Decreased Libido Research Articles

Lipid-Lowering Therapy Associated Erectile Dysfunction and Testicular Pain: A Rare Case Report

Lipid-lowering therapy (LLT) includes a diverse group of pharmaceuticals designed to reduce blood levels of cholesterol and triglyceride (TG), helping to prevent cardiovascular diseases like myocardial infarction and stroke. LLT includes treatment with several lipid-lowering drugs (LLD), including hydroxymethylglutaryl (HMG-CoA) reductase inhibitors (statin), PCSK9 Inhibitors, cholesterol-absorbing inhibitors (Ezetimibe), Bile Acid Sequestrants, Fibrates, Niacin (Vitamin B3), Omega-3 Fatty Acids, Bempedoic Acid, and combination therapy. The efficacy and safety of these molecules vary widely. Statins are the first-line LLD for treating hypercholesterolemia and are widely used for cardiovascular disease prevention. Common side effects include muscle-related issues such as myalgia, muscle atrophy, and, rarely, rhabdomyolysis. However, adverse effects on male reproductive health are infrequent and often underreported. Other medication classes employed in LLT mostly share many of the ADRs seen with statins, although individual classes may have unique ADRs depending on the pharmacokinetics and pharmacodynamics. Here, we are reporting a unique case of a 50-year-old male patient with no prior history of sexual dysfunction or testicular issues and other comorbidities or habits, who developed loss of libido, erectile dysfunction (ED) and testicular pain with most of the LLD, which promptly resolved on discontinuation of the LLT. This case highlights the importance of considering potential reproductive side effects when prescribing LLT and monitoring male patients for symptoms of sexual dysfunction.

Efficacy of Tribulus terrestris on diabetes and sexual disorders: A narrative review

Tribulus terrestris L. (T. terrestris) is widely distributed worldwide (Australia, Europe, India, North Africa). It typically contains a substantial amount of active ingredients, especially saponins, alkaloids, flavonoids, tannins, terpenoids, and phenol carboxylic acids. Additionally, T. terrestris has been frequently used in folk medicine and as a food supplement, highlighting the importance of evaluating its phytopharmacological properties. Various hypotheses suggest that this species may have significant potential in preventing and improving various human conditions, including diabetes, inflammatory diseases, low sexual desire, and infertility. Phytochemical studies reveal a significant disparity in the content of active substances, with a notable gap in the concentrations of spirostanol saponins and furostanol, which are the predominant active ingredients associated with therapeutic effects. The objective of this present review is to evaluate T. terrestris -based formulations by exploring various potential mechanisms of action, aiming to determine whether the use of T. terrestris supplements is justified in the context of diabetes and its complications.

Sexual Aversion, Disgust, and Fear of Intimacy: A Comprehensive Case History Using a Multimodal Therapeutic Approach.

This single-case study examines the psychotherapeutic journey of a 23-year-old woman experiencing a persistent and long-standing fear of emotional intimacy and aversion to physical intimacy, which led to the active avoidance of sexual encounters, psychological distress, and interpersonal difficulties. Over 26 one-hour sessions, an integrative therapeutic approach was employed, combining elements from psychodynamic, acceptance and commitment, cognitive-behavioral, and exposure therapies, with psychoeducation and sex education playing pivotal roles. The treatment resulted in significant improvements, as evidenced by both quantitative and qualitative assessments. Quantitative measures of emotional distress-specifically anxiety, depression, and fear of intimacy-initially increased during intentional exposure but showed significant improvements at 6-month and 1-year follow-ups. Qualitative data revealed enhancements in self-concept, increased self-compassion, and improved social functioning aligned with the individual's life aspirations. This case study highlights effective therapeutic strategies for addressing sexual aversion in young adults and demonstrates the potential for alleviating symptoms and enriching quality of life through an integrative approach.

Psychological and sociodemographic factors associated with hypoactive sexual desire in Ecuadorian women.

Human sexuality is a multifaceted process, and sexual desire plays a central role in the triphasic model of the sexual response cycle, as proposed by Helen Singer Kaplan. In this cross-sectional correlational study, we examined the relationship between various sociodemographic factors, such as age and motherhood, and sexual variables, including erotophobia, erotophilia, homophobia, and unconventional sex, with hypoactive sexual desire in women from Quito, Ecuador. The study sample comprised 421 women between the ages of 18 and 50, who were administered the Revised Sexual Opinion Survey and the Inhibited Sexual Desire Scale to assess their sexual attitudes and levels of desire. The findings revealed that age (F = 7.13, p < 0.001) and motherhood (F = 13.72, p < 0.001) had a significant impact on inhibited sexual desire. Furthermore, significant correlations were observed between inhibited sexual desire and age (r = 0.16, p < 0.001), motherhood (r = 0.18, p < 0.001), erotophobia (r = 0.19, p < 0.001), erotophilia (r = -0.21, p < 0.001), and homophobia (r = -0.18, p < 0.001). These results suggest that women who are older, mothers, or have higher levels of erotophobia are more likely to experience hypoactive sexual desire. In contrast, higher levels of erotophilia and homophobia were inversely related to hypoactive sexual desire. This contributes to a deeper understanding of how different personal and sexual attitudes influence sexual desire in Ecuadorian women.

