reproductive hormone levels, androgen receptor CAG repeat length and their longitudinal relationships with decline in cognitive subdomains in men: The European Male Ageing Study. Physiol Behav 2022; 252:113825. [PMID: 35487276 DOI: 10.1016/j.physbeh.2022.113825] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/08/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE It has been proposed that endogenous sex hormone levels may present a modifiable risk factor for cognitive decline. However, the evidence for effects of sex steroids on cognitive ageing is conflicting. We therefore investigated associations between endogenous hormone levels, androgen receptor CAG repeat length, and cognitive domains including visuoconstructional abilities, visual memory, and processing speed in a large-scale longitudinal study of middle-aged and older men. METHODS Men aged 40-79 years from the European Male Ageing Study (EMAS) underwent cognitive assessments and measurements of hormone levels at baseline and follow-up (mean = 4.4 years, SD ± 0.3 years). Hormone levels measured included total and calculated free testosterone and estradiol, dihydrotestosterone, luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulphate and sex hormone-binding globulin. Cognitive function was assessed using the Rey-Osterrieth Complex Figure Copy and Recall, the Camden Topographical Recognition Memory and the Digit Symbol Substitution Test. Multivariate linear regressions were used to examine associations between baseline and change hormone levels, androgen receptor CAG repeat length, and cognitive decline. RESULTS Statistical analyses included 1,827 and 1,423 participants for models investigating relationships of cognition with hormone levels and CAG repeat length, respectively. In age-adjusted models, we found a significant association of higher baseline free testosterone (β=-0.001, p=0.005) and dihydrotestosterone levels (β=-0.065, p=0.003) with greater decline on Rey-Osterrieth Complex Figure Recall over time. However, these effects were no longer significant following adjustment for centre, health, and lifestyle factors. No relationships were observed between any other baseline hormone levels, change in hormone levels, or androgen receptor CAG repeat length with cognitive decline in the measured domains. CONCLUSIONS In this large-scale prospective study there was no evidence for an association between endogenous sex hormone levels or CAG repeat length and cognitive ageing in men. These data suggest that sex steroid levels do not affect visuospatial function, visual memory, or processing speed in middle-aged and older men.
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Affiliation(s)
- Margot J Overman
- Gerontology and Geriatrics, KU Leuven, Leuven, Belgium; Department of Psychiatry, University of Oxford, UK
| | - Neil Pendleton
- Clinical & Cognitive Neurosciences, Institute of Brain, Behaviour and Mental Health, The University of Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University Spain; CIBEROBN Instituto de Salud Carlos III. Santiago de Compostela, Spain
| | - Gianni Forti
- Endocrinology Unit, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skåne University Hospital, University of Lund, Lund, Sweden
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, Surrey, UK
| | - Ilpo T Huhtaniemi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London UK
| | | | - Michael Ej Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - Margus Punab
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - David M Lee
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Leen Antonio
- Department of Andrology and Endocrinology, KU Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Evelien Gielen
- Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, KU Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Frederick Cw Wu
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - Jos Tournoy
- Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
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Antonio L, Wu FCW, Moors H, Matheï C, Huhtaniemi IT, Rastrelli G, Dejaeger M, O’Neill TW, Pye SR, Forti G, Maggi M, Casanueva FF, Slowikowska-Hilczer J, Punab M, Tournoy J, Vanderschueren D, Forti G, Petrone L, Corona G, Rastrelli G, Maggi (Florence) M, Vanderschueren D, Tournoy J, Borghs H, Antonio (Leuven) L, Kula K, Slowikowska-Hilczer J, Walczak-Jedrzejowska (Łódz) R, Huhtaniemi (London) I, Giwercman (Malmö) A, Wu F, Silman A, O’Neill T, Finn J, Pye (Manchester) S, Casanueva F, Crujeiras (Santiago) AB, Bartfai G, Földesi I, Fejes (Szeged) I, Punab M, Korrovitz (Tartu) P. Erectile dysfunction predicts mortality in middle-aged and older men independent of their sex steroid status. Age Ageing 2022; 51:6568537. [PMID: 35429269 DOI: 10.1093/ageing/afac094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/19/2021] [Revised: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial. Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known. We studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men. DESIGN survival status was assessed in 1,788 community-dwelling men, aged 40-79, who participated in the European Male Ageing Study (EMAS). Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality. RESULTS about 420 (25.3%) men died during a mean follow-up of 12.6 ± 3.1 years. Total T levels were similar in both groups, but free T was lower in those who died. Men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms (adjusted hazard ratio (HR) and 95% confidence intervals: 1.75 (1.28-2.40, P = 0.001)). Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.13-1.74, P = 0.002), 1.28 (1.04-1.59, P = 0.023) and 1.12 (0.90-1.39, P = 0.312), respectively). Further adjusting for total T, free T or oestradiol did not influence the observed risk. CONCLUSIONS sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.
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Affiliation(s)
- Leen Antonio
- Department of Chronic Diseases and Metabolism, KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Frederick C W Wu
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, The University of Manchester, Manchester, UK
| | - Hannes Moors
- Department of Public Health and Primary Care, KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Cathy Matheï
- Department of Public Health and Primary Care, KU Leuven, Academic Center for General Practice, Leuven, Belgium
| | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Giulia Rastrelli
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Marian Dejaeger
- Department of Public Health and Primary Care, KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Terence W O’Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen R Pye
- Centre for Epidemiology Versus Arthritis, The University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gianni Forti
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, University of Florence, Florence, Italy
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS); CIBER de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | | | - Margus Punab
- Andrology Centre, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Department of Chronic Diseases and Metabolism, KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Dejaeger M, Antonio L, Bouillon R, Moors H, Wu FCW, O'Neill TW, Huhtaniemi IT, Rastrelli G, Forti G, Maggi M, Casanueva FF, Slowikowska-Hilczer J, Punab M, Gielen E, Tournoy J, Vanderschueren D. Aging Men With Insufficient Vitamin D Have a Higher Mortality Risk: No Added Value of its Free Fractions or Active Form. J Clin Endocrinol Metab 2022; 107:e1212-e1220. [PMID: 34662423 DOI: 10.1210/clinem/dgab743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Low total 25-hydroxyvitamin D (25(OH)D) has been associated with mortality. Whether vitamin D in its free form or 1,25-dihydroxyvitamin D (1,25(OH)2D), provide any additional information is unclear. OBJECTIVE To determine what level of 25(OH)D is predictive for mortality and if free 25(OH)D or 1,25(OH) 2 D concentrations have any added value. METHODS This prospective cohort comprised 1915 community-dwelling men, aged 40 to 79 years. Intervention included determination of association of total and free 25(OH)D and 1,25(OH) 2 D concentrations with survival status. Vitamin D results were grouped into quintiles. For total 25(OH)D, specific cutoff values were also applied. Cox proportional hazard models were used adjusted for center, body mass index, smoking, alcohol, physical activity, season of blood sample, kidney function, and number of comorbidities. RESULTS A total of 469 (23.5%) men died during a mean follow-up of 12.3 ± 3.4 years. Compared to those with normal vitamin D values (> 30 µg/L), men with a total 25(OH)D of less than 20 µg/L had an increased mortality (hazard ratio [HR] 2.03 [95% CI, 1.39-2.96]; P < .001). Likewise, men in the lowest 3 free 25(OH)D quintiles (< 4.43 ng/L) had a higher mortality risk compared to the highest quintile (HR 2.09 [95% CI, 1.34-3.25]; P < .01). Mortality risks were similar across all 1,25(OH)2D and vitamin D binding protein quintiles. CONCLUSION Aging men with vitamin D deficiency have a 2-fold increased mortality risk. Determinations of either the free fractions of vitamin D or measurement of its active form offer no additional information on mortality risks.
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Affiliation(s)
- Marian Dejaeger
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Leen Antonio
- Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Roger Bouillon
- Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Hannes Moors
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Frederick C W Wu
- Division of Endocrinology, Medicine and Health, University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, M13 9PL Manchester, UK
| | - Ilpo T Huhtaniemi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London W12 ONN, UK
| | - Giulia Rastrelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy
| | - Gianni Forti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS); CIBER de Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, 15890 Santiago de Compostela, Spain
| | | | - Margus Punab
- Andrology Centre, Tartu University Hospital, 50090 Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Evelien Gielen
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Dirk Vanderschueren
- Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
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Rastrelli G, O'Neill T, Corona G, Bartfai G, Casanueva F, Forti G, Vanderschueren D, Slowikowska-Hilczer J, Giwercman A, Punab M, Huhtaniemi I, Wu F, Maggi M. PS-8-6 Predictors of Decline in Sexual Desire or Development of Hypoactive Sexual Desire Disorder: Longitudinal Results From the European Male Ageing Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.080] [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: 10/24/2022]
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Rastrelli G, Corona G, O'Neill T, Bartfai G, Casanueva F, Forti G, Vanderschueren D, Slowikowska-Hilczer J, Giwercman A, Punab M, Huhtaniemi I, Wu F, Maggi M. PS-8-5 Clinical Correlates of Self-Reported Premature Ejaculation With or Without Complaints: Cross-Sectional Results From the European Male Ageing Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.079] [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: 11/28/2022]
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Antonio L, Dejaeger M, Wu FC, O’Neill T, Pye S, Huhtaniemi IT, Rastrelli G, Forti G, Casanueva FF, Slowikowska-Hilczer J, Punab M, Vanderschueren DM, Tournoy J. OR02-06 Sexual Symptoms Predict All-Cause Mortality Independently of Sex Steroids in Ageing Men. J Endocr Soc 2020. [PMCID: PMC7207597 DOI: 10.1210/jendso/bvaa046.1109] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The association between low testosterone (T) and higher mortality in men remains controversial. Most studies focus only on the association between total T (TT) and mortality. While TT declines with age, free T (FT) shows a greater fall, due to the rise in SHBG. Moreover, higher LH as well as sexual dysfunction, often co-existing with low T, have also been associated with mortality in ageing men. Objective: To study the interrelationships between sex steroids, gonadotrophins and sexual symptoms with all-cause mortality in a large prospective cohort of European men. Methods: 1913 community-dwelling men, aged 40-79, participated in the European Male Ageing Study (EMAS) between 2003-2005. Sexual symptoms were assessed via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. In 5 of 8 EMAS centres, survival status was available until 1 April 2018. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality. Because of the wide age range at study entry, age was used as time-scale, instead of years since inclusion adjusting for age. Results were expressed as hazard ratios (HR) with 95% confidence intervals, adjusted for centre, BMI and smoking. Results: 483 (25.3%) men died during a mean follow-up of 12.4±3.3 years. Men who died had a higher BMI (p=0.002), but smoking status did not differ. TT levels were similar in both groups, but FT was lower in those who died (mean±SD: 312±86 pmol/L vs 270±84, p<0.001) and LH was higher (5.7±3.3 U/L vs 7.8±5.8, p<0.001). Men in the lowest FT quartile had higher mortality risk compared to men in the highest quartile (HR 1.43 (1.06-1.95); p=0.021). Also men in the highest FSH quartile had increased mortality risk (HR 1.38 (1.02-1.88); p=0.036). However, there was no association with TT, E2 or LH. Men with 3 sexual symptoms had a higher mortality risk compared to men with no sexual symptoms (HR 1.77 (1.28-2.41); p<0.001). In particular erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.15-1.73); p=0.001; HR 1.30 (1.06-1.60); p=0.012; HR 1.14 (0.93-1.40); p=0.203 respectively). Further adjusting for TT and FT did not influence the observed HRs. Also in men with normal TT (>12 nmol/L), the presence of sexual symptoms increased mortality risk (HR 1.51 (1.15-1.97); p=0.003). Finally, men with TT<8 nmol/L and sexual symptoms had a higher mortality risk compared to men with normal TT and no sexual symptoms (HR 1.92 (1.05-3.52); p=0.035). Conclusions: Men with the lowest FT and highest FSH levels have an increased mortality risk. Sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of T levels. As both vascular disease and low T can influence erectile function, sexual symptoms can be an early sign for increased cardiovascular risk and mortality, as well as a sequela of low T.
