Decrease In Free Testosterone Research Articles

Parietal and occipital hair loss patterns in initial stages of androgenic alopecia in men

Background. The initial stages of androgenetic alopecia in men are characterized by a variety of clinical manifestation in the parietal or occipital scalp regions. However, the differences in the pathogenesis of hair loss patterns are not well understood, selective treatment has not been developed.
 Aims. Trichological characteristics of patients with initial stages of androgenetic alopecia with identification of genetic and non-genetic factors that determine the hair loss in the different scalp regions, and their response to conservative therapy.
 Materials and methods: Trichograms were photodocumented using an AramoSG microcamera (Republic of Korea). The genetic factor was analyzed by mini-sequencing of single nucleotide polymorphisms rs929626, rs5919324, rs1998076, rs12565727, rs756853. The non-genetic factors study included hormonal status (total and free testosterone, dihydrotestosterone, 17OH-progesterone, dehydroepiandrostenone, SHBG) and blood content of trace elements (Mg, Ca, Zn, Cu, Se, Fe) and vitamins (B12, D, E, folic acid). Conservative treatment was topical application of a minoxidil 5% (twice-a-day, 4 months) and a micronutrient deficiencies personalized correction.
 Results. The study included 47 man with initial stages of androgenetic alopecia. Their trichological examination showed two patterns, consisting a predominant decrease in the hair density and diameter in the parietal and occipital scalp regions, which were subgroups formation criteria. An intergroup comparison revealed similar genetic risk, while hormonal parameters (increased dihydrotestosterone levels, a decrease in free testosterone) characterized the subgroup with parietal hair loss pattern. Also, a multiple deficiency of Zn, Cu, Se and vitamins B12, D, folic acid was detected in all patients. Subsequent conservative treatment had a positive effect in patients with parietal hair loss pattern, while in patients with occipital pattern no significant response was observed.
 Conclusions. The study develops ideas about differences between androgen-dependent parietal and androgen-independent occipital hair loss patterns in the initial stages of androgenetic alopecia, which requires different approaches to their conservative therapy.

Low Testosterone Level and Risk of Adverse Clinical Events among Male Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Cohort Studies.

The phenomenon of low testosterone level is extremely common in male patients with chronic kidney diseases (CKDs). This meta-analysis aimed to evaluate whether the low circulating testosterone could independently predict adverse outcomes among male patients with chronic kidney diseases (CKDs). The data till May 2022 were systematically searched from Pubmed, Web of Science, and Embase from inception. Studies meeting the PICOS (population, intervention/exposure, control/comparison, outcomes, and study design) principles were included in this meta-analysis. Study-specific effect estimates were pooled using fixed-effects (I2 > 50%) or random-effects models (I2 < 50%). Ultimately, 9 cohort studies covering 5331 patients with CKDs were involved in this meta-analysis. The results suggested that per 1-standard deviation (SD) decrease in total testosterone independently increased the risk of all-cause mortality by 27% [hazard risk (HR) 1.27, 95% confidence interval (CI) 1.16–1.38], cardiovascular mortality by 100% (HR 2.00, 95% CI 1.39–2.86), cardiovascular events by 20% (HR 1.20, 95% CI 1.04–1.39), and infectious events by 41% (HR 1.41, 95% CI 1.08–1.84). Besides, with per 1-SD decrease in free testosterone, the risk of overall adverse events increased by 66% (HR 1.66, 95% CI 1.34–2.05). Stratified analyses indicated that the negative relationship of the total testosterone with all-cause death risk was independent of factors involving age, race, body mass index, diabetes, hypertension, C-reactive protein, creatinine, and sex hormone binding globulin. In conclusion, it was identified that low endogenous testosterone could serve as an independent predictor of adverse clinical events among male patients with CKDs.

