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Yassin A, Kelly D, Nettleship J, Talib R, Al-Zoubi RM, Aboumarzouk OM, Albaba B. Testosterone treatment and change of categories of the International prostate symptom score (IPSS) in hypogonadal patients: 12 years prospective controlled registry study. Aging Male 2023; 26:2220567. [PMID: 37287273 DOI: 10.1080/13685538.2023.2220567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Functional hypogonadism is a condition characterized by low testosterone concentrations, occurring more commonly in men as they age. The International Prostate Symptom Score (IPSS) is used to categorize the severity of lower urinary tract symptoms (LUTS) and related symptoms in hypogonadal men. Testosterone therapy (TTh) has previously shown potential in improving total IPSS in men with hypogonadism. However, concerns regarding the effects of urinary function following TTh often prevent treatment in hypogonadal men. To explore this further, two population-based single-center, prospective, cumulative registry studies were combined to contribute to a total population of 1176 men with symptoms of hypogonadism. The total population was separated into a TTh group receiving testosterone undecanoate (TU) for up to 12 years and a control group that did not receive treatment. IPSS was recorded at both baseline and at final recorded visit for each patient. Long-term TTh with TU in hypogonadal men resulted in significant improvements in IPSS categories, even in patients with severe symptoms at baseline. In the control group, untreated hypogonadal men experienced a worsening of IPSS categories. These data indicate that TTh improves LUTS in men with hypogonadism and suggest that previous concerns regarding urinary function may have been overstated.
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Affiliation(s)
- Aksam Yassin
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology & Men's Health, Doha, Qatar
- Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
- Weill Cornell School of Medicine, Urology, Doha, Qatar
| | - Daniel Kelly
- Biomolecular Research Centre, Sheffield Hallam University, Sheffield, UK
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Joanne Nettleship
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Raidh Talib
- Hamad Medical Corporation, Department of Surgery, Division of Urology/Andrology & Men's Health, Doha, Qatar
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow, UK
| | - Bassam Albaba
- Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
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2
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Joaquim VHA, da Silva JG, Jannig PR. Understanding the role of sirtuin 1 in muscle physiology during androgen deprivation. J Physiol 2023; 601:4659-4660. [PMID: 37786954 DOI: 10.1113/jp285588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Affiliation(s)
- Victor H A Joaquim
- Laboratory of Biochemistry and Molecular Biology of the Exercise, School of Physical Education and Sports of University of São Paulo, São Paulo, Brazil
| | - João G da Silva
- Laboratory of Biochemistry and Molecular Biology of the Exercise, School of Physical Education and Sports of University of São Paulo, São Paulo, Brazil
| | - Paulo R Jannig
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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3
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Zhao H, Li JM, Li ZR, Zhang Q, Zhong MK, Yan MM, Qiu XY. Major adverse cardiovascular events associated with testosterone treatment: a pharmacovigilance study of the FAERS database. Front Pharmacol 2023; 14:1182113. [PMID: 37502210 PMCID: PMC10370495 DOI: 10.3389/fphar.2023.1182113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Background and purpose: Testosterone is an essential sex hormone in maintaining masculine characteristics, which is prescribed for male hypogonadism as testosterone replacement treatment (TRT). Herein, we investigated long-standing controversies about the association between TRT and major adverse cardiovascular events (MACEs), based on real world adverse event (AE) reports, registered in the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: Publicly available FAERS data from 1 January 2004 to 31 December 2022 were retrieved from the Food and Drug Administration (FDA) website. The data mining protocol including the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) was applied to analyze overreporting caused by risk factors and MACEs, including TRT, morbidities, and ages. The ROR and the BCPNN were also applied to investigate the annually developing trend of pharmacovigilance (PV) signals in the real world, retrospectively. Results: A total of 3,057 cases referring to MACEs, with a median age of 57 years old (yo), were identified from 28,921 cases of testosterone users. MACEs related to PV signals have emerged since 2014, including cardiac death, non-fatal myocardial infarction, and non-fatal stroke. Myocardial infarction (MI) (ROR: 9.46; IC025: 3.08), acute myocardial infarction (AMI) (ROR: 16.20; IC025: 3.72), ischemic cardiomyopathy (ROR: 11.63; IC025: 2.20), and cardiomyopathy (ROR: 5.98; IC025: 1.96) were the most significant signals generated, and weaker signals included cardiac failure acute (ROR: 4.01; IC025: 0.71), cardiac arrest (ROR: 1.88; IC025: 0.56), and ventricular fibrillation (VF) (ROR: 2.38; IC025: 0.38). The time-to-onset (TTO) of MACEs was calculated with a median of 246 days for AMI. Conclusion: For myocardial infarction and cardiomyopathy, TRT statistically tended to increase the risk of MACEs, while for cardiac arrhythmia, cardiac failure, and stroke, TRT demonstrated beneficial effects among the population with morbidities, such as testosterone deficiency (TD), diabetes mellitus (DM), and hypertension. MACEs were rare but led to serious outcomes including significant increase in death and disability. Since 2018, and before 2014, reports referring to TRT associated with MACEs were relatively scarce, which indicated that there might be a considerable number of cases that went unrecorded, due to neglection. Health workers and testosterone users might pay more attention to testosterone-induced MACEs.
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Affiliation(s)
- Hui Zhao
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun-Min Li
- School of Pharmacy, Fudan University, Shanghai, China
| | - Zi-Ran Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Zhang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Kang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Ming Yan
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yan Qiu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
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Walther A, Ehlert U, Schneeberger M, Eggenberger L, Flückiger C, Komlenac N, Heald A, Rice T, Palm S, Seidler ZE, Ogrodniczuk JS, Oliffe JL, Rice SM, Kealy D, Weber R, Zimmermann D. Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone. Front Psychiatry 2023; 14:1129386. [PMID: 37415687 PMCID: PMC10321526 DOI: 10.3389/fpsyt.2023.1129386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). Aim This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. Methods The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. Expected results Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. Discussion This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. Clinical Trial Registration ClinicalTrials.gov, identifier NCT05435222.