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Affiliation(s)
| | | | - Frederick C Wu
- University of Manchester and Manchester Royal Infirmary, Manchester, United Kingdom
| | | | - Stephen Pye
- The University of Manchester, Manchester, United Kingdom
| | | | | | | | | | | | | | | | - Jos Tournoy
- University Hospitals Leuven, Leuven, Belgium
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Corona G, Goulis DG, Huhtaniemi I, Zitzmann M, Toppari J, Forti G, Vanderschueren D, Wu FC. European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: Endorsing organization: European Society of Endocrinology. Andrology 2020; 8:970-987. [PMID: 32026626 DOI: 10.1111/andr.12770] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evidence regarding functional hypogonadism, previously referred to as 'late-onset' hypogonadism, has increased substantially during the last 10 year. OBJECTIVE To update the European Academy of Andrology (EAA) guidelines on functional hypogonadism. METHODS Expert group of academicians appointed by the EAA generated a series of consensus recommendations according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. RESULTS The diagnosis of functional hypogonadism should be based on both the presence of clinical symptoms supported by repeatedly low morning fasting serum total testosterone (T) measured with a well-validated assay, after exclusion of organic causes of hypogonadism. Lifestyle changes and weight reduction should be the first approach in all overweight and obese men. Whenever possible, withdrawal/modification of drugs potentially interfering with T production should be advised. Testosterone replacement therapy (TRT) is contraindicated in men with untreated prostate or breast cancer, as well as severe heart failure. Severe low urinary tract symptoms and haematocrit >48%-50% represent relative contraindications for TRT. Prostate-specific antigen and digital rectal examination of the prostate should be undertaken in men >40 years of age before initiating TRT to exclude occult prostate cancer. Transdermal T should be preferred for initiation of TRT, whereas gonadotrophin therapy is only recommended when fertility is desired in men with secondary hypogonadism. TRT is able to improve sexual function in hypogonadal men. Other potential positive outcomes of TRT remain uncertain and controversial. CONCLUSION TRT can reliably improve global sexual function in men with hypogonadism in the short term. Long-term clinical benefits, and safety of TRT in functional hypogonadism, remain to be fully documented. Clinicians should therefore explicitly discuss the uncertainties and benefits of TRT and engage them in shared management decision-making.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilpo Huhtaniemi
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.,Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Michael Zitzmann
- Institute of Reproductive Medicine, University Clinic Muenster, Muenster, Germany
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.,Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Gianni Forti
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Frederick C Wu
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
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Kanakis GA, Nordkap L, Bang AK, Calogero AE, Bártfai G, Corona G, Forti G, Toppari J, Goulis DG, Jørgensen N. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology 2019; 7:778-793. [DOI: 10.1111/andr.12636] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- G. A. Kanakis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology Aristotle University of Thessaloniki Thessaloniki Greece
| | - L. Nordkap
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
| | - A. K. Bang
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
| | - A. E. Calogero
- Department of Clinical and Experimental Medicine University of Catania Catania Italy
| | - G. Bártfai
- Department of Obstetrics, Gynecology, and Andrology Albert Szent‐Györgyi Medical University Szeged Hungary
| | - G. Corona
- Medical Department, Endocrinology Unit Azienda Usl, Maggiore‐Bellaria Hospital Bologna Italy
| | - G. Forti
- Department of Experimental Clinical and Biomedical Sciences ‘Mario Serio’, Endocrine Unit University of Florence Florence Italy
| | - J. Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology Turku University Hospital Turku Finland
| | - D. G. Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology Aristotle University of Thessaloniki Thessaloniki Greece
| | - N. Jørgensen
- University Department of Growth and Reproduction, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Rigshospitalet Copenhagen Denmark
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Rastrelli G, ÓNeill T, Bartfai G, Casanueva F, Forti G, Slowikowska-Hilczer J, Punab M, Vanderschueren D, Maggi M, Huhtaniemi I, Wu F. PS-08-001 Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism: Prospective Results from the EMAS. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.105] [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: 10/26/2022]
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11
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Sparano C, Parenti G, Cilotti A, Bencini L, Calistri M, Mannucci E, Biagini C, Vezzosi V, Mannelli M, Forti G, Petrone L. Clinical impact of the new SIAPEC-IAP classification on the indeterminate category of thyroid nodules. J Endocrinol Invest 2019; 42:1-6. [PMID: 29546655 DOI: 10.1007/s40618-018-0871-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/09/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND The increasing frequency in the diagnosis of thyroid nodules has raised a growing interest in the search for new diagnostic tools to better select patients deserving surgery. In 2014, the major Italian Societies involved in the field drafted a new cytological classification, to better stratify pre-surgical risk of thyroid cancer, especially for the indeterminate category, split into TIR3A and TIR3B subclasses, associated to different therapeutic decisions. MATERIALS AND METHODS This retrospective cross-sectional survey analyzed thyroid fine-needle aspiration biopsy performed at our outpatient clinic before and after the introduction of the new SIAPEC-IAP consensus in May 2014. RESULTS 8956 thyroid nodules were included in the analysis: 5692 were evaluated according to the old classification and 3264 according to the new one. The new criteria caused the overall prevalence of TIR3 to increase from 6.1 to 20.1%. Of those, 10.7 and 9.4% were included in the TIR3A and TIR3B subgroups, respectively. Each of the 213 TIR3B nodules underwent surgery and 86 (40.4%) were diagnosed as thyroid cancer, while among the 349 TIR3A nodules, only 15 of the 60 that underwent surgery were found to be thyroid cancer. CONCLUSIONS This analysis shows that the new SIAPEC-IAC criteria significantly increased the proportion of the overall TIR3 diagnosis. The division of TIR3 nodules into two subgroups (A and B) allowed a better evaluation of the oncologic risk and a better selection of patients to be referred to surgery.
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Affiliation(s)
- C Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Parenti
- Endocrinology Unit, Medical-Geriatric Department, Azienda Ospedaliero-Universitaria Careggi, Viale Pieraccini 18, 50139, Florence, Italy
| | - A Cilotti
- Endocrinology Unit, Medical-Geriatric Department, Azienda Ospedaliero-Universitaria Careggi, Viale Pieraccini 18, 50139, Florence, Italy
| | - L Bencini
- Department of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - M Calistri
- Department of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - E Mannucci
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - C Biagini
- Ultrasound Service, Diagnostic Center of the Pubblica Assistenza di Signa, Florence, Italy
| | - V Vezzosi
- Department of Histopathology and Molecular Diagnostics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - M Mannelli
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Forti
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - L Petrone
- Endocrinology Unit, Medical-Geriatric Department, Azienda Ospedaliero-Universitaria Careggi, Viale Pieraccini 18, 50139, Florence, Italy.
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12
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Rastrelli G, O'Neill TW, Ahern T, Bártfai G, Casanueva FF, Forti G, Keevil B, Giwercman A, Han TS, Slowikowska-Hilczer J, Lean MEJ, Pendleton N, Punab M, Antonio L, Tournoy J, Vanderschueren D, Maggi M, Huhtaniemi IT, Wu FCW. Symptomatic androgen deficiency develops only when both total and free testosterone decline in obese men who may have incident biochemical secondary hypogonadism: Prospective results from the EMAS. Clin Endocrinol (Oxf) 2018; 89:459-469. [PMID: 29855071 DOI: 10.1111/cen.13756] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Limited evidence supports the use of free testosterone (FT) for diagnosing hypogonadism when sex hormone-binding globulin (SHBG) is altered. Low total testosterone (TT) is commonly encountered in obesity where SHBG is typically decreased. We aimed to assess the contribution of FT in improving the diagnosis of symptomatic secondary hypogonadism (SH), identified initially by low total testosterone (TT), and then further differentiated by normal FT (LNSH) or low FT (LLSH). DESIGN Prospective observational study with a median follow-up of 4.3 years. PATIENTS Three thousand three hundred sixty-nine community-dwelling men aged 40-79 years from eight European centres. MEASUREMENTS Subjects were categorized according to baseline and follow-up biochemical status into persistent eugonadal (referent group; n = 1880), incident LNSH (eugonadism to LNSH; n = 101) and incident LLSH (eugonadism to LLSH; n = 38). Predictors and clinical features associated with the transition from eugonadism to LNSH or LLSH were assessed. RESULTS The cumulative incidence of LNSH and LLSH over 4.3 years was 4.9% and 1.9%, respectively. Baseline obesity predicted both LNSH and LLSH, but the former occurred more frequently in younger men. LLSH, but not LNSH, was associated with new/worsened sexual symptoms, including low desire [OR = 2.67 (1.27-5.60)], erectile dysfunction [OR = 4.53 (2.05-10.01)] and infrequent morning erections [OR = 3.40 (1.48-7.84)]. CONCLUSIONS These longitudinal data demonstrate the importance of FT in the diagnosis of hypogonadism in obese men with low TT and SHBG. The concurrent fall in TT and FT identifies the minority (27.3%) of men with hypogonadal symptoms, which were not present in the majority developing low TT with normal FT.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Terence W O'Neill
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tomas Ahern
- Andrology Research Unit, Division of Endocrinology, Diabetes & Gastroenterology, Domain of Cardiovascular, Metabolic and Nutritional Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - György Bártfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS)
- CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Gianni Forti
- Endocrine Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Brian Keevil
- Department of Clinical Biochemistry, University Hospital of South Manchester, Wythenshawe, Manchester, UK
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Malmö University Hospital, University of Lund, Malmö, Sweden
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | | | - Michael E J Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre Hope Hospital, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jos Tournoy
- Gerontology and Geriatrics, Department of Chronic diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Frederick C W Wu
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
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13
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Samavat J, Cantini G, Lotti F, Di Franco A, Tamburrino L, Degl'Innocenti S, Maseroli E, Filimberti E, Facchiano E, Lucchese M, Muratori M, Forti G, Baldi E, Maggi M, Luconi M. Massive Weight Loss Obtained by Bariatric Surgery Affects Semen Quality in Morbid Male Obesity: a Preliminary Prospective Double-Armed Study. Obes Surg 2018; 28:69-76. [PMID: 28702741 DOI: 10.1007/s11695-017-2802-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the effect of massive weight loss on the seminal parameters at 6 months from bariatric surgery. DESIGN Two-armed prospective study performed in 31 morbidly obese men, undergoing laparoscopic roux-en-Y-gastric bypass (n = 23) or non-operated (n = 8), assessing sex hormones, conventional (sperm motility, morphology, number, semen volume), and non-conventional (DNA fragmentation and seminal interleukin-8), semen parameters, at baseline and after 6 months from surgery or patients' recruitment. RESULTS In operated patients only, a statistically significant improvement in the sex hormones was confirmed. Similarly, a positive trend in the progressive/total sperm motility and number was observed, though only the increase in semen volume and viability was statistically significant (Δ = 0.6 ml and 10%, P < 0.05, respectively). A decrease in the seminal interleukin-8 levels and in the sperm DNA fragmentation was also present after bariatric surgery, whereas these parameters even increased in non-operated subjects. Age-adjusted multivariate analysis showed that the BMI variations significantly correlated with the changes in the sperm morphology (β = -0.675, P = 0.025), sperm number (β = 0.891, P = 0.000), and semen volume (r = 0.618, P = 0.015). CONCLUSION The massive weight loss obtained with bariatric surgery was associated with an improvement in some semen parameters. The correlations found between weight loss and semen parameter variations after surgery suggest that these might occur early downstream of the testis and more slowly than the changes in the sex hormones.
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Affiliation(s)
- Jinous Samavat
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Giulia Cantini
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Francesco Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Alessandra Di Franco
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Lara Tamburrino
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Selene Degl'Innocenti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Erminio Filimberti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Enrico Facchiano
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy
| | - Marcello Lucchese
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Piazza Santa Maria Nuova, 50122, Florence, Italy
| | - Monica Muratori
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Gianni Forti
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Elisabetta Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy
| | - Michaela Luconi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, viale Pieraccini 6, 50139, Florence, Italy.
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14
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Abstract
The basal endocrine status of 29 patients treated with curative radiation therapy for nasopharyngeal carcinoma was assessed; they were disease-free for a minimum of 4 years from the end of treatment. None showed clinical evidence of endocrine disease, and most of them had a substantially normal hormonal blood pattern. A slightly elevated TSH value, suggesting subclinical primary hypothyroidism, was found only in two male patients, which could be ascribed to the radiotherapeutic treatment of the neck. Although we cannot exclude more subtle alterations of hypothalamic-pituitary function, the percentage incidence of endocrine impairment in our patients seems lower than previously reported by other authors.
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15
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Lotti F, Tamburrino L, Marchiani S, Maseroli E, Vitale P, Forti G, Muratori M, Maggi M, Baldi E. DNA fragmentation in two cytometric sperm populations: relationship with clinical and ultrasound characteristics of the male genital tract. Asian J Androl 2018; 19:272-279. [PMID: 26924281 PMCID: PMC5427780 DOI: 10.4103/1008-682x.174854] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 11/04/2022] Open
Abstract
We investigated whether DNA fragmentation in two cytometric sperm populations (PIdimmer and PIbrighter) with different biological characteristics and clinical relevance is related to clinical and color-Doppler ultrasound (CDUS) parameters of the male genital tract. One hundred and sixty males of infertile couples without genetic abnormalities were evaluated for clinical, scrotal, and transrectal CDUS characteristics, presence of prostatitis-like symptoms (with the National Institutes of Health-Chronic Prostatitis Symptom Index) and sperm DNA fragmentation (sDF) in PIdimmer and PIbrighter populations (using TUNEL/PI method coupled with flow cytometry). Data were adjusted for age (Model 1) along with waistline, testosterone levels, smoking habit, and sexual abstinence (Model 2). According to the statistical Model 2, PIdimmer sDF was associated with testicular abnormalities, including lower clinical and ultrasound volume (r = -0.21 and r = -0.20, respectively; P < 0.05), higher FSH levels (r = 0.34, P < 0.0001) and occurrence of testicular inhomogeneity (P < 0.05) and hypoechogenicity (P < 0.05). PIbrighter sDF was associated with prostate-related symptoms and abnormal signs, including higher NIH-CPSI total and subdomain scores, a higher prevalence of prostatitis-like symptoms and of CDUS alterations such as macro-calcifications, severe echo-texture inhomogeneity, hyperemia (all P < 0.05), and higher arterial peak systolic velocity (r = 0.25, P < 0.05). Our results suggest that DNA fragmentation in PIdimmer sperm, which is related to poor semen quality, mainly originates in the testicles, likely due to apoptosis. Conversely, DNA fragmentation in PIbrighter sperm appears to mainly originate during or after transit through the prostate, increasing with the presence of an inflammatory status of the organ. These results could lead to new perspectives for the identification of therapeutic targets to reduce sDF.
