Aging Male Symptoms Scale Research Articles

Clinical outcome of testosterone supplementation assessed by andropausal male symptom scores in type 2 diabetes testosterone-deficient patients receiving testosterone compared to those not receiving testosterone: A nested case-control study

Background and aimsThis study aimed to explore the proportion of andropause in male patients with type 2 diabetes using an aging male symptoms scale and assess the clinical outcome of testosterone supplementation in patients with deficient testosterone levels at a tertiary care hospital. MethodsMale patients with diabetes and total serum testosterone levels (≤12 nmol/L) were included in the study. Patients with testosterone supplementation, the standard of care among testosterone-deficient male patients, were included in the study (n = 35). Those not exposed to testosterone supplementation were considered controls (n = 35) and reassessed over 14 weeks for aging male symptom scores (AMS). ResultsThe prevalence of andropause among the participants was 11% (117/1057). Data was analyzed as per protocol analysis. Exposure group had a frequency of 25.80%, and 19.35% in moderate and severe symptoms of AMS scores. Non-exposure group had frequency of 26.66% and 23.34% in moderate and severe symptoms of AMS scores. A significant mean difference (t = −2.93, P-value <0.05) was noted between exposure and non-exposure to testosterone supplementation. ConclusionResults concluded that andropause is prevalent in patients with type 2 diabetes and low testosterone levels. Testosterone therapy affects aging andropausal symptoms such as the feeling of general well-being, joint pain and muscular ache, sleep problems, anxiety, and libido among patients with type 2 diabetes.

PD23-09 LUTS, ED, AND QOL IMPROVE UNDER LONG-TERM TESTOSTERONE THERAPY IN OBESE MEN WITH FUNCTIONAL HYPOGONADISM

You have accessJournal of UrologyCME1 Apr 2023PD23-09 LUTS, ED, AND QOL IMPROVE UNDER LONG-TERM TESTOSTERONE THERAPY IN OBESE MEN WITH FUNCTIONAL HYPOGONADISM Ahmad Haider, Karim Sultan Haider, Gheorghe Doros, and Abdulmaged Traish Ahmad HaiderAhmad Haider More articles by this author , Karim Sultan HaiderKarim Sultan Haider More articles by this author , Gheorghe DorosGheorghe Doros More articles by this author , and Abdulmaged TraishAbdulmaged Traish More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in elderly men are closely associated with quality of life (QoL). We aimed to assess long-term effects of testosterone therapy (TTh) in hypogonadal men in a registry study. METHODS: 898 men with hypogonadism, 481 men chose TTh by means of testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group). 417 men opted against TTh and served as controls (CTRL). 14-year data are presented. Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids and quality of life to account for baseline differences between the groups. Means and standard deviations of absolute measures over 14 years are reported. RESULTS: Baseline age was 56.5±8.0 years in the T-group and 62.7±5.3 years in CTRL (p<0.0001). Mean follow-up was 11.0±3.2 years in the T-group and 11.1±3.3 in CTRL. Median follow-up was 12 years in the T-group and 12 years in CTRL. At baseline, alpha-blockers were used by 36.6% (T-group) and 50.2% (CTRL) (p<0.0001), 5α-reductase inhibitors by 2.1% and 8.6% (p<0.0001), and PDE5-Inhibitors by 26.4% and 22.1% (p=0.1308). IPSS (baseline: 6.4±3.7) decreased to 1.5±0.7 (p<0.0001) in the T-group in year 14. In CTRL, IPSS (baseline: 4.9±1.9) increased to 11.4±5.1 (p<0.0001). Estimated adjusted difference between groups: -11.0 (p<0.0001). Residual bladder volume (RBV) in the T-group (baseline: 50.7±25.9) decreased by 39.3±1.4 mL (p<0.0001) in year 14. In CTRL, RBV (baseline: 51.7±16.7) increased by 58.8±1.5 mL (p<0.0001). Estimated adjusted difference between groups: -94.4 mL [95% CI: -98.2;-90.7] (p<0.0001). IIEF-EF in the T-group increased from 17.3±5.9 (mild to moderate) by 11.1±0.2 to 29.5±0.9 (no ED) in year 14. In CTRL, IIEF-EF decreased from 19.7±3.5 (mild to moderate) by 14.5±0.2 to 6.8±0.9 (severe). Estimated adjusted difference between groups: 23.5 (95% CI: 23.0;24.1) (p<0.0001). QoL, assessed by the Aging Males’ Symptoms scale (AMS), improved from 53.0±9.8 (severe symptoms) by 29.8 points in the T-group to 17.2 (no symptoms) and worsened from 40.4±5.6 (moderate symptoms) by 24.7 points to 66.7 (severe symptoms) in CTRL. CONCLUSIONS: In men with functional hypogonadism, long-term TTh improves LUTS and ED sustainably over 14 years. This may have contributed to improvements in QoL. In the untreated control group, LUTS, ED, and QoL deteriorated. Source of Funding: Data entry was compensated by Bayer AG © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e675 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Haider More articles by this author Karim Sultan Haider More articles by this author Gheorghe Doros More articles by this author Abdulmaged Traish More articles by this author Expand All Advertisement PDF downloadLoading ...

