Androgen Deficiency In The Aging Male Research Articles

(201) The Need for Enhanced Wellness Among Male Resident Physicians: A Critical Look at Participation Rates

Abstract Introduction The demanding nature of medical residency-characterized by long working hours, irregular sleep schedules, and high-stress environments-poses significant health risks to resident physicians. These challenging work environments often interfere with resident’s ability to seek healthcare and wellness opportunities. This is further compounded in males who, studies suggest, are less likely to visit a doctor than their female counterparts. While numerous studies have explored specific health concerns such as resident burnout and depression, there remains a pressing need to prioritize overall wellness in this vulnerable population. Objective Our study aims to evaluate the male resident physician response to health and wellness initiatives. Methods This is a prospective study to evaluate male physicians in medical training who elected to undergo wellness screening at our institution. Following approval by the Institutional Review Board, participants were contacted via e-mail regarding participation in men’s health screening. Baseline demographics were obtained including age, specialty, and post-graduation year (PGY). Participants were asked to complete the Androgen Deficiency in the Aging Male (ADAM) and 36-Item Short Form Health Survey (SF-36) questionnaires in additional to obtaining lab work: BMP, CBC, Lipid panel, thyroid panel, testosterone, FSH, LSH, and estradiol. Survey questionnaire data was obtained through Research Electronic Data Capture (RedCAP). Results Out of 651 male residents and fellows, only 27 residents expressed interest in participation (response rate 4.1%). Of those, 66.7% (18/27) completed the surveys, and a mere 33.3% (6/18) completed the lab tests. While physical parameters scored highly (Table 1), role limitations due to emotional problems and energy/fatigue raised significant concerns with median scores of 50% and 47.5%, respectively. Similarly, perceived health change was stagnant with a median score of 50%. General health perception was middling at 62.5% whereas emotional well-being (72%) and social functioning (68.8%) were comparatively better, but not reaching optimal levels. Conclusions The low participation in voluntary health screenings among male resident physicians underscores a pressing need for enhanced wellness programs tailored to this group. It is vital for medical institutions to address barriers to participation and create a culture that prioritizes the health and wellbeing of its residents. These efforts may lead to better detection and management of health issues, improved overall wellness, and a more positive experience during the demanding period of residency. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Tolmar pharmaceuticals.

(292) Underneath the White Coat: Testosterone Deficiency in Male Resident Physicians

Abstract Introduction Resident physicians are a vulnerable population often subjected to long working hours, atypical sleep schedules, and high stress working environments. These conditions have been associated with hypogonadism in other populations, but hypogonadism has been inadequately studied in this unique population. Symptoms of hypogonadism have a high degree of overlap with conditions such as burnout and depression, both of which have been well-established in this population. Objective This study aims to examine the prevalence of hypogonadism among male resident physicians, a demographic susceptible to conditions contributing to hormone deficiencies due to their demanding work environment. Methods This is a prospective study to evaluate male physicians in medical training who voluntarily participated in wellness screening at our institution. Following approval by the Institutional Review Board, residents at a high-volume tertiary referral center were contacted via e-mail regarding participation in men’s health screening. Baseline demographics were obtained including age, specialty, and post-graduation year (PGY). Participants were asked to complete the Androgen Deficiency in the Aging Male (ADAM) and 36-Item Short Form Health Survey (SF-36) questionnaires in additional to obtaining lab work: BMP, CBC, Lipid panel, thyroid panel, testosterone, FSH, LSH, and estradiol. Survey questionnaire data was obtained through Research Electronic Data Capture (RedCAP). Results Out of 651 male residents and fellows contacted, 27 residents responded (4.1%) with 66.7% (18/27) completing surveys and 33.3% (6/18) undergoing lab tests. Two-thirds (4/6) of these participants had total testosterone levels <400ng/dl and two participants met serum criteria for hypogonadism. Half (9/18) of participants scored positively in their ADAM responses. 44.4% (8/18) reported their health as worse compared to a year prior (Table 1). Conclusions The preliminary findings suggest a significant prevalence of hypogonadism symptoms among male resident physicians. Given the severe impact of hypogonadism on overall health and work productivity, implementing wellness screening among this population could lead to earlier detection and management. However, additional research is required, especially considering the low response rate of this study. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Tolmar Pharmaceuticals.