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Affiliation(s)
- Francesco Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Lara Tamburrino
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Sara Marchiani
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Pasquale Vitale
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Monica Muratori
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Elisabetta Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
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16
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Eendebak RJAH, Ahern T, Swiecicka A, Pye SR, O'Neill TW, Bartfai G, Casanueva FF, Maggi M, Forti G, Giwercman A, Han TS, Słowikowska-Hilczer J, Lean MEJ, Punab M, Pendleton N, Keevil BG, Vanderschueren D, Rutter MK, Tampubolon G, Goodacre R, Huhtaniemi IT, Wu FCW. Elevated luteinizing hormone despite normal testosterone levels in older men-natural history, risk factors and clinical features. Clin Endocrinol (Oxf) 2018; 88:479-490. [PMID: 29178359 DOI: 10.1111/cen.13524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/05/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Elevated luteinizing hormone (LH) with normal testosterone (T) suggests compensated dysregulation of the gonadal axis. We describe the natural history, risk factors and clinical parameters associated with the development of high LH (HLH, LH >9.4 U/L) in ageing men with normal T (T ≥ 10.5 nmol/L). DESIGN, PATIENTS AND MEASUREMENTS We conducted a 4.3-year prospective observational study of 3369 community-dwelling European men aged 40-79 years. Participants were classified as follows: incident (i) HLH (n = 101, 5.2%); persistent (p) HLH (n = 128, 6.6%); reverted (r) HLH (n = 46, 2.4%); or persistent normal LH (pNLH, n = 1667, 85.8%). Potential predictors and changes in clinical features associated with iHLH and rHLH were analysed using regression models. RESULTS Age >70 years (OR = 4.12 [2.07-8.20]), diabetes (OR = 2.86 [1.42-5.77]), chronic pain (OR = 2.53 [1.34-4.77]), predegree education (OR = 1.79 [1.01-3.20]) and low physical activity (PASE ≤ 78, OR = 2.37 [1.24-4.50]) predicted development of HLH. Younger age (40-49 years, OR = 8.14 [1.35-49.13]) and nonsmoking (OR = 5.39 [1.48-19.65]) predicted recovery from HLH. Men with iHLH developed erectile dysfunction, poor health, cardiovascular disease (CVD) and cancer more frequently than pNLH men. In pHLH men, comorbidities, including CVD, developed more frequently, and cognitive and physical function deteriorated more, than in pNLH men. Men with HLH developed primary hypogonadism more frequently (OR = 15.97 [5.85-43.60]) than NLH men. Men with rHLH experienced a small rise in BMI. CONCLUSIONS Elevation of LH with normal T is predicted by multiple factors, reverts frequently and is not associated with unequivocal evidence of androgen deficiency. High LH is a biomarker for deteriorating health in aged men who tend to develop primary hypogonadism.
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Affiliation(s)
- Robert J A H Eendebak
- Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, Institute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, University of Manchester, Manchester, UK
| | - Tomas Ahern
- Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, Institute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, University of Manchester, Manchester, UK
| | - Agnieszka Swiecicka
- Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, Institute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, University of Manchester, Manchester, UK
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain
- Instituto Salud Carlos III, CIBER de Fisiopatología Obesidad y Nutricion(CB06/03), Santiago de Compostela, Spain
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL) and Ashford and St Peter's NHS Foundation Trust, Egham, Surrey, UK
| | | | - Michael E J Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Neil Pendleton
- Centre for Clinical and Cognitive Neuroscience, University of Manchester, Manchester, UK
| | - Brian G Keevil
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Martin K Rutter
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science, Manchester, UK
| | - Gindo Tampubolon
- Cathie Marsh Institute for Social Research. Faculty of Humanities, University of Manchester, Manchester, UK
| | - Royston Goodacre
- School of Chemistry, Manchester Institute for Biotechnology, University of Manchester, Manchester, UK
| | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, UK
- Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Frederick C W Wu
- Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, Institute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, University of Manchester, Manchester, UK
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17
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Swiecicka A, Eendebak RJAH, Lunt M, O’Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Slowikowska-Hilczer J, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Huhtaniemi IT, Wu FCW, Rutter MK. Reproductive Hormone Levels Predict Changes in Frailty Status in Community-Dwelling Older Men: European Male Ageing Study Prospective Data. J Clin Endocrinol Metab 2018; 103:701-709. [PMID: 29186457 PMCID: PMC5800832 DOI: 10.1210/jc.2017-01172] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/13/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Clinical sequelae of androgen deficiency share common features with frailty. Evidence supporting the role of androgens in the development of frailty is limited and conflicting. OBJECTIVE To determine associations between male reproductive hormones and prospective changes in frailty status. DESIGN/SETTING A 4.3-year prospective cohort study of community-dwelling men participating in the European Male Ageing Study. PARTICIPANTS A total of 3369 men aged 40 to 79 from eight European centers. INTERVENTION None. MAIN OUTCOME MEASURE Frailty status was determined using frailty index (FI; n = 2278) and frailty phenotype (FP; n = 1980). RESULTS After adjusting for baseline frailty, age, center, and smoking, the risk of worsening FI decreased with higher testosterone (T), free T, and dihydrotestosterone (DHT) [percentage change (95% confidence interval) in FI associated with 1 standard deviation higher hormone level: -3.0 (-5.9, -1.0) for total T; -3.9 (-6.8, -2.0) for free T; and -3.9 (-6.8, -2.0) for DHT]. After further adjustment for body mass index, only free T remained a significant predictor of FI change. In fully adjusted models, higher luteinizing hormone and follicle-stimulating hormone were positively related to worsening FI only in men <60 years, and higher estradiol predicted lower likelihood of improving FP [odds ratio: 0.68 (0.52, 0.88)]. CONCLUSIONS These prospective data support the hypothesis that higher androgen levels may protect elderly men from worsening frailty. However, the causal nature of these relationships requires further investigation. Whereas raised gonadotropins in men <60 years might be an early marker of frailty, the role of estradiol in frailty needs further clarification.
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Affiliation(s)
- Agnieszka Swiecicka
- Andrology Research Unit, Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom
| | - Robert J. A. H. Eendebak
- Andrology Research Unit, Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, University of Manchester and NIHR Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9PL, United Kingdom
| | - Terence W. O’Neill
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, University of Manchester and NIHR Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9PL, United Kingdom
| | - György Bartfai
- Department of Obstetrics, Gynaecology, and Andrology, Albert Szent-Györgyi Medical University, Szeged H-6725, Hungary
| | - Felipe F. Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, Santiago de Compostela 15706, Spain
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Florence 50139, Italy
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Malmö University Hospital, University of Lund, SE-221 00 Lund, Sweden
| | - Thang S. Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham TW20 0EX, United Kingdom
- Ashford and St. Peter’s NHS Foundation Trust, Surrey TW15 3AA, United Kingdom
| | | | - Michael E. J. Lean
- Department of Human Nutrition, University of Glasgow, Glasgow G31 2ER, United Kingdom
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Hope Hospital, Salford M6 8HD, United Kingdom
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, 50406 Tartu, Estonia
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, B-3001 Leuven, Belgium
| | - Ilpo T. Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London W12 0HS, United Kingdom
- Department of Physiology, Institute of Biomedicine, University of Turku, FI-20520 Turku, Finland
| | - Frederick C. W. Wu
- Andrology Research Unit, Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom
| | - Martin K. Rutter
- Andrology Research Unit, Division of Diabetes, Endocrinology, and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NT, United Kingdom
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18
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Swiecicka A, Lunt M, Ahern T, O’Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Lean MEJ, Pendleton N, Punab M, Slowikowska-Hilczer J, Vanderschueren D, Huhtaniemi IT, Wu FCW, Rutter MK. Nonandrogenic Anabolic Hormones Predict Risk of Frailty: European Male Ageing Study Prospective Data. J Clin Endocrinol Metab 2017; 102:2798-2806. [PMID: 28609827 PMCID: PMC5546856 DOI: 10.1210/jc.2017-00090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/04/2017] [Indexed: 12/19/2022]
Abstract
CONTEXT Low levels of nonandrogenic anabolic hormones have been linked with frailty, but evidence is conflicting and prospective data are largely lacking. OBJECTIVE To determine associations between nonandrogenic anabolic hormones and prospective changes in frailty status. DESIGN/SETTING A 4.3-year prospective observational study of community-dwelling men participating in the European Male Ageing Study. PARTICIPANTS Men (n = 3369) aged 40 to 79 years from eight European centers. MAIN OUTCOME MEASURES Frailty status was determined using frailty phenotype (FP; n = 2114) and frailty index (FI; n = 2444). ANALYSIS Regression models assessed relationships between baseline levels of insulinlike growth factor 1 (IGF-1), its binding protein 3 (IGFBP-3), dehydroepiandrosterone sulfate (DHEA-S), 25-hydroxyvitamin D (25OHD), and parathyroid hormone (PTH), with changes in frailty status (worsening or improving frailty). RESULTS The risk of worsening FP and FI decreased with 1 standard deviation higher IGF-1, IGFBP-3, and 25OHD in models adjusted for age, body mass index, center, and baseline frailty [IGF-1: odds ratio (OR) for worsening FP, 0.82 (0.73, 0.93), percentage change in FI, -3.7% (-6.0, -1.5); IGFBP-3: 0.84 (0.75, 0.95), -4.2% (-6.4, -2.0); 25OHD: 0.84 (0.75, 0.95); -4.4%, (-6.7, -2.0)]. Relationships between IGF-1 and FI were attenuated after adjusting for IGFBP-3. Higher DHEA-S was associated with a lower risk of worsening FP only in men >70 years old [OR, 0.57 (0.35, 0.92)]. PTH was unrelated to change in frailty status. CONCLUSIONS These longitudinal data confirm the associations between nonandrogenic anabolic hormones and the changes in frailty status. Interventional studies are needed to establish causality and determine therapeutic implications.
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Affiliation(s)
- Agnieszka Swiecicka
- Andrology Research Unit, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PT, United Kingdom
| | - Tomás Ahern
- Andrology Research Unit, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Terence W. O’Neill
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PT, United Kingdom
- National Institute for Health Research, Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom
| | - György Bartfai
- Department of Obstetrics, Gynecology and Andrology, Albert Szent-György Medical University, H6725 Szeged, Hungary
| | - Felipe F. Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, 50139 Florence, Italy
| | - Aleksander Giwercman
- Reproductive Medicine Center, Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden
| | - Thang S. Han
- Institute of Cardiovascular Research, Royal Holloway University of London and Ashford and St. Peter’s National Health Service Foundation Trust, Surrey KT16 0PZ, United Kingdom
| | - Michael E. J. Lean
- Department of Human Nutrition, University of Glasgow, Glasgow G31 2ER, United Kingdom
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Hope Hospital, Salford M6 8HD, United Kingdom
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, 50406 Tartu, Estonia
| | | | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, BE-3000 Leuven, Belgium
| | - Ilpo T. Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
- Department of Physiology, Institute of Biomedicine, University of Turku, FI-20520 Turku, Finland
| | - Frederick C. W. Wu
- Andrology Research Unit, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
| | - Martin K. Rutter
- Andrology Research Unit, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom
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19
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Cook MJ, Oldroyd A, Pye SR, Ward KA, Gielen E, Ravindrarajah R, Adams JE, Lee DM, Bartfai G, Boonen S, Casanueva F, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Vanderschueren D, Wu FC, O'Neill TW. Frailty and bone health in European men. Age Ageing 2017; 46:635-641. [PMID: 27852598 PMCID: PMC5859977 DOI: 10.1093/ageing/afw205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background frailty is associated with an increased risk of fragility fractures. Less is known, however, about the association between frailty and bone health. Methods men aged 40-79 years were recruited from population registers in eight European centres for participation in the European Male Aging Study. Subjects completed a comprehensive assessment which included quantitative ultrasound (QUS) scan of the heel (Hologic-SAHARA) and in two centres, dual-energy bone densitometry (dual-energy x-ray absorptiometry, DXA). Frailty was defined based on an adaptation of Fried's phenotype criteria and a frailty index (FI) was constructed. The association between frailty and the QUS and DXA parameters was determined using linear regression, with adjustments for age, body mass index and centre. Results in total, 3,231 subjects contributed data to the analysis. Using the Fried categorisation of frailty, pre-frail and frail men had significantly lower speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) compared to robust men (P< 0.05). Similar results were seen using the FI after categorisation into 'high', 'medium' and 'low' levels of frailty. Using the Fried categorisation, frail men had lower femoral neck bone mineral density (BMD) compared to robust men (P < 0.05), but not lower lumbar spine BMD. Using the FI categorisation, a 'high' level of frailty (FI > 0.35) was associated with lower lumbar spine BMD (P < 0.05) when compared to those with low (FI < 0.2), but not lower femoral neck BMD. When analysed as a continuous variable, higher FI was linked with lower SOS, BUA and QUI (P < 0.05). Conclusions optimisation of bone health as well as prevention of falls should be considered as strategies to reduce fractures in frail older people.
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Affiliation(s)
- Michael J. Cook
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Address correspondence to: Michael J. Cook. Tel: (+44) 1612755499; Fax: (+44) 1613060547.