MP79-16 ANALYSIS OF THE EFFECT OF TESTOSTERONE REPLACEMENT ON BODY COMPOSITION, PHYSICAL FITNESS AND THE CORRELATION WITH HYPOGONADAL SYMPTOMS IN THE TESTOSTERONE DEFICIENCY

You have accessJournal of UrologyCME1 Apr 2023MP79-16 ANALYSIS OF THE EFFECT OF TESTOSTERONE REPLACEMENT ON BODY COMPOSITION, PHYSICAL FITNESS AND THE CORRELATION WITH HYPOGONADAL SYMPTOMS IN THE TESTOSTERONE DEFICIENCY Tae Yong Park, Dong Su Kim, Jeong Kyun Yeo, and Min Gu Park Tae Yong ParkTae Yong Park More articles by this author , Dong Su KimDong Su Kim More articles by this author , Jeong Kyun YeoJeong Kyun Yeo More articles by this author , and Min Gu ParkMin Gu Park More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aimed to investigate how testosterone replacement therapy (TRT) change body composition and physical fitness, and which those changes correlate with serum testosterone level and hypogonadal symptoms. METHODS: Seventy patients with testosterone deficiency (TD) were divided into group I (n: 23) and group II (n :47). Only group II was given testosterone enanthate intramuscularly for 6 months. Both groups were investigated following items at the beginning and end of the study: Baseline demographics and serologic test; questionnaires of aging male symptom (AMS) scale and international prostate symptom score (IPSS); BMI, waist circumference, body composition; and physical fitness. Body composition was assessed by bioelectrical impedance analysis. Seven types of basic exercise tests were used to measure physical fitness. RESULTS: No significant difference was observed in baseline measurements between the two groups before treatment. After 6 months, group I showed no significant change in all measurements. Group II showed significant improvement in IPSS and AMS scales. Hematocrit, and prostate specific antigen slightly increased, while total cholesterol significantly decreased after treatment. As to body composition parameters, TRT significantly decreased body fat mass, visceral fat mass and waist circumference. Skeletal muscle mass was significantly increased by TRT although upper body muscle appeared to be more responsive. Most parameters of physical fitness resulted in improvement except for flexibility and endurance. The decrease of waist circumference was significantly correlated with serum testosterone level changes. AMS scale improvement was correlated with the changes of IPSS, cardiorespiratory fitness and agility. CONCLUSIONS: TRT improved hypogonadal and lower urinary tract symptoms. TRT also resulted in overall improvement in metabolic syndrome components, body composition and physical fitness. Testosterone increment and hypogonadal symptom improvement are correlated with waist circumference, cardiorespiratory fitness, and agility, respectively. Combined adjunctive exercise program that improve those parameters, might maximize the effect of TRT. Source of Funding: No conflict of interests © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1147 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tae Yong Park More articles by this author Dong Su Kim More articles by this author Jeong Kyun Yeo More articles by this author Min Gu Park More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of Vitamin D Supplementation on Testosterone, Prostate, and Lower Urinary Tract Symptoms: A Prospective, Comparative Study.

Several studies have associated the serum vitamin D level with total testosterone levels and the prostate volume. Herein, we investigated the effect of vitamin D supplementation on testosterone, prostate, and lower urinary tract symptoms (LUTS) in men. Men over 40 years of age diagnosed with a vitamin D deficiency (25[OH]D <20 ng/mL) who received vitamin D supplementation for one year were included in the study and administered 25,000 IU of cholecalciferol every 2 weeks. Prostate ultrasound, uroflowmetry, postvoid residual urine volume measurement, and serological tests (serum testosterone levels, etc.) were performed upon diagnosis and one year later. Participants also answered the International Prostate Symptom Score (IPSS) and Aging Males' Symptoms Scale (AMS) questionnaires. A significant increase was observed in the vitamin D level following one year of vitamin D supplementation, with a significant decrease in the postvoid residual urine volume, total IPSS score and without a significant change in the prostate volume. Improved psychological subscale score of AMS questionnaire was observed with a statistical significance. Vitamin D supplementation suppressed the increase in the prostate volume and improved the LUTS. Although there is no direct effect on serum testosterone levels, vitamin D supplementation helped improve hypogonadal symptoms.