The Impact of a Web-Based Educational Initiative in Malang Regency: Enhancing Late Onset Hypogonadism (LOH) Awareness Through Community Service

Late Onset Hypogonadism (LOH), commonly known as andropause, poses significant hormonal challenges for elderly men, impacting their overall quality of life. With testosterone levels naturally declining from the age of 30 and accelerating beyond 40, this hormonal imbalance can manifest in symptoms that degrade the well-being of men. This community service initiative aimed to improve understanding and early detection of LOH among the Indonesian male population. A web-based application, "Skrining Andropause" was developed, allowing individuals to self-assess their LOH risk through the validated Androgen Deficiency in the Aging Male (ADAM) questionnaire. The application included educational videos to enhance public awareness of andropause. Pre- and post-tests were conducted as success indicators, involving 40 male participants aged 40 and above in Malang Regency. Statistical analyses were performed to assess the impact on knowledge related to andropause across different educational backgrounds and age groups. Significant improvement in public understanding of andropause was observed (p=0.000). While educational backgrounds were not significantly associated with initial knowledge (p=0.100), nor with the increase in pre-to-post-test scores (p=0.100). When associating age groups with initial knowledge (p=0.308) and the increase in pre-to-post-test scores (p=0.308), results were not statistically significant. The observed substantial improvement in andropause understanding highlights the efficacy of our educational approach. Respondents, irrespective of educational background, shared a baseline understanding, with those with basic education showing the most significant improvement. Notably, the youngest age group displayed the highest baseline awareness. However, the oldest age group exhibited the least responsiveness to our educational media.

Testosterone replacement therapy: Patient reported preferences

ABSTRACT Introduction Hypogonadism is common in the aging man, though it is often underdiagnosed and undertreated. Men with symptomatic hypogonadism can be treated with testosterone replacement therapy (TRT) in a wide variety of methods, such as intramuscular, transdermal, subcutaneous, intranasal, and oral. A number of factors including cost, efficacy, adverse effects, and mechanism and frequency of administration, must be considered when prescribing TRT to promote maximum patient satisfaction and clinical results. Objective This study seeks to determine the attitudes, opinions, and preferences of men regarding their testosterone replacement therapy and the factors that influence these preferences. Methods An anonymous online survey was distributed via REDcap, an online data collection engine, to 783 men currently on TRT in a single men's health clinic. Men answered questions relating to demographics, comorbidities, and social history, as well as validated questionnaires: Sexual Health Inventory for Men (SHIM) for erectile dysfunction and Androgen Deficiency in the Aging Male (ADAM) for hypogonadism. They were also asked about prior and current method of TRT and overall satisfaction with their current regimen. Patient preferences regarding administration, cost, effectiveness, and adverse side effects were assessed both qualitatively and in head-to-head comparisons. Results The average age of the 130 respondents was 64.3 years (32-87). The most commonly reported method of administration was injection (57.3%), followed by topical ointment (21.8%), under-the-skin autoinjector (9.7%), implantable pellet (7.3%), and swallowed pill (4.0%). Overall satisfaction with current therapy was reported as very satisfied (36.0%), somewhat satisfied (25.6%), neutral (22.4%), somewhat dissatisfied (8.8%), and very dissatisfied (7.2%). Submuscular injection was the most commonly preferred method of administration at 40.5%, followed by swallowed pill (32.5%), under-the-skin autoinjector (23.8%), topical ointment (23.0%), nasal spray (20.6%), implantable pellet (15.9%), and skin patch (10.3%). When asked about preferences regarding testosterone injection therapy, 66.4% preferred self-administration at home; only 17.6% of patients preferred longer lasting injections if they had to be administered in the clinic. Patients ranked the potential benefits of therapy from most to least important as: improved sexual function, increased muscle strength, increased libido, reduced fatigue, decreased fat mass, increased bone density, improvement in depression, reduced hair loss, improvement with other medical problems, and improvement in anemia. Patients ranked the potential side effects of therapy from most to least concerning as: heart problems, blood clots, liver problems, breast growth, difficulty urinating, testicular shrinkage, gastrointestinal irritation, acne, and skin irritation. In head-to-head comparisons, patients preferred an administration method with the most therapeutic efficacy, fewest side effects, most convenient administration, preferred method of administration, and preferred frequency of dosing over cost. Furthermore, patients preferred efficacy and fewer side effects to convenience, method, and frequency of dosing. Conclusions The majority of respondents were overall satisfied with their current therapy. The preferred TRT option was self-injection therapy at home. Treatment efficacy and fewer side effects were the most important considerations for patients on TRT. Patient preferences should be a strong consideration for providers when prescribing testosterone replacement therapy. Disclosure Work supported by industry: no.