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Affiliation(s)
- Andreas Walther
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Michèle Schneeberger
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | | | - Nikola Komlenac
- Institute of Diversity in Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Adrian Heald
- Department of Endocrinology, University of Manchester, Manchester, United Kingdom
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Simona Palm
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Zac E. Seidler
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Simon M. Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rainer Weber
- Faculty of Medicine and University Hospital Cologne, Clinic and Polyclinic for Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - David Zimmermann
- Andrology and Urology Centre, Uroviva Network, Zurich, Switzerland
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Christodoulaki A, He H, Zhou M, Cardona Barberán A, De Roo C, Chuva De Sousa Lopes SM, Baetens M, Menten B, Van Soom A, De Sutter P, Weyers S, Boel A, Stoop D, Heindryckx B. Characterization of ovarian tissue oocytes from transgender men reveals poor calcium release and embryo development, which might be overcome by spindle transfer. Hum Reprod 2023:7111257. [PMID: 37029914 DOI: 10.1093/humrep/dead068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/15/2023] [Indexed: 04/09/2023] Open
Abstract
STUDY QUESTION Can spindle transfer (ST) overcome inferior embryonic development of in vitro matured ovarian tissue oocytes (OTO-IVM) originating from testosterone-treated transgender men? SUMMARY ANSWER ST shows some potential to overcome the embryo developmental arrest observed in OTO-IVM oocytes from transgender men. WHAT IS KNOWN ALREADY OTO-IVM is being applied as a complementary approach to increase the number of oocytes/embryos available for fertility preservation during ovarian tissue cryopreservation in cancer patients. OTO-IVM has also been proposed for transgender men, although the potential of their oocytes remains poorly investigated. Currently, only one study has examined the ability of OTO-IVM oocytes originating from transgender men to support embryo development, and that study has shown that they exhibit poor potential. STUDY DESIGN, SIZE, DURATION Both ovaries from 18 transgender men undergoing oophorectomy were collected for the purposes of this study, from November 2020 to September 2022. The patients did not wish to cryopreserve their tissue for fertility preservation and donated their ovaries for research. All patients were having testosterone treatment at the time of oophorectomy and some of them were also having menses inhibition treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS Sibling ovaries were collected in either cold or warm medium, to identify the most optimal collection temperature. Cumulus oocyte complexes (COCs) from each condition were isolated from the ovarian tissue and matured in vitro for 48 h. The quality of OTO-IVM oocytes was assessed by calcium pattern releasing ability, embryo developmental competence following ICSI, and staining for mitochondrial membrane potential. In vitro matured metaphase I (MI) oocytes, germinal vesicle (GV) oocytes, and in vivo matured oocytes with aggregates of smooth endoplasmic reticulum (SERa) were donated from ovarian stimulated women undergoing infertility treatment and these served as Control oocytes for the study groups. ST was applied to overcome poor oocyte quality. Specifically, enucleated mature Control oocytes served as cytoplasmic recipients of the OTO-IVM spindles from the transgender men. Embryos derived from the different groups were scored and analysed by shallow whole genome sequencing for copy number variations (CNVs). MAIN RESULTS AND THE ROLE OF CHANCE In total, 331 COCs were collected in the cold condition (OTO-Cold) and 282 were collected in the warm condition (OTO-Warm) from transgender men. The maturation rate was close to 54% for OTO-Cold and 57% for OTO-Warm oocytes. Control oocytes showed a calcium releasing ability of 2.30 AU (n = 39), significantly higher than OTO-Cold (1.47 AU, P = 0.046) oocytes (n = 33) and OTO-Warm (1.03 AU, P = 0.036) oocytes (n = 31); both values of calcium release were similar between the two collection temperatures. Mitochondrial membrane potential did not reveal major differences between Control, OTO-Warm, and OTO-Cold oocytes (P = 0.417). Following ICSI, 59/70 (84.2%) of Control oocytes were fertilized, which was significantly higher compared to 19/47 (40.4%) of OTO-Cold (P < 0.01) and 24/48 (50%) of OTO-Warm oocytes (P < 0.01). In total, 15/59 (25.4%) blastocysts were formed on Day 5 in the Control group, significantly higher than 0/19 (0%) from the OTO-Cold (P = 0.014) and 1/24 (4.1%) in OTO-Warm oocytes (P = 0.026). Application of ST rescued the poor embryo development, by increasing the Day 5 blastocyst rate from 0% (0/19) to 20.6% (6/29) (P = 0.034), similar to that in the ICSI-Control group (25.4%, 15/59). A normal genetic profile was observed in 72.7% (8/11) of OTO-Cold, 72.7% (8/11) of OTO-Warm and 64.7% (11/17) of Control Day 3-Day 5 embryos. After ST was applied for OTO-IVM oocytes, 41.1% (7/17) of the embryos displayed normal genetic patterns, compared to 57.1% (4/7) among ST-Control Day 3-Day 5 embryos. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Due to the limited access to human oocytes and ovarian tissue, our results should be interpreted with some caution, as only a limited number of human oocytes and embryos could be investigated. WIDER IMPLICATIONS OF THE FINDINGS The results of this study, clearly indicate that OTO-IVM oocytes originating from transgender patients are of inferior quality, which questions their use for fertility preservation. The poor quality is likely to be related to cytoplasmic factors, supported by the increased blastocyst numbers following application of ST. Future research on OTO-IVM from transgender men should focus on the cytoplasmic content of oocytes or supplementation of media with factors that promote cytoplasmic maturation. A more detailed study on the effect of the length of testosterone treatment is also currently missing for more concrete guidelines and guidance on the fertility options of transgender men. Furthermore, our study suggests a potentially beneficial role of experimental ST in overcoming poor embryo development related to cytoplasmic quality. STUDY FUNDING/COMPETING INTEREST(S) A.C. is a holder of FWO grants (1S80220N and 1S80222N). A.B. is a holder of an FWO grant (1298722N). B.H. and A.V.S. have been awarded with a special BOF (Bijzonder Onderzoeksfonds), GOA (Geconcerteerde onderzoeksacties) and 2018000504 (GOA030-18 BOF) funding. B.H. has additional grants from FWO-Vlaanderen (Flemish Fund for Scientific Research, G051516N and G1507816N) and Ghent University Special Research Fund (Bijzonder Onderzoeksfonds, BOF funding (BOF/STA/202109/005)), and has been receiving unrestricted educational funding from Ferring Pharmaceuticals (Aalst, Belgium). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Christodoulaki
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - H He
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - M Zhou
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - A Cardona Barberán