| | - Alexander Oldroyd
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stephen R. Pye
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Kate A. Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Evelien Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | | | - Judith E. Adams
- Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK
| | - David M. Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, The University of Manchester, ManchesterM13 9PL, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Steven Boonen
- University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felipe Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III,Santiago de Compostela, Spain
| | - Gianni Forti
- Endocrine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Sweden
| | - Thang S. Han
- Egham & Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Institute of Cardiovascular Research, Royal Holloway, University of London (ICR2UL), Chertsey, UK
| | | | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Poland
| | | | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frederick C. Wu
- Andrology Research Unit,Centre for Endocrinology and Diabetes,University of Manchester, Manchester,UK
| | - Terence W. O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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20
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Casamonti E, Vinci S, Serra E, Fino MG, Brilli S, Lotti F, Maggi M, Coccia ME, Forti G, Krausz C. Short-term FSH treatment and sperm maturation: a prospective study in idiopathic infertile men. Andrology 2017; 5:414-422. [DOI: 10.1111/andr.12333] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/16/2016] [Accepted: 01/07/2017] [Indexed: 12/11/2022]
Affiliation(s)
- E. Casamonti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - S. Vinci
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - E. Serra
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - M. G. Fino
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - S. Brilli
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - F. Lotti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - M. Maggi
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - M. E. Coccia
- Center for Artificial Reproductive Techniques; University of Florence; Florence Italy
| | - G. Forti
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
| | - C. Krausz
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences “Mario Serio”; University of Florence; Florence Italy
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21
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Han TS, Correa E, Lean MEJ, Lee DM, O'Neill TW, Bartfai G, Forti G, Giwercman A, Kula K, Pendleton N, Punab M, Rutter MK, Vanderschueren D, Huhtaniemi IT, Wu FCW, Casanueva FF. Changes in prevalence of obesity and high waist circumference over four years across European regions: the European male ageing study (EMAS). Endocrine 2017; 55:456-469. [PMID: 27734258 PMCID: PMC5272876 DOI: 10.1007/s12020-016-1135-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/22/2016] [Indexed: 11/11/2022]
Abstract
Diversity in lifestyles and socioeconomic status among European populations, and recent socio-political and economic changes in transitional countries, may affect changes in adiposity. We aimed to determine whether change in the prevalence of obesity varies between the socio-politically transitional North-East European (Łódź, Poland; Szeged, Hungary; Tartu, Estonia), and the non-transitional Mediterranean (Santiago de Compostela, Spain; Florence, Italy) and North-West European (Leuven, Belgium; Malmö, Sweden; Manchester, UK) cities. This prospective observational cohort survey was performed between 2003 and 2005 at baseline and followed up between 2008 and 2010 of 3369 community-dwelling men aged 40-79 years. Main outcome measures in the present paper included waist circumference, body mass index and mid-upper arm muscle area. Baseline prevalence of waist circumference ≥ 102 cm and body mass index ≥ 30 kg/m2, respectively, were 39.0, 29.5 % in North-East European cities, 32.4, 21.9 % in Mediterranean cities, and 30.0, 20.1 % in North-West European cities. After median 4.3 years, men living in cities from transitional countries had mean gains in waist circumference (1.1 cm) and body mass index (0.2 kg/m2), which were greater than men in cities from non-transitional countries (P = 0.005). North-East European cities had greater gains in waist circumference (1.5 cm) than in Mediterranean cities (P < 0.001). Over 4.3 years, the prevalence of waist circumference ≥ 102 cm had increased by 13.1 % in North-East European cities, 5.8 % in the Mediterranean cities, 10.0 % in North-West European cities. Odds ratios (95 % confidence intervals), adjusted for lifestyle factors, for developing waist circumference ≥ 102 cm, compared with men from Mediterranean cities, were 2.3 (1.5-3.5) in North-East European cities and 1.6 (1.1-2.4) in North-West European cities, and 1.6 (1.2-2.1) in men living in cities from transitional, compared with cities from non-transitional countries. These regional differences in increased prevalence of waist circumference ≥ 102 cm were more pronounced in men aged 60-79 years than in those aged 40-59 years. Overall there was an increase in the prevalence of obesity (body mass index ≥ 30 kg/m2) over 4.3 years (between 5.3 and 6.1 %) with no significant regional differences at any age. Mid-upper arm muscle area declined during follow-up with the greatest decline among men from North-East European cities. In conclusion, increasing waist circumference is dissociated from change in body mass index and most rapid among men living in cities from transitional North-East European countries, presumably driven by economic and socio-political changes. Information on women would also be of value and it would be of interest to relate the changes in adiposity to dietary and other behavioural habits.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, Egham & Ashford and St Peter's NHS Foundation Trust, University of London (ICR2UL), Surrey, UK.
| | - Elon Correa
- School of Computing, Science and Engineering, University of Salford, Salford, UK
| | - Michael E J Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - David M Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, The University of Manchester, Manchester, UK
| | - Terrence W O'Neill
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Gianni Forti
- Endocrinology Unit, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skåne University Hospital, University of Lund, Lund, Sweden
| | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland
| | - Neil Pendleton
- Institute of Brain Behaviour and Mental Health, Salford Royal NHS Trust, University of Manchester, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Martin K Rutter
- The Endocrinology and Diabetes Research Group, Institute of Human Development, Department of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK
| | - Frederick C W Wu
- Andrology Research Unit, The University of Manchester, Manchester, UK
| | - Felipe F Casanueva
- Department of Medicine, CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela University, Santiago de Compostela, Spain.
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22
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Tamburrino L, Cambi M, Marchiani S, Manigrasso I, Degl'Innocenti S, Forti G, Maggi M, Baldi E, Muratori M. Sperm DNA fragmentation in cryopreserved samples from subjects with different cancers. Reprod Fertil Dev 2017; 29:637-645. [DOI: 10.1071/rd15190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022] Open
Abstract
Sperm cryopreservation is widely used by cancer patients undergoing chemo- or radiotherapy. Evidence suggests that IVF outcome with cryopreserved spermatozoa from cancer patients is less successful. To determine whether sperm DNA fragmentation (SDF) is involved in the lower fertilising ability of cryopreserved spermatozoa of cancer patients, SDF was evaluated in thawed spermatozoa from 78 men affected by different cancers and 53 men with non-cancer pathologies. SDF was assessed by the terminal deoxyribonucleotidyl transferase-mediated dUTP–digoxigenin nick end-labelling (TUNEL), propidium iodide (PI), flow cytometry procedure, which allows determination of two different cell populations (PIbrighter and PIdimmer) and thus to determine the percentage of DNA fragmented sperm in both. PIdimmer spermatozoa are totally unviable, whereas PIbrighter spermatozoa with SDF may be motile and morphologically normal, having higher biological relevance in the reproductive process. We found that the proportion of DNA fragmented PIbrighter cells was significantly higher in thawed spermatozoa from cancer than non-cancer patients. Moreover, a positive correlation was found between the degree of DNA fragmentation and sperm motility in the PIbrighter population of spermatozoa from cancer patients that wasn’t seen in non-cancer patients. The results of the present study suggest that higher SDF levels may contribute to the lower IVF success of cryopreserved spermatozoa from cancer patients and that evaluation of SDF could complement genetic counselling as part of the routine management of cancer patients who seek fertility preservation.
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23
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Eendebak RJAH, Huhtaniemi IT, Pye SR, Ahern T, O'Neill TW, Bartfai G, Casanueva FF, Maggi M, Forti G, Alston RD, Giwercman A, Han TS, Kula K, Lean MEJ, Punab M, Pendleton N, Keevil BG, Vanderschueren D, Rutter MK, Tampubolon G, Goodacre R, Wu FCW. The androgen receptor gene CAG repeat
in relation to 4-year changes in
androgen-sensitive endpoints in
community-dwelling older European men. Eur J Endocrinol 2016; 175:583-593. [PMID: 27634944 DOI: 10.1530/eje-16-0447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/17/2016] [Accepted: 09/15/2016] [Indexed: 01/24/2023]
Abstract
CONTEXT The androgen receptor (AR) gene exon 1 CAG repeat length has been proposed to be a determinant of between-individual variations in androgen action in target tissues, which might regulate phenotypic differences of human ageing. However, findings on its phenotypic effects are inconclusive. OBJECTIVE To assess whether the AR CAG repeat length is associated with longitudinal changes in endpoints that are influenced by testosterone (T) levels in middle-aged and elderly European men. DESIGN Multinational European observational prospective cohort study. PARTICIPANTS A total of 1887 men (mean ± s.d. age: 63 ± 11 years; median follow up: 4.3 years) from centres of eight European countries comprised the analysis sample after exclusion of those with diagnosed diseases of the hypothalamic-pituitary-testicular (HPT) axis. MAIN OUTCOME MEASURES Longitudinal associations between the AR CAG repeat and changes in androgen-sensitive endpoints (ASEs) and medical conditions were assessed using regression analysis adjusting for age and centre. The AR CAG repeat length was treated as both a continuous and a categorical (6-20; 21-23; 24-39 repeats) predictor. Additional analysis investigated whether results were independent of baseline T or oestradiol (E2) levels. RESULTS The AR CAG repeat, when used as a continuous or a categorical predictor, was not associated with longitudinal changes in ASEs or medical conditions after adjustments. These results were independent of T and E2 levels. CONCLUSION Within a 4-year time frame, variations in the AR CAG repeat do not contribute to the rate of phenotypic ageing, over and above, which might be associated with the age-related decline in T levels.
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Affiliation(s)
- Robert J A H Eendebak
- Faculty of Medical and Human SciencesInstitute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Ilpo T Huhtaniemi
- Department of Surgery and CancerInstitute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Stephen R Pye
- Arthritis Research UK Centre for EpidemiologyCentre for Musculoskeletal Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tomas Ahern
- Faculty of Medical and Human SciencesInstitute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for EpidemiologyCentre for Musculoskeletal Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics and Gynaecology and AndrologyAlbert Svent Gyorgy Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of MedicineUniversity Santiago de Compostela, Santiago de Compostela, UK
| | - Mario Maggi
- Department of Clinical PhysiopathologyAndrology Unit, University of Florence, Florence, Italy
| | - Gianni Forti
- Department of Clinical PhysiopathologyAndrology Unit, University of Florence, Florence, Italy
| | - Robert D Alston
- Faculty of Medical and Human SciencesInstitute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Aleksander Giwercman
- Department of UrologyScanian Andrology Centre, Malmo University Hospital, Lund University, Malmo, Sweden
| | - Thang S Han
- Department of EndocrinologyUniversity College London, London, UK
| | - Krzysztof Kula
- Department of Andrology and Reproductive EndocrinologyMedical University Lodz, Lodz, Poland
| | | | - Margus Punab
- United LabsAndrology Unit, Tartu University Clinic, Tartu, Estonia
| | - Neil Pendleton
- Salford Royal NHS TrustSchool of Community Based Medicine, University of Manchester, Manchester, UK
| | - Brian G Keevil
- Department of Clinical BiochemistryUniversity South Manchester Hospital, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and EndocrinologyCatholic University Leuven, Leuven, Belgium
| | - Martin K Rutter
- Manchester Diabetes CentreCentral Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre
- Faculty of Medical and Human SciencesInstitute of Human Development, Endocrinology and Diabetes Research Group
| | | | - Royston Goodacre
- School of ChemistryManchester Institute for Biotechnology, University of Manchester, Manchester, UK
| | - Frederick C W Wu
- Faculty of Medical and Human SciencesInstitute of Human Development, Centre for Endocrinology and Diabetes, Andrology Research Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Ahern T, Swiecicka A, Eendebak RJAH, Carter EL, Finn JD, Pye SR, O'Neill TW, Antonio L, Keevil B, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean MEJ, Pendleton N, Punab M, Rastrelli G, Rutter MK, Vanderschueren D, Huhtaniemi IT, Wu FCW. Natural history, risk factors and clinical features of primary hypogonadism in ageing men: Longitudinal Data from the European Male Ageing Study. Clin Endocrinol (Oxf) 2016; 85:891-901. [PMID: 27374987 DOI: 10.1111/cen.13152] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/29/2016] [Accepted: 06/29/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In ageing men, the incidence and clinical significance of testosterone (T) decline accompanied by elevated luteinizing hormone (LH) are unclear. We describe the natural history, risk factors and clinical features associated with the development of biochemical primary hypogonadism (PHG, T < 10·5 nmol/l and LH>9·4U/l) in ageing men. DESIGN, PATIENTS AND MEASUREMENTS A prospective observational cohort survey of 3,369 community-dwelling men aged 40-79 years, followed up for 4·3 years. Men were classified as incident (i) PHG (eugonadal [EUG, T ≥ 10·5 nmol/l] at baseline, PHG at follow-up), persistent (p) PHG (PHG at baseline and follow-up), pEUG (EUG at baseline and follow-up) and reversed (r) PHG (PHG at baseline, EUG at follow-up). Predictors and changes in clinical features associated with the development of PHG were analysed by regression models. RESULTS Of 1,991 men comprising the analytical sample, 97·5% had pEUG, 1·1% iPHG, 1·1% pPHG and 0·3% rPHG. The incidence of PHG was 0·2%/year. Higher age (>70 years) [OR 12·48 (1·27-122·13), P = 0·030] and chronic illnesses [OR 4·24 (1·08-16·56); P = 0·038] predicted iPHG. Upon transition from EUG to PHG, erectile function, physical vigour and haemoglobin worsened significantly. Men with pPHG had decreased morning erections, sexual thoughts and haemoglobin with increased insulin resistance. CONCLUSIONS Primary testicular failure in men is uncommon and predicted by old age and chronic illness. Some clinical features attributable to androgen deficiency, but not others, accompanied the T decline in men who developed biochemical PHG. Whether androgen replacement can improve sexual and/or physical function in elderly men with PHG merits further study.
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Affiliation(s)
- Tomás Ahern
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
| | - Agnieszka Swiecicka
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
| | - Robert J A H Eendebak
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
| | - Emma L Carter
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
| | - Joseph D Finn
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Leen Antonio
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Brian Keevil
- Department of Clinical Biochemistry, University Hospital of South Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatología Obesidad y Nutricion (CB06/03), Santiago de Compostela University, Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Malmö University Hospital, University of Lund, Lund, Sweden
| | - Thang S Han
- Institute of Cardiovascular Research, "Royal Holloway University of London (ICR2UL), Egham & Agham and St Peter's NHS Foundation Trust, Egham, Surrey, UK
| | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland
| | - Michael E J Lean
- Department of Human Nutrition, University of Glasgow, Glasgow, UK
| | - Neil Pendleton
- School of Community Based Medicine, Hope Hospital, The University of Manchester, Salford, UK
| | - Margus Punab
- United Laboratories of Tartu University Clinics, Andrology Unit, Tartu, Estonia
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Martin K Rutter
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, UK
- Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Frederick C W Wu
- Andrology Research Unit, Centre for Endocrinology & Diabetes, Institute of Human Development, Old St Mary's Building, The University of Manchester, Manchester, UK
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25
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Fisher AD, Ristori J, Fanni E, Castellini G, Forti G, Maggi M. Gender identity, gender assignment and reassignment in individuals with disorders of sex development: a major of dilemma. J Endocrinol Invest 2016; 39:1207-1224. [PMID: 27287420 DOI: 10.1007/s40618-016-0482-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Disorders of Sex Development (DSD) are a wide range of congenital conditions characterized by an incongruence of components involved in sexual differentiation, including gender psychosexual development. The management of such disorders is complex, and one of the most crucial decision is represented by gender assignment. In fact, the primary goal in DSD is to have a gender assignment consistent with the underlying gender identity in order to prevent the distress related to a forthcoming Gender Dysphoria. Historically, gender assignment was based essentially on surgical outcomes, assuming the neutrality of gender identity at birth. This policy has been challenged in the past decade refocusing on the importance of prenatal and postnatal hormonal and genetic influences on psychosexual development. AIMS (1) to update the main psychological and medical issues that surround DSD, in particular regarding gender identity and gender assignment; (2) to report specific clinical recommendations according to the different diagnosis. METHODS A systematic search of published evidence was performed using Medline (from 1972 to March 2016). Review of the relevant literature and recommendations was based on authors' expertise. RESULTS A review of gender identity and assignment in DSD is provided as well as clinical recommendations for the management of individuals with DSD. CONCLUSIONS Given the complexity of this management, DSD individuals and their families need to be supported by a specialized multidisciplinary team, which has been universally recognized as the best practice for intersexual conditions. In case of juvenile GD in DSD, the prescription of gonadotropin-releasing hormone analogues, following the World Professional Association for Transgender Health and the Endocrine Society guidelines, should be considered. It should always be taken into account that every DSD person is unique and has to be treated with individualized care. In this perspective, international registries are crucial to improve the understanding of these challenging conditions and clinical practice, in providing a better prediction of gender identity.