MP35-04 TESTOSTERONE REPLACEMENT THERAPY: PATIENT REPORTED PREFERENCES

You have accessJournal of UrologyCME1 May 2022MP35-04 TESTOSTERONE REPLACEMENT THERAPY: PATIENT REPORTED PREFERENCES Charles Loeb, Jake Miller, Douglas Schneider, and Faysal Yafi Charles LoebCharles Loeb More articles by this author , Jake MillerJake Miller More articles by this author , Douglas SchneiderDouglas Schneider More articles by this author , and Faysal YafiFaysal Yafi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002589.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with symptomatic hypogonadism can be treated with testosterone replacement therapy (TRT) in a variety of methods. Multiple factors including cost, efficacy, adverse effects, and mechanism and frequency of administration must be considered when prescribing to promote maximum patient satisfaction and clinical results. We aim to determine the attitudes, opinions and preferences of men regarding their TRT and the factors that influence these preferences. METHODS: An anonymous online survey was distributed to 783 men currently on TRT in a single men’s health clinic. Men answered questions on demographics, comorbidities, social history and validated questionnaires Sexual Health Inventory for Men (SHIM) and Androgen Deficiency in the Aging Male (ADAM). They were asked about prior and current methods and overall satisfaction with current TRT. Preferences regarding administration, cost, effectiveness and adverse effects were assessed qualitatively and in head-to-head comparisons. RESULTS: The median age of 140 respondents was 65 years (32–87). The most commonly reported method of administration was intramuscular injection (A). Overall satisfaction with current therapy was reported as very or somewhat satisfied in the majority of respondents (B). The most commonly preferred methods of administration were intramuscular injection (22%), swallowed pill (18%), subcutaneous auto-injector (13%), topical ointment (13%), nasal spray (12%), dissolved oral solution (8%) and skin patch (5%) (C). The most commonly preferred injection method was self-administration at home (D). The most preferred potential benefit was improved sexual function (E). The most concerning potential side effects were cardiac related (F). Higher satisfaction was associated with use of injection (OR 7.21, p=0.011), pellet (12.58, p=0.011), autoinjector (13.50, p=0.006), and sexually active patients (3.30, p=0.002). Lower satisfaction was associated with older age (OR 0.94, p=0.012) and positive ADAM score (0.04, p=0.003). CONCLUSIONS: The majority of respondents were satisfied overall with their current therapy. The preferred TRT option was self-injection therapy at home. Treatment efficacy and fewest side effects were the most important considerations for patients on TRT. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e588 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Loeb More articles by this author Jake Miller More articles by this author Douglas Schneider More articles by this author Faysal Yafi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Testosterone Replacement Therapy: Patient Reported Preferences

ABSTRACT Introduction Hypogonadism is common in the aging man, though it is often underdiagnosed and undertreated. Men with symptomatic hypogonadism can be treated with testosterone replacement therapy (TRT) in a wide variety of methods, such as intramuscular, transdermal, subcutaneous, intranasal, and oral. A number of factors including cost, efficacy, adverse effects, and mechanism and frequency of administration, must be considered when prescribing TRT to promote maximum patient satisfaction and clinical results. Objective This study seeks to determine the attitudes, opinions, and preferences of men regarding their testosterone replacement therapy and the factors that influence these preferences. Methods An anonymous online survey was distributed via REDcap, an online data collection engine, to 783 men currently on TRT in a single men's health clinic. Men answered questions relating to demographics, comorbidities, and social history, as well as validated questionnaires: Sexual Health Inventory for Men (SHIM) for erectile dysfunction and Androgen Deficiency in the Aging Male (ADAM) for hypogonadism. They were also asked about prior and current method of TRT and overall satisfaction with their current regimen. Patient preferences regarding administration, cost, effectiveness, and adverse side effects were assessed both qualitatively and in head-to-head comparisons. Results The average age of the 130 respondents was 64.3 years (32-87). The most commonly reported method of administration was injection (57.3%), followed by topical ointment (21.8%), under-the-skin auto-injector (9.7%), implantable pellet (7.3%), and swallowed pill (4.0%). Overall satisfaction with current therapy was reported as very satisfied (36.0%), somewhat satisfied (25.6%), neutral (22.4%), somewhat dissatisfied (8.8%), and very dissatisfied (7.2%). Submuscular injection was the most commonly preferred method of administration at 40.5%, followed by swallowed pill (32.5%), under-the-skin auto-injector (23.8%), topical ointment (23.0%), nasal spray (20.6%), implantable pellet (15.9%), and skin patch (10.3%). When asked about preferences regarding testosterone injection therapy, 66.4% preferred self-administration at home; only 17.6% of patients preferred longer lasting injections if they had to be administered in the clinic. Patients ranked the potential benefits of therapy from most to least important as: improved sexual function, increased muscle strength, increased libido, reduced fatigue, decreased fat mass, increased bone density, improvement in depression, reduced hair loss, improvement with other medical problems, and improvement in anemia. Patients ranked the potential side effects of therapy from most to least concerning as: heart problems, blood clots, liver problems, breast growth, difficulty urinating, testicular shrinkage, gastrointestinal irritation, acne, and skin irritation. In head-to-head comparisons, patients preferred an administration method with the most therapeutic efficacy, fewest side effects, most convenient administration, preferred method of administration, and preferred frequency of dosing over cost. Furthermore, patients preferred efficacy and fewer side effects to convenience, method, and frequency of dosing. Conclusions The majority of respondents were overall satisfied with their current therapy. The preferred TRT option was self-injection therapy at home. Treatment efficacy and fewer side effects were the most important considerations for patients on TRT. Patient preferences should be a strong consideration for providers when prescribing testosterone replacement therapy. Disclosure No