Hormonal characteristics of androgen status and their relationship with the anthropometric and metabolic parameter in men depending on the severity of hypertension

Background. According to the literature data, long-term and poorly controlled hypertension (HTN) leads to target organs damage, and in some cases, to the development of associated diseases, the severity of which in men may be partly due to the characteristics of the androgenic status.The aim: to reveal the features of hormonal indicators of androgen status and their relationship with the anthropometric and metabolic characteristics of the therapeutic clinic male patients, depending on the severity of HTN.Materials and methods. 296 men aged 59,0 [54,0; 65,0] years with confirmed HTN were examined. All study participants in the morning on an empty stomach underwent anthropometry, determination of metabolic and androgenic status, and assessment of comorbid burden. Depending on the severity of hypertension, all patients were divided into two groups (G): G1 (n = 134) – patients with hypertension without a history of coronary artery disease or stroke; G2 (n = 162) – patients with hypertension with a history of ischemic heart disease (IHD) and/or stroke.Results. In male patients of G2 with severe HTN, a decrease in the levels of free testosterone (FT) and, to a greater extent, dehydroepiandrosterone sulfate (DHEA-S), as well as total cholesterol, high and low density lipoproteins, was revealed. The correlation analysis performed revealed statistically significant negative correlations between the levels of total testosterone (TT) and FT with body mass index, the value of the ratio of waist circumference to hips, only the level of FT – with the presence of IHD, chronic heart failure (CHF), disorders of carbohydrate metabolism and abdominal type of fat distribution, and the level of DHEA-S – with the presence of IHD and CHF.Conclusion. A decrease in FT and DHEA-S is associated with early progression of atherosclerosis and the risk of developing HTN-associated cardiovascular events, which can aggravate the course of HTN.

Association between changes in fat distribution and biomarkers for breast cancer.

We assessed the associations between changes in total and abdominal fat and changes in biomarkers for breast cancer risk using data of the SHAPE-2 trial. In the SHAPE-2 trial, 243 postmenopausal overweight women were included. The intervention in this trial consisted of 5-6 kg weight loss either by diet only or exercise plus diet. After 16 weeks, we measured serum sex hormones, inflammatory markers, total body fat (measured by DEXA scan) and intra and subcutaneous abdominal fat (measured by MRI). Associations between changes in different body fat depots and biomarkers were analysed by linear regression using the study cohort irrespective of randomisation to make maximal use of the distribution of changes in fat measures. We found that a loss in total body fat was associated with favourable changes in free oestradiol, free testosterone, leptin and sex hormone binding globulin (SHBG). The loss of intra-abdominal fat was associated with a decrease in free testosterone, hsCRP and leptin, and an increase in SHBG. In the multivariable analysis, the best fitted models for the biomarkers free oestradiol, SHBG leptin and adiponectin included only total body fat. For free testosterone, this was subcutaneous abdominal fat, and for hsCRP and IL-6, only intra-abdominal fat change was important. For IL-6 and adiponectin, however, associations were weak and not significant. We conclude that, in our population of healthy overweight postmenopausal women, loss of fat at different body locations was associated with changes in different types of biomarkers, known to be related to risk of breast cancer.

The gonadotrophic response of Royal Marines during an operational deployment in Afghanistan.

Military training has been associated with changes in the hypothalamic-pituitary-gonadal axis consistent with central hypogonadism. Often such changes have been associated with body mass loss, though sleep deprivation and other psychological stress may also contribute. The effects of deployment in a combat zone on the hypothalamic-pituitary-gonadal axis in military personnel are not known. The objective was to investigate the hypothalamic-pituitary-gonadal axis in male military personnel deployed in Afghanistan. Eighty-nine Royal Marines were investigated pre-deployment, following 3 months in Afghanistan and following 2 weeks mid-tour leave. Testosterone, sex hormone-binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinising hormone (LH), 17-hydroxyprogesterone, androstenedione (AD) and insulin were assayed and body mass recorded. The results showed that body mass (kg) dropped from 83.2 ± 9.2 to 79.2 ± 8.2 kg during the first 3 months of deployment (p < 0.001). Total testosterone did not change, but SHBG increased (30.7 ± 9.7 vs. 42.3 ± 14.1 nmol/L, p < 0.001), resulting in a significant (p < 0.001) fall in calculated free testosterone (435.2 ± 138 vs. 375.1 ± 98 pmol/L). Luteinising hormone and FSH increased by 14.3% (p < 0.001) and 4.9% (p = 0.003) respectively. Free testosterone, SHBG, LH and FSH returned to baseline following 2 weeks of mid-tour leave. Androstenedione (AD) decreased by 14.5% (p = 0.024), and insulin decreased by 26% (p = 0.039), over the course of deployment. In this study of lean Royal Marines, free testosterone decreased during operational deployment to Afghanistan. There was no evidence to suggest major stress-induced central hypogonadism. We postulate that reduced body mass, accompanied by a decrease in insulin and AD synthesis, may have contributed to an elevated SHBG, leading to a decrease in free testosterone.