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Affiliation(s)
- A D Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - J Ristori
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - E Fanni
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Castellini
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - G Forti
- Endocrine Unit, "Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies" (DENOThe), Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Florence, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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26
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Laurent MR, Cook MJ, Gielen E, Ward KA, Antonio L, Adams JE, Decallonne B, Bartfai G, Casanueva FF, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Lean MEJ, Lee DM, Pendleton N, Punab M, Claessens F, Wu FCW, Vanderschueren D, Pye SR, O'Neill TW. Lower bone turnover and relative bone deficits in men with metabolic syndrome: a matter of insulin sensitivity? The European Male Ageing Study. Osteoporos Int 2016; 27:3227-3237. [PMID: 27273111 DOI: 10.1007/s00198-016-3656-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/26/2016] [Indexed: 01/26/2023]
Abstract
UNLABELLED We examined cross-sectional associations of metabolic syndrome and its components with male bone turnover, density and structure. Greater bone mass in men with metabolic syndrome was related to their greater body mass, whereas hyperglycaemia, hypertriglyceridaemia or impaired insulin sensitivity were associated with lower bone turnover and relative bone mass deficits. INTRODUCTION Metabolic syndrome (MetS) has been associated with lower bone turnover and relative bone mass or strength deficits (i.e. not proportionate to body mass index, BMI), but the relative contributions of MetS components related to insulin sensitivity or obesity to male bone health remain unclear. METHODS We determined cross-sectional associations of MetS, its components and insulin sensitivity (by homeostatic model assessment-insulin sensitivity (HOMA-S)) using linear regression models adjusted for age, centre, smoking, alcohol, and BMI. Bone turnover markers and heel broadband ultrasound attenuation (BUA) were measured in 3129 men aged 40-79. Two centres measured total hip, femoral neck, and lumbar spine areal bone mineral density (aBMD, n = 527) and performed radius peripheral quantitative computed tomography (pQCT, n = 595). RESULTS MetS was present in 975 men (31.2 %). Men with MetS had lower β C-terminal cross-linked telopeptide (β-CTX), N-terminal propeptide of type I procollagen (PINP) and osteocalcin (P < 0.0001) and higher total hip, femoral neck, and lumbar spine aBMD (P ≤ 0.03). Among MetS components, only hypertriglyceridaemia and hyperglycaemia were independently associated with PINP and β-CTX. Hyperglycaemia was negatively associated with BUA, hypertriglyceridaemia with hip aBMD and radius cross-sectional area (CSA) and stress-strain index. HOMA-S was similarly associated with PINP and β-CTX, BUA, and radius CSA in BMI-adjusted models. CONCLUSIONS Men with MetS have higher aBMD in association with their greater body mass, while their lower bone turnover and relative deficits in heel BUA and radius CSA are mainly related to correlates of insulin sensitivity. Our findings support the hypothesis that underlying metabolic complications may be involved in the bone's failure to adapt to increasing bodily loads in men with MetS.
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Affiliation(s)
- M R Laurent
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 7003, 3000, Leuven, Belgium.
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, PO box 901, 3000, Leuven, Belgium.
- Center for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - M J Cook
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - E Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 7003, 3000, Leuven, Belgium
- Center for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - K A Ward
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
| | - L Antonio
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, PO box 901, 3000, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 902, 3000, Leuven, Belgium
| | - J E Adams
- Radiology Department, and Manchester Academic Health Science Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - B Decallonne
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 902, 3000, Leuven, Belgium
| | - G Bartfai
- Department of Obstetrics, Gynecology and Andrology, Albert Szent-György Medical University, Semmelweis u. 1, 6725, Szeged, Hungary
| | - F F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, Travesía de Choupana s/n, 15706, Santiago de Compostela, Spain
| | - G Forti
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - A Giwercman
- Department of Urology, Scanian Andrology Centre, Malmö University Hospital, University of Lund, Jan Waldenströms gata 35, 20502, Malmö, Sweden
| | - I T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK
| | - K Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Pomorska 45/47, Śródmieście, 90-406, Łódź, Poland
| | - M E J Lean
- Department of Human Nutrition, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
| | - D M Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, University of Manchester, Humanities Bridgeford Street-G17, Manchester, M13 9PL, UK
| | - N Pendleton
- School of Community Based Medicine, University of Manchester, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - M Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, L. Puusepa 1a, Tartu, Estonia
| | - F Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, PO box 901, 3000, Leuven, Belgium
| | - F C W Wu
- Developmental and Regenerative Biomedicine Research Group, Andrology Research Unit, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, Grafton Street, Manchester, M13 9WL, UK
| | - D Vanderschueren
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 902, 3000, Leuven, Belgium
| | - S R Pye
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - T W O'Neill
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, 29 Grafton Street, Manchester, M13 9WU, UK
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27
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Antonio L, Wu FCW, O'Neill TW, Pye SR, Ahern TB, Laurent MR, Huhtaniemi IT, Lean MEJ, Keevil BG, Rastrelli G, Forti G, Bartfai G, Casanueva FF, Kula K, Punab M, Giwercman A, Claessens F, Decallonne B, Vanderschueren D. Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone. J Clin Endocrinol Metab 2016; 101:2647-57. [PMID: 26909800 DOI: 10.1210/jc.2015-4106] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT During aging, total testosterone (TT) declines and SHBG increases, resulting in a greater decrease in calculated free T (cFT). Currently, guidelines suggest using TT to diagnose androgen deficiency and to reserve cFT only for men with borderline TT. OBJECTIVE Our objective was to investigate if either low cFT or low TT is more strongly associated with androgen-related clinical endpoints. METHODS A total of 3334 community-dwelling men, aged 40-79 years, were included in this study. Differences in clinical variables between the referent group of men with both normal TT (≥10.5 nmol/liter) and normal cFT (≥220 pmol/liter) with those who had normal TT/low cFT, low TT/normal cFT, and low TT/low cFT were assessed by regression models adjusted for age, center, body mass index, and comorbidities. RESULTS A total of 2641 men had normal TT (18.4 ± 5.5 [mean ± SD] nmol/liter)/normal cFT (326 ± 74 pmol/liter), 277 men had normal TT (14.2 ± 3.7)/low cFT (194 ± 23), 96 men had low TT (9.6 ± 0.7)/normal cFT (247 ± 20), and 320 men had low TT (7.8 ± 2.5)/low cFT (160 ± 55). Men with normal TT/low cFT were older and in poorer health. They had higher SHBG and LH and reported more sexual and physical symptoms, whereas hemoglobin and bone ultrasound parameters were lower compared to the referent group. Men with low TT/normal cFT were younger and more obese. They had lower SHBG, but LH was normal, whereas features of androgen deficiency were lacking. CONCLUSIONS Low cFT, even in the presence of normal TT, is associated with androgen deficiency-related symptoms. Normal cFT, despite low TT, is not associated with cognate symptoms; therefore, cFT levels should be assessed in men with suspected hypogonadal symptoms.
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Affiliation(s)
- Leen Antonio
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Frederick C W Wu
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Terence W O'Neill
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Stephen R Pye
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Tomas B Ahern
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Michaël R Laurent
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Ilpo T Huhtaniemi
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Michael E J Lean
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Brian G Keevil
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Giulia Rastrelli
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Gianni Forti
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - György Bartfai
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Felipe F Casanueva
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Krzysztof Kula
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Margus Punab
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Aleksander Giwercman
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Frank Claessens
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Brigitte Decallonne
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
| | - Dirk Vanderschueren
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, Leuven, Belgium; Andrology Research Unit (F.C.W.W., T.B.A.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals National Health Services (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Centre of Epidemiology (T.W.O.N., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit (T.W.O.N.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, Leuven, Belgium; Department of Surgery and Cancer, Imperial College London (I.T.H.), Hammersmith Campus, London, UK; Department of Physiology (I.T.H.), Institute of Biomedicine, University of Turku, Turku, Finland; Department of Human Nutrition (M.E.J.L.), University of Glasgow, Glasgow, UK; Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester, UK; Sexual Medicine and Andrology Unit (G.R.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Endocrinology Unit (G.F.), Department of Experimental Clinical and Biochemical Sciences, University of Florence, Florence, Italy; Department of Obstetrics, Gynaecology and Andrology (G.B.), Albert Szent-György Medica
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Tournoy J, Overman M, Pendleton N, O'Neill T, Bartfai G, Casanueva F, Forti G, Rastrelli G, Giwercman A, Han T, Huhtaniemi I, Kula K, Lean M, Punab M, Lee D, Correa E, Verschueren S, Antonio L, Gielen E, Rutter M, Vanderschueren D, Wu F. P2‐419: Evaluation of 25‐Hydroxyvitamin D and 1,25‐Dihydroxyvitamin D and Cognitive Decline in the European Male Ageing Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1631] [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] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | | | | | - Felipe Casanueva
- Instituto Salud Carlos III, Complejo Hospitalario Universitario de SantiagoSantiagoSpain
| | | | | | | | - Thang Han
- The University of ManchesterManchesterUnited Kingdom
| | | | | | | | - Margus Punab
- United Laboratories of Tartu University ClinicsTartuEstonia
| | - David Lee
- University of ManchesterManchesterUnited Kingdom
| | - Elon Correa
- University of ManchesterManchesterUnited Kingdom
| | | | | | | | | | | | - Frederick Wu
- University of ManchesterManchesterUnited Kingdom
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Muratori M, Tarozzi N, Cambi M, Boni L, Iorio AL, Passaro C, Luppino B, Nadalini M, Marchiani S, Tamburrino L, Forti G, Maggi M, Baldi E, Borini A. Variation of DNA Fragmentation Levels During Density Gradient Sperm Selection for Assisted Reproduction Techniques: A Possible New Male Predictive Parameter of Pregnancy? Medicine (Baltimore) 2016; 95:e3624. [PMID: 27196465 PMCID: PMC4902407 DOI: 10.1097/md.0000000000003624] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Predicting the outcome of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is one main goal of the present research on assisted reproduction. To understand whether density gradient centrifugation (DGC), used to select sperm, can affect sperm DNA integrity and impact pregnancy rate (PR), we prospectively evaluated sperm DNA fragmentation (sDF) by TUNEL/PI, before and after DGC. sDF was studied in a cohort of 90 infertile couples the same day of IVF/ICSI treatment. After DGC, sDF increased in 41 samples (Group A, median sDF value: 29.25% [interquartile range, IQR: 16.01-41.63] in pre- and 60.40% [IQR: 32.92-93.53] in post-DGC) and decreased in 49 (Group B, median sDF value: 18.84% [IQR: 13.70-35.47] in pre- and 8.98% [IQR: 6.24-15.58] in post-DGC). PR was 17.1% and 34.4% in Group A and B, respectively (odds ratio [OR]: 2.58, 95% confidence interval [CI]: 0.95-7.04, P = 0.056). After adjustment for female factor, female and male age and female BMI, the estimated OR increased to 3.12 (95% CI: 1.05-9.27, P = 0.041). According to the subgroup analysis for presence/absence of female factor, heterogeneity in the association between the Group A and B and PR emerged (OR: 4.22, 95% CI: 1.16-15.30 and OR: 1.53, 95% CI: 0.23-10.40, respectively, for couples without, n = 59, and with, n = 31, female factor).This study provides the first evidence that the DGC procedure produces an increase in sDF in about half of the subjects undergoing IVF/ICSI, who then show a much lower probability of pregnancy, raising concerns about the safety of this selection procedure. Evaluation of sDF before and after DGC configures as a possible new prognostic parameter of pregnancy outcome in IVF/ICSI. Alternative sperm selection strategies are recommended for those subjects who undergo the damage after DGC.
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Affiliation(s)
- Monica Muratori
- From the Department of Experimental, Clinical and Biomedical Sciences, Unit of Sexual Medicine and Andrology, Center of Excellence DeNothe, University of Florence (MM, MC, ALI, CP, BL, SM, LT, GF, MM, EB); Tecnobios Procreazione, Centre for Reproductive Health, Bologna (NT, MN, AB); and Clinical Trials Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Florence (LB), Italy
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Cocci A, Gacci M, Drake M, Castellini G, Ricca V, Forti G, Wu F, Maggi M. P-06-005 Lower urinary tract symptoms, depression and adverse life events: data from the European Male Ageing Study. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.330] [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: 10/21/2022]
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O'Connell MDL, Tajar A, O'Neill TW, Roberts SA, Lee DM, Pye SR, Silman AJ, Finn JD, Bartfai G, Boonen S, Casanueva FF, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Wu FCW. Frailty Is Associated with Impaired Quality of Life and Falls in Middle-Aged and Older European Men. J Frailty Aging 2016; 2:77-83. [PMID: 27070662 DOI: 10.14283/jfa.2013.12] [Citation(s) in RCA: 6] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Adapt a measure of frailty for use in a cohort study of European men and explore relationships with age, health related quality of life and falls. DESIGN Longitudinal cohort study. SETTING 8 European centers. PARTICIPANTS 3047 men aged 40-79 participating in the European Male Ageing Study (EMAS). MEASUREMENTS Frailty was assessed using an adaptation of the Cardiovascular Health Study criteria. Health related quality of life was evaluated using the Rand Short Form-36 (SF-36) questionnaire which comprises both mental and physical component scores. Self reported falls in the preceding 12 months were recorded at 2-year follow-up. RESULTS 78 men (2.6%) were classified as frail (≥3 criteria) and 821 (26.9%) as prefrail (1-2 criteria). The prevalence of frailty increased from 0.1% in men aged 40-49 up to 6.8% in men aged 70-79. Compared to robust men, both prefrail and frail men had lower health related quality of life. Frailty was more strongly associated with the physical than mental subscales of the SF-36. Frailty was associated with higher risk of falls OR (95% CI) 2.92 (1.52, 5.59). CONCLUSIONS Frailty, assessed by the EMAS criteria, increased in prevalence with age and was related to poorer health related quality of life and higher risk of falls in middle-aged and older European men. These criteria may help to identify a vulnerable subset of older men.