Frequency and determinants of hypogonadism and erectile dysfunction in men with newly detected type 2 diabetes

Introduction: Hypogonadism in males is characterized by low serum testosterone (T) levels together with clinical symptoms and is more common in diabetes mellitus (DM). Association between DM and hypogonadism has been studied in different populations but is not clearly known in Bangladeshi population. Objectives: The objective of this study was to find out the frequency and determinants of hypogonadism and erectile dysfunction (ED) in men with newly detected type 2 DM diabetes (T2DM). Materials and Methods: A cross-sectional study encompassing 1940 newly T2DM male patients (age: 42.57 ± 7.4 years; body mass index [kg/m2]: 26 ± 5.1; mean ± standard deviation) was carried out in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, to see hypogonadism. Measurement of serum total testosterone (TT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle stimulation hormone (FSH) was measured by chemiluminescent technology. Results: Among hypogonadal subjects, according to calculated Free Testosterone (cFT) and Androgen Deficiency in the Aging Male (ADAM) criteria, the frequency of hypogonadotropic hypogonadism was 80% which, on the basis of TT and ADAM criteria, was 92.5%. There was no significant difference for hypogonadism among either the hemoglobin A1c (HbA1c) categories (P = 0.23) or age groups (P = 0.9). Hypogonadal and eugonadal groups significantly differed both according to TT and ADAM (81.5% vs. 43.4%, P = 0.01) and cFT and ADAM (93.3% vs. 47.7%, P ≤ 0.001) criteria for ED. There was a significant difference between the groups for SHBG (21.7 ± 11.6 vs. 30.71 ± 22, P = 0.05) by TT and ADAM criteria. Similarly, cFT and ADAM criteria also revealed a statistically significant difference for SHBG (38.04 ± 19.90 vs. 25.28 ± 19.37 nmol/l, P = 0.03) and total cholesterol (211.40 ± 44.7 vs. 191.3 ± 32.64 mg/dl, P = 0.04). However, in both the groups, LH, follicle-stimulating hormone (FSH), HbA1c, fasting blood sugar, 2 h after 75 g glucose, triglyceride, high-density lipoprotein, and low-density lipoprotein did not differ significantly. cFT significantly correlated with age (r = ‒0.3503, P = 001) and SHBG (r = ‒0.37, P ≤ 0.01) whereas TT with SHBG (r = 0.58, P = 0.01). By multiple regression, ED and SHBG were significant predictors for hypogonadism (P = 0.01 and 0.03, respectively). Conclusion: It was concluded that a significant number of newly detected male T2DM subjects have symptoms of hypogonadism judged on the basis of TT, cFT, and ADAM scores. Poor glycemic control may affect gonadal and erectile functions. This aspect should be considered while diagnosing male subjects as T2DM.

Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile

IntroductionMale obesity has a negative correlation with plasma testosterone (T) levels and sexual function (SF).AimTo evaluate the effect of weight loss through bariatric surgery (BS) on SF, low T symptoms, and hormonal profiles in obese men.MethodsThirty-three men who underwent BS participated in this cohort study. Before surgery, all participants underwent clinical examinations, including anthropometric, lipid, glycemic, and hormonal evaluations. SF was evaluated using the International Index of Erectile Function (IIEF) questionnaire; low T symptoms were evaluated using the Aging Males’ Symptoms (AMS) and Androgen Deficiency in the Aging Male (ADAM) questionnaires. The participants were reevaluated 6 months post-surgery.Main outcome measuresSex hormone profile, SF, and low T symptomsResultsAfter BS, a significant increase in mean total T (201 ± 111–548 ± 190 ng/dL, P < .001), free T (5.8 ± 2.8–9.3 ± 3.4 ng/dL, P < .001), bioavailable T (110.3 ± 57.8–198.6 ± 74.3 ng/dL, P < .001), and sexual hormone-binding globulin (19.8 ± 13.7–54.6 ± 23.2 nmol/L, P < .001) levels. There was a significant decrease in estradiol (64.6 ± 27.4–29.2 ± 20.0 [pg/mL], P < .001). SF significantly improved. The total IIEF score increased 5.2 points (62.3 ± 7.4–67.5 ± 7.4, P = .004), erectile function subdomain increased 2.4 points (25.7 ± 4.1–28.1 ± 3.9, P = .011), desire subdomain increased 1.0 points (8.3 ± 1.5–9.3 ± 1.6, P = .006), and intercourse satisfaction subdomain increased 1.2 points (11.4 ± 1.9–12.6 ± 1.8, P = .012). Post-surgery, a 44% reduction (P = .001) was observed in the positive ADAM questionnaire, and improvements in all domains of the AMS questionnaire were found (P < .001).ConclusionSignificant weight loss through BS improves erectile function, hormonal profile, and symptoms of T deficiency.Machado FP, Rhoden EL, Pioner SR, et al. Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile. Sex Med 2021;9:100400.