Efficacy and Safety of Maca (Lepidium meyenii) in Patients with Symptoms of Late-Onset Hypogonadism: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

To evaluated the efficacy and safety of gelatinized Maca (Lepidium meyenii) for eugonadal patients with late onset hypogonadism symptoms (LOH). Participants were instructed to receive 1,000 mg of Maca or placebo, two pills at a time, three times per day for 12 weeks before food intake. To evaluate the efficacy of the drug, Aging Males' Symptoms scale (AMS), Androgen Deficiency in the Aging Males (ADAM), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF) questionnaires, serologic tests (total testosterone and free testosterone, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride), body weight, and waist circumference were assessed at 4 and 12 weeks after treatment. A total of 80 participants were enrolled and randomly assigned to Maca treated group (n=41) or the placebo group (n=39). AMS, IIEF, and IPSS were significantly (p<0.05) improved in Maca treated group than in the placebo group. ADAM positive rate was also significantly (p<0.0001) decreased in Maca treated group. Maca may be considered an effective and safe treatment for eugonadal patients with late onset hypogonadism symptoms.

Extract from Cucurbita pepo improves BPH symptoms without affecting sexual function: a 24-month noninterventional study

PurposeTo assess the symptoms, quality of life and sexual well-being in patients with lower urinary tract symptoms due to benign prostatic hyperplasia LUTS/BPH treated with pumpkin seed soft extract (PSE) in routine practice.MethodsThis noninterventional study included 130 men treated for up to 24 months. The International Prostate Symptom Score (IPSS) and related quality of life, Aging Males’ Symptoms Scale (AMS), and International Index of Erectile Function (IIEF-5) were recorded. Descriptive statistical methods were applied. The mean with 95% confidence interval (CI) was calculated for the primary end point (change in IPSS after 12-month treatment).ResultsAnalysis at 12 months included 83 patients [mean (SD) age 65.2 (8.7) years and IPSS (15.6 (3.4), IPSS-QoL 3.4 (0.9)]. AMS and IIEF-5 indicated mild or mild to moderate disorder regarding sexual well-being and erectile dysfunction, respectively. After 12 months, the mean IPSS change from baseline was − 4.7 (95% CI − 5.4 to − 3.9), with 83% (95% CI 65.3 to 84.1) and 53% (95% CI 42.3 to 63.7) of the patients achieving reductions by at least 3 and 5 points, respectively. The proportion of patients with IPSS-QoL below 3 points (mostly satisfied) was 11% (9/83) at baseline and rose to 62% (51/83) and 73% (40/55) at 12 and 24 months, respectively. AMS and IIEF-5 scores did not indicate a negative impact on sexual function during treatment.ConclusionIn men with a moderate LUTS suggestive of BPH, a low progression risk and an active sex life, treatment with pumpkin seed soft extract provided symptomatic relief, improved IPSS-QoL, and maintained sexual well-being.Trial registrationDRKS00010729, June 22, 2016.

