Aging Male Symptoms Research Articles

P-02-58 Hypogonadism Prevalence Among Men WHO Admitted to Urology Outpatient Clinic in Turkey: A Multicentric Study

Hypogonadism(HG) is defined as low serum testosterone level among men. The threshold level of serum testosterone level and indications for testosterone replacement therapy is still not clear in the literature. The aim of this study is to detect the prevalence and associated factors of hypogonadism among men, who admitted to urology outpatient clinics for reasons other than sexual dysfunction. This is a multicentric study designed and conducted by Turkish Society of Urological Surgery, Andrology Study Group. Male patients between 50 and 75 years of age who were admitted to the urology outpatient clinic for complaints other than sexual dysfunction and whose total testosterone value was measured were included in the study. The correlation between testosterone value and symptom scores such as aging male symptoms (AMS) and international index of erectile function (IIEF) were also evaluated. A total of 774 patients were included in the study. Mean patient age was 60,0±6,1. The most common complaint was non-neurogenic male lower urinary tract symptoms (LUTS)(%52,3) Hypogonadism prevalence was 12,1% according to EAU criteria (< 8 nmol/L ∼231 ng/dl) Our study showed no statistically significant correlation between hypogonadism and AMS or IIEF scores. (Table 1) In our study, the body mass index(BMI) was found to be the most strongly correlated factor with serum testosterone levels regardless of patient had hypogonadism or not. (r= -0,168 & p< 0,001) Subgroup analysis revealed the prevalence of HG as 18% in men with BMI>=30kg/m2 . In this specific group, the symptom scores based on IIEF and ASM were similar with men with BMI< 30.

P0838HYPERPROLACTINEMIA IN CKD PATIENTS AND ITS ASSOCIATION WITH STRENGHT, SEXUAL DYSFUNCTION ANS QUALITY OF LIFE

Abstract Background and Aims Hyperprolactinemia is a hormonal disorder associated with many diseases, including chronic kidney disease (CKD). Some studies have shown that serum prolactin (PRL) levels increase as CKD progresses, due to decreased renal clearance and increased production. This prolactin retention leads to inhibition of gonadotropic hormone production, and testosterone deficiency in male patients with CKD. Thus, this study aimed to evaluate PRL levels in male patients with different stages of CKD and its association with clinical and laboratory characteristics, strength, sexual dysfunction, and quality of life. Method This is a transversal study conducted in a tertiary hospital in southern Brazil. Patients with CKD stage IV and V were included and divided into three groups: 1) stage IV; 2) non-dialysis-dependent stage V and; 3) dialysis-dependent stage V (VD). Patients with prescribed hormone therapy were excluded. PRL, creatinine, testosterone, estradiol, albumin, SHBG, LH, and FSH levels were measured. Free testosterone was estimated by the Vermeulen equation. Patients were also evaluated for strength and musculoskeletal function through the “handgrip strength” test. For evaluation of the quality of life and sexual dysfunction, validated questionnaires were applied: AMS (Aging Male's Symptoms Scale), ADAM (Androgen Deficiency in the Aging Male) and SF-36 Health. Results In this study, 164 patients were included (IV=75; V=41; VD=48). The mean age was 64 [55-71] years and BMI 26,9 [23,3-30,04] kg/m2. The dialysis-dependent group had higher prevalence of hyperprolactinemia (22,6% vs. 49% vs. 66%, p&amp;lt;0,001), higher PRL (13,4 vs. 19,43 vs. 26,13, p&amp;lt;0,001) and estradiol (25,6 vs. 24,4 vs. 30,5, p=0,041). PRL levels were positive correlated with CKD stage (rs=0,482, p&amp;lt;0,001) and creatinine (rs=0,467, p&amp;lt;0,001) and negative correlated with testosterone (rs=-0,286, p&amp;lt;0,001) and free testosterone levels (rs=-0,307, p&amp;lt;0,001). There was no difference in PRL levels between hemodialysis and peritoneal dialysis (p=1,000). Analyzes related to the association of PRL levels with strength, quality of life, and sexual dysfunction are still being analyzed. Conclusion Hyperprolactinemia is associated with the severity of CKD, with a higher prevalence in dialysis patients. The relation of PRL levels with strength, quality of life, and sexual dysfunction are being evaluated.