The impact of cannabis use on male sexual function: A 10-year, single-center experience.

Despite increasing consumption rates in much of the world, the impact of cannabis use on various components of male sexual function remains poorly established. The purpose of this study was to further evaluate the relationship between cannabis use and reproductive and sexual function using a large patient cohort from a single academic andrology clinic. This is a historical cohort study from a single academic center andrology clinic. Patients from 2008-2017 were included. Intake questionnaires provided baseline demographic information, as well as data regarding substance use and various sexual function parameters. Subjects were categorized as cannabis users or non-users. Cannabis users and non-users were compared using descriptive statistics and Chi-squared tests, and regression analyses were performed to test for association. A total of 7809 males were included in the study; 993 (12.7%) were cannabis users and 6816 (87.3%) were non-users. Cannabis users had a higher mean Sexual Health Inventory for Men (SHIM) score (21.9±4.4 vs. 21.2±4.8, p<0.001) and mean serum total testosterone (13.4±12.0 nmol/L vs. 12.6±11.8 nmol/L, p=0.04) than non-users, although they also had a higher rate of positive Androgen Deficiency in the Aging Male (ADAM) scores (52% vs. 46%, p<0.001). Cannabis users also reported higher sexual frequency compared to non-users (8.8 events/month vs. 7.8 events/month, p<0.05). On multivariate analysis, cannabis use was not associated with SHIM score or serum testosterone concentration. Cannabis use was associated with positive ADAM scores. Cannabis use was not associated with clinically significant deleterious effects on male sexual parameters in this cohort.

Prevalence and Risk Factors of Testosterone Deficiency in Aging Thai Male Outpatients

Background: Testosterone deficiency in men, characterized by a reduced concentration of serum testosterone, causes a constellation of signs and symptoms that may include decreased libido, erectile dysfunction, increased body fat, fatigue, and psychological problem. Testosterone deficiency in adult men is often overlooked, because they ignore their symptoms or attribute them to alternate causes, including aging and underlying diseases that made them lose the opportunity for treatment. The present study aimed to describe the prevalence of testosterone deficiency and to study potential risk factors associated with testosterone deficiency among Thai men in Phramongutklao Hospital. Objective: To determine the prevalence of testosterone deficiency and potential risk factors associated with testosterone deficiency in Thai men. Materials and Methods: Thai male older than 40 years old who visited in urological outpatient unit at Phramongkutklao Hospital between July and October 2018 were included. Demographic data, medical information, and the androgen deficiency in the aging male (ADAM) questionnaires were collected. The participants having symptoms of testosterone deficiency from ADAM questionnaires were requested to measure serum total testosterone levels and were repeated if serum testosterone level was less than 300 ng/dL. Results: Data from 156 men were collected. The mean age of the participants was 67±8.73 years. Prevalence of testosterone deficiency was 5.8%. Obesity, waist circumference at or greater than 90 cm, diabetes mellitus, and dyslipidemia were identified as risk factors of testosterone deficiency. There was an association between three symptoms of ADAM questionnaires, which were decreased libido, erectile dysfunction, and decreased enjoyment of life, with testosterone deficiency. Conclusion: Prevalence of testosterone deficiency among Thai men at Phramongkutklao Hospital is about 5.8%. Clarification of the underlying causes for the changes in testosterone level may provide helpful information so that preventive action can be taken. Low libido, erectile dysfunction, and decreased enjoyment of life may be specific symptoms of testosterone deficiency and should be the questions to ask the suspected patients. Keywords: Testosterone deficiency; Total testosterone; Prevalence; ADAM questionnaires

The application value of serum 25(OH)D3, uric acid, triglyceride, and homeostasis model assessment of insulin resistance in male patients with hyperuricemia combined with hypogonadism