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - C De Roo
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - S M Chuva De Sousa Lopes
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Baetens
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium
| | - B Menten
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium
| | - A Van Soom
- Department of Reproduction, Obstetrics and Herd Health, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
| | - P De Sutter
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - S Weyers
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - A Boel
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - D Stoop
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - B Heindryckx
- Department for Reproductive Medicine, Ghent-Fertility And Stem cell Team (G-FAST), Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Valderrábano RJ, Pencina K, Storer TW, Reid KF, Kibel AS, Burnett AL, Huang G, Dorff T, Privat F, Ghattas-Puylara C, Wilson L, Latham NK, Holmberg M, Bhasin S. Testosterone replacement in prostate cancer survivors with testosterone deficiency: Study protocol of a randomized controlled trial. Andrology 2023; 11:93-102. [PMID: 36181480 PMCID: PMC9771994 DOI: 10.1111/andr.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most men diagnosed with prostate cancer today have organ-confined disease and low risk of disease recurrence after radical prostatectomy. Testosterone deficiency in prostate cancer survivors contributes to impaired health-related quality of life but testosterone treatment is viewed as a contraindication in this population. OBJECTIVES We describe the design of the first randomized trial to determine the safety and efficacy of testosterone treatment in men who have undergone prostatectomy for non-aggressive prostate cancer and have symptomatic testosterone deficiency. METHODS Surviving Prostate cancer while Improving quality of life through Rehabilitation with Testosterone Trial is a randomized, placebo-controlled, double-blind, parallel group trial in 142 men, ≥ 40 years, who have undergone radical prostatectomy for organ-confined prostate cancer, Gleason score ≤ 7 (3+4), Stage pT2, N0, M0 lesions and have symptomatic testosterone deficiency and undetectable prostate specific antigen for > 2 years after surgery. Eligible participants are randomized to weekly intramuscular injections of 100-mg testosterone cypionate or placebo for 12 weeks and followed for another 12 weeks. Primary endpoint is change from baseline in sexual activity. Secondary outcomes include change in sexual desire, erectile function, energy, lean and fat mass, physical and cognitive performance. Safety is assessed by monitoring prostate-specific antigen, lower urinary tract symptoms, hemoglobin, and adverse events. RESULTS The trial is being conducted at two trial sites in Boston, MA and Baltimore, MD. As of July 30, 2022, 42 participants have been randomized. No prostate-specific antigen or clinical recurrence has been noted to-date. DISCUSSION Recruitment was slowed by coronavirus disease 2019-related closures, slow subsequent ramp-up of research activities, and patient concerns about safety of testosterone treatment. Despite these challenges, participant retention has been high. CONCLUSION The Surviving Prostate cancer while Improving quality of life through Rehabilitation with Testosterone Trial, a placebo-controlled, randomized trial, will determine whether testosterone replacement therapy is safe and efficacious in correcting symptoms of testosterone deficiency in prostate cancer survivors, and potentially inform clinical practice.
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Affiliation(s)
- Rodrigo J. Valderrábano
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Karol Pencina
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Thomas W. Storer
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Kieran F. Reid
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Adam S. Kibel
- Department of Urology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, MA
| | - Arthur L. Burnett
- Department of Urology, Johns Hopkins University School of
Medicine, Baltimore, MD
| | - Grace Huang
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Tanya Dorff
- Department of Medical Oncology and Therapeutics Research,
City of Hope National Medical Center, Duarte, CA
| | - Fabiola Privat
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Catherine Ghattas-Puylara
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Lauren Wilson
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Nancy K. Latham
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
| | - Mats Holmberg
- ANOVA, Karolinska University Hospital, Stockholm,
Sweden
- Department of Medicine, Huddinge, Karolinska Institutet,
Stockholm, Sweden
| | - Shalender Bhasin
- Research Program in Men’s Health, Aging and
Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston,
MA
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7
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Jabari M. Trans Dermal Testosterone Compared to Intramuscular Testosterone for Young Males with Delayed Puberty: A PRISMA Guided Systematic Review. Int J Gen Med 2023; 16:733-744. [PMID: 36872942 PMCID: PMC9984275 DOI: 10.2147/ijgm.s396144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
Background Challenges in selecting the right formulation of testosterone (TE) for young males with delayed puberty (DP) arise from the fact that there is limited evidence based guidelines in recommending the most efficient and safe formulation of TE. Objective To evaluate the existing evidence and systematically review the interventional effects of transdermal TE to other modes of TE administration for the treatment of DP among young and adolescent males. Methods All types of methodologies published in English were searched from the data sources including MEDLINE, Embase, Cochrane Reviews, Web of Science, AMED and Scopus from 2015 till 2022. Boolean operators with keywords "types of TE", "modes of TE administration", "DP", "transdermal TE", "constitutional delay of growth and puberty, (CDGP)" "adolescent boys" and "hypogonadism" to optimize the search results. The main outcomes of concern were optimal serum TE level, body mass index, height velocity, testicular volume, pubertal stage (Tanner), The secondary outcomes included in this study were adverse events and patient satisfaction. Results After screening 126 articles, 39 full texts were reviewed. Only five studies could be included after careful screening and rigid quality assessments. Most studies were at high or unclear risk of bias with short duration and follow up periods. Only one study was a clinical trial covering all the outcomes of interests. Conclusion This study points out the favorable effects of transdermal TE treatment for DP in boys, while the existence of the vast gap in research needs to be acknowledged. Despite the utmost demand in an appropriate TE treatment for young males with DP, scarce efforts and trials are being undertaken to provide clear clinical guidance of treatment. Quality of life, cardiac events, metabolic parameters, coagulation profiles are important aspects of the treatment are overlooked and under evaluated in most studies. Systematic Review Registration PROSPERO CRD 42022369699.