Efficacy of fenugreek seed extract on men's psychological and physical health: a randomized placebo-controlled double-blind clinical trial.

Limited research has examined the effects of fenugreek (Trigonella foenum-graecum L.) supplementation to improve healthy younger men's aging male symptoms. The study objective was to examine whether a fenugreek seed extract would improve healthy men's aging male symptoms, health-related quality of life (HRQoL), grip strength, and anxiety. Randomized double-blind placebo-controlled trial was employed, using a parallel design, with assessments at baseline, Day 30, and Day 60. Healthy male volunteers (n=57, mean age=26.1 years) were randomized to: fenugreek 400mg/d (n=19), fenugreek 500mg/d (n=19), or placebo group (n=19). The fenugreek groups reported significant improvements in aging male symptoms, anxiety levels, grip strength, and indicators of HRQoL compared to the placebo group, p's<0.05. No adverse events were reported. Fenugreek supplementation is an effective nutritional intervention for improving aging male symptoms, anxiety levels, grip strength, and aspects of HRQoL in healthy recreationally active men. Future researchers are encouraged to examine the health and ergogenic effects of fenugreek supplementation in hypogonadal and older populations. Clinicaltrials.gov identifier NCT03528538.

SAT-051 Effects of Testosterone Replacement on Glycemic Control and Other Cardiovascular Risk Factors in Hypogonadal Men with Uncontrolled Type 2 Diabetes (Stride Study): Design, Implementation and Baseline Data

Up to 40% of men with type II diabetes are testosterone deficient. There is growing evidence that testosterone therapy has a beneficial effect on glycemic control, insulin resistance and may have a cardioprotective effect, contrary to the traditional view that testosterone is detrimental to the heart. Our study aims to evaluate the effect of testosterone therapy on glycaemic control other cardiovascular risk factors, symptomatic benefit and quality of life in a randomised double-blind placebo controlled add-on of testosterone therapy to their normal hypoglycemic medication in hypogonadal men with uncontrolled type 2 diabetes. The study population includes 65 eligible men (140 screened) with poorly controlled diabetes (HbA1c between 53 and 80 mmol/mol) and confirmed hypogonadism by early morning [0800−1200h] total testosterone [TT] ≤12 nmol/L or calculated free testosterone ≤255 pmol/L on two occasions ≥1 week apart, with at least two symptoms of hypogonadism. The trial is divided into 2 phases. Phase 1: patients are randomly assigned to either treatment (depot testosterone undecanoate) arm or the placebo arm for 6 months. Phase 2: open label phase for 6 months with subjects on placebo on placebo initiated on to testosterone therapy while subjects in the treatment group continue to receive treatment for the 12 month duration. No change to anti- glycaemic therapy was made during the first phase of the study. The primary endpoint is HbA1c. Secondary endpoints include body composition (bioelectrical impedence DEXA scan), HOMA-IR, lipid profile, blood pressure (24 hr BP monitor), carotid media intima thickness, monocyte mRNA cytokine expression, Questionnaires include AMS (Aging Male Symptom Score), IIEF-5(International Index of Erectile Dysfunction), SF36-Quality of life, Mini mental score, New questionnaire for hypogonadism in diabetes (to be validated), NERI (New England Research Institute) hypogonadal screener. Baseline data indicate the mean age 59 (42-77) years. Mean Duration of diabetes was 8.6(0-21) years. 18 men were on Insulin. The remaining 47 men were either diet controlled or on oral hypoglycaemic medications. 9 men had pre-existing history of MI and 4 had history of angina. Mean HbA1c at baseline was 65(53-80) mmol/mol. Mean total testosterone level was 8.9(2.1-16.9) nmol/l. Mean weight and BMI at baseline were 107(71-187) kg and 34.5(24-52) respectively. Mean waist circumference was 115.7(46-160) cm The primary aim of this is to determine if testosterone therapy improves glycemic control in men with uncontrolled diabetes. Secondly to assess beneficial effects on specific cardiovascular parameters as well as QOL. This could have a major clinical implication on how we treat patients with hypogonadism and type 2 diabetes.