BackgroundThe purpose of this study was to investigate the application value of serum 25(OH)D3, uric acid, triglyceride (TG), and homeostasis model assessment of insulin resistance (HOMA-IR) in male patients with hyperuricemia combined with hypogonadism.MethodsFrom August 2018 to August 2020, a total of 198 male patients with primary hyperuricemia were prospectively enrolled in our hospital for inpatient treatment in the department of Metabolism and Endocrinology. They are divided into normal gonadal function group (normal group, n = 117) and hypogonadal function group (hypogonadism group, n = 81), according to free testosterone (FT) level, International Index of Erectile Function (IIEF-5), and androgen deficiency in the aging male (ADAM) questionnaires. Laboratory indexes were compared between two groups. Multivariate logistic regression was applied to analyze the influencing factors of hypogonadism.ResultsAmong the 198 hyperuricemia patients, 40.91 % were hypogonadism. Compared with the normal group, the BMI, waist circumference (WC), and the prevalence of non-alcoholic fatty liver disease (NAFLD), hyperlipidemia (HLP), and obesity (OB) in the hypogonadism group were higher, and the difference was statistically significant (P < 0.05, respectively). The levels of fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), triacylglycerol (TG), serum uric acid (SUA), alanine transaminase (ALT) of hypogonadism group were higher than those of normal group, while the levels of TT, FT, E2, 25(OH)D3 of hypogonadism group were lower than those of normal group (P < 0.05, respectively). Pearson’s linear correlation was used to analyze the correlation between the indicators with significant differences in general data and laboratory indicators and hypogonadism. BMI, WC, HOMA-IR, TG, SUA, TT, FT, 25(OH)D3, E2 were positively correlated with hypogonadism (r = 0.556, 0.139, 0.473, 0.143, 0.134, 0.462, 0.419, 0.572, 0.601, P = 0.012, 0.027, 0.018, 0.019, 0.028, 0.029, 0.030, 0.009, 0.003, respectively). Taking the above indicators as independent variables and hypogonadism as the dependent variable, logistic regression analysis found that the risk factors for hypogonadism were SUA, WC, BMI, HOMA-IR, TG, TT, FT, E2, and 25(OH) D3.ConclusionsSerum 25(OH)D3, SUA, HOMA-IR, TG levels were positively correlated with male hyperuricemia patients with hypogonadism. They have important application value in the diagnosis of male hyperuricemia patients with hypogonadism.

Evaluation of predictors of erectile dysfunction and hypogonadism in men with types 2 diabetes mellitus

Background: Now a day erectile dysfunction (ED) and hypogonadism of the patients with type 2 diabetes mellitus (T2DM) become two common complaints. The association among hypogonadism, erectile dysfunction and type 2 diabetes of man seem to be increased. The aim of this study was to evaluate the predictors of erectile dysfunction and hypogonadism in men with types 2 diabetes mellitus (T2DM). Methods: This was a cross-sectional study which was conducted in the Department of Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh Hospital, Bangladesh during the period from January 2019 to December 2019. In total 352 newly detected T2DM male patients, with complete data were finalized as the study population. All data were processed by using SPSS program version 23.0.Results: In this study, according to complement fixation test (cFT) and androgen deficiency in the aging male (ADAM) criteria, 119 (33.81%) participant had low cFT&amp; ADAM positive under hypogonadal, 84 (23.86%) were with normal TT &amp; ADAM negative (eugonadal), 37 (10.51%) were with low TT &amp; ADAM negative (eugonadal), 112 (31.82%) were with normal TT &amp; ADAM positive (eugonadal). On the other hand, according to the cFT and ADAM score in total 119 (33.81%) hypogonadal patients were with low cFT &amp; ADAM positive. Besides this, 102 (43.78%) eugonadal patients were with normal cFT &amp; ADAM negative and 131 (56.22%) eugonadal patients were with normal cFT &amp; ADAM positive.Conclusions: Hence, universal screening of testosterone level and androgen deficiency symptoms is recommended in newly detected T2DM patients.

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

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.

Penile vascular abnormalities in young men with persistent side effects after finasteride use for the treatment of androgenic alopecia.

BackgroundThe constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA).MethodsThis was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use.ResultsA significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29–43) and control group (median: 29; IQR: 27–32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5–16] compared to 3 [2–8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5–16) vs. 1 (0–2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study.ConclusionsWhile the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.

MP78-08 CAN ORGANIC DIET BE PROTECTIVE AGAINST HYPOGONADISM AND ERECTILE DYSFUNCTION?