Low-serum testosterone levels pre-liver transplantation are associated with reduced rates of early acute allograft rejection in men.

Low pretransplant serum testosterone has recently been associated with increased mortality in men awaiting liver transplantation, but the potential impact on rejection has not yet been investigated. Pretransplantation serum testosterone, SHBG, and other variables were collected on 190 consecutive men who received a liver transplant between 2007 and 2013. Rates of subsequent acute cellular rejection were recorded. Multivariable analysis was performed to define variables associated with rejection and other clinically important end points. Thirty (16%) of 190 men experienced acute cellular rejection. Lower pretransplant testosterone was associated with lower rejection rates, -7% (95% confidence interval [CI], -2% to -12%) per nmol/L decrease in total testosterone and -4% (95% CI, -0.5% to -7%) per 10 pmol/L decrease in free testosterone. Total testosterone (correlation 0.29, P=0.04) and free testosterone (correlation 0.37, P=0.01) correlated significantly with the histological severity of rejection. Older age at transplant (+5% [95% CI, 9%-2%]) per year, and nonautoimmune etiology of liver disease (OR, 1.0 for autoimmune, 0.22 [95% CI, 0.07-0.73] for hepatitis C virus, and 0.58 [95% CI, 0.21-1.71] for other etiologies) were also associated with decreased rejection risk. In a generalized linear model including the covariates testosterone, SHBG, age, etiology, and MELD, total testosterone remained a significant predictor of rejection (adjusted OR, 1.06; P=0.03), as did age at transplant (OR, 0.95; P=0.01). Low preliver transplant serum testosterone independently predicts a decreased risk of acute allograft rejection. Whether testosterone is a marker of disease-associated immune dysfunction or has immune-modulatory effects requires further study.

Low levels of free testosterone correlated with bone mineral densities of femoral necks in aged healthy Shanghainese men.

The aim of the study was to investigate the influence of serum testosterone concentrations on bone mineral densities (BMDs) in healthy aged men in Shanghai area. Eighty-four participants, registered in the physical examination center of our hospital were included. Liquid chromatography tandem mass spectrometry (LC-MS/MS) was used to measure concentrations of total testosterone (TT) and free testosterone (FT) in serum. BMDs of the lumbar spine, femoral neck, the trochanter major, and Ward's triangle were determined with dual energy X-ray absorptiometry (DXA). The correlations of TT and FT with BMDs at the different skeleton sites were analyzed; stratified analyses by age were performed with 10-year range groups and the changing trends of TT and FT with increasing age were further investigated. In addition, we performed a stratified quartile TT and FT analysis of their correlations with BMDs of different bones in each group. The average age of the participants was 71.8 ± 9.6 years (50-90 years). In a stratified analysis by age, no significant TT changes with increasing age was found, but there was a significant decrease of FT in men older than 80 years (p<0.05). In a stratified FT quartile analysis, FT in the first quartile group correlated significantly with BMDs of the lumbar spine, femoral neck and Ward's triangle; however, there was only a significant correlation between FT and BMD of the femoral neck after adjustment for age and body mass index (BMI). FT blood serum concentrations decreased significantly in healthy men aged over 80 and positively correlated with BMDs of femoral necks.

Inhibitory effects of mitotane on viability and secretory activity in mouse gonadotroph cell lines

Mitotane represents the mainstay medical treatment for metastatic, inoperable or recurrent adrenocortical carcinoma. Besides the well-known adverse events, mitotane therapy is associated also with endocrinological effects, including sexual and reproductive dysfunction. The majority of male patients undergoing adjuvant mitotane therapy show a picture of hypogonadism, characterized by low free testosterone and high sex hormone binding globulin levels and unmodified LH concentrations. Since mitotane has been shown to have direct pituitary effects, we investigated whether mitotane may influence both cell viability and function of gonadotroph cells in the settings of two pituitary cell lines. We found that mitotane reduces cell viability, induces apoptosis, modifies cell cycle phase distribution and secretion of gonadotroph cells. The present data strengthen previous evidence showing a direct mitotane effect at pituitary level and represent a possible explanation of the lack of LH increase following decrease in free testosterone in patients undergoing adjuvant mitotane therapy.