MP45-06 SHOULD WE TREAT TESTOSTERONE DEFICIENCY IN PATIENTS WHO DO NOT HAVE SYMPTOMS?

INTRODUCTION AND OBJECTIVE: Testosterone replacement therapy (TRT) is effective for treating the symptoms and ameliorating the metabolic consequences of hypogonadism. TRT improves muscle mass, bone mineral density, mood, and sexual performance. However, a significant number of patients have low serum levels of testosterone without any subjective symptoms or complaints. We evaluated the suitability of TRT for patients with non-symptomatic late-onset hypogonadism. METHODS: Seventy patients whose initial serum levels of testosterone were < 300 ng/dL without any symptoms or complaints were consecutively enrolled and followed for 30 weeks. All patients received 1,000 mg parenteral testosterone undecanoate on day 1, followed by additional injections on weeks 6, 18, and 30. Serological tests (for total testosterone, lipid profile, glucose, and prostate-specific antigen [PSA]) were performed and Body Mass Index (BMI), International Index of Erectile Function (IIEF) score, International Prostate Symptom Score (IPSS), the Aging Males’ Symptoms (AMS) questionnaire, and the Global Assessment Questionnaire (GAQ) were performed at baseline and at the end of the study. RESULTS: Mean patient age was 56.2 ± 10.5 years. The total IIEF score increased from 44.9 ± 12.9 at baseline to 54.8 ± 13.0 on week 30 (p < 0.001). The AMS score improved from 37.9 ± 11.5 at baseline to 24.6 ± 13.2 on week 30 (p < 0.001). Baseline and 30-week total testosterone levels were 272.2 ± 48.2 and 598.2 ± 52.5 ng/dL, respectively (p < 0.0001). No significant changes were detected in the IPSS, lipid profiles, glucose, BMI, or PSA level. The percentage of patients reporting improvement in the GAQ was 58.6%. Improvements in the sexual desire domain of the IIEF, sexual subscale of the AMS, and change in total testosterone (>300 ng/dL) were significantly correlated with a positive GAQ response. The majority of adverse events were mild, reversible, and of short duration. CONCLUSIONS: Although a patient may not complain of any subjective symptoms at the initial visit, TRT can be considered in patients with low testosterone levels and decreased sexual desire and function. It is postulated that patients with low testosterone levels may not recognize their symptoms. Thus, more specific screening is needed for such patients. Source of Funding: None

Optimizing Aging Male Symptom Questionnaire Through Genetic Algorithms Based Machine Learning Techniques.

PurposeGenetic algorithm (GA) is a machine learning optimization strategy where sample strategies compete for fitness to evolve an optimum solution. This study evolves the Aging Male Symptoms (AMS) with GA to better identify late onset hypogonadism (LOH) with serum testosterone.Materials and MethodsGA was trained on a training set of standard AMS questionnaire on a nationwide LOH epidemiology study. Random matrices of selectors for particular items were generated. Each generation of was evolved through a fitness function determined by sensitivity. Threshold to determine positive serum testosterone level for LOH was randomized for each competing strategy. After 2,000 runs, with each run producing the best result out of a set of 3,000 randomly generated sets evolved through 300 generations, the best AMS selection matrix was then applied to a separately enrolled validation set to compare outcomes.ResultsPredictability for serum testosterone levels dropped markedly above 3.5 ng/mL during pilot training. Limiting the training to testosterone thresholds between 2.5 and 3.5 ng/mL the GA 93 different strategies. Only a selection of 5 items, determining for a threshold of 20 points and determining for a serum testosterone level of 3.16 ng/mL, showed robust reproducibility within the internal validation set. Applying these conditions to the independent validation set showed sensitivity improved from 0.66 to 0.77, with a specificity of 0.07 to 0.19, respectively.ConclusionsGA method of selecting questionnaires improved AMS questionnaire significantly. This method can be easily applied to other questionnaires that do not correlate with physiological markers.