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Affiliation(s)
- Mosleh Jabari
- Department of Endocrinology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Gorgey AS, Khalil RE, Gill R, Khan R, Adler RA. Effects of dose de-escalation following testosterone treatment and evoked resistance exercise on body composition, metabolic profile, and neuromuscular parameters in persons with spinal cord injury. Physiol Rep 2021; 9:e15089. [PMID: 34713983 PMCID: PMC8554770 DOI: 10.14814/phy2.15089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
The dose de-escalation (DD) effects of testosterone and evoked resistance training (RT) on body composition, cardiometabolic, and neuromuscular variables were investigated. Thirteen men with chronic complete spinal cord injury (SCI) were followed for additional 16 weeks after receiving either testosterone treatment only (TT) or TT+RT. During the 16-week DD period, the TT+RT group underwent a program of once weekly electrical stimulation with gradually decreasing ankle weights and testosterone patches of 2 mg day-1 (TT+RT group). The TT only group did not receive any intervention throughout the detraining period (no-TT group). Body composition was tested using anthropometrics, dual energy X-ray absorptiometry, and magnetic resonance imaging. After an overnight fast, basal metabolic rate (BMR), lipid panel, serum testosterone, inflammatory biomarkers, glucose effectiveness, and insulin sensitivity were measured. Finally, peak isometric and isokinetic torques were measured only in the TT+RT group. All measurements were conducted at the beginning and at the end of DD. Absolute thigh muscle cross-sectional areas (CSAs) demonstrated interaction effects (p < 0.05) between the TT+RT (-8.15%, -6.5%) and no-TT (2.3%, 4.4%) groups. Similarly, absolute knee extensor muscle CSA demonstrated interaction effects (p < 0.05) between the TT+RT (-11%, -7.0%) and no-TT (2.6%, 3.8%) groups. There was a trend (p = 0.07) of increasing visceral adipose tissue (VAT) CSAs in the TT+RT (18%) and in the no-TT (16% cm2 ) groups. There was an interaction (p = 0.005) between TT+RT (decreased by 3.7%) and no-TT groups (increased by 9.0%) in BMR. No interactions were evident between groups over time for biomarkers related to carbohydrate, lipid metabolism, or inflammation. Finally, there were no changes (p > 0.05) in peak isometric or isokinetic torques and rise time following 16 weeks of the DD period in the TT+RT group. TT+RT during 16 weeks of DD was minimally effective at preventing detraining relative to no-TT on muscle size, BMR, and VAT. However, neuromuscular gains were successfully maintained.
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Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders CenterHunter Holmes McGuire VAMCRichmondVirginiaUSA
- Department of Physical Medicine & RehabilitationVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders CenterHunter Holmes McGuire VAMCRichmondVirginiaUSA
| | - Ranjodh Gill
- Endocrinology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
- Endocrine DivisionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Rehan Khan
- Radiology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
| | - Robert A. Adler
- Endocrinology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
- Endocrine DivisionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
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9
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Tarszabó R, Bányai B, Ruisanchez É, Péterffy B, Korsós-Novák Á, Lajtai K, Sziva RE, Gerszi D, Hosszú Á, Benkő R, Benyó Z, Horváth EM, Masszi G, Várbíró S. Influence of Vitamin D on the Vasoactive Effect of Estradiol in a Rat Model of Polycystic Ovary Syndrome. Int J Mol Sci 2021; 22:ijms22179404. [PMID: 34502321 PMCID: PMC8431242 DOI: 10.3390/ijms22179404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the vasoactive effect of estradiol in a rat model of early PCOS and the influence of vitamin D deficiency (VDD). We created a model of chronic hyperandrogenism and VDD in adolescent female Wistar rats (N = 46) with four experimental groups: vitamin D supplemented (T-D+), VDD (T-D-), hyperandrogenic and vitamin D supplemented (T+D+), and hyperandrogenic and VDD (T+D-). T+ groups received an 8-week-long transdermal Androgel treatment, D-animals were on vitamin D-reduced diet and D+ rats were supplemented orally with vitamin D3. Estrogen-induced vasorelaxation of thoracic aorta segments were measured with a wire myograph system with or without the inhibition of endothelial nitric oxide synthase (eNOS) or cyclooxygenase-2 (COX-2). The distribution of estrogen receptor (ER), eNOS and COX-2 in the aortic wall was assessed by immunohistochemistry. VDD aortas showed significantly lower estradiol-induced relaxation independently of androgenic status that was further decreased by COX-2 inhibition. COX-2 inhibition failed to alter vessel function in D+ rats. Inhibition of eNOS abolished the estradiol-induced relaxation in all groups. Changes in vascular function in VDD were accompanied by significantly decreased ER and eNOS staining. Short-term chronic hyperandrogenism failed to, but VDD induced vascular dysfunction, compromised estrogen-dependent vasodilatation and changes in ER and eNOS immunostaining.
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Affiliation(s)
- Róbert Tarszabó
- Department of Obstetrics and Gynecology, Markusovszky Lajos University Teaching Hospital, Markusovszky Lajos Street 5, 9700 Szombathely, Hungary
- Correspondence:
| | - Bálint Bányai
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
| | - Éva Ruisanchez
- Department of Translational Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (É.R.); (Z.B.)
| | - Borbála Péterffy
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
| | - Ágnes Korsós-Novák
- Department of Pathology, Hetényi Géza Hospital, Tószegi Street 21, 5000 Szolnok, Hungary;
| | - Krisztina Lajtai
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary;
| | - Réka Eszter Sziva
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary;
| | - Dóra Gerszi
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary;
| | - Ádám Hosszú
- 1st Department of Pediatrics, Semmelweis University, 1082 Budapest, Hungary;
| | - Rita Benkő
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
| | - Zoltán Benyó
- Department of Translational Medicine, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (É.R.); (Z.B.)
| | - Eszter Mária Horváth
- Department of Physiology, Semmelweis University, Tűzoltó Street 37-47, 1094 Budapest, Hungary; (B.B.); (B.P.); (K.L.); (R.E.S.); (D.G.); (R.B.); (E.M.H.)