Clinical Correlates of Antipsychotic Plasma Levels with Long-Acting Paliperidone: Corrélats cliniques des concentrations plasmiques de palipéridone à libération prolongée.

The majority of patients with schizophrenia experience dramatic improvement in psychotic symptoms when treated with antipsychotic medication. Maintenance treatment can prevent relapses but problems with medication adherence limit effectiveness. Long-acting injectable antipsychotics (LAIs) provide an opportunity to establish adherence but challenges remain in ensuring that the dose selected is therapeutic. Therapeutic drug monitoring has not been established as valuable for LAIs in the maintenance treatment of schizophrenia. This exploratory study was undertaken to describe plasma paliperidone levels in outpatients treated with the LAI paliperidone palmitate and to determine whether paliperidone levels are associated with subjective experience on medication and side effects. Twenty-one outpatients with schizophrenia receiving treatment with LAI paliperidone consented to participation in this study. Blood samples were obtained for measurement of paliperidone and prolactin levels at the first visit. A second paliperidone level was obtained at the time of the next injection for 18 of the participants. Clinical rating scales were administered at the first visit to assess illness severity, attitudes regarding medication, subjective well-being and side effects. Paliperidone levels were highly correlated at the two time points (ρ = .85; P < .001). Mean paliperidone level at the first visit was 34.9 ng/ml and ranged from 5.1 to 73.9 ng/ml. Higher paliperidone levels were correlated with higher prolactin levels (ρ = 0.59, P < .01) and lower sexual desire (ρ = -.58, P < .01). We demonstrated that paliperidone levels can be measured reliably in patients receiving LAI paliperidone. Higher plasma levels were associated with higher prolactin levels and reduced sexual desire but not with measures of subjective experience on medications or other side effects. Measurement of paliperidone levels in patients treated with paliperidone palmitate may have the potential to minimize the dose of medication prescribed and, in turn, the severity of sexual side effects.

Virtual reality exposure therapy for sexual aversion: a proof-of-concept study on acceptability, adequacy, and clinical effects.

Sexual dysfunctions impair theintimate relationships of up to one-third of the population. Virtual reality (VR) offers innovative treatment options for both mental and sexual disorders, such as female orgasmic disorder and erectile disorder. Sexual aversion disorder (SAD)-the anxiety, disgust, and avoidance of sexual contexts-is a chronic condition commonly treated with anxiety-reducing strategies, such as exposure-based therapy. Despite exposure's efficacy in reducing SAD symptoms, VR exposure therapy's (VRET) effectiveness remains unexplored for this condition. This proof-of-concept study examines the acceptability, adequacy, and clinical effects of a VRET's simulation protocol for SAD. In the laboratory, 15 adults suffering from SAD (Mage = 35.00; SD = 11.36) viewed 15 virtual sexual scenarios of increasing intensity (eg, flirting, nudity, genital stimulation) adjusted to their sexual preferences and gender identities. Levels of anxiety, disgust, and catastrophizing beliefs were measured throughout the scenarios using standard self-report measures. Participants also completed validated questionnaires on sexual presence and simulation realism, as well as open-ended questions on scenarios' representativeness and adequacy immediately after immersion. Six months after the laboratory visit, participants completed a negative effects questionnaire and were screened for SAD symptoms again. Repeated-measures ANOVAs and descriptive analyses were performed. Levels of anxiety and disgust significantly increased with the intensity of sexual scenarios. Catastrophizing levels were high and tended to augment with increasing exposure levels. A significant reduction in symptoms of SAD was found from pre-simulation to the 6-month follow-up assessment. Sexual presence and realism scores were moderate. Qualitative assessment revealed that all participants reported the sexual scenarios were representative of real-life situations that tend to elicit SAD symptoms for them. Reported negative effects were generally mild. This proof-of-concept study suggests that VRET may have the potential to elicit self-reported emotional and cognitive manifestations of SAD (sex-related anxiety, disgust, and catastrophizing), while also hinting at its acceptability, adequacy, and benefits in alleviating SAD symptoms. While this study marks the first exploration of the clinical relevance of gender-inclusive virtual sexual scenarios for SAD, its design and sample composition may impact observed effects and the generalizability of findings. This study invites future clinical trials to assess VRET efficacy for SAD.