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (MP78)1 Apr 2020MP78-08 CAN ORGANIC DIET BE PROTECTIVE AGAINST HYPOGONADISM AND ERECTILE DYSFUNCTION? Farouk M. El-Khatib*, Mohamad M. Osman, Linda M. Huynh, Sharmin Dianatnejad, Qiaqia Wu, Maxwell Towe, Natalie Yafi Roberts, and Faysal A. Yafi Farouk M. El-Khatib*Farouk M. El-Khatib* More articles by this author , Mohamad M. OsmanMohamad M. Osman More articles by this author , Linda M. HuynhLinda M. Huynh More articles by this author , Sharmin DianatnejadSharmin Dianatnejad More articles by this author , Qiaqia WuQiaqia Wu More articles by this author , Maxwell ToweMaxwell Towe More articles by this author , Natalie Yafi RobertsNatalie Yafi Roberts More articles by this author , and Faysal A. YafiFaysal A. Yafi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000964.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is increasing evidence supporting relationships between diet, hypogonadism, and erectile dysfunction (ED). We sought to assess the dietary patterns of patients presenting to a men’s health clinic and to look for any correlations between dietary habits and signs and symptoms of hypogonadism and ED. METHODS: Men who presented to our men’s health clinic between August 2018 and June 2019 were enrolled. Clinical demographics were collected and patients completed the Androgen Deficiency in the Aging Male (ADAM), the International Index of Erectile Function (IIEF-5), STOP-BANG questionnaire screens for obstructive sleep apnea (OSA), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) questionnaires, as well as an expansive dietary survey. This included questions about consumption of water, coffee, sugary drinks, drinks with artificial sweeteners, alcoholic drinks, as well as dietary preferences such as organic diet, processed foods and intermittent fasting, amongst others. Laboratory values including total testosterone (TT), free testosterone (FT) and estradiol (E) were also collected. Univariate and multivariate analyses were constructed to identify demographics and dietary habits that were predictive of hypogonadism or ED. In this study, men were included if they answered all the questionnaires and were excluded if they received testosterone replacement therapy. RESULTS: During this period, 445 men presented to the clinic, of which 297 were included. Organic diet was followed by 30 (10.1%) men, 52 (19.4%) did not consume processed foods and 31 (11.7%) performed intermittent fasting. On univariate analysis, organic vs non-organic diet was significantly associated with higher SHIM scores 19.1±5.9 vs 16.4±7.9 (p= 0.03). Hypogonadism and ED were diagnosed in 3.3% and 33.3% in men who followed an organic diet vs 15.7% and 41.9% in men who did not (p= 0.069 and p= 0.366, respectively). After adjusting for age and BMI, adherence to an organic diet was significantly associated with higher SHIM scores (p= 0.045). Hypogonadism, ED and LUTS were diagnosed in 6.5%, 29.0% and 19.4%, respectively, in men who performed intermittent fasting compared to 15.5%, 41.4% and 31.9% in men who did not (p= 0.178, p= 0.187 and p= 0.154). Men who consumed processed foods were younger (p= 0.05) and had higher body mass index (BMI) (p= 0.033). CONCLUSIONS: This is the first reported study showing that adherence to an organic diet may potentially be protective against hypogonadism and ED. Larger prospective interventional studies are needed to validate these results. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1176-e1176 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farouk M. El-Khatib* More articles by this author Mohamad M. Osman More articles by this author Linda M. Huynh More articles by this author Sharmin Dianatnejad More articles by this author Qiaqia Wu More articles by this author Maxwell Towe More articles by this author Natalie Yafi Roberts More articles by this author Faysal A. Yafi More articles by this author Expand All Advertisement PDF downloadLoading ...

Relationship between Hypogonadal Symptoms, Sexual Dysfunction and Chronic Prostatitis in Middle-Aged Men by Self-Reported Questionnaires, even without Biochemical Testosterone Deficiency.

PurposeTo investigate the association of erectile dysfunction (ED), premature ejaculation (PE), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men with late-onset hypogonadism (LOH).Materials and MethodsWe reviewed the data of 408 enrolled men between January 2014 and January 2019. All participants completed the Androgen Deficiency in the Aging Male (ADAM), international index of erectile function-5 (IIEF-5), National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and premature ejaculation diagnostic tool (PEDT) questionnaires. Participants were divided by ADAM positive (ADAM+: Group 1) and ADAM negative (ADAM−: Group 2).ResultsTotal of 289 subjects were in Group 1 and 119 were in Group 2. The mean age was 53.8±7.8 years. The mean total testosterone was 4.8±1.2 ng/dL and showed no differences between the groups (p=0.839). In Groups 1 and 2, ED (IIEF≤21) was identified in 233 (80.6%) versus 37 (31.1%), respectively (p<0.001). The prevalence of PE (PEDT≥9) was 112 (38.7%) versus 13 (10.9%) in Groups 1 and 2, respectively (p<0.001). However, PE (intravaginal ejaculation latency time<5 minutes) showed no differences between the groups (p=0.863). The incidence of chronic prostatitis (NIH-CPSI pain score≥4) showed significant differences with 49 (17.0%) versus 8 (6.7%) in Groups 1 and 2, respectively (p=0.007). IIEF-5 total score showed the significantly highest negative correlation (r=−0.313, p<0.001).ConclusionsThose who complained of LOH symptoms and positive results in the ADAM questionnaire need to be assessed concurrently with the above questionnaires. This could aid useful to detect of ED, PE, and chronic prostatitis co-occurrence.