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Affiliation(s)
- M D L O'Connell
- Prof. Frederick C.W. Wu, Email address: , Phone: +44 161 2766330. Fax: +44 161 2766363
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Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A. Correction: Hyponatremia Improvement Is Associated with a Reduced Risk of Mortality: Evidence from a Meta-Analysis. PLoS One 2016; 11:e0152846. [PMID: 27018590 PMCID: PMC4809535 DOI: 10.1371/journal.pone.0152846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Di Franco A, Guasti D, Squecco R, Mazzanti B, Rossi F, Idrizaj E, Gallego-Escuredo JM, Villarroya F, Bani D, Forti G, Vannelli GB, Luconi M. Searching for Classical Brown Fat in Humans: Development of a Novel Human Fetal Brown Stem Cell Model. Stem Cells 2016; 34:1679-91. [DOI: 10.1002/stem.2336] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/05/2016] [Accepted: 01/19/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandra Di Franco
- Department of Experimental and Clinical Biomedical Sciences; Endocrinology Unit, University of Florence; Italy
| | - Daniele Guasti
- Department of Experimental and Clinical Medicine; Histology and Embryology Unit, University of Florence; Italy
| | - Roberta Squecco
- Department of Experimental and Clinical Medicine; Section of Physiological Sciences, University of Florence; Italy
| | - Benedetta Mazzanti
- Department of Experimental and Clinical Medicine; Haematology Unit, University of Florence; Italy
| | - Francesca Rossi
- Italian National Research Council, Institute of Applied Physics; Sesto Fiorentino Italy
| | - Eglantina Idrizaj
- Department of Experimental and Clinical Medicine; Section of Physiological Sciences, University of Florence; Italy
| | - José M. Gallego-Escuredo
- Departament de Bioquimica i Biologia Molecular; Institute of Biomedicine, University of Barcelona, and Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutrición; Barcelona Catalonia Spain
| | - Francesc Villarroya
- Departament de Bioquimica i Biologia Molecular; Institute of Biomedicine, University of Barcelona, and Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutrición; Barcelona Catalonia Spain
| | - Daniele Bani
- Department of Experimental and Clinical Medicine; Histology and Embryology Unit, University of Florence; Italy
| | - Gianni Forti
- Department of Experimental and Clinical Biomedical Sciences; Endocrinology Unit, University of Florence; Italy
| | - Gabriella Barbara Vannelli
- Department of Experimental and Clinical Medicine; Section of Anatomy and Histology, University of Florence; Florence Italy
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences; Endocrinology Unit, University of Florence; Italy
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Forti G. Lessons learned in andrology: from endocrinology to andrology and backwards: the round trip of a clinician. Andrology 2016; 4:185-8. [DOI: 10.1111/andr.12120] [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] [Indexed: 11/29/2022]
Affiliation(s)
- G. Forti
- Endocrine Unit; Department of Biomedical; Experimental and Clinical Sciences “Mario Serio”; University of Florence; Viale Pieraccini 6 50139 Florence City
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Wade KF, Lee DM, McBeth J, Ravindrarajah R, Gielen E, Pye SR, Vanderschueren D, Pendleton N, Finn JD, Bartfai G, Casanueva FF, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Punab M, Wu FCW, O'Neill TW. Chronic widespread pain is associated with worsening frailty in European men. Age Ageing 2016; 45:268-74. [PMID: 26679698 PMCID: PMC4776622 DOI: 10.1093/ageing/afv170] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/23/2015] [Indexed: 12/21/2022] Open
Abstract
Background: we hypothesised that chronic widespread pain (CWP), by acting as a potential stressor, may predispose to the development of, or worsening, frailty. Setting: longitudinal analysis within the European Male Ageing Study (EMAS). Participants: a total of 2,736 community-dwelling men aged 40–79. Methods: subjects completed a pain questionnaire and shaded a manikin, with the presence of CWP defined using the American College of Rheumatology criteria. Physical activity, smoking, alcohol consumption and depression were measured. Repeat assessments took place a median of 4.3 years later. A frailty index (FI) was used, with frail defined as an FI >0.35. The association between CWP at baseline and the new occurrence of frailty was examined using logistic regression; the association between CWP at baseline and change in FI was examined using negative binomial regression. Results: at baseline, 218 (8.3%) men reported CWP. Of the 2,631 men who were defined as non-frail at baseline, 112 (4.3%) were frail at follow-up; their mean FI was 0.12 (SD 0.1) at baseline and 0.15 (SD 0.1) at follow-up, with a mean change of 0.03 (SD 0.08) P ≤ 0.001. Among men who were non-frail at baseline, those with CWP were significantly more likely to develop frailty. After adjustment for age and centre, compared with those with no pain, those with CWP at baseline had a 70% higher FI at follow-up; these associations remained significant after further adjustment for smoking, body mass index, depression, physical activity and FI at baseline. Conclusion: the presence of CWP is associated with an increased risk of frailty in older European men.
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Affiliation(s)
- Katie Fredrika Wade
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust-Manchester Academic Health Science Centre, Manchester, UK
| | - David M Lee
- Cathie Marsh Institute for Social Research, The University of Manchester, Manchester, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rathi Ravindrarajah
- Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Evelien Gielen
- Geriatric Medicine Department, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Neil Pendleton
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Salford, UK
| | - Joseph D Finn
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Gianni Forti
- Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Frederick C W Wu
- Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust-Manchester Academic Health Science Centre, Manchester, UK
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McCabe PS, Pye SR, Beth JM, Lee DM, Tajar A, Bartfai G, Boonen S, Bouillon R, Casanueva F, Finn JD, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Pendleton N, Punab M, Vanderschueren D, Wu FC, O'Neill TW. Low vitamin D and the risk of developing chronic widespread pain: results from the European male ageing study. BMC Musculoskelet Disord 2016; 17:32. [PMID: 26774507 PMCID: PMC4715359 DOI: 10.1186/s12891-016-0881-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background The association between low levels of vitamin D and the occurrence of chronic widespread pain (CWP) remains unclear. The aim of our analysis was to determine the relationship between low vitamin D levels and the risk of developing CWP in a population sample of middle age and elderly men. Methods Three thousand three hundred sixty nine men aged 40–79 were recruited from 8 European centres for a longitudinal study of male ageing, the European Male Ageing Study. At baseline participants underwent assessment of lifestyle, health factors, physical characteristics and gave a fasting blood sample. The occurrence of pain was assessed at baseline and follow up (a mean of 4.3 years later) by shading painful sites on a body manikin. The presence of CWP was determined using the ACR criteria for fibromyalgia. Serum 25-hydroxyvitamin D (25-(OH) D) was assessed by radioimmunoassay. Logistic regression was used to determine the relationship between baseline vitamin D levels and the new occurrence of CWP. Results Two thousand three hundred thirteen men, mean age 58.8 years (SD = 10.6), had complete pain and vitamin data available and contributed to this analysis. 151 (6.5 %) developed new CWP at follow up and 577 (24.9 %) were pain free at both time points, the comparator group. After adjustment for age and centre, physical performance and number of comorbidities, compared to those in upper quintile of 25-(OH) D ( ≥36.3 ng/mL), those in the lowest quintile (<15.6 ng/mL) were more likely to develop CWP (Odds Ratio [OR] = 1.93; 95 % CI = 1.0-3.6). Further adjustment for BMI (OR = 1.67; 95 % CI = 0.93-3.02) or depression (OR = 1.77; 95 % CI = 0.98-3.21), however rendered the association non-significant. Conclusions Low vitamin D is linked with the new occurrence of CWP, although this may be explained by underlying adverse health factors, particularly obesity and depression.
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Affiliation(s)
- Paul S McCabe
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK
| | - John Mc Beth
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.,Arthritis Research Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - David M Lee
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK
| | - Abdelouahid Tajar
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary
| | - Steven Boonen
- University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Roger Bouillon
- Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felipe Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, ; Santiago de Compostela, Spain
| | - Joseph D Finn
- Andrology Research Unit, Centre for Endocrinology and Diabetes, University of Manchester, Manchester, UK
| | - Gianni Forti
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Lund, Sweden
| | - Ilpo T Huhtaniemi
- Department of Reproductive Biology, Imperial College London, London, UK
| | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Neil Pendleton
- Clinical Gerontology, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frederick C Wu
- Andrology Research Unit, Centre for Endocrinology and Diabetes, University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Antonio L, Wu F, O'Neill T, Pye S, Carter E, Finn J, Laurent M, Huhtaniemi I, Rutter M, Rastrelli G, Forti G, Bartfai G, Casanueva F, Kula K, Punab M, Giwercman A, Claessens F, Decallonne B, Vanderschueren D. Low free testosterone is associated with hypogonadal signs and symptoms in men with normal total testosterone levels: results from the European Male Ageing Study. Arch Public Health 2015. [PMCID: PMC4582226 DOI: 10.1186/2049-3258-73-s1-p10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wade K, Lee D, Pendleton N, Vanderschueren D, Bartfai G, Casanueva F, Forti G, Giwercman A, Kula K, Punab M, Huhtaniemi I, Wu F, O'Neill T. 59DOES CHRONIC PAIN INCREASE THE RISK OF DEVELOPING FRAILTY? RESULTS FROM THE EUROPEAN MALE AGEING STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv112.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pye SR, Vanderschueren D, Boonen S, Gielen E, Adams JE, Ward KA, Lee DM, Bartfai G, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Wu FC, O'Neill TW. Low heel ultrasound parameters predict mortality in men: results from the European Male Ageing Study (EMAS). Age Ageing 2015; 44:801-7. [PMID: 26162912 PMCID: PMC4547925 DOI: 10.1093/ageing/afv073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/02/2015] [Indexed: 11/24/2022] Open
Abstract
Background: low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men. Methods: men aged 40–79 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (Hologic—SAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model. Results: from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.0–1.4). Compared with those in higher quintiles (2nd–5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.1–2.3 and SOS: HR = 1.6; 95% CI = 1.2–2.2). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men.