The effect of a very low calorie diet on insulin sensitivity, beta cell function, insulin clearance, incretin hormone secretion, androgen levels and body composition in obese young women

Objective. Evaluation of the effect of an 8-week very low calorie diet (VLCD, 500–600 kcal daily) on weight, body fat distribution, glucose, insulin and lipid metabolism, androgen levels and incretin secretion in obese women. Methods. Seventeen overweight women (BMI >28) were recruited to the study. Glucose, insulin and lipid metabolism were evaluated by euglycemic clamp technique, indirect calorimetry and an oral glucose tolerance test (OGTT). Insulin sensitivity was calculated as glucose disposal rate (GDR) and insulin sensitivity index (ISI), and also by HOMA-IR. Insulin secretion rate (ISR) was calculated from plasma C-peptide measurements. Secretion of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) was measured during an oral glucose tolerance test. Abdominal fat distribution was assessed by dual x-ray absorptiometry scan and computed tomography. Results. Ten women completed the intervention. The subjects lost an average 11% of their baseline weight. There was a significant loss of subcutaneous abdominal fatty tissue (p <0.01) and intra-abdominal fatty tissue (p =0.05). Whole body (HOMA-IR) (p <0.05) insulin sensitivity increased significantly, but peripheral (ISI) insulin sensitivity was unaltered after weight loss. GIP increased (p <0.05) and GLP-1 was unaltered after the dietary intervention. Insulin responses did not differ before and after dietary intervention, however, a significant increase in insulin clearance (p <0.05) was observed. The weight loss resulted in a significant decrease in free testosterone. Conclusion. A VLCD is an effective weight loss treatment, which results in an immediate improvement in several metabolic parameters.

A five-year prospective study of bone mineral density in men and women with diabetes: The Fremantle Diabetes Study

To examine longitudinally the effect of diabetes on bone structure and metabolism, we measured bone mineral density (BMD) and turnover markers in 26 type 1 (mean age 49years) and 27 type 2 (mean age 65years) diabetic patients without known osteoporosis from a community-based sample at baseline and 5years later. In the 17 type 1 men, BMD fell at the femoral neck (0.804±0.145 vs. 0.769±0.129g/cm(2); P=0.003) with no change at lumbar spine or forearm. In the 11 type 2 women, BMD decreased at all sites except spine (femoral neck 0.779±0.119 vs. 0.742±0.090g/cm(2); P=0.019). BMD did not fall at any site in type 1 women or type 2 men. There was an increase in serum alkaline phosphatase and trend to higher serum beta carboxyl-terminal type I collagen telopeptide concentrations in the type 1 patients, and a decrease in free testosterone in the type 1 men. These data show that the rate of demineralization at the femoral neck in type 1 men is similar to that in older post-menopausal type 2 women. Changes in biochemical markers suggest that, in type 1 men, there is ineffective bone formation associated with accelerated bone resorption and lower sex steroid bioavailability. These findings may have implications for the clinical management of young male adults with diabetes.

Physiological Effects of Concurrent Training in Elderly Men

The aim of the present study was to investigate the effects of concurrent strength and endurance training on neuromuscular and hormonal parameters in elderly men. 23 healthy men (65±4 years) were randomly assigned to 1 of 3 groups: concurrent (CG, n=8), strength (SG, n=8) or endurance group (EG, n=7). The programs consisted, of strength training, endurance training on a cycle ergometer or a combination of both in the same session 3 times per week over a duration of 12 weeks. Subjects were evaluated on parameters related to muscle strength, muscle activation and serum hormones. There were significant increases in lower-body strength in all groups (P<0.05), with higher increases in SG (67%) than CG (41%) and both were higher than EG (25%) (p<0.01). Only SG and CG increased upper-body strength (p<0.01), with no significant difference between the 2 groups. Furthermore, there were significant decreases in free testosterone in EG after training. Significant increases in isometric strength and maximal muscle activation (p<0.05) as well as decreases in the submaximal muscle activation to the same load, were only seen in SG (p<0.05). The present results suggest that the interference effect observed due to concurrent strength and endurance training could be related to impairment of neural adaptations.