Differences in Male Climacteric Symptoms and Lifestyle Depending on the Duration of Working among Rotating Night Shift Workers

Background: There are various health problems in rotating shift workers. There have been few studies on the associations of male climacteric symptoms with duration of working and lifestyle. Objective: The aim of this study was to determine the differences in male climacteric symptoms depending on the number of working years and to determine whether lifestyle habits differ depending on the number of working years in rotating shift workers. Methods: We collected participant’s data from the manufacturing companies in Japan during the period from March to May in 2017. We conducted a self-administered questionnaire survey in 1561 male rotating night shift workers. Male climacteric symptoms were evaluated by using the Aging Males’ Symptoms (AMS) rating scale. We analyzed 636 rotating shift workers aged over 40 years old whose all AMS data was collected. Results: A significant difference in psychological AMS score was found between men who had worked for 10 - 19 years (9.4 ± 3.9) and men who had worked for more than 40 years (7.6 ± 3.0) (p = 0.011). Sexual functional AMS score significantly differed depending on the number of working years (less than 10 years: 8.1 ± 3.9, 10 - 19 years: 9.8 ± 4.1, 20 - 29 years: 7.9 ± 3.3, 30 - 39 years: 9.3 ± 3.5, more than 40 years: 9.3 ± 3.5) (p < 0.001). The proportion of workers with a balanced meal intake was significantly lower in men who had worked for less than 10 years and the proportions of such workers were significantly higher in men who had worked for 10 - 19 years and for more than 40 years. The proportions of men who did not drink alcohol were high in men who had worked for less than 10 years and 20 - 29 years and low in men who had worked more than 30 years. Conclusion: Psychological AMS score and sexual functional AMS score are significantly different among the 5 groups according to the number of working years on rotating shift. In addition, well-balanced diet on day shift and reduction of alcohol drinking is a related-factor for long-term rotating night shift workers.

Testicular volume and clinical correlates of hypothalamic-pituitary-testicular function: A cross-sectional study in obese men.

The aim of this study was to determine whether testicular volume is correlated with clinical and biochemical markers of hypothalamic–pituitary–testicular (HPT) axis function. This was a cross-sectional substudy of a larger randomized controlled trial including obese men, body mass index (BMI) ≥30 kg m−2, with a total testosterone level <12 nmol l−1. Testicular volume was measured by orchidometer, testosterone by liquid chromatography/tandem mass spectrometry, and body composition by dual-energy X-ray absorptiometry. Men completed the Aging Males' Symptoms (AMS) score, International Index of Erectile Function-5 (IIEF-5), physical function, and handgrip dynamometer testing. Eighty-nine men participated with a median (interquartile range [IQR]) age of 53.1 (47.6, 59.2) years, BMI of 37.0 (34.6, 40.5) kg m−2, and a total testosterone of 7.0 (6.1, 7.9) nmol l−1. Median testicular volume was 18 (IQR: 10, 20) ml. Testicular volume was negatively correlated with BMI (τ = −0.1952, P = 0.010) and total fat mass (τ = −0.2115, P = 0.005) independent of age and testosterone. When BMI, testosterone, sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were present in a multivariable model, only BMI (-0.38 ml change in testicular volume per 1 kg m-2 BMI; 95% CI: −0.74, −0.02; P = 0.04) and LH (-0.92 ml change in testicular volume per 1 IU l-1 LH; 95% CI: −1.75, −0.095; P = 0.03) remained independent significant predictors of testicular volume. Testicular volume was positively correlated with IIEF-5 (τ = 0.2092, P = 0.021), but not related to handgrip strength, physical function tests, or AMS. In obese men, testicular volume is inversely and independently associated with measures of adiposity, but not with most clinical or biochemical markers of HPT axis action. From a clinical perspective, this suggests that obesity might compromise the reliability of reduced testicular volume as a sign of androgen deficiency in men.