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Affiliation(s)
- Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Steven Boonen
- Leuven University Division of Geriatric Medicine and Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Evelien Gielen
- Leuven University Division of Geriatric Medicine and Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Judith E Adams
- Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK
| | - Kate A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - David M Lee
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Santiago de Compostela University, Complejo Hospitalario, Universitario de Santiago (CHUS), A Coruña, Spain
| | - Joseph D Finn
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | | | | | - Thang S Han
- Royal Free and University College Hospital Medical School, London, UK
| | | | | | | | - Neil Pendleton
- Geriatric Medicine, Salford Royal Hospital NHS Trust, Manchester, UK
| | - Margus Punab
- United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Frederick C Wu
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
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Rastrelli G, Carter EL, Ahern T, Finn JD, Antonio L, O'Neill TW, Bartfai G, Casanueva FF, Forti G, Keevil B, Maggi M, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Wu FCW. Development of and Recovery from Secondary Hypogonadism in Aging Men: Prospective Results from the EMAS. J Clin Endocrinol Metab 2015; 100:3172-82. [PMID: 26000545 DOI: 10.1210/jc.2015-1571] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Secondary hypogonadism is common in aging men; its natural history and predisposing factors are unclear. OBJECTIVES The objectives were 1) to identify factors that predispose eugonadal men (T ≥ 10.5 nmol/L) to develop biochemical secondary hypogonadism (T < 10.5 nmol/L; LH ≤ 9.4 U/L) and secondary hypogonadal men to recover to eugonadism; and 2) to characterize clinical features associated with these transitions. DESIGN The study was designed as a prospective observational general population cohort survey. SETTING The setting was clinical research centers. PARTICIPANTS The participants were 3369 community-dwelling men aged 40-79 years in eight European centers. INTERVENTION Interventions included observational follow-up of 4.3 years. MAIN OUTCOME MEASURE Subjects were categorized according to change/no change in biochemical gonadal status during follow-up as follows: persistent eugonadal (n = 1909), incident secondary hypogonadal (n = 140), persistent secondary hypogonadal (n = 123), and recovered from secondary hypogonadism to eugonadism (n = 96). Baseline predictors and changes in clinical features associated with incident secondary hypogonadism and recovery from secondary hypogonadism were analyzed by regression models. RESULTS The incidence of secondary hypogonadism was 155.9/10 000/year, whereas 42.9% of men with secondary hypogonadism recovered to eugonadism. Incident secondary hypogonadism was predicted by obesity (body mass index ≥ 30 kg/m(2); odds ratio [OR] = 2.86 [95% confidence interval, 1.67; 4.90]; P < .0001), weight gain (OR = 1.79 [1.15; 2.80]; P = .011), and increased waist circumference (OR = 1.73 [1.07; 2.81], P = .026; and OR = 2.64 [1.66; 4.21], P < .0001, for waist circumference 94-102 and ≥102 cm, respectively). Incident secondary hypogonadal men experienced new/worsening sexual symptoms (low libido, erectile dysfunction, and infrequent spontaneous erections). Recovery from secondary hypogonadism was predicted by nonobesity (OR = 2.28 [1.21; 4.31]; P = .011), weight loss (OR = 2.24 [1.04; 4.85]; P = .042), normal waist circumference (OR = 1.93 [1.01; 3.70]; P = .048), younger age (< 60 y; OR = 2.32 [1.12; 4.82]; P = .024), and higher education (OR = 2.11 [1.05; 4.26]; P = .037), but symptoms did not show significant concurrent improvement. CONCLUSION Obesity-related metabolic and lifestyle factors predispose older men to the development of secondary hypogonadism, which is frequently reversible with weight loss.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Emma L Carter
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Tomas Ahern
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Joseph D Finn
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Leen Antonio
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Terence W O'Neill
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Gyorgy Bartfai
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Felipe F Casanueva
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Gianni Forti
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Brian Keevil
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Mario Maggi
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Aleksander Giwercman
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Thang S Han
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Ilpo T Huhtaniemi
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Krzysztof Kula
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Michael E J Lean
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Neil Pendleton
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Margus Punab
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Dirk Vanderschueren
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
| | - Frederick C W Wu
- Sexual Medicine and Andrology Unit (G.R., G.F., M.M.), Department of Experimental Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; Andrology Research Unit (E.L.C., T.A., J.D.F., F.C.W.W.), Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Andrology and Endocrinology (L.A., D.V.), Katholieke Universiteit Leuven, B 3000 Leuven, Belgium; Arthritis Research UK Centre for Epidemiology (T.W.O.), Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester and National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H6725 Szeged, Hungary; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, Centro de Investigación Biomedical en Red de Fisiopatología Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15076 Santiago de Compostela, Spain; Department of Clinical Biochemistry (B.K.), Istituto Nazionale Biostrutture e Biosistemi (M.M.), Consorzio Interuniversitario, 00136 Rome, Italy; University Hospital of South Manchester, Manchester M13 9WL, United Kingdom; Reproductive Medicine Centre (A.G.), Malmö University Hospital, University of Lund, SE-205 02 Malmö, Sweden; Department of Endocrinology (T.S.H.), Ashford and St Peter's National Health Service Trust, Surrey KT16 0PZ, United Kingdom; Department of Surgery and Cancer (I.T.H.), Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Depar
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Muratori M, Marchiani S, Tamburrino L, Cambi M, Lotti F, Natali I, Filimberti E, Noci I, Forti G, Maggi M, Baldi E. DNA fragmentation in brighter sperm predicts male fertility independently from age and semen parameters. Fertil Steril 2015; 104:582-90.e4. [PMID: 26151619 DOI: 10.1016/j.fertnstert.2015.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 03/26/2015] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate whether sperm DNA fragmentation (sDF), measured in brighter, dimmer, and total populations, predicts natural conception, and to evaluate the intra-individual variability of sDF. DESIGN Prospective study. SETTING Outpatient clinic and diagnostic laboratory. PATIENT(S) A total of 348 unselected patients and 86 proven fertile men. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) sDF was revealed with the use of terminal deoxynucleotide transferase-mediated dUTP nick-end labeling (TUNEL)/propidium iodide (PI). Receiver operating characteristic (ROC) curves were built before and after matching fertile men to patients for age (76:152) or semen parameters (68:136) or both (49:98). Intra-individual variability of sDF was assessed over 2 years. RESULT(S) Brighter (area under ROC curve [AUC] 0.718 ± 0.54), dimmer (AUC 0.655 ± 0.63), and total (AUC 0.757 ± 0.54) sDF predict male fertility in unmatched and age- or semen parameters-matched subjects. After matching for both age and semen parameters, only brighter (AUC 0.711 ± 0.83) and total (AUC 0.675 ± 0.92) sDF predict male fertility. At high values of total sDF, brighter predicts natural conception better than total sDF. Intra-individual coefficients of variation of sDF were 9.2 ± 8.6% (n = 25), 12.9 ± 12.7% (n = 53), and 14.0 ± 12.6% (n = 70) over, respectively, 100-day and 1- and 2-year periods, appearing to be the most stable of the evaluated semen parameters. CONCLUSION(S) The predictive power of total sDF partially depends on age and semen parameters, whereas brighter sDF independently predicts natural conception. Therefore, brighter sDF is a fraction of sDF that adds new information to the routine semen analysis. At high levels of sDF, distinguishing the two sperm populations improves the predictive power of sDF. Overall, our results support the idea that TUNEL/PI can be of clinical usefulness in the male fertility workup.
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Affiliation(s)
- Monica Muratori
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy.
| | - Sara Marchiani
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Lara Tamburrino
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Marta Cambi
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Francesco Lotti
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Ilaria Natali
- Seminology Laboratory, Azienda USL3 Pistoia, Pistoia, Italy
| | | | - Ivo Noci
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Gianni Forti
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Mario Maggi
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental, Clinical and Biomedical Sciences, DeNoth Center of Excellence, University of Florence, Florence, Italy
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Corona G, Gacci M, Maseroli E, Rastrelli G, Vignozzi L, Sforza A, Forti G, Mannucci E, Maggi M. Clinical correlates of enlarged prostate size in subjects with sexual dysfunction. Asian J Androl 2015; 16:767-73. [PMID: 24830688 PMCID: PMC4215685 DOI: 10.4103/1008-682x.126382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 01/10/2023] Open
Abstract
Digito-rectal examination (DRE) of the prostate provides useful information on the state of prostate growth and on the presence of suspected peripheral nodules. The aim of this study is to describe the clinical and biochemical correlates of finding an enlarged prostate size at DRE in subjects with sexual dysfunction (SD). A consecutive series of 2379 patients was retrospectively studied. The analysis was focused on a subset of subjects (n = 1823; mean age 54.7 ± 11.4) selected for being free from overt prostatic diseases. Several parameters were investigated. After adjusting for confounders, the presence of an enlarged prostate size at DRE was associated with a higher risk of metabolic syndrome (HR = 1.346 (1.129–1.759); P = 0.030), type 2 diabetes mellitus (HR = 1.489 (1.120–1.980); P = 0.006), increased LDL cholesterol (>100 mg dl−1; HR = 1.354 (1.018–1.801); P = 0.037) and increased mean blood pressure (BP) values (HR = 1.017 (1.007–1.027) for each mmHg increment; P = 0.001). Accordingly, enlarged prostate size was also associated with a higher risk of arteriogenic erectile dysfunction (ED), as well as with other andrological conditions, such as varicocele and premature ejaculation (PE). PSA levels were significantly higher in subjects with enlarged prostate size when compared to the rest of the sample (HR = 3.318 (2.304; 4.799) for each log unit increment in PSA levels; P < 0.0001). Arteriogenic ED, according to different criteria, was also associated with increased PSA levels. In conclusion, our data support the need to examine prostate size either by clinical (DRE) or biochemical (PSA) inspection in subjects with SD, in order to have insights into the nature of the SD and the metabolic and cardiovascular (CV) background of the patient.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology; University of Florence, Florence, Italy
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43
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Tamburrino L, Marchiani S, Vicini E, Muciaccia B, Cambi M, Pellegrini S, Forti G, Muratori M, Baldi E. Quantification of CatSper1 expression in human spermatozoa and relation to functional parameters. Hum Reprod 2015; 30:1532-44. [PMID: 25983333 DOI: 10.1093/humrep/dev103] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 12/17/2014] [Accepted: 04/20/2015] [Indexed: 01/03/2023] Open
Abstract
STUDY QUESTION Is CatSper1 expression in human spermatozoa related to semen parameter values and sperm functions? SUMMARY ANSWER CatSper1 expression is positively related to progressive and hyperactivated (HA) motility, [Ca(2+)]i responsiveness to progesterone but not the acrosome reaction (AR). WHAT IS KNOWN ALREADY The role of cationic channel of sperm (CatSper) in sperm functions is clear in animal models but less defined in human sperm cells. Current knowledge is mostly based on low specificity CatSper inhibitors showing agonistic and toxic effects on human spermatozoa and is thus of little help in clarifying the role of the CatSper channel in human sperm functions. STUDY DESIGN, SIZE, DURATION CatSper1 protein expression was evaluated in 115 men undergoing semen analysis for couple infertility. CatSper1 expression was related to routine semen parameters, motility kinematic parameters and basal and progesterone-stimulated [Ca(2+)]i and the AR. PARTICIPANTS/MATERIALS, SETTING, METHODS CatSper1 expression was evaluated (n = 85 normozoospermic, n = 30 asthenozoospermic patients) by immunofluorescence coupled to flow cytometry leading to quantitative measurement of the percentage of ejaculated sperm cells expressing the protein. Semen analysis was evaluated according to World Health Organization guidelines. Kinematic parameters were evaluated by a computer-aided sperm analysis system. [Ca(2+)]i was measured by a spectrofluorimetric method in fura-2-loaded spermatozoa. The AR was evaluated in live sperm cells by fluorescent-labeled lectin. MAIN RESULTS AND THE ROLE OF CHANCE CatSper1 protein expression in spermatozoa was reduced in asthenozoospermic men (mean ± SD: 53.0 ± 15.5%, n = 30 versus 67.9 ± 17.1% in normozoospermic, n = 85, P < 0.01) and was significantly correlated with progressive (r = 0.36, P < 0.001), total (r = 0.35, P < 0.001) and HA (r = 0.41, P < 0.005) motility. In addition to a higher percentage of spermatozoa not expressing CatSper1, asthenozoospermic men showed a large number of spermatozoa with immunofluorescent signal localized outside the principal piece compared with those in normozoospermia. A significant positive correlation was found between CatSper1 protein expression and the increase of [Ca(2+)]i in response to progesterone (r = 0.36, P < 0.05, n = 40) but not with basal [Ca(2+)]i. No correlation was found with the AR, either basal or in response to progesterone. LIMITATIONS, REASONS FOR CAUTION The study is partly descriptive. Furthermore, we cannot rule out the possibility that some round cells remain after a single round of 40% density gradient centrifugation or that this step may have removed some defective or slow swimming sperm, and therefore this preparation may not be representative of the entire sperm sample. Although our data suggest that CatSper1 may be a useful marker for infertility, and a possible contraceptive target, any clinical application is limited without further research. WIDER IMPLICATIONS OF THE FINDINGS Our results demonstrate an association of CatSper1 expression with human sperm progressive and HA motility and provide preliminary evidence that lack of expression or mislocalization of CatSper1 in spermatozoa may be involved in the pathogenesis of asthenozoospermia. However, mechanistic studies are needed to confirm that the correlations between CatSper1 expression and sperm functions are causative. STUDY FUNDING/COMPETING INTERESTS Supported by grants from Ministry of University and Scientific Research (PRIN project to E.B. and FIRB project to S.M.) and by Regione Toscana (to G.F.). L.T. was recipient of a grant from Accademia dei Lincei (Rome, Italy). The authors have no conflicts of interest to declare.
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Affiliation(s)
- L Tamburrino
- Department of Biomedical Experimental and Clinical Sciences, Center of Excellence DENOthe, University of Florence, Viale Pieraccini 6, Florence I-50139, Italy
| | - S Marchiani
- Department of Biomedical Experimental and Clinical Sciences, Center of Excellence DENOthe, University of Florence, Viale Pieraccini 6, Florence I-50139, Italy
| | - E Vicini
- Fondazione Pasteur Cenci Bolognetti, Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, Italy
| | - B Muciaccia
- Fondazione Pasteur Cenci Bolognetti, Department of Anatomy, Histology, Forensic Medicine and Orthopedic, Section of Histology, Sapienza University of Rome, Italy
| | - M Cambi
- Department of Biomedical Experimental and Clinical Sciences, Center of Excellence DENOthe, University of Florence, Viale Pieraccini 6, Florence I-50139, Italy
| | - S Pellegrini
- Centro Procreazione Assistita 'Demetra' of Florence, Via Caccini 18, Florence I-50139, Italy
| | - G Forti
- Department of Biomedical Experimental and Clinical Sciences, Center of Excellence DENOthe, University of Florence, Viale Pieraccini 6, Florence I-50139, Italy
| | - M Muratori
- Department of Biomedical Experimental and Clinical Sciences, Center of Excellence DENOthe, University of Florence, Viale Pieraccini 6, Florence I-50139, Italy
| | - E Baldi
- Department of Biomedical Experimental and Clinical Sciences, Center of Excellence DENOthe, University of Florence, Viale Pieraccini 6, Florence I-50139, Italy
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Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A. Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One 2015; 10:e0124105. [PMID: 25905459 PMCID: PMC4408113 DOI: 10.1371/journal.pone.0124105] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/25/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hyponatremia is the most common electrolyte disorder and it is associated with increased morbidity and mortality. However, there is no clear demonstration that the improvement of serum sodium concentration ([Na(+)]) counteracts the increased risk of mortality associated with hyponatremia. Thus, we performed a meta-analysis that included the published studies that addressed the effect of hyponatremia improvement on mortality. METHODS AND FINDINGS A Medline, Embase and Cochrane search was performed to retrieve all English-language studies of human subjects published up to June 30th 2014, using the following words: "hyponatremia", "hyponatraemia", "mortality", "morbidity" and "sodium". Fifteen studies satisfied inclusion criteria encompassing a total of 13,816 patients. The identification of relevant abstracts, the selection of studies and the subsequent data extraction were performed independently by two of the authors, and conflicts resolved by a third investigator. Across all fifteen studies, any improvement of hyponatremia was associated with a reduced risk of overall mortality (OR=0.57[0.40-0.81]). The association was even stronger when only those studies (n=8) reporting a threshold for serum [Na(+)] improvement to >130 mmol/L were considered (OR=0.51[0.31-0.86]). The reduced mortality rate persisted at follow-up (OR=0.55[0.36-0.84] at 12 months). Meta-regression analyses showed that the reduced mortality associated with hyponatremia improvement was more evident in older subjects and in those with lower serum [Na(+)] at enrollment. CONCLUSIONS This meta-analysis documents for the first time that improvement in serum [Na(+)] in hyponatremic patients is associated with a reduction of overall mortality.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Corinna Giuliani
- Endocrine Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
| | - Joseph G. Verbalis
- Division of Endocrinology and Metabolism, Georgetown University, Washington, DC, 20007, United States of America
| | - Gianni Forti
- Endocrine Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
| | - Mario Maggi
- Andrology Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
| | - Alessandro Peri
- Endocrine Unit, “Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies” (DENOThe), Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Careggi Hospital, 50139, Florence, Italy
- * E-mail:
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Antonio L, Wu FCW, O'Neill TW, Pye SR, Carter EL, Finn JD, Rutter MK, Laurent MR, Huhtaniemi IT, Han TS, Lean MEJ, Keevil BG, Pendleton N, Rastrelli G, Forti G, Bartfai G, Casanueva FF, Kula K, Punab M, Giwercman A, Claessens F, Decallonne B, Vanderschueren D. Associations between sex steroids and the development of metabolic syndrome: a longitudinal study in European men. J Clin Endocrinol Metab 2015; 100:1396-404. [PMID: 25636052 DOI: 10.1210/jc.2014-4184] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Low testosterone (T) has been associated with incident metabolic syndrome (MetS), but it remains unclear if this association is independent of sex hormone binding globulin (SHBG). Estradiol (E2) may also be associated with MetS, but few studies have investigated this. OBJECTIVE To study the association between baseline sex steroids and the development of incident MetS and to investigate the influence of SHBG, body mass index (BMI) and insulin resistance on this risk. METHODS Three thousand three hundred sixty nine community-dwelling men aged 40-79 years were recruited for participation in EMAS. MetS was defined by the updated NCEP ATP III criteria. Testosterone and E2 levels were measured by liquid and gas chromatography/mass spectrometry, respectively. Logistic regression was used to assess the association between sex steroids and incident MetS. RESULTS One thousand six hundred fifty one men without MetS at baseline were identified. During follow-up, 289 men developed incident MetS, while 1362 men did not develop MetS. Men with lower baseline total T levels were at higher risk for developing MetS [odds ratio (OR) = 1.72, P < .001), even after adjustment for SHBG (OR = 1.43, P = .001), BMI (OR = 1.44, P < .001) or homeostasis model assessment of insulin resistance (HOMA-IR) (OR = 1.64, P < .001). E2 was not associated with development of MetS (OR = 1.04; P = .56). However, a lower E2/T ratio was associated with a lower risk of incident MetS (OR = 0.38; P < .001), even after adjustment for SHBG (OR = 0.48; P < .001), BMI (OR = 0.60; P = .001) or HOMA-IR (OR = 0.41; P < .001). CONCLUSIONS In men, lower T levels, but not E2, are linked with an increased risk of developing MetS, independent of SHBG, BMI or insulin resistance. A lower E2/T ratio may be protective against developing MetS.