| | - Gabriella Masszi
- Department of Internal Medicine, National Institute of Psychiatry and Addictions, Lehel Street 59-61, 1135 Budapest, Hungary;
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői Street 78/a, 1082 Budapest, Hungary;
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10
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Wang C, Yuen F, Swerdloff R. Extrahypothalamic ER Alpha Are Required for Testosterone Effects on Physical Activity and Fat Mass in Mice. Endocrinology 2021; 162:6220414. [PMID: 33842977 PMCID: PMC9633325 DOI: 10.1210/endocr/bqab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Christina Wang
- Correspondence: Christina Wang, MD, Clinical and Translational Science Institute, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, California 90502, USA. E-mail:
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502, USA
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11
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Jenkins CR, Rittel A, Sturdivant RX, Wan J, Clerc PG, Manning E, Jenkins LM, Wardian JL, Graybill SD. Glycemic benefits with adherence to testosterone therapy in men with hypogonadism and type 2 diabetes mellitus. Andrology 2021; 9:1076-1085. [PMID: 33606360 DOI: 10.1111/andr.12990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND While previous studies have demonstrated testosterone's beneficial effects on glycemic control in men with hypogonadism and Type 2 Diabetes, the extent to which these improvements are observed based on the degree of treatment adherence has been unclear. OBJECTIVES To evaluate the effects of long-term testosterone therapy in A1C levels in men with Type 2 Diabetes Mellitus and hypogonadism, controlling for BMI, pre-treatment A1C, and age among different testosterone therapy adherence groups. MATERIALS AND METHODS We performed a retrospective analysis of 1737 men with diabetes and hypogonadism on testosterone therapy for 5 years of data from 2008-2018, isolating A1C, lipid panels, and BMI results for analysis. Subjects were categorized into adherence groups based on quartiles of the proportion of days covered (> 75% of days, 51-75% of days, 26-50% of days and 0-25% of days), with >75% of days covered considered adherent to therapy. RESULTS Pre-treatment median A1C was 6.8%. Post-treatment median A1C was 7.1%. The adherent group, >75%, was the only group notable for a decrease in A1C, with a median decrease of -0.2 (p = 0.0022). BMI improvement was associated with improved post-treatment A1C (p = 0.007). When controlling for BMI, age, and pre-treatment A1C, the >75% adherence group was associated with improved post-treatment A1C (p < 0.001). DISCUSSION When controlling for all studied variables, testosterone adherence was associated with improved post-treatment A1C. The higher the initial A1C at the initiation of therapy, the higher the potential for lowering the patient's A1C with >75% adherence. Further, all groups showed some reduction in BMI, which may indicate that testosterone therapy may affect A1C independent of weight loss. CONCLUSION Even when controlling for improved BMI, pre-treatment A1C, and age, testosterone positively impacted glycemic control in diabetes patients with hypogonadism, with the most benefit noted in those most adherent to therapy (>75%).
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Affiliation(s)
- Craig R Jenkins
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Alex Rittel
- Data Innovation Branch, Defense Healthcare Management Systems, San Antonio, TX, USA
| | - Rodney X Sturdivant
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jen Wan
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Philip G Clerc
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Evan Manning
- Department of Medicine, Internal Medicine, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Lydia M Jenkins
- Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX, USA
| | - Jana L Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA
| | - Sky D Graybill
- Department of Medicine, Endocrinology Service, Brooke Army Medical Center, Ft Sam Houston, TX, USA
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12
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Sarchielli E, Comeglio P, Filippi S, Cellai I, Guarnieri G, Marzoppi A, Cipriani S, Vignozzi L, Morelli A, Maggi M. Neuroprotective Effects of Testosterone in the Hypothalamus of an Animal Model of Metabolic Syndrome. Int J Mol Sci 2021; 22:1589. [PMID: 33557413 DOI: 10.3390/ijms22041589] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
Metabolic syndrome (MetS) is known to be associated to inflammation and alteration in the hypothalamus, a brain region implicated in the control of several physiological functions, including energy homeostasis and reproduction. Previous studies demonstrated the beneficial effects of testosterone treatment (TTh) in counteracting some MetS symptoms in both animal models and clinical studies. This study investigated the effect of TTh (30 mg/kg/week for 12 weeks) on the hypothalamus in a high-fat diet (HFD)-induced animal model of MetS, utilizing quantitative RT-PCR and immunohistochemical analyses. The animal model recapitulates the human MetS features, including low testosterone/gonadotropin plasma levels. TTh significantly improved MetS-induced hypertension, visceral adipose tissue accumulation, and glucose homeostasis derangements. Within hypothalamus, TTh significantly counteracted HFD-induced inflammation, as detected in terms of expression of inflammatory markers and microglial activation. Moreover, TTh remarkably reverted the HFD-associated alterations in the expression of important regulators of energy status and reproduction, such as the melanocortin and the GnRH-controlling network. Our results suggest that TTh may exert neuroprotective effects on the HFD-related hypothalamic alterations, with positive outcomes on the circuits implicated in the control of energy metabolism and reproductive tasks, thus supporting a possible role of TTh in the clinical management of MetS.
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13
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Caliber M, Hackett G. Important lessons about testosterone therapy- weight loss vs. testosterone therapy for symptom resolution, classical vs. functional hypogonadism, and shortterm vs. lifelong testosterone therapy. Aging Male 2020; 23:585-591. [PMID: 30651008 DOI: 10.1080/13685538.2018.1549211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In this commentary, we highlight important findings from a notable RCT by Ng Tang Fui et al. 2016 which investigated the effects of testosterone treatment in dieting obese men. First, a myopic focus on weight loss can detract from important improvements in body composition. Second, while weight loss in obese men may increase testosterone levels, this increase is commonly not enough to result in an improvement in symptoms associated with testosterone deficiency. Third, the RCT by Ng Tang Fui et al. adds evidence to the growing number of clinical trials showing that testosterone therapy should not be restricted to men with classical hypogonadism. Finally, the beneficial effects of testosterone therapy are not maintained after cessation of treatment. Currently, the British Society for Sexual Medicine guidelines are the only clinical guidelines which acknowledge that weight loss per se does not automatically translate to resolution of hypogonadal symptoms, that testosterone therapy can greatly benefit men with testosterone deficiency who do not have classical hypogonadism, and that cessation of testosterone therapy causes reappearance of symptoms and reversal of benefits. Lifelong testosterone therapy is therefore recommended for persistent health benefits in most men with testosterone deficiency. Physicians and patients need to be informed of this.