Longitudinal Trends of AMS and IIEF-5 Scores in Randomly-Selected Community Men 40 to 80 Years Old: Preliminary Results

IntroductionMost of conclusions on the relationship between age and reproductive health in aging men relied on cross-sectional data. AimTo better characterize the natural degradation trajectory of reproductive health of aging men based on longitudinal data. MethodsA community cohort study was performed in randomly selected men 40 to 80 years old, initiated in 2012 and followed up in 2014 and 2016. Participants were investigated by face-to-face structured interview, including demographic information and International Index of Erectile Function (IIEF-5) and Aging Males’ Symptoms (AMS) scales. Main Outcome MeasuresThe differences among the 3 assessments of IIEF-5 and AMS were analyzed, and progression trajectories were traced. ResultsThe high degree of variability on AMS and IIEF-5 was evident across individual subjects, as was the variability within individuals. The average IIEF-5 score of 248 subjects decreased from 16.9 to 14.1 during the 4 years, and the total AMS score increased from 22.6–27.0 (P < .001). Longitudinal data, both of individuals and of groups, showed the more rapid increase or decrease on AMS or IIEF-5 scores over 4 years in the 61–70 age group than in other age groups. Clinical ImplicationThe evidence of the greatest changes on AMS and IIEF-5 scores in the 61–70 age group prompts the importance of early intervention to postpone the degradation of reproductive health. Strength & LimitationsCompared with cross-sectional data, longitudinal data can provide a more natural progression trajectory of reproductive health of aging male individuals. The low follow-up rate might affect the parameter estimation to some extent. ConclusionCohort data over 4 years’ follow-up showed more abrupt changes on AMS and IIEF-5 scores in the 61–70 age group than in other age groups.Zheng J-B, Liang Q-F, Li J-H, et al. Longitudinal Trends of AMS and IIEF-5 Scores in Randomly-Selected Community Men 40 to 80 Years Old: Preliminary Results. J Sex Med 2019;16:1567–1573.

Differences in male climacteric symptoms with aging among rotating night shift workers

Objective The aim of this study was to clarify the actual status of male climacteric symptoms in rotating night shift workers and how to cope with the symptoms. Methods We planned a self-administered questionnaire survey in male rotating night shift workers. Male climacteric symptoms were evaluated by using the Aging Males’ Symptoms (AMS) scale. Results Of 1891 questionnaires that were sent, 1561 were collected. There were significant differences in total AMS scores among the age groups. In all age groups, there were high proportions of men with increased need for sleep and often feeling tired (64.9%) and decrease in muscular strength (60.7%). There were significant differences in AMS scores for somatic symptoms between men in their 20 s and those in their 40 s or 50 s and between men in their 30 s and those in their 50 s and in AMS scores for sexual symptoms between men in their 20 s and those in their 30 s, 40 s, 50 s or 60 s, between men in their 30 s and those in their 40 s, 50 s or 60 s and between men in their 40 s and those in their 50 s or 60 s. Conclusion Significant age-dependent differences are found in somatic symptoms and sexual symptoms in rotating night shift workers.

Prevalence of testosterone deficiency among aging men with and without morbidities

In this cross-sectional study 1852 men aged 40–70 years attending primary health care were invited to fill out the aging male symptoms (AMS) scale. Out of these, 1222 men were found positive for the AMS and agreed to provide blood samples for the general blood test, lipid profile, glucose levels, and assessment of both total and free testosterone (T) levels. Men were screened for the following morbidities and syndromes: dyslipidemia, arterial hypertension, obesity, type II diabetes, metabolic syndrome, and chronic obstructive pulmonary disease (COPD). Testosterone deficiency was diagnosed if total T ≤ 3.46 ng/mL or free T ≤ 72 pg/mL. Among all 1222 men with positive AMS, decreased blood testosterone levels were detected in 669 men (55%). A total of 402 men were found healthy and 820 men were detected with different morbidities. Out of 669 men with testosterone deficiency, only 2.8% had no co-morbidities and 97.2% were men with co-morbidities. Testosterone levels were found significantly higher among healthy men (median 4.7 ng/mL) as compared to the men with morbidities (median 2.55 ng/mL, p<.001), adjusted for age. Testosterone deficiency was detected in significantly lower proportion of 402 men without co-morbidities as compared to the 820 men with co-morbidities: in 19 men (4.7) and in 650 men (79.3%, p<.05), respectively.