Decreasing Testosterone with Increasing Age: More Factors, More Questions

Many studies have now demonstrated that as men age, their serum testosterone concentrations fall. The first studies were cross-sectional. One of the earliest was in 83 healthy men, aged 20–88 yr, in New Mexico (1). The serum total testosterone concentration fell only marginally with age, but as the SHBG concentration increased with age, the free testosterone concentration fell markedly, so the mean free testosterone concentration at age 80 yr was less than one third of that at age 20 yr. Later cross-sectional studies in larger groupsofmen, conducted, amongotherplaces, inMassachusetts (2),TheNetherlands (3), and at a consortium of six sites across the United States (4), confirmed that with increasing age, the total testosterone concentration falls only slightly, but the free testosterone concentration falls to a much greater degree. These larger studies also demonstrated that adiposity and comorbid conditions were independently associated with decreases in total and free testosterone. Longitudinal studies later confirmed the fall in testosterone with increasing age. In the Baltimore Longitudinal Study of Aging, the serum total testosterone concentration decreased modestly with increasing age, and an index of the free testosterone concentration decreased even more (5). By the eighth decade of life, 28% of men had total testosterone concentrations that would be considered hypogonadal by the standards of young men, and 68% had free testosterone index values considered hypogonadal by the standards of young men. In the Massachusetts Male Aging Study, longitudinal observation also showed a decrease in total testosterone with increasing age and a greater decrease in free testosterone (6). The Massachusetts Male Aging Study results, in addition, showed a greaterdeclinewhenagingwasaccompaniedbythedevelopmentof obesity,anewcomorbidcondition,oranuntowardevent inaman’s life, such as loss of a wife. In this issue of the Journal, Wu et al. (7) describe results from 3220 men equally distributed across 4 decades from 40 to 79 yr observed cross-sectionally in the European Male Aging Study (EMAS). The results from these men confirm and extend the results of the previous studies. As in the previous studies, the EMAS data show that the serum concentration of total testosterone fell slightly, only0.4%peryear, but the free testosterone fell 1.3%peryear.The serumconcentrationof total testosteronewasalso lower thegreater the degree of obesity. Although much of the effect of obesity was explained by a decrease in SHBG, the serum-free testosterone concentration was also lower at all ages in men with a BMI 30 kg/m orgreater than inthosewithaBMIless than25kg/m butnotnearly as much as the total testosterone. Comorbidity was also associated with a lower total and, to a lesser degree, free testosterone concentration at all ages. The report from the EMAS extends the results of previous studies, suggesting different mechanisms for the different factors involved in the fall in testosterone with increasing age. Increasing age was associated with increasing serum concentration of LH, suggesting that an important factor in the fall in free testosterone with increasing age is testicular failure. Obesity and comorbidity, however, were not associated with an increase in LH, suggesting that their influence on free testosterone was exerted by a pituitary or hypothalamic mechanism. These results add to the unanswered questions about the consequences of the fall in testosterone with increasing age in men. We have not known whether the fall in testosterone with increasing age alone has adverse consequences, such as on physical, sexual, and cognitive function and vitality. Now we can also ask whether the decreases in testosterone due to obesity and comorbidity have clinical consequences different from those of age alone. We have also not known whether increasing the serum testosterone concentration of elderly men would improve physical, sexual, and cognitive function and vitality. Now we can also ask whether increasing the serum testosterone concentration when it is low because of obesity or comorbidity will be beneficial. The results of these new data from the EMAS, finally, will influence the design of future studies to test the effect of testosterone in elderly men with low testosterone concentrations. Should such studies intentionally include or exclude men with obesity or comorbidity? If men with obesity or comorbidity are included, should

Free testosterone levels and implications on clinical outcomes in elderly men

Aging is accompanied by a progressive decline in serum testosterone. Evidence concerning the clinical manifestations of low serum testosterone levels is contradictory. We aimed to examine the age-related decline in testosterone and the possible clinical outcomes, including erectile dysfunction, prostatism, cognitive function, daily life activities, depression, and osteoporosis. One hundred and twenty men underwent comprehensive geriatric assessment. Testosterone and free testosterone levels were measured, geriatric assessment scales, International Index of Erectile Function (IIEF) and International Prostate Symptom Scale (IPSS) were performed, and bone mineral densities were determined. The mean age of the 120 men was 73.8+/-5.90. A significant decrease in testosterone and free testosterone levels with increasing age was determined (p=0.021). It was also found that erectile dysfunction, as determined by IIEF (r=0.66, p<0.001), and symptoms of prostatism determined by IPSS (r=-0.23, p=0.016), were significantly associated with low free testosterone levels. Laboratory parameters, obesity, osteoporosis, cognitive function, daily life activities, and cardiovascular diseases were not significantly different between groups with low and normal free testosterone levels. Age-related decrease in free testosterone may lead to erectile dysfunction and symptoms of prostatism in elderly men.

Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism

Mentha spicata Labiatae, known as spearmint and Mentha piperita Labiatae, known as peppermint can be used for various kinds of illnesses in herbal medicine and flavoring in industry. M. spicata Labiatae grows on the Anamas plateau of Yenithornarbademli town of Isparta, located in southwest part of Turkey. In this town, clinicians thought that consumption of tea steeped with M. spicata or M. piperita caused a diminished libido. Because antiandrogenic effects of spearmint and peppermint were found previously in rats, it was decided to observe the effect of this herbal tea on the androgen levels in hirsute women.Twenty-one female hirsute patients, 12 with polycystic ovary syndrome and 9 with idiopathic hirsutism were included to the study. They were took a cup of herbal tea which was steeped with M. spicata for 5 days twice a day in the follicular phase of their menstrual cycles. After treatment with spearmint teas, there was a significant decrease in free testosterone and increase in luteinizing hormone, follicle-stimulating hormone and estradiol. There were no significant decreases in total testosterone or dehydroepiandrostenedione sulphate levels. Spearmint can be an alternative to antiandrogenic treatment for mild hirsutism. Further studies are needed to test the reliability of these results and the availability of spearmint as a drug for hirsutism.

The effect of continuous combined HRT on glucose homeostasis and plasma lipids: A placebo-controlled study in postmenopausal women with type 2 diabetes

Background Hyperandrogenicity in women is a risk factor for cardiovascular disease and noninsulin-dependent diabetes mellitus (NIDDM). Estradiol alone decreases hyperandrogenicity and have beneficial effects on glucose metabolism and plasma lipids in postmenopausal women with type 2 diabetes. Objectives To analyse effects on glucose homeostasis and plasma lipids by 2 mg estradiol and 1 mg norethisterone acetate (NETA) given as a daily tablet during 6 months in postmenopausal women with type 2 diabetes. Design Randomised, double-blind, placebo-controlled, cross-over design. Material and methods Thirty-one postmenopausal women with type 2 diabetes, glycosylated haemoglobin (HbA1c) of 6% or more and sex hormone-binding globulin (SHBG) values of 60 nmol/L or less were included. Anthropometric variables, blood pressure, sex steroid hormones, HbA1c, serum and lipoprotein lipids, plasminogen activator inhibitor 1 (PAI-1) and insulin-like growth factor 1 (IGF-1) were measured. An oral glucose tolerance test (OGTT) was performed and blood glucose, insulin and C-peptide were analysed. All measurements were taken at baseline and after each 6-month period. Results An increase of SHBG and a decrease in free testosterone and PAI-1 levels was induced by the estradiol/NETA treatment compared with placebo. Lipoprotein(a) decreased but otherwise lipid metabolism was unaffected. No differences were recorded in glucose homeostasis between active treatment and placebo. Conclusion Estradiol/NETA therapy decreased hyperandrogenicity in postmenopausal women with type 2 diabetes. Lipoprotein(a) and PAI-1 which are independent risk factors for coronary heart disease decreased. No changes in glucose homeostasis were found.

Simvastatin Improves Hyperandrogenism, Hyperandrogenemia, LH and Lipid Profile in Women With PCOS: A Randomized, Cross-over Study

Simvastatin Improves Hyperandrogenism, Hyperandrogenemia, LH and Lipid Profile in Women With PCOS: A Randomized, Cross-over Study

Sex, Hormones, and Alzheimer's Disease

More women than men have Alzheimer's disease (AD). Retrospective studies suggested that hormone replacement therapy (HRT) might counteract this disparity by reducing the risk of developing dementia. However, a recent, large, prospective study revealed the puzzling result that HRT increased dementia risk. A review of the literature was conducted to generate hypotheses that might explain why more women than men have AD, and how HRT may increase dementia risk. Longer life span of women than men may be the largest factor in the preponderance of women with AD. Longer duration of disease, less vascular dementia, and less testosterone in women than men may also contribute somewhat. HRT might increase dementia risk by several mechanisms: greater risk of strokes, leading to dementia; use of medroxyprogesterone acetate and estrone, which might have somewhat different possible effects on neuronal and cerebrovascular function than may progesterone and estradiol; decrease of free testosterone which might protect against AD; a dose or delivery method perhaps producing drug levels that might lie outside a hypothetical beneficial range; and down-regulation of estrogen receptors on cholinergic neurons, possibly reducing cholinergic activity. Further study is required to discern by which of several possible mechanisms HRT increases dementia risk.