MP35-11 LUTS, ED, AND QOL IMPROVE UNDER LONG-TERM TESTOSTERONE THERAPY IN OBESE MEN WITH FUNCTIONAL HYPOGONADISM

You have accessJournal of UrologyCME1 May 2022MP35-11 LUTS, ED, AND QOL IMPROVE UNDER LONG-TERM TESTOSTERONE THERAPY IN OBESE MEN WITH FUNCTIONAL HYPOGONADISM Ahmad Haider, Karim Sultan Haider, Gheorghe Doros, and Abdulmaged Traish Ahmad HaiderAhmad Haider More articles by this author , Karim Sultan HaiderKarim Sultan Haider More articles by this author , Gheorghe DorosGheorghe Doros More articles by this author , and Abdulmaged TraishAbdulmaged Traish More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002589.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in elderly men are closely associated with quality of life (QoL). We aimed to assess long-term effects of testosterone therapy (TTh) in obese hypogonadal men in a registry study. METHODS: Of 476 obese men with functional hypogonadism, 281 men chose TTh by means of testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group). 195 men opted against TTh and served as controls (CTRL). 12-year data are presented. Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids and quality of life to account for baseline differences between the groups. RESULTS: Mean age at baseline: 59.9±5.5 years (T-group) and 62.9±5.0 (CTRL) (p <0.0001). Mean (median) follow-up: T-group 9.4±3.0 (11), CTRL 8.9±3.0 (10) years. Alpha-blockers were used at baseline by 53.7% in the T-group and 56.4% in CTRL (p=0.3963), PDE5 inhibitors by 23.1% in the T-group and 26.2% in CTRL (p=0.4501). IPSS (baseline: 7.9±3.4) decreased by 5.8±0.2 (p <0.0001) in the T-group in year 12. In CTRL, IPSS (baseline: 5.1±1.8) increased by 4.2±0.3 (p <0.0001). Estimated adjusted difference between groups: −9.3 [95% CI: −10.7; −9.3] (p <0.0001). Residual bladder volume (RBV) in the T-group (baseline: 61.1±22.8) decreased by 48.8±1.6 mL (p <0.0001) in year 12. In CTRL, RBV (baseline: 53.7±16.0) increased by 39.1±2.3 mL (p <0.0001). Estimated adjusted difference between groups: −87.3 mL [95% CI: −93.5; −81.1] (p <0.0001). IIEF-EF in the T-group increased from 17.5±5.9 (mild to moderate) by 11.1±0.3 to 29.2±1.1 (no ED) in year 12. In CTRL, IIEF-EF decreased from 18.9±3.9 (mild to moderate) by 14.4±0.4 to 7.7±1.1 (severe). Estimated adjusted difference between groups: 25.5 (95% CI: 24.5; 26.5) (p <0.0001 for all). QoL, assessed by the Aging Males’ Symptoms scale (AMS), improved from 53.7±9.5 (severe symptoms) by 31.1 points in the T-group to 16.9 (no symptoms) and worsened from 40.0±5.7 (moderate symptoms) by 21.8 points to 69.8 (severe symptoms) in CTRL. CONCLUSIONS: In obese men with functional hypogonadism, long-term TTh improves LUTS and ED sustainably over 12 years. This may have contributed to improvements in QoL. In the untreated control group, LUTS, ED, and QoL deteriorated. Source of Funding: Data entry and statistical analysis was compensated by Bayer AG © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e591 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Haider More articles by this author Karim Sultan Haider More articles by this author Gheorghe Doros More articles by this author Abdulmaged Traish More articles by this author Expand All Advertisement PDF DownloadLoading ...

What is a predictive factor of the efficacy of testosterone replacement for late-onset hypogonadism?

ABSTRACT Introduction Testosterone replacement therapy (TRT) is a worldwide first-choice method of treatment for late-onset hypogonadism (LOH). In the diagnosis of LOH in Japan, we use 8.5 pg/mL of serum free-testosterone (FT) level measured by RIA as a lower limit. Objective The objective of this study is to determine the predictors of the TRT efficacy for LOH. Methods A total of 56 patients who attended our men's health clinic between August 2002 and June 2021 with the data available before and after TRT were enrolled into this study. These patients were divided into responders to TRT (Group 1, n=45, 80%) and non-responders to TRT (Group 2, n=11, 20%) according to clinical response including patient's satisfaction. Evaluated parameters obtained before TRT were following: age, BMI, aging males symptoms scale (AMS), sexual health inventory for men (SHIM), serum luteinizing hormone (LH), follicular stimulating hormone (FSH), testosterone (T), FT, prolactin (PRL), estradiol (E2) and T/E ratio. For statistical analysis, we used a multivariable logistic regression model. Results Univariate analysis revealed PRL (OR 0.96; 95% CI 0.93-0.99, P&amp;lt;0.03), E2 (OR 0.87; 95% CI 0.77-0.98, P&amp;lt;0.02), T/E (OR 1.13; 95% CI 1.01-1.27, P&amp;lt;0.04) as predictive factors. Then we carried out multivariate analyses of these factors and determined T/E ratio as an independent predictive factor (OR 1.16; 95% CI 1.04-1.29, P&amp;lt;0.01). Conclusion This study suggested that low value of T/E ratio might predict the low response to TRT. Although further study with a larger number of patients is necessary, we propose the measurement of serum E2 level as well as testosterone level before TRT. Disclosure Work supported by industry: no.

