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Abu Zaid M, Dinh PC, Monahan PO, Fung C, El-Charif O, Feldman DR, Hamilton RJ, Vaughn DJ, Beard CJ, Cook R, Althouse S, Ardeshir-Rouhani-Fard S, Sesso HD, Huddart R, Mushiroda T, Kubo M, Eileen Dolan M, Einhorn LH, Fossa SD, Travis LB. Adverse Health Outcomes in Relationship to Hypogonadism After Chemotherapy: A Multicenter Study of Testicular Cancer Survivors. J Natl Compr Canc Netw 2019; 17:459-468. [PMID: 31085753 PMCID: PMC6712564 DOI: 10.6004/jnccn.2018.7109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study examined the prevalence of hypogonadism, its clinical and genetic risk factors, and its relationship to adverse health outcomes (AHOs) in North American testicular cancer survivors (TCS) after modern platinum-based chemotherapy. PATIENTS AND METHODS Eligible TCS were <55 years of age at diagnosis and treated with first-line platinum-based chemotherapy. Participants underwent physical examinations and completed questionnaires regarding 15 AHOs and health behaviors. Hypogonadism was defined as serum testosterone levels ≤3.0 ng/mL or use of testosterone replacement therapy. We investigated the role of 2 single nucleotide polymorphisms (rs6258 and rs12150660) in the sex hormone-binding globulin (SHBG) locus implicated in increased hypogonadism risk in the general population. RESULTS Of 491 TCS (median age at assessment, 38.2 years; range, 18.7-68.4 years), 38.5% had hypogonadism. Multivariable binary logistic regression analysis identified hypogonadism risk factors, including age at clinical evaluation (odds ratio [OR], 1.42 per 10-year increase; P= .006) and body mass index of 25 to <30 kg/m2 (OR, 2.08; P= .011) or ≥30 kg/m2 (OR, 2.36; P= .005) compared with <25 kg/m2. TCS with ≥2 risk alleles for the SHBG SNPs had a marginally significant increased hypogonadism risk (OR, 1.45; P= .09). Vigorous-intensity physical activity appeared protective (OR, 0.66; P= .07). Type of cisplatin-based chemotherapy regimen and socioeconomic factors did not correlate with hypogonadism. Compared with TCS without hypogonadism, those with hypogonadism were more likely to report ≥2 AHOs (65% vs 51%; P= .003), to take medications for hypercholesterolemia (20.1% vs 6.0%; P<.001) or hypertension (18.5% vs 10.6%; P= .013), and to report erectile dysfunction (19.6% vs 11.9%; P= .018) or peripheral neuropathy (30.7% vs 22.5%; P= .041). A marginally significant trend for increased use of prescription medications for either diabetes (5.8% vs 2.6%; P= .07) or anxiety/depression (14.8% vs 9.3%; P= .06) was observed. CONCLUSIONS At a relatively young median age, more than one-third of TCS have hypogonadism, which is significantly associated with increased cardiovascular disease risk factors, and erectile dysfunction. Providers should screen TCS for hypogonadism and treat symptomatic patients.
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Affiliation(s)
- Mohammad Abu Zaid
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Paul C. Dinh
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Patrick O. Monahan
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Chunkit Fung
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, New York
| | - Omar El-Charif
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Darren R. Feldman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NewYork
| | | | - David J. Vaughn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clair J. Beard
- Department of Radiation Oncology, Dana-FarberCancer Institute
| | - Ryan Cook
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Sandra Althouse
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | | | - Howard D. Sesso
- Divisions of Preventive Medicine andAging, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Taisei Mushiroda
- The RIKEN Center for Integrative Medical Science, Yokohama, Japan
| | | | - M. Eileen Dolan
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Lawrence H. Einhorn
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Sophie D. Fossa
- Department of Oncology, Oslo University Hospital, Radium Hospital, Oslo, Norway
| | - Lois B. Travis
- Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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Isaksson S, Bogefors K, Ståhl O, Eberhard J, Giwercman YL, Leijonhufvud I, Link K, Øra I, Romerius P, Bobjer J, Giwercman A. High risk of hypogonadism in young male cancer survivors. Clin Endocrinol (Oxf) 2018; 88:432-441. [PMID: 29245176 DOI: 10.1111/cen.13534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 05/29/2017] [Revised: 11/08/2017] [Accepted: 12/10/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Cancer and its treatment in childhood and young adulthood can cause hypogonadism, leading to increased risk of long-term morbidity and mortality. The aim of this study was to evaluate the risk of presenting with biochemical signs of hypogonadism in testicular cancer survivors (TCS) and male childhood cancer survivors (CCS) in relation to the type of treatment given. DESIGN Case-control study. PATIENTS Ninety-two TCS, 125 CCS (mean age 40 and median age 34 years, respectively; mean follow-up time 9.2 and 24 years, respectively) and a corresponding number of age-matched controls. MEASUREMENTS Fasting morning blood samples were analysed for total testosterone (TT), follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The odds ratios (OR) for hypogonadism, defined as primary, secondary, compensated or ongoing androgen replacement, were calculated for TCS and CCS and for subgroups defined by diagnosis and treatment. RESULTS Hypogonadism was found in 26% of CCS and 36% of TCS, respectively (OR: 2.1, P = .025 and OR = 2.3, P = .021). Among CCS, the OR was further increased in those given testicular irradiation (OR = 28, P = .004). Radiotherapy other than cranial or testicular irradiation plus chemotherapy, or cranial irradiation without chemotherapy, associated also with increased ORs (OR = 3.7, P = .013, and OR = 4.4, P = .038, respectively). Among TCS, those receiving >4 cycles of cisplatin-based chemotherapy had OR = 17, P = .015. CONCLUSIONS Biochemical signs of testosterone deficiency are recognized as markers of decreased life expectancy. Thus, the risk of hypogonadism in TCS and CCS should be recognized and emphasizes the need of long-term follow-up for these men.