PS-05-003 The role of nutritional intervention in the treatment of male hypogonadism secondary to obesity

The aim of the study was to evaluate the effects of nutritional intervention on body composition and hormonal profile in a group of obese patients after a weight loss of 10%. In particular, the study focused on the evaluation of aromatase activity, calculated as the ratio between total testosterone and estradiol. 28 patients aged between 18 and 65 were enrolled, fat percentage was > 30% and it was estimated with total body densitometry. Body composition (anthropometry, circumferences, DEXA), hormonal profile, cardiovascular risk indices and the HOMA index were evaluated. The patients underwent two tests: Yale Food Addiction Scale (YFAS) and Aging Male Symptoms (AMS), respectively for the assessment of carbohydrate dependence and symptoms related to hypogonadism. The nutritional treatment was based on hypocaloric, high-protein diet (1.5 g/kg ideal body weight/day). Diet energy gap was between 170–250 kcal/day. After a mean time of 6 months and a mean weight loss of 10% from baseline, a significant increase in serum total testosterone levels (405.3 ± 124.8 vs 298.2 ± 81.4 ng / dl, p = 0.002) and a significant reduction of estradiol (37.8 ± 16.2 vs 46.4 ± 12.1 pg / ml, p = 0.049) were observed. There was also a significant reduction in the percentage of total (36.1 ± 4.7 vs 39.8 ± 6.9, p = 0.0001) and segmental fat mass (android fat mass 46.3 ± 6.5% vs 52.1 ± 6.3% P = 0.0012; gynoid fat mass 36.4 ± 5.9 % vs 39.1 ± 6.1% p = 0.0001). The lean mass remained unchanged. The reduction in aromatase activity (expressed as the total testosterone / estradiol ratio) was statistically significant (110.9 ± 52.8 vs 69.1 ± 34.1, p = 0.003). Food addiction has not improved after the nutritional intervention and probiotic supplementation.

SUN-232 Testosterone Deficiency among Thai Men with Type 2 Diabetes: Prevalence and Associated Factors

Objective: The aim of this study is to determine the prevalence and associated factors of hypogonadism among Thai men with type 2 diabetes mellitus (T2DM). Methods: We have conducted a cross-sectional study to determine the prevalence of low testosterone level and its associated factors among 200 Thai men with T2DM who attended at Diabetes Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand between January 2014 and October 2017. The patient characteristics were collected and their symptoms about androgen deficiency, aging male symptoms, erectile dysfunction, and depression and quality of life were evaluated by using Thai version of ADAM, AMS, IIEF-15, PHQ-9 and WHOQOL BREF-THAI questionnaires, respectively. Blood tests for their total testosterone (TT), sex hormone binding globulin (SHBG), free testosterone (cFT) and bioavailable testosterone (cBT) were calculated using Vermeulen’s method were performed. TT < 10 nmol/L, cFT < 0.23 nmol/L or cBT< 5.3 nmol/L were defined as testosterone deficiency. Results: Overall, 11.8 % of men with T2DM had testosterone deficiency (TT < 10 nmol/L). The prevalence of testosterone deficiency was similar among all three criteria. Of noted, 88.2% had secondary hypogonadism and all of them had mild symptoms of androgen deficiency. Waist circumference was significantly positive correlated with testosterone deficiency (OR 1.06, 95%CI) while SHBG levels was significantly negative correlated with testosterone deficiency (OR 0.95, 95% CI). There was no relationship between serum TT level and duration of diabetes, FPG and A1C. Conclusion: Testosterone deficiency among Thai men with T2DM was prevalent. Clinicians should beware of clinical manifestations of hypogonadism to detect and supplement testosterone accordingly.