Outcomes of treatment for LOH syndrome assessed by free testosterone

ABSTRACT Objective Late-onset hypogonadism (LOH) is defined by reduced serum testosterone levels, and androgen replacement therapy (ART) is widely used. While serum total testosterone (TT) is used as an indicator for diagnosis and treatment for LOH in the United States and Europe, serum free testosterone (FT) is used in Japan. Patients with low FT levels (less than 8.5 pg/mL) are to be indicated for ART as LOH, and patients with moderate FT levels (between 8.5 pg/mL and 11.8 pg/mL) are also to be considered for ART as LOH borderline. In this study, we examined the outcomes of LOH and LOH borderline patients who were treated by ART. Methods We examined Aging Male Symptom (AMS) scale scores of LOH (n=76) and LOH borderline patients (n=16) who were treated with ART for at least 6 months at our hospital. Results In LOH patients, AMS score decreased from 52.1±12.3 to 41.5±12.2 (p&amp;lt;0.05). On the other hand, in borderline cases AMS score also decreased from 55.8±10.2 to 36.5±8.45 (p&amp;lt;0.05). There was no significant difference between two groups. Conclusion ART improves AMS score both in LOH and LOH borderline patients, but there were no significant differences between two groups in this study. Disclosure Work supported by industry: no.

Management of Acromegaly associated Late-onset hypogonadism by Siddha medicine: A case report

Male Hypogonadism is the condition diagnosed in men with signs and symptoms of testosterone deficiency. Hypogonadism may be further classified as primary or secondary caused due to organic or functional pathology. This classification has significant therapeutic implications for instituting gonadotropin therapy to restore testosterone levels, spermatogenesis and so fertility is possible in secondary hypogonadism but not in primary hypogonadism. Testosterone replacement therapy (TRT) remains the mainstay and primary therapeutic option in the treatment of hypogonadism. In this case report, we discuss acromegaly associated Late-onset hypogonadism (LOH) treated successfully with Siddha medicine regimen on screening with Androgen deficiency in aging male (ADAM’s) Questionnaire, laboratory investigation of total testosterone level and evaluated the patient’s quality of life using the Aging Male’s symptoms scale (AMS) for prognosis. Siddha treatment regimen such as Poonaikali vidhai chooranam with Amukkra chooranam was administered for one year. Total testosterone level improved from 70 ng/dl to 172 ng/dl and ADAM’s score reduced from 49 to 27, while AMS score reduced from 5 to 1 indicating an alternative ray of hope to TRT.

Age and training intensity differently affect male runners' endocrine and sexual parameters.

Physical activity is widely recognized to improve health and its inclusion in daily life at all ages is highly recommended. Gonadal hormones are known to be affected by physical activity. The exercise-induced effects on male runners of different ages were investigated by dividing 31 runners by age (Young, Y, 30-55 years; Old, O, 56-70 years) and amount of training (Light, L, <50 km/week; Heavy, H, 50 or more km/week). To test the somatic, sexual, and psychological health aspects, the Aging Male's Symptoms Scale (AMS) and the International Index of Erectile Function-6 (IIEF-6) questionnaires were administered and blood samples were drawn for adrenocorticotropic hormone, testosterone (Total-TT), free testosterone (Free-T), cortisol (C), dihydrotestosterone (DHT), estradiol, and sex hormone-binding globulin determinations. Clinical evaluations and questionnaire results showed the presence in all groups of some subclinical symptoms and "Light" dysfunctions. TT in the old-heavy (OH) group was significantly lower than in the OL group (2.38 ± 0.18 ng/mL vs. 3.36 ± 0.44 ng/ml, P = 0.05). The TT/DHT ratio was significantly higher in YH than in OH (3.64 ± 0.16 vs. 2.92 ± 0.23, P < 0.05). TT was positively correlated with AMS sexual subscale and negatively correlated with IIEF-6. Physical activity can significantly affect andrological health and testosterone levels in runners at all ages. Thus, due to the important testosterone-mediated vital functions in men, the evaluation of these parameters would be indicated in old as well as in young subjects.

Predictive factors for elevated prostate specific antigen and hematocrit levels during testosterone replacement therapy in patients with testosterone deficiency