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Affiliation(s)
- S Isaksson
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - K Bogefors
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - Y L Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - I Leijonhufvud
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
| | - K Link
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - I Øra
- Department of Pediatrics, Pediatric Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - P Romerius
- Department of Pediatrics, Pediatric Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - J Bobjer
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Skane University Hospital, Malmö, Sweden
| | - A Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
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Abstract
Epidemiological studies have found that men with low or low normal endogenous testosterone are at an increased risk of mortality than those with higher levels. Cardiovascular disease accounts for the greater proportion of deaths in those with low testosterone. Cancer and respiratory deaths in some of the studies are also significantly more prevalent. Disease-specific studies have identified that there are higher mortality rates in men with cardiovascular, respiratory and renal diseases, type 2 diabetes and cancer with low testosterone. Obesity, metabolic syndrome, type 2 diabetes, cardiovascular disease and inflammatory disorders are all associated with an increased prevalence of testosterone deficiency. Two major questions that arise from these findings are (1) is testosterone deficiency directly involved in the pathogenesis of these conditions and/or a contributory factor impairing the body's natural defences or is it merely a biomarker of ill health and the severity of underlying disease process? (2) Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival? This review will discuss the current state of knowledge and discuss whether or not there are any answers to either of these questions. There is convincing evidence that low testosterone is a biomarker for disease severity and mortality. Testosterone deficiency is associated with adverse effects on certain cardiovascular risk factors that when combined could potentially promote atherosclerosis. The issue of whether or not testosterone replacement therapy improves outcomes is controversial. Two retrospective studies in men with diagnosed hypogonadism with or without type 2 diabetes have reported significantly improved survival.
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Affiliation(s)
- Vakkat Muraleedharan
- Robert Hague Centre for Diabetes & Endocrinology, Barnsley Hospital, NHS Foundation Trust, Barnsley; Department of Human Metabolism, University of Sheffield Medical School, Sheffield, UK
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Pye SR, Huhtaniemi IT, Finn JD, Lee DM, O'Neill TW, Tajar A, Bartfai G, Boonen S, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean ME, Pendleton N, Punab M, Rutter MK, Vanderschueren D, Wu FCW. Late-onset hypogonadism and mortality in aging men. J Clin Endocrinol Metab 2014; 99:1357-66. [PMID: 24423283 DOI: 10.1210/jc.2013-2052] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [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 Late-onset hypogonadism (LOH) has recently been defined as a syndrome in middle-aged and elderly men reporting sexual symptoms in the presence of low T. The natural history of LOH, especially its relationship to mortality, is currently unknown. OBJECTIVE The aim of this study was to clarify the associations between LOH, low T, and sexual symptoms with mortality in men. DESIGN, SETTING, AND PARTICIPANTS Prospective data from the European Male Aging Study (EMAS) on 2599 community-dwelling men aged 40-79 years in eight European countries was used for this study. MAIN OUTCOME MEASURE(S) All-cause, cardiovascular, and cancer-related mortality was measured. RESULTS One hundred forty-seven men died during a median follow-up of 4.3 years. Fifty-five men (2.1%) were identified as having LOH (31 moderate and 24 severe). After adjusting for age, center, body mass index (BMI), current smoking, and poor general health, compared with men without LOH, those with severe LOH had a 5-fold [hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.7, 11.4] higher risk of all-cause mortality. Compared with eugonadal men, the multivariable-adjusted risk of mortality was 2-fold higher in those with T less than 8 nmol/L (irrespective of symptoms; HR 2.3; 95% CI 1.2, 4.2) and 3-fold higher in those with three sexual symptoms (irrespective of serum T; compared with asymptomatic men; HR 3.2; 95% CI 1.8, 5.8). Similar risks were observed for cardiovascular mortality. CONCLUSIONS Severe LOH is associated with substantially higher risks of all-cause and cardiovascular mortality, to which both the level of T and the presence of sexual symptoms contribute independently. Detecting low T in men presenting with sexual symptoms offers an opportunity to identify a small subgroup of aging men at particularly high risk of dying.