Licorice consumption and serum testosterone in healthy man.

We have previously found that licorice can reduce serum testosterone in healthy men. These results were not confirmed in another study, where the same amounts of licorice did not decrease salivary testosterone values. In the actual study we treated more cases with the same amount of licorice and reproduced our previous data. The mean testosterone values decreased by 26 % after one week of treatment (p < 0.01). There was also a significant increase in 17-OHP and LH concentrations and a slight, but not significant decrease in free testosterone. Licorice treatment, in addition, did not affect the response of testosterone and 17-OHP to stimulation with beta-HCG.

Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism

Objective To compare second versus third generation combination oral contraceptives (OCs) in the treatment of hirsutism. Methods Women with hirsutism, as defined by a minimum Ferriman-Gallwey score of 10, were randomized in a double-blind fashion to receive an OC containing either ethinyl estradiol/desogestrel or ethinyl estradiol/levonorgestrel for 9 months of treatment. Ferriman-Gallwey scores, androgen levels and sex hormone-binding globulin were measured at baseline and every 3 months for the duration of the study. Hormones were measured in duplicate by radioimmunoassay. Results Of the 47 women enrolled, 24 were randomized to ethinyl estradiol/desogestrel and 23 were randomized to ethinyl estradiol/levonorgestrel. Mean sex hormone-binding globulin increased significantly in subjects using the desogestrel-containing contraceptive compared with the levonorgestrel-containing contraceptive. Ten subjects completed the 9 months of treatment in the levonorgestrel group and 11 completed the study in the desogestrel group. Mean free testosterone and 3α-androstanediol glucuronide decreased significantly in the group receiving ethinyl estradiol/desogestrel but not in the ethinyl estradiol/levonorgestrel group. Mean Ferriman-Gallwey scores decreased significantly in both treatment groups. Improvement in mean Ferriman-Gallwey score was 35.7 ± 38.1% (p < 0.001) for the ethinyl estradiol/desogestrel arm and 33.4 ± 27.3% (p < 0.001) for the ethinyl estradiol/levonorgestrel arm. There were no statistically significant differences found in the improvement of Ferriman-Gallwey scores between the two treatment arms, although the power to detect a difference was limited by the small sample size. Conclusions Treatment of hirsute women with third generation OCs containing desogestrel results in a significant increase in sex hormone-binding globulin and decrease in free testosterone and 3α-androstanediol glucuronide. Both second and third generation OCs were clinically effective in treating hirsutism.

A randomized controlled trial of second- versus third-generation oral contraceptives in the treatment of acne vulgaris

Objective: This study was undertaken to compare the clinical efficacy of second- versus third-generation oral contraceptives in the treatment of acne. Study Design: Thirty-four women with acne were randomly selected to receive an oral contraceptive containing 0.3 mg of ethinyl estradiol (EE)/0.15 mg of desogestrel or 0.3 mg of EE/0.15 mg of levonorgestrel for 9 months. Acne was scored by lesion counting by a single examiner, and serum was analyzed for sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and free and total testosterone at baseline and 3-month intervals. Results: At baseline, the two treatment groups did not differ in the mean age, body mass index, acne lesion counts, SHBG, DHEAS, or free and total testosterone. Mean acne lesion counts decreased significantly in both groups from baseline (P <.02). In subjects completing 9 months of therapy, acne decreased by 52.8% in the EE/levonorgestrel group (n = 9) and by 58.5% in the EE/desogestrel group (n = 7) (between groups: P not significant). Mean SHBG increased by 46.3 nmol/L in the EE/desogestrel group (P not significant), and 20.0 nmol/L in the EE/levonorgestrel group (P <.05). Decreases in free testosterone from baseline occurred in each group, but these differences did not reach statistical significance. Conclusion: Oral contraceptives containing EE/desogestrel and EE/levonorgestrel were both effective in treating acne. (Am J Obstet Gynecol 2003;188:1158-60.)