Objective: We examined risk factors associated with prostate specific antigen (PSA) and hematocrit (hct) elevation during testosterone replacement therapy (TRT) in patients with testosterone deficiency (TD). Methods: We retrospectively analyzed the medical records of patients receiving TRT for ≥3 months. We investigated the following parameters: age, body mass index, comorbidities, TRT type, TRT duration, pre-TRT prostate volume, pre- and post-TRT serological tests, prostate biopsies, prostate cancer diagnoses, pre- and post-TRT aging male symptom scale scores, hct elevation, and PSA elevation. The patients were divided into two groups based on the PSA elevation status for comparison, following which we analyzed the predictive factors for PSA elevation. They were also divided into two groups based on hct elevation status. Results: The PSA elevation group showed a statistically significantly higher mean age, pre-TRT prostate volume, and PSA level compared to the non-elevation group. The PSA non-elevation group showed a significantly higher percentage of smokers, while the PSA elevation group showed a statistically significantly higher prevalence of benign prostatic hyperplasia (BPH_LUTS). The results demonstrated that a large pre-TRT prostate volume, high pre-TRT PSA levels, BPH_LUTS, and being a non-smoker were the contributing factors for PSA elevation. The hct elevation group showed statistically significantly higher pre-TRT Hb, hct, and post-TRT testosterone levels, and dyslipidemia rates, as well as a non-statistically significant prevalence of testosterone enanthate (TE) and testosterone undecanoate (TU) intramuscular injection. The pre-TRT Hb and hct levels were contributing factors for hct elevation during TRT. TE injection showed marginal statistical significance. Conclusions: We identified large prostate volumes, high PSA levels, BPH_LUTS, and being non-smokers prior to TRT as risk factors for PSA elevation during TRT. Interestingly, we found that TRT-induced hct elevation was likely to occur in patients with high pre-TRT Hb and hct levels. Additionally, the hct levels should be monitored when using TE for TRT.

Risk Factors Affecting Decreased Libido Among Middle-Aged to Elderly Men; Nocturnal Voiding is an Independent Risk Factor of Decreased Libido.

IntroductionDecreased libido in middle-aged and elderly men is often difficult to treat, and identifying the risk factors affecting decreased libido is important for the clinical management of decreased libido. However, limited information is available regarding specific risk factors in this population.AimThe present study investigated the risk factors for decreased libido among middle-aged and elderly men.MethodsPatients who attended our male andropausal outpatient clinic between 2009 and 2015 were enrolled. All patients completed a self-administered questionnaire, which included the Aging Male Symptoms (AMS) scale, International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM). Information on waist size, body mass index, present illness, present use of any medication, and lifestyle habits were collected by each attending physician. Blood biochemical data such as free testosterone, total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-Chol), and hemoglobin A1c values were assessed. Libido was assessed based on AMS scale question 17, and a score of 4 or higher was defined as severely decreased libido (severe group).Main Outcome MeasureThe clinical factors associated with severely decreased libido were analyzed based on multiple regression analysis.ResultsA total of 292 subjects were included in the analysis, 111 (38%) of which belonged to the severe group. The mean age of study subjects was 66.2 years, and the mean FT value was 7.1 ± 2.2. Comparisons of each variable among the severe and not severe groups showed significant differences in older age, current cigarette smoking, AMS scale, IPSS, frequency of nocturnal voiding, SHIM score, and HDL-Chol value. Multivariate regression analysis revealed that current cigarette smoking, frequent nocturnal voiding, and a low SHIM score were the independent risk factors for severely decreased libido. Furthermore, the frequency of nocturnal voiding significantly increased with severity of decreased libido.ConclusionCurrent cigarette smoking, frequent nocturnal voiding, and a low SHIM score were the independent risk factors for a severely low libido.K Shigehara, Y Kato, M Iijima, et al. Risk Factors Affecting Decreased Libido Among Middle-Aged to Elderly Men; Nocturnal Voiding is an Independent Risk Factor of Decreased Libido. Sex Med 2021;9:100426.

Serum concentrations of dihydrotestosterone are associated with symptoms of hypogonadism in biochemically eugonadal men

PurposeSymptoms of hypogonadism are often reported by subjects with normal serum testosterone (T) levels. We aimed to assess the association between clinical symptoms in andrological outpatients and sex steroids levels.MethodsThis is a retrospective cross-sectional cohort study in an Academic clinic and research unit. International Index of Erectile Function (IIEF, EF domain) and Aging Males Symptoms scale (AMS) questionnaires were completed by 635 and 574 men, respectively (mean age: 47.3 ± 13.9 and 47.4 ± 13.8 years, p = 0.829), free of interfering medications with complaints possibly related to hypogonadism.ResultsSerum total/free T as well as dihydro-T (DHT) was associated with IIEF-EF and AMS scores in the overall population using univariate analyses. Multivariate approaches revealed DHT concentrations in subjects with normal T levels (n = 416, Total T > 12 nmol/L) to be significant predictors of AMS scores. A 0.1 nmol/l serum DHT increase within the eugonadal range was associated with a 4.67% decrease in odds of having worse symptoms (p = 0.011). In men with biochemical hypogonadism (Total T < 12 nmol/L), total and free T rather than DHT were associated with AMS results. This association was not found for IIEF-EF scores. Indirect effects of age and BMI were seen for relations with hormone concentrations but not questionnaire scores.ConclusionDHT can be associated with symptoms of hypogonadism in biochemically eugonadal men. Serum DHT measurement might be helpful once the diagnosis of hypogonadism has been ruled out but should not be routinely included in the primary diagnostic process.