124 The Persistent Effects of 5α-reductase Inhibitors Used in the Treatment of Androgenic Alopecia on Men's Health

The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) – collectively termed Post-Finasteride Syndrome (PFS) – has garnered recent attention with the Food and Drug Administration (FDA) and French National Agency for Drug Safety (ANSM), resulting in amendment of finasteride’s label to include a warning of the risk of persistent side effects. The purpose of this study is to further elucidate the persistent sexual, genitourinary, physical, psychiatric, cognitive, and androgenic effects of 5ARIs in men treated for androgenic alopecia (AGA). This was a retrospective case-control study that evaluated the sexual, genitourinary, physical, psychiatric, cognitive, and androgenic effects of 5ARIs in 25 subjects with a history of 5ARI use for AGA and 25 controls. Patient self-reported symptoms and validated questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used to evaluate outcomes in a standardized manner. Penile Duplex Doppler Ultrasound (PDDU) results were used to evaluate penile vascular parameters.

120 Adherence to an Organic Diet is Protective Against Hypogonadism and Erectile Dysfunction

There is increasing evidence supporting relationships between diet, hypogonadism, erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). We sought to assess the dietary patterns of patients presenting to a men’s health clinic and to look for any correlations between dietary habits and signs and symptoms of hypogonadism and ED. Men who presented to our men’s health clinic between August 2018 and June 2019 were enrolled. Clinical demographics were collected and patients completed the Androgen Deficiency in the Aging Male (ADAM), the International Index of Erectile Function (IIEF-5), STOP-BANG questionnaire screens for obstructive sleep apnea (OSA), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) questionnaires, as well as an expansive dietary survey. This included questions about consumption of water, coffee, sugary drinks, drinks with artificial sweeteners, alcoholic drinks, as well as dietary preferences such as organic diet, processed foods and intermittent fasting, amongst others. Laboratory values including total testosterone (TT), free testosterone (FT) and estradiol (E) were also collected. Univariate and multivariate analyses were constructed to identify demographics and dietary habits that were predictive of hypogonadism or ED. In this study, men were included if they answered all the questionnaires and were excluded if they received testosterone replacement therapy.

Association of total and calculated free testosterone with androgen deficiency symptoms in patients with type 2 diabetes.

The Androgen Deficiency in the Aging Male (ADAM) questionnaire is commonly used to screen type 2 diabetes mellitus (T2DM) patients for androgen deficiency symptoms, but the association of low total (TT) and free testosterone (FT) levels with divergent responses to the ADAM questionnaire remains unclear. The aim of this study was to assess the predictive ability of TT and calculated FT (cFT) levels for accurately classifying ADAM status. We recruited 70 patients each with positive (group A) and negative (group B) responses to the ADAM questionnaire and 70 age-matched healthy controls (group C) (mean age, 50.5 years); serum levels of TT were estimated and cFT were estimated using Vermeulen equation. Hypogonadism was defined as the presence of symptoms (positive ADAM score) along with TT level < 300 ng/dL or calculated (cFT) <6.35 ng/dL. BMI was highest in group A (P < 0.05), followed by groups B and C. Group A had longer diabetes durations (P < 0.05) and higher fasting plasma glucose (FPG) and HbA1c levels than group B (P < 0.001). TT levels and cFT were significantly lower in Group A than in the other two groups. In group A, 51 (73%) men had low TT levels (<300 ng/dL) and 48 (69%) had low cFT (<6.35 ng/dL). TT levels < 300 ng/dL had higher sensitivity and specificity (73 and 96%, respectively) than cFT < 6.35 ng/dL (69 and 90%, respectively) for predicting ADAM status. Multivariate-adjusted logistic regression showed that diabetes duration, HbA1c level, and BMI predicted low TT levels, whereas diabetes duration and HbA1c and high-density lipoprotein levels were significant predictors of low cFT. TT levels were a better predictor of ADAM responses than cFT in male T2DM patients. Our results suggest that TT level is better than cFT for diagnosing hypogonadism in T2DM patients when equilibrium dialysis is not feasible.