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Affiliation(s)
- S R Pye
- Andrology Research Unit (S.R.P., J.D.F., F.C.W.W.) and Manchester Diabetes Centre (M.K.R.), The University of Manchester, and Arthritis Research UK Epidemiology Unit (S.R.P., D.M.L., T.W.O., A.T.), Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Surgery and Cancer (I.T.H.), Imperial College London, Hammersmith Campus, London W12 ONN, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H-6721 Szeged, Hungary; Departments of Geriatric Medicine (S.B.) and Andrology and Endocrinology (D.V.), Catholic University of Leuven, Leuven B-3000, Belgium; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, and Centro de Investigación Biomédica en Red de Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15705 Santiago de Compostela, Spain; Endocrinology Unit (G.F.), Department of Clinical Physiopathology, University of Florence, 50121 Florence, Italy; Reproductive Medicine Centre (A.G.), Skåne University Hospital, University of Lund, SE-22 184 Lund, Sweden; Department of Endocrinology (T.S.H.), University College London, London W1T 3AA, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Department of Human Nutrition (M.E.L.), University of Glasgow, Glasgow G12 8TA, United Kingdom; School of Community-Based Medicine (N.P.), University of Manchester, Salford Royal National Health Service Trust, Salford M6 8HD, United Kingdom; and Andrology Unit (M.P.), United Laboratories of Tartu University Clinics, 51014 Tartu, Estonia
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, B-9000 Ghent, Belgium
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Corona G, Rastrelli G, Monami M, Guay A, Buvat J, Sforza A, Forti G, Mannucci E, Maggi M. Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol 2011; 165:687-701. [PMID: 21852391 DOI: 10.1530/eje-11-0447] [Citation(s) in RCA: 285] [Impact Index Per Article: 21.9] [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: 01/09/2023]
Abstract
OBJECTIVE To verify whether hypogonadism represents a risk factor for cardiovascular (CV) morbidity and mortality and to verify whether testosterone replacement therapy (TRT) improves CV parameters in subjects with known CV diseases (CVDs). DESIGN Meta-analysis. METHODS An extensive Medline search was performed using the following words 'testosterone, CVD, and males'. The search was restricted to data from January 1, 1969, up to January 1, 2011. RESULTS Of the 1178 retrieved articles, 70 were included in the study. Among cross-sectional studies, patients with CVD have significantly lower testosterone and higher 17-β estradiol (E(2)) levels. Conversely, no difference was observed for DHEAS. The association between low testosterone and high E(2) levels with CVD was confirmed in a logistic regression model, after adjusting for age and body mass index (hazard ratio (HR)=0.763 (0.744-0.783) and HR=1.015 (1.014-1.017), respectively, for each increment of total testosterone and E(2) levels; both P<0.0001). Longitudinal studies showed that baseline testosterone level was significantly lower among patients with incident overall- and CV-related mortality, in comparison with controls. Conversely, we did not observe any difference in the baseline testosterone and E(2) levels between case and controls for incident CVD. Finally, TRT was positively associated with a significant increase in treadmill test duration and time to 1 mm ST segment depression. CONCLUSIONS Lower testosterone and higher E(2) levels correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk. Whether low testosterone is just an association with CV risk, or an actual cause-effect relationship, awaits further studies.
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Affiliation(s)
- Giovanni Corona
- Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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