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Affiliation(s)
- Leen Antonio
- Department of Clinical and Experimental Medicine (L.A., B.D., D.V.), KU Leuven, Laboratory of Clinical and Experimental Endocrinology, B-3000 Leuven, Belgium; Department of Cellular and Molecular Medicine (L.A., M.R.L., F.C.), KU Leuven, Laboratory of Molecular Endocrinology, B-3000 Leuven, Belgium; Department of Endocrinology (L.A., B.D., D.V.), University Hospitals Leuven, B-3000 Leuven, Belgium; Andrology Research Unit (F.C.W.W., E.L.C., J.D.F., M.K.R.), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester M13 9WL, United Kingdom; Manchester Royal Infirmary (F.C.W.W.), Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom; Arthritis Research UK Centre of Epidemiology (T.W.O., S.R.P.), The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom; NIHR Manchester Musculoskeletal Biomedical Research Unit (T.W.O.), Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom; The Endocrinology and Diabetes Research Group (M.K.R.), Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL United Kingdom; Manchester Diabetes Centre (M.K.R.), Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom; Department of Clinical and Experimental Medicine (M.R.L.), KU Leuven, Laboratory of Gerontology and Geriatrics, B-3000 Leuven, Belgium; Department of Surgery and Cancer (I.T.H.), Imperial College London, Hammersmith Campus, London W12 ONN, United Kingdom; Department of Endocrinology (T.S.H.), Ashford and St. Peter's NHS Foundation Trust Hospital, Chertsey, Surrey, KT16 0PZ, United Kingdom; Department of Hum
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Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, Mannucci E, Maggi M. Prevalence of Endocrine and Metabolic Disorders in Subjects with Erectile Dysfunction: A Comparative Study. J Sex Med 2015; 12:956-65. [DOI: 10.1111/jsm.12832] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Cantini G, Di Franco A, Samavat J, Forti G, Mannucci E, Luconi M. Effect of liraglutide on proliferation and differentiation of human adipose stem cells. Mol Cell Endocrinol 2015; 402:43-50. [PMID: 25575456 DOI: 10.1016/j.mce.2014.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 12/27/2014] [Accepted: 12/28/2014] [Indexed: 01/10/2023]
Abstract
Glucagon-Like Peptide-1 (GLP-1) receptor agonists, used as glucose-lowering drugs, also induce weight loss by inhibiting food intake. The present study was aimed at the assessment of the in vitro effects of the GLP-1 receptor agonist liraglutide on proliferation and differentiation of human adipose stem cells (ASC) obtained from subcutaneous adipose tissue of morbidly obese subjects undergoing bariatric surgery. Liraglutide (10-100 nM) significantly inhibited ASC proliferation and viability, with a maximum effect at 6 days of culture (45% and 50%, for liraglutide 10 and 100 nM, respectively); the effect was reverted by exendin 9-39. Glucose uptake was significantly reduced by liraglutide in a dose dependent manner. Treatment with liraglutide reduced intracellular lipid accumulation in differentiating ASC, together with FABP-4 mRNA expression (-18%, -23%, -46%, for 1 nM, 10 nM and 100 nM, respectively), whereas it stimulated adiponectin (APN) expression (1.86-, 2.64-, 2.28-fold increase, for 1 nM, 10 nM and 100 nM, respectively). Liraglutide exerts effects on human adipose cell precursors, inhibiting proliferation and differentiation, while stimulating the expression of the insulin-sensitizing adipokine APN. These effects could contribute to the actions of GLP-1 receptor agonists on body weight and insulin sensitivity.
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Affiliation(s)
- Giulia Cantini
- Endocrinology Unit, Department Of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Alessandra Di Franco
- Endocrinology Unit, Department Of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Jinous Samavat
- Endocrinology Unit, Department Of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Gianni Forti
- Endocrinology Unit, Department Of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Edoardo Mannucci
- Diabetes Agency, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy.
| | - Michaela Luconi
- Endocrinology Unit, Department Of Experimental and Clinical Biomedical Sciences, University of Florence, Italy.
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Muratori M, Tamburrino L, Marchiani S, Cambi M, Olivito B, Azzari C, Forti G, Baldi E. Investigation on the Origin of Sperm DNA Fragmentation: Role of Apoptosis, Immaturity and Oxidative Stress. Mol Med 2015; 21:109-22. [PMID: 25786204 PMCID: PMC4461587 DOI: 10.2119/molmed.2014.00158] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/30/2015] [Indexed: 01/16/2023] Open
Abstract
Sperm DNA fragmentation (sDF) represents a threat to male fertility, human reproduction and the health of the offspring. The causes of sDF are still unclear, even if apoptosis, oxidative assault and defects in chromatin maturation are hypothesized. Using multicolor flow cytometry and sperm sorting, we challenged the three hypothesized mechanisms by simultaneously evaluating sDF and signs of oxidative damage (8-hydroxy, 2'-deoxyguanosine [8-OHdG] and malondialdehyde [MDA]), apoptosis (caspase activity and cleaved poly[ADP-ribose] polymerase [cPARP]) and sperm immaturity (creatine phosphokinase [CK] and excess of residual histones). Active caspases and c-PARP were concomitant with sDF in a high percentage of spermatozoa (82.6% ± 9.1% and 53.5% ± 16.4%, respectively). Excess of residual histones was significantly higher in DNA-fragmented sperm versus sperm without DNA fragmentation (74.8% ± 17.5% and 37.3% ± 16.6%, respectively, p < 0.005), and largely concomitant with active caspases. Conversely, oxidative damage was scarcely concomitant with sDF in the total sperm population, at variance with live sperm, where 8-OHdG and MDA were clearly associated to sDF. In addition, most live cells with active caspase also showed 8-OHdG, suggesting activation of apoptotic pathways in oxidative-injured live cells. This is the first investigation on the origin of sDF directly evaluating the simultaneous presence of the signs of the hypothesized mechanisms with DNA breaks at the single cell level. The results indicate that the main pathway leading to sperm DNA breaks is a process of apoptosis, likely triggered by an impairment of chromatin maturation in the testis and by oxidative stress during the transit in the male genital tract. These findings are highly relevant for clinical studies on the effects of drugs on sDF and oxidative stress in infertile men and for the development of new therapeutic strategies.
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Affiliation(s)
- Monica Muratori
- Sexual Medicine and Andrology Unit, Department of Experimental and Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Italy
| | - Lara Tamburrino
- Sexual Medicine and Andrology Unit, Department of Experimental and Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Italy
| | - Sara Marchiani
- Sexual Medicine and Andrology Unit, Department of Experimental and Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Italy
| | - Marta Cambi
- Sexual Medicine and Andrology Unit, Department of Experimental and Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Italy
| | - Biagio Olivito
- Pediatric Section, Department of Health Sciences, University of Florence and Anna Meyer Children’s University Hospital, Florence, Italy
| | - Chiara Azzari
- Pediatric Section, Department of Health Sciences, University of Florence and Anna Meyer Children’s University Hospital, Florence, Italy
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Italy
| | - Elisabetta Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Italy
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49
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Han TS, Lee DM, Lean MEJ, Finn JD, O'Neill TW, Bartfai G, Forti G, Giwercman A, Kula K, Pendleton N, Punab M, Rutter MK, Vanderschueren D, Huhtaniemi IT, Wu FCW, Casanueva FF. Associations of obesity with socioeconomic and lifestyle factors in middle-aged and elderly men: European Male Aging Study (EMAS). Eur J Endocrinol 2015; 172:59-67. [PMID: 25326134 DOI: 10.1530/eje-14-0739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Social and lifestyle influences on age-related changes in body morphology are complex because lifestyle and physiological response to social stress can affect body fat differently. OBJECTIVE In this study, we examined the associations of socioeconomic status (SES) and lifestyle factors with BMI and waist circumference (WC) in middle-aged and elderly European men. DESIGN AND SETTING A cross-sectional study of 3319 men aged 40-79 years recruited from eight European centres. OUTCOMES We estimated relative risk ratios (RRRs) of overweight/obesity associated with unfavourable SES and lifestyles. RESULTS The prevalence of BMI ≥ 30 kg/m(2) or WC ≥ 102 cm rose linearly with age, except in the eighth decade when high BMI, but not high WC, declined. Among men aged 40-59 years, compared with non-smokers or most active men, centre and BMI-adjusted RRRs for having a WC between 94 and 101.9 cm increased by 1.6-fold in current smokers, 2.7-fold in least active men and maximal at 2.8-fold in least active men who smoked. Similar patterns but greater RRRs were observed for men with WC ≥ 102 cm, notably 8.4-fold greater in least active men who smoked. Compared with men in employment, those who were not in employment had increased risk of having a high WC by 1.4-fold in the 40-65 years group and by 1.3-fold in the 40-75 years group. These relationships were weaker among elderly men. CONCLUSION Unfavourable SES and lifestyles associate with increased risk of obesity, especially in middle-aged men. The combination of inactivity and smoking was the strongest predictor of high WC, providing a focus for health promotion and prevention at an early age.
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Affiliation(s)
- T S Han
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - D M Lee
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M E J Lean
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - J D Finn
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - T W O'Neill
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - G Bartfai
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - G Forti
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - A Giwercman
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - K Kula
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - N Pendleton
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M Punab
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M K Rutter
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The Un
| | - D Vanderschueren
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - I T Huhtaniemi
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - F C W Wu
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - F F Casanueva
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The Un
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Samavat J, Facchiano E, Lucchese M, Forti G, Mannucci E, Maggi M, Luconi M. Hypogonadism as an additional indication for bariatric surgery in male morbid obesity? Eur J Endocrinol 2014; 171:555-60. [PMID: 25117463 DOI: 10.1530/eje-14-0596] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Male obesity is often associated with reduced levels of circulating total (TT) and calculated free testosterone (cFT), with normal/reduced gonadotropins. Bariatric surgery often improves sex steroid and sex hormone-binding globulin (SHBG) levels. The aim of this study was to assess the effects of bariatric surgery on waist circumference (WC) and BMI, and on TT levels, in morbidly obese men, stratified, according to the gonadal state, in eugonadal and hypogonadal (TT<8 nmol/l) subjects. DESIGN A cohort of morbidly obese patients (29 with hypogonadism (HG) and 26 without) undergoing bariatric surgery (37, 10, 6, and 2, with Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, biliopancreatic diversion and gastric sleeve, respectively) was studied at 6 and 12 months from the operation. METHODS Anthropometric parameters (weight, BMI, WC) and sex hormones (gonadotropins, TT, cFT, estradiol (E2), SHBG) were assessed. RESULTS WC was the only parameter significantly correlated with androgens, but not with E2, SHBG, and gonadotropins, at baseline. After surgery, a significant increase in TT, cFT, and SHBG, accompanied by a decrease in E2, was evident in the two groups. However, both TT and cFT, but not E2, SHBG, and gonadotropin variations, were significantly higher in the hypogonadal group at follow-up, with an overall 93% complete recovery from HG. Reduction in WC, but not BMI, was significantly greater in hypogonadal men (ΔWC=-29.4±21.6 vs -14.4±17.4 at 12 months, P=0.047). CONCLUSIONS Recovery from obesity-associated HG is one of the beneficial effects of bariatric surgery in morbidly obese men. The present findings suggest that the gonadal state is a predictor of WC decrease after bariatric surgery.
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Affiliation(s)
- Jinous Samavat
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Enrico Facchiano
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Marcello Lucchese
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Gianni Forti
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Edoardo Mannucci
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Mario Maggi
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Michaela Luconi
- Endocrinology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, ItalyBariatric and Metabolic SurgeryCareggi HospitalDiabetes AgencyAzienda Ospedaliera-Universitaria Careggi, Florence, ItalySexual Medicine and Andrology UnitDepartment of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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