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Affiliation(s)
- Monica Caliber
- American Medical Writers Association, Fort Lauderdale, FL, USA
| | - Geoff Hackett
- Good Hope Hospital, Birmingham, UK
- Department of Urology, Aston University, Birmingham, UK
- Heart of England NHS Foundation Trust, Birmingham, UK
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14
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Chang S, Skakkebæk A, Davis SM, Gravholt CH. Morbidity in Klinefelter syndrome and the effect of testosterone treatment. Am J Med Genet C Semin Med Genet 2020; 184:344-355. [PMID: 32496001 PMCID: PMC7413637 DOI: 10.1002/ajmg.c.31798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022]
Abstract
Klinefelter syndrome (KS; 47,XXY) is the most common sex chromosome abnormality in males (150 per 100,000 males). The condition leads to hypergonadotropic hypogonadism and ever since the condition was described approximately 80 years ago, testosterone treatment has been the cornerstone in care for individuals with KS. However, KS is associated with an array of health-related and socioeconomic challenges and it is becoming progressively clear that proper care for boys and men with KS reaches far beyond simply supplementing with testosterone. There are no widely implemented guidelines for KS care, and studies investigating crucial aspects of testosterone treatment in individuals with KS, including both beneficial and potentially adverse effects, have only begun to emerge during the last decades. For this descriptive review, we present an overview of literature describing health-related outcomes of testosterone treatment in KS and outline the clinical applications of testosterone treatment in KS. Collectively, beneficial effects of testosterone treatment on overall health in KS are described with few apparent adverse effects. However, larger randomized studies in adult and pediatric patients are warranted to elucidate key aspects of treatment. We stress the implementation of centralized multidisciplinary clinics and the need for a dedicated international guideline to ensure optimal care of boys and men with KS.
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Affiliation(s)
- Simon Chang
- Department of Endocrinology and Internal Medicine, Aarhus university Hospital, Aarhus, Denmark
- Department of Internal Medicine, Lillebaelt Hospital, Kolding, Denmark
- Unit for Thrombosis Research, Hospital of South West Jutland, Esbjerg, Denmark
| | - Anne Skakkebæk
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus university Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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15
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Sarchielli E, Comeglio P, Filippi S, Cellai I, Guarnieri G, Guasti D, Rapizzi E, Rastrelli G, Bani D, Vannelli G, Vignozzi L, Morelli A, Maggi M. Testosterone improves muscle fiber asset and exercise performance in a metabolic syndrome model. J Endocrinol 2020; 245:259-279. [PMID: 32134722 DOI: 10.1530/joe-19-0532] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 11/08/2022]
Abstract
Lifestyle modifications, including physical exercise (PhyEx), are well-known treatments for metabolic syndrome (MetS), a cluster of metabolic and cardiovascular risk factors often associated to hypogonadism. Given the trophic role of testosterone on skeletal muscle (SkM), this study was aimed at evaluating the effects of testosterone treatment on SkM metabolism and exercise performance in male rabbits with high-fat diet (HFD)-induced MetS. HFD rabbits, treated or not with testosterone (30 mg/kg/week) for 12 weeks, were compared to regular diet animals (RD). A subset of each group was exercise-trained for 12 weeks. HFD increased type-II (fast, glycolytic) and decreased type-I (slow, oxidative) muscle fibers compared to RD as evaluated by RT-PCR and histochemistry. Testosterone reverted these effects, also inducing the expression of mitochondrial respiration enzymes and normalizing HFD-induced mitochondrial cristae reduction. Moreover, testosterone significantly increased the expression of myogenic/differentiation markers and genes related to glucidic/lipid metabolism. At the end of the PhyEx protocol, when compared to RD, HFD rabbits showed a significant reduction of running distance and running time, while testosterone counteracted this effect, also decreasing lactate production. In the trained groups, muscle histology showed a significant reduction of oxidative fibers in HFD compared to RD and the positive effect of testosterone in maintaining oxidative metabolism, as also demonstrated by analyzing mitochondrial ultrastructure, succinate dehydrogenase activity and ATP production. Our results indicate that testosterone could be useful to promote oxidative muscle metabolism altered by MetS, thus improving exercise performance. Conversely, testosterone administration to otherwise eugonadal rabbits (RD) only increased muscle fiber diameter but not endurance performance.
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Affiliation(s)
- Erica Sarchielli
- Anatomy and Histology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Comeglio
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Sandra Filippi
- Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Department of Neuroscience, Drug Research and Child Care, University of Florence, Florence, Italy
| | - Ilaria Cellai
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Giulia Guarnieri
- Anatomy and Histology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Guasti
- Anatomy and Histology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elena Rapizzi
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Daniele Bani
- Anatomy and Histology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gabriella Vannelli
- Anatomy and Histology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy
- Andrology, Women's Endocrinology and Gender Incongruence, Careggi Hospital, Florence, Italy
| | - Annamaria Morelli
- Anatomy and Histology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture e Biosistemi), Rome, Italy
- Endocrinology, Careggi Hospital, Florence, Italy
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16
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Chang S, Christiansen CF, Bojesen A, Juul S, Münster AMB, Gravholt CH. Klinefelter syndrome and testosterone treatment: a national cohort study on thrombosis risk. Endocr Connect 2020; 9:34-43. [PMID: 31829966 PMCID: PMC6993257 DOI: 10.1530/ec-19-0433] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Klinefelter syndrome (KS), 47,XXY, can be viewed as a disease model for investigating the risk of thrombosis in male hypogonadism and the subsequent risk related to testosterone treatment. We describe rates of thrombotic risk factors, thrombosis and thrombosis mortality in KS and the association with testosterone treatment. METHODS National registry-based matched cohort study with follow-up from 1995 to 2016 set in Denmark. For the study, 1155 men with KS were each matched by year and month of birth to 100 men from the background population. First thrombotic events and thrombosis mortality was evaluated by event rates and hazard ratios (HRs) and by applying testosterone treatment as a time-dependent covariate. RESULTS The KS cohort had higher incidence of venous thromboembolism relative to the comparison cohort (HR, 3.95; 95% CI, 2.83-5.52). Total thrombotic deaths were increased in KS (HR, 1.76; 95% CI, 1.18-2.62), and all-cause mortality was increased in KS following arterial thrombosis (HR 1.73; 95% CI 1.22-2.47). Only 48.7% of men with KS redeemed prescriptions for testosterone. Untreated men with KS were on average born 12 years before those treated, and the majority of untreated men with KS with available biochemistry were hypogonadal. Testosterone treatment in KS was associated with a non-significant decrease in venous thromboembolism and thrombotic deaths. CONCLUSION Thrombosis and thrombotic deaths are increased in KS. Only half of the men with KS ever received testosterone treatment, despite overt hypogonadism in the non-treated. Testosterone treatment in Klinefelter syndrome was insignificantly associated with lower incidence rates of venous thrombosis and thrombotic deaths.