Associations between smoking, sex hormone levels and late-onset hypogonadism in men differ depending on age.

Few studies have investigated whether associations between smoking, sex hormone levels, and symptoms of late-onset hypogonadism (LOH) in men are affected by age. This multi-center, cross-sectional study involving 6,296 men aged 40-79 years was conducted between June 1, 2013 and August 31, 2016 in 6 provinces of China. Total testosterone, free testosterone, and Aging Males’ Symptoms scale (AMS) scores were compared depending on smoking status and the number of cigarettes smoked. Total testosterone was higher in smokers than in non-smokers in all except the 70-79 year old subgroup. Free testosterone was higher in smokers than non-smokers for the 40-49 and 50-59 year old subgroups, but not the 60-69 and 70-79 year old subgroups. Total testosterone was positively associated with number of cigarettes consumed in smokers aged 40-49 and 50-59 years. Sexual and somatic AMS scores were higher in current and ex-smokers than in non-smokers in all age subgroups from 40 to 79 years and were negatively associated with cigarette consumption in smokers aged 40-49 years. These results indicate that, as men age, the positive association between smoking and testosterone weakens, while the positive association between smoking and LOH symptoms becomes stronger.

Efficacy of testosterone replacement therapy plus alternate-day tadalafil for patients with late-onset hypogonadism: An open-label, randomized, crossover study.

To examine the efficacy and safety of combination treatment with testosterone replacement therapy plus alternate-day tadalafil (10mg) in patients with late-onset hypogonadism. In this open-label, randomized, crossover study, 29 patients with late-onset hypogonadism were randomly assigned to receive testosterone replacement therapy for 12weeks followed by combination treatment for 12weeks (Group 1) or combination treatment for 12weeks followed by testosterone replacement therapy (Group 2). Symptom questionnaires were administered and blood tests were performed prior to and following each treatment to assess safety and efficacy. At the end of the study, participants were asked about their treatment preferences. An adverse effect, a rheum symptom, occurred in only one participant, and 26 participants completed the study without any toxicity. Scores on the Aging Male Symptoms scale and the modified short version of the International Index of Erectile Function, and Overactive Bladder Symptom scores were significantly improved in the combination treatment phase of Group 2, whereas no significant difference between the phases were observed in Group 1. In total, 12 out of the 14 participants in Group 1 and 11 out of the 12 participants in Group 2 preferred combination treatment, which reached statistical significance (P=0.008 and 0.004 for Groups 1 and 2, respectively). Testosterone replacement therapy with add-on alternate-day tadalafil is a safe and satisfactory treatment for patients with late-onset hypogonadism.

Efficacy and safety of keishibukuryogan, a traditional Japanese Kampo medicine, for hot flashes in prostate cancer patients receiving androgen deprivation therapy.

BackgroundThe efficacy and safety of keishibukuryogan, a traditional Japanese medicine, were investigated for the treatment of hot flashes in prostate cancer (PC) patients receiving androgen deprivation therapy.MethodsThirty patients were enrolled and orally administered 2.5 g keishibukuryogan three times daily for 12 weeks. The frequency, strength, and duration of hot flashes were self-evaluated by the patients in a diary every 4 weeks. All patients also completed a questionnaire to determine their aging male symptoms (AMS) scale score and underwent blood biochemical testing.ResultsTwenty-five patients completed the 12-week treatment. Hot flash strength significantly improved 4, 8, and 12 weeks after treatment. Their frequency was significantly reduced at the 8-week visit, and duration was significantly shorter after the 8-week visit. In addition, the score of the AMS somatic subscale was improved at the 8- and 12-week visits. Among the somatic items, questions 3 (excessive sweating) and 5 (increased need for sleep) were significantly improved. Obesity, radiation, and a longer duration of PC were predictive factors for treatment response. Prostate specific antigen and total testosterone levels were unchanged, and no patients had severe adverse effects.ConclusionsKeishibukuryogan was an effective and safe treatment for hot flashes in PC patients.

Testosterone deficiency syndrome among males with type 2 diabetes mellitus in East Malaysia.