230 Glucose, Glycated Hemoglobin A levels and Erectile Function in 16 Hypogonadal Men with Type 2 Diabetes (T2DM) before and after Testosterone Therapy

Erectile function and glucose disposal deteriorate progressively in hypogonadal diabetic men, resulting in reduced quality of life. To compare glucose, glycated hemoglobin A (HbA1c) and erectile function in diabetic hypogonadal men who opted to remain untreated with testosterone (T) for long-term then commenced T treatment, based on medical advice by their cardiologists and urologists. Registry study of hypogonadal men in a urological office. Of 805 patients, 16 men who declined to undergo testosterone therapy (TTh) and experienced major cardiovascular adverse events (MACE) and lower urinary tract symptoms (LUTS) during 7 years of observation period. These men were then advised by their cardiologist and urologist to start TTh (TU 1000 mg/12 weeks). T levels were measured at trough levels right before the next injection. Glucose and HbA1c levels were measured at each visit and erectile function was assessed by the IIEF-EF, and quality of life by the aging male symptoms scale (AMS).

MALE REPRODUCTIVE FUNCTION IN CONCURRENT VIBRATION DISEASE AND ARTERIAL HYPERTENSION

Objectives - to study the severity of androgen deficiency and erectile dysfunction in patients with vibration disease and in its combination with arterial hypertension. Material and methods. 145 male patients with various forms of vibration disease were thoroughly examined. The following groups were defined - I stage and II stage vibration disease induced by local vibration; II stage, induced by local vibration with concurrent arterial hypertension; I and II stage vibration disease induced by whole body vibration; II stage vibration disease induced by whole body vibration with concurrent arterial hypertension. The control group included 30 patients. Evaluation of erectile function in men with vibration disease and its combination with arterial hypertension was carried out using the scale of severity of erectile dysfunction (International Index of Erectile Function, IIEF-5). The questionnaire for detection of androgen deficiency (Dedov II, Kalinchenko SYu, 2006) and the AMS (aging males' symptoms) questionnaire assisted in revealing the symptoms of aging in men. Results. According to the IIEF-5 questionnaire results the erectile dysfunction was defined in patients with vibration disease, most pronounced in II stage of vibration disease induced by whole body vibration and in vibration disease of any etiology with concurrent arterial hypertension. AMS-questionnaire presented the most expressed signs of androgen deficiency in patients with II stage of vibration disease induced by whole body vibration and in vibration disease of any etiology with concurrent arterial hypertension (p

Testosterone Therapy in Men With Hypogonadism Prevents Progression From Prediabetes to Type 2 Diabetes: Eight-Year Data From a Registry Study.

Type 2 diabetes (T2D) is a public health threat. Prediabetes represents a window of opportunity for intervention to prevent T2D. Men with T2D and prediabetes often have low testosterone. Since testosterone improves glycemic control in T2D, we investigated whether testosterone therapy (TTh) in men with hypogonadism and prediabetes prevents progression to T2D. Three hundred and sixteen men with prediabetes (defined as HbA1c 5.7-6.4%) and total testosterone levels ≤12.1 nmol/L combined with symptoms of hypogonadism were analyzed. Two hundred and twenty-nine men received parenteral testosterone undecanoate (T-group), and 87 men with hypogonadism served as untreated control subjects. Metabolic and anthropometric parameters were measured twice yearly for 8 years. HbA1c decreased by 0.39 ± 0.03% (P < 0.0001) in the T-group and increased by 0.63 ± 0.1% (P < 0.0001) in the untreated group. In the T-group, 90% achieved normal glucose regulation (HbA1c <5.7%). In the untreated group, 40.2% progressed to T2D (HbA1c >6.5%). TTh was also associated with significant improvements in fasting glucose, triglyceride:HDL ratio, triglyceride-glucose index, lipid accumulation product, total cholesterol, LDL, HDL, non-HDL, triglycerides, and Aging Males' Symptoms (AMS) scale. Significant deterioration in all these parameters was seen in the untreated group. Mortality was 7.4% in the T-group and 16.1% in the untreated group (P < 0.05). The incidence of nonfatal myocardial infarction was 0.4% in the T-group and 5.7% in the untreated group (P < 0.005). Long-term TTh completely prevents prediabetes progression to T2D in men with hypogonadism and improves glycemia, lipids, and AMS score. TTh holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism.

A Chinese Cross-Sectional Study on Symptoms in Aging Males: Prevalence and Associated Factors.