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Affiliation(s)
- Simon Chang
- Unit for Thrombosis Research, Institute of Regional Health Research, University of Southern Denmark and Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Correspondence should be addressed to S Chang:
| | | | - Anders Bojesen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Svend Juul
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Anna-Marie B Münster
- Unit for Thrombosis Research, Institute of Regional Health Research, University of Southern Denmark and Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
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17
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Al-Sharefi A, Mohammed A, Abdalaziz A, Jayasena CN. Androgens and Anemia: Current Trends and Future Prospects. Front Endocrinol (Lausanne) 2019; 10:754. [PMID: 31798530 PMCID: PMC6867967 DOI: 10.3389/fendo.2019.00754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ahmed Al-Sharefi
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Azmi Mohammed
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Altayeb Abdalaziz
- The Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Channa N. Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Nordenström A, Röhle R, Thyen U, Bouvattier C, Slowikowska-Hilczer J, Reisch N, Claahsen van der Grinten H, Brac de la Perriere A, Cohen-Kettenis PT, Köhler B. Hormone therapy and patient satisfaction with treatment, in a large cohort of diverse disorders of sex development. Clin Endocrinol (Oxf) 2018; 88:397-408. [PMID: 29149458 DOI: 10.1111/cen.13518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/31/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe and investigate the hormone treatments in individuals with different forms of disorders of sex development (DSD) and the patients' own views on their treatment. DESIGN Multicentre cross-sectional clinical evaluation, dsd-LIFE in 6 European countries from February 2014 to September 2015. PARTICIPANTS A total of 1040 adolescents and adults (≥16 years) with different DSD conditions. MAIN OUTCOMES MEASURES Hormone replacement, information received and patient satisfaction. RESULTS Included were women with Turner syndrome (301), 46,XX GD (n = 20), and women with 45,X/46XY (n = 24). Individuals with Klinefelter syndrome (n = 218), 46,XX males (n = 6), individuals with different forms of 46,XY DSD (n = 243): 46,XY DSD conditions (n = 222), men with 45,X/46XY (n = 21) 46,XX CAH, (n = 226). Oestrogen ± progestin was used by 306 (81%) individuals, 72 (19%) received ethinylestradiol and 198 had testosterone treatment. The overall adherence was good, with 10% of women with oestrogen and 5% of those on testosterone had stopped the medication despite 20% reporting dissatisfaction with the treatment, mostly because of psychological side effects. Glucocorticoid replacement in patients with CAH was very seldom stopped. More than 75% were satisfied with the information about the treatment, but the satisfaction with information about treatment options and side effects was lower. CONCLUSIONS More than 50% in the total cohort had hormone replacement. Although adherence was generally good, this study shows that hormone replacement therapy may be improved. This may be achieved by better individualization of the treatment and by providing specific information to patients regarding both long-term and short-term hormonal effects and side effects.
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Affiliation(s)
- Anna Nordenström
- Department of Womens' and Childrens' Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Röhle
- Charité Universitätsmedizin Koordinierungszentrum Klinische Studien (KKS), Berlin, Germany
| | - Ute Thyen
- Klinik für Kinder- und Jugendmedizin, Universität zu Lübeck, Lübeck, Germany
| | - Claire Bouvattier
- Department of Pediatric Endocrinology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | | | - Nicole Reisch
- Medizinische Klinik and Poliklinik IV, Department of Endocrinology, University Hospital Munich, Munich, Germany
| | | | | | - Peggy T Cohen-Kettenis
- Medical Center Amsterdam Department of Child Psychiatry, VU University, Amsterdam, The Netherlands
| | - Birgit Köhler
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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Azul D, Nygren U, Södersten M, Neuschaefer-Rube C. Transmasculine People's Voice Function: A Review of the Currently Available Evidence. J Voice 2016; 31:261.e9-261.e23. [PMID: 27318608 DOI: 10.1016/j.jvoice.2016.05.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aims to evaluate the currently available discursive and empirical data relating to those aspects of transmasculine people's vocal situations that are not primarily gender-related, to identify restrictions to voice function that have been observed in this population, and to make suggestions for future voice research and clinical practice. METHODS We conducted a comprehensive review of the voice literature. Publications were identified by searching six electronic databases and bibliographies of relevant articles. Twenty-two publications met inclusion criteria. Discourses and empirical data were analyzed for factors and practices that impact on voice function and for indications of voice function-related problems in transmasculine people. The quality of the evidence was appraised. RESULTS The extent and quality of studies investigating transmasculine people's voice function was found to be limited. There was mixed evidence to suggest that transmasculine people might experience restrictions to a range of domains of voice function, including vocal power, vocal control/stability, glottal function, pitch range/variability, vocal endurance, and voice quality. CONCLUSIONS More research into the different factors and practices affecting transmasculine people's voice function that takes account of a range of parameters of voice function and considers participants' self-evaluations is needed to establish how functional voice production can be best supported in this population.
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Affiliation(s)
- David Azul
- Discipline of Speech Pathology, Department of Community and Allied Health, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia.
| | - Ulrika Nygren
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, and Department of Speech and Language Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Maria Södersten
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, and Department of Speech and Language Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Christiane Neuschaefer-Rube
- Clinic of Phoniatrics, Pedaudiology and Communication Disorders, Medical Faculty and University Hospital of the RWTH Aachen University, Aachen, Germany
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Cherrier MM, Anderson K, Shofer J, Millard S, Matsumoto AM. Testosterone treatment of men with mild cognitive impairment and low testosterone levels. Am J Alzheimers Dis Other Demen 2015; 30:421-30. [PMID: 25392187 PMCID: PMC10852633 DOI: 10.1177/1533317514556874] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
INTRODUCTION This study investigated the effects of testosterone (T) treatment on cognition, mood, and quality of life in men with mild cognitive impairment (MCI) and low serum T levels. METHODS A total of 351 community-dwelling men were screened, and 37 men evidenced both MCI and low T of whom 27 agreed for further screening. Twenty-two met all the study inclusion/exclusion criteria and enrolled in a 6-month randomized, double-blind, placebo-controlled study. RESULTS Total T levels significantly increased in the T treatment group. No significant changes were observed in measures of cognition, mood, or quality of life other than improvement in 1 objective measure of verbal memory (P < .05) and decreased depression symptoms (P < .02) in the treatment group. CONCLUSIONS Testosterone treatment may modestly improve verbal memory and depression symptoms in men with both MCI and low T.