ABSTRACTType 2 diabetes mellitus (T2DM) may be independently associated with testosterone deficiency syndrome (TDS). Both conditions are linked with reduced quality of life and cardiovascular comorbidities. The magnitude of TDS among T2DM men and its predictors has still not been well established in Malaysia. This study aimed to determine the prevalence of TDS and its predictors among men with T2DM attending a government health clinic in Kuching, Sarawak. TDS severity and level of serum total testosterone were also explored. A cross-sectional study was conducted involving 360 respondents. Aging Males Symptoms Scale (AMS) score > 26 and serum total testosterone ≤ 12 nmol/L were used to diagnose TDS. The prevalence of TDS in current study was 19.7%. Multivariate analysis showed that determinants for TDS included age (Adjusted OR 1.061: 95% CI 1.020; 1.103), Iban ethnicity (Adjusted OR 2.469: 95% CI 1.154; 5.283) and a waist circumference equal or greater than 90 cm (Adjusted OR 3.655: 95% CI 1.472; 9.081). However, there was no significant association between TDS and the level of serum total testosterone (p = 0.581). We concluded that the prevalence of TDS in this study was relatively low. The severity of this condition may not be influenced by testosterone level. Physicians might consider a diagnosis of TDS if elder diabetic men with abdominal obesity present to primary care clinics with clinical features of hypogonadism. Health care providers also might consider lowering their threshold to screen for TDS among Iban men with T2DM.

Efficacy of testosterone replacement therapy on pain in hypogonadal men with chronic pain syndrome: A subanalysis of a prospective randomised controlled study in Japan (EARTH study).

The present study investigated the efficacy of 6months of testosterone replacement therapy (TRT) on chronic pain syndrome in late-onset hypogonadal (LOH) men. Sixty hypogonadal patients with chronic pain syndrome (31 patients in TRT group and 29 controls) were extracted from a previous randomised controlled study in Japan. Chronic pain was evaluated based on bodily pain (BP) subscale of Short-form (36) Health Survey (SF-36), and patients with a score of 50.0 or less were defined as suffering from chronic pain. SF-36 scores, Aging Male Symptoms (AMS) scale, international prostatic symptoms score (IPSS) and prostate-specific antigen (PSA) levels at baseline and a 6-month visit for the two groups were collected and compared. There were no statistically significant differences in baseline backgrounds between the two groups. Six-month TRT could contribute to significant improvements in BP, mental health of SF-36 and sleep disturbance (AMS question 4). Though the PSA level in the TRT group also significantly elevated at 6months, the increase was not clinically significant. No significant improvements were evident in any characteristics in the controls. In conclusion, 6-month TRT can improve pain and some aspects of quality of life in LOH men with chronic pain.

A double blind, placebo-controlled randomized comparative study on the efficacy of phytosterol-enriched and conventional saw palmetto oil in mitigating benign prostate hyperplasia and androgen deficiency

BackgroundThe present clinical trial was conducted to evaluate the efficacy and tolerability of a standardized saw palmetto oil containing 3% β-sitosterol in the treatment of benign prostate hyperplasia (BPH) and androgen deficiency.MethodsSubjects aged 40–65 years with symptomatic BPH were randomized to 12-week double-blind treatment with 500 mg doses of β-sitosterol enriched saw palmetto oil, conventional saw palmetto oil and placebo orally in the form of capsules (n = 33 in each group). BPH severity was determined using the International Prostate Symptom Score (IPSS), uroflowmetry, serum measurement of prostate specific antigen (PSA), testosterone and 5α-reductase. During the trial, the androgen deficiency was evaluated using Aging Male Symptoms (AMS) scale, the Androgen Deficiency in the Aging Male (ADAM) questionnaire, serum levels of free testosterone.ResultsSubjects treated with β-sitosterol enriched saw palmetto oil showed significant decrease in IPSS, AMS and ADAM scores along with reduced postvoiding residual volume (p < 0.001), PSA (p < 0.01) and 5α-reductase from baseline to end of 12-week treatment as compared to placebo. There was also a significant increment in the maximum and average urine flow rate (p < 0.001), and serum free testosterone level of subjects treated with enriched saw palmetto oil as compared to placebo.ConclusionThis study demonstrates the efficacy of β-sitosterol enriched saw palmetto oil superior to conventional oil thus extending the scope of effective BPH and androgen deficiency treatment with improved quality of life through the intake of functional ingredients.Trial registrationCTRI/2018/12/016724 dated 19/12/2018 prospectively registered. URL: http://ctri.nic.in/Clinicaltrials/advsearch.php