The Aging Male Symptoms (AMS) scale is a questionnaire designed for assessing health-related quality of life and aging-related symptoms in men. Additional knowledge of the severity of aging symptoms in males revealed by high AMS scores and the factors associated with it in the Chinese population is required. A nationally representative prevalence and risk factor estimate of AMS scores was performed to identify the associated factors for AMS severity in China. Men aged between 35 and 70 years were recruited at 33 study centers in 21 provinces, 4 municipalities, and 4 autonomous regions. The prevalence of high AMS scores and its association with demographic, anatomical, lifestyle, and clinical variables were evaluated. Chi-square tests and logistic regression models were used for analysis. Odds ratios (ORs) and 95% confidence intervals were calculated. In this study, 918 of 9,164 (10%, p < .001) men aged between 35 and 70 years, had AMS scores ≥50. Univariate and multivariable analyses showed that an age of >40 years, poor marital relations, type 2 diabetes mellitus (T2DM), history of fracture, and smoking ≥25 cigarettes per day were the major factors that were associated with the severity of AMS (OR ≥2; p < .05). Hypertension, low income, a low education level, alcohol consumption, lack of exercise, and a waist-to-hip ratio ≥0.9 were also moderately associated with AMS severity (OR 1–2; p < .05). The current study revealed the nationally representative prevalence of severe AMS scores in Chinese men and the factors associated with severe AMS. Antiaging intervention studies should target men with specific associated factors.

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

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

MY-T study: Symptom-based titration decisions when using testosterone nasal gel, Natesto®.

Natesto®, testosterone nasal gel (TNG), is a testosterone therapy (TTh) indicated for adult male hypogonadism. This study allowed titration decisions to be based on physicians' assessment of patient symptoms. Hypogonadal males on active topical testosterone therapy (TThE) or naive to any form of testosterone therapy (TThN) were treated with 22 mg TNG daily (11 mg twice daily) for 90 days. Titration was determined by the physician at day 90 wherein the dose was increased to 33 mg daily if symptoms were not properly managed. Total testosterone (TT) levels were collected at day 90 and 120 and the quantitative Androgen Deficiency in the Aging Male (qADAM) symptom questionnaire was administered on days 0, 30, 60, 90, and 120. At study endpoint, 77.0% of all patients were in the normal TT range. Mean qADAM scores increased from 30.8 at baseline to 35.5 (6.6) at day 90. Physician assessments resulted in 37% patients being up-titrated for an additional 30 days, however, qADAM scores did not change significantly at the higher dose. The majority of patients achieved the normal range of testosterone with TNG when physicians based their titration decision on an assessment of symptoms. Sexual function and energy-related symptoms were predictive of improvements resulting from treatment. These symptoms were the most relevant indicators for physicians in making decisions relating to titration.

The severity of hypogonadism symptoms and its risk factors among male employees of Tehran University of Medical Sciences

Objectives The current study was conducted to examine the severity of hypogonadism symptoms and their risk factors among the male employees of Tehran University of Medical Sciences (TUMS). Methods This cross-sectional study was conducted on 80 male employees aged 40–60 years, with hypogonadism, at TUMS. The participants were selected through census sampling. The data collection tools included the demographic questionnaire and the Aging Male Symptoms (AMS) questionnaire. The participants first completed the demographic questionnaire and then the AMS questionnaire. SPSS statistical software version 22 (Chicago, IL) was used to analyze the data, and one-way ANOVA tests, Pearson’s correlation coefficient, and stepwise multivariate logistic regression were applied. Results Based on our findings, the mean overall score of hypogonadism symptoms was 41.71 ± 9.20. Based on Pearson’s correlation coefficient results, there was a statistically significant association between the severity of hypogonadism symptoms and age (p < .001). Furthermore, there were significant associations between the economic status, cigarette consumption and hours of sleep and the severity of hypogonadism symptoms (p < .001). Conclusions The current study’s results showed that certain factors can affect hypogonadism in males. Thus, it is important to reduce the severity of hypogonadism symptoms and to modify the factors related to this phenomenon.