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Affiliation(s)
- M M Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - K Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - J Shofer
- Geriatric, Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - S Millard
- Geriatric, Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - A M Matsumoto
- Geriatric, Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Abstract
PURPOSE To support nurse practitioners in their encounters with aging male patients with signs and symptoms related to the decline of male sex hormones. DATA SOURCES An electronic search was conducted on studies from 2006 to 2013 from the following databases: PubMed, CINAHL, Scopus, and related health resources websites. The search terms used included male menopause, andropause, androgen deficiency, testosterone deficiency, late-onset hypo-gonadism, and testosterone replacement therapy. Relevant studies in English were selected for an integrative review. CONCLUSIONS Androgen deficiency syndrome has been overlooked in clinical settings. However, there has been an increase in health needs related to low testosterone levels. A diagnosis should be made carefully, considering other possible causes of the problems as well as the decision to initiate testosterone treatment (TT) and monitoring. In this article, the current awareness of androgen deficiency syndrome, pathophysiology of aging men's sex organ, clinical presentation, differential diagnoses, diagnostic strategy, clinical management, monitoring, and referral plans are discussed. IMPLICATIONS FOR PRACTICE The rapidly growing aged population in our society makes androgen deficiency syndrome a growing issue that needs to be understood, adequately diagnosed, and carefully managed by nurse practitioners.
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Affiliation(s)
- Yaelim Lee
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Bang AK, Jørgensen N, Rajpert-De Meyts E, Juul A. UGT2B17 Genotype and the Pharmacokinetic Serum Profile of Testosterone during Substitution Therapy with Testosterone Undecanoate. A Retrospective Experience from 207 Men with Hypogonadism. Front Endocrinol (Lausanne) 2013; 4:94. [PMID: 23908645 PMCID: PMC3725801 DOI: 10.3389/fendo.2013.00094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/15/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Testosterone (T) is mainly excreted in the urine as testosterone glucuronide (TG). This glucuronidation is partly dependent on the UGT2B17 genotype, and TG excretion is therefore lower in men having the UGT2B17 deletion. However, the possible influence of UGT2B17 genotype on serum T during androgen therapy is unknown. We retrospectively investigated the possible association between the UGT2B17 gene polymorphism and serum T levels in hypogonadal men during Testosterone undecanoate (TU) substitution therapy. SUBJECTS AND METHODS Two hundred and seven patients treated with TU (Nebido(®)) were genotyped by quantitative polymerase chain reaction for the UGT2B17 deletion polymorphism. All were given 1000 mg TU per injection at 0, 6, and 18 weeks. Blood samples were taken 2 and 6 weeks after the first and second injection, prior to the third injection, and after 2-3 years of treatment. We analyzed for the levels of T, luteinizing hormone (LH), sex-hormone-binding globulin, estradiol, prostate specific antigen, hematocrit, hemoglobin, and total cholesterol. RESULTS The UGT2B17 genotype frequency was: ins/ins: 42%, ins/del: 44%, and del/del: 14%. During the initial 18 weeks of TU treatment, large intra- and inter-individual variations in serum T levels were observed. Large peaks in T levels, ranging from 6.7 to 69.5 nmol/l, were noted 2 weeks after injections, regardless of the genotype. T levels did not differ between the three genotypes prior to the third injection, but the del/del group had significantly lower levels of LH. At follow-up after 2-3 years, the injection interval or daily T dosage was not dependent on the UGT2B17 genotype. CONCLUSION In conclusion, we found large intra- and inter-individual variations in serum T during standard TU treatment regimen in hypogonadal men. Only subtle differences in serum T and LH were noted according to UGT2B17 genotype, which however suggest that the UGT2B17 genotype exert modest influence on the pharmacokinetic profile of T after TU treatment.
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Affiliation(s)
- Anne Kirstine Bang
- Department of Growth and Reproduction, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Anne Kirstine Bang, Department of Growth and Reproduction, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark e-mail:
| | - Niels Jørgensen
- Department of Growth and Reproduction, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ewa Rajpert-De Meyts
- Department of Growth and Reproduction, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Yassin AA, Haffejee M. Testosterone depot injection in male hypogonadism: a critical appraisal. Clin Interv Aging 2007; 2:577-90. [PMID: 18225458 PMCID: PMC2686335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testosterone compounds have been available for almost 70 years, but the pharmaceutical formulations have been less than ideal. Traditionally, injectable testosterone esters have been used for treatment, but they generate supranormal testosterone levels shortly after the 2- to 3-weekly injection interval and then testosterone levels decline very rapidly, becoming subnormal in the days before the next injection. The rapid fluctuations in plasma testosterone are subjectively experienced as disagreeable. Testosterone undecanoate is a new injectable testosterone preparation with a considerably better pharmacokinetic profile. After 2 initial injections with a 6-week interval, the following intervals between two injections are almost always 12-weeks, amounting eventually to a total of 4 injections per year. Plasma testosterone levels with this preparation are nearly always in the range of normal men, so are its metabolic products estradiol and dihydrotestosterone. The "roller coaster" effects of traditional parenteral testosterone injections are not apparent. It reverses the effects of hypogonadism on bone and muscle and metabolic parameters and on sexual functions. Its safety profile is excellent due to the continuous normalcy of plasma testosterone levels. No polycythemia has been observed, and no adverse effects on lipid profiles. Prostate safety parameters are well within reference limits. There was no impairment of uroflow. Testosterone undecanoate is a valuable contribution to the treatment options of androgen deficiency.
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Affiliation(s)
- Aksam A Yassin
- Clinic of Urology/Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman-UAE,Correspondence: Aksam A Yassin, Rathausallee 94 A, 22846 Norderstedt-Hamburg, Germany, Tel +49 40 526 21 57, Fax +49 40 526 28 20, Email
| | - Mohamed Haffejee
- Urology Division at the University of Witwaterstrand & Johannesburg Hospital, Johannesburg, South Africa
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