Thyroid hormones in female and male reproduction with special reference to dogs and cats

Thyroid hormones have an important function in numerous physiological processes in humans and animals, including the regulation of metabolism, growth and development of individual and reproductive function. The thyroid hormones, triiodothyronine (T3) and thyroxine (T4), have a direct effect on the reproductive organs and an indirect effect in interaction with other hormones. Thyroid hormones influence the reproductive system by regulating metabolism and tissue development of the ovaries, uterus and placenta. Changes in the serum concentrations of T3 and T4 lead to disturbances in overall body function. Thyroid dysfunction, including hypothyroidism and hyperthyroidism, can lead to significant reproductive problems. The aim of this review was to describe the functions of thyroid hormones and the effects of hypothyroidism and hyperthyroidism on the animal reproductive system. Hypothyroidism is often caused by autoimmune diseases such as lymphocytic thyroiditis, and is associated with later puberty, reduced fertility and abnormalities in reproductive organ development. Hypothyroidism can lead to a prolonged interval, absent cycles, silent oestrus cycles, prolonged oestrus bleeding, and a lack of libido, with the occurrence of infertility, miscarriages, stillbirths and mummified foetuses. In males, hypothyroidism leads to a decrease in libido, semen quality, ejaculate volume, testicular atrophy, hypospermia and azoospermia. Hyperthyroidism, on the other hand, is usually the result of thyroid cancer, which produces excessive amounts of thyroid hormones. Increased concentrations of thyroid hormones lead to disturbances in the physiological balance of reproductive hormones, irregular oestrus cycles, anovulation and reduced fertility, as well as a decrease in the weight of the ovaries and the number of healthy follicles, with a simultaneous increase in the number of atretting follicles. The effects of hyperthyroidism on male fertility include disorders of spermatogenesis, changes in sex hormone levels and changes in sperm quality, such as hypospermia, oligozoospermia, asthenozoospermia and teratozoospermia. It is important to diagnose and treat thyroid disorders in time in order to prevent negative effects on fertility and reproduction in animals.

Results of a randomized waitlist-controlled trial of online cognitive behavioral sex therapy and online mindfulness-based sex therapy for hypoactive sexual desire dysfunction in women.

This study aimed to investigate the efficacy of two internet-delivered psychological treatments for hypoactive sexual desire dysfunction (HSDD) in women: internet-based cognitive behavioral sex therapy (iCBST) and internet-based mindfulness-based sex therapy (iMBST). Women with HSDD were randomly assigned to one of three groups: iCBST, iMBST, or a waitlist control group. The interventions consisted of eight modules delivered via an e-health platform with e-coach support to enhance adherence. Sexual desire and sexual distress were assessed at baseline and at 3-, 6-, and 12-month follow-ups (active conditions only). Per protocol, of the 266 consenting women, 106 were randomized to iCBST (Mage = 36.1, SD = 10.3), 106 to iMBST (Mage = 36.4, SD = 0.2), and 54 to the control condition (Mage = 36.7, SD = 11.0). Primary analyses utilized an intention-to-treat approach with linear mixed models. Clinical significance, assessed with clinical cutoffs and the reliable change index, was examined for active conditions. Compared to the control condition, both iCBST and iMBST demonstrated significant improvements in sexual desire and sexual distress at 3-month (d = 0.89-1.14) and 6-month follow-up (d = 0.74-1.18). Results were sustained at 12-month follow-up, with 35 and 41% demonstrating reliable improvements and additional 20 and 24% achieving clinically significant improvements in sexual desire after iCBST and iMBST. Regarding sexual distress, 49 and 42% exhibited reliable change, with an additional 37%-42% achieving clinically significant improvements. Results provide support for the overall long-term efficacy of psychological therapies in treating HSDD in women. However, fewer than one in four women showed improvements in sexual desire that met the threshold for clinically significant change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Results of a Randomized Waitlist-Controlled Trial of Online Cognitive Behavioral Sex Therapy and Online Mindfulness-Based Sex Therapy for Hypoactive Sexual Desire Dysfunction in Women

Supplemental Material for Results of a Randomized Waitlist-Controlled Trial of Online Cognitive Behavioral Sex Therapy and Online Mindfulness-Based Sex Therapy for Hypoactive Sexual Desire Dysfunction in Women

Too much or not enough? Self-reported experiences of relational distress based on level of sexual desire

ABSTRACT The diagnostic of sexual desire disorders is based on not only physiological and psychological symptoms but also on the extent of distress about these symptoms. Using data from a 2022 national survey of 3,000 respondents in Austria, this paper explores the range of relational distress individuals experience about their level of sexual desire. Participants were asked, ‘Have you ever been ostracised or ridiculed in your life for feeling too much (not enough) sexual desire? If yes, in what way?’ Gender and sexual minorities were more likely than cisgender and heterosexual participants to report negative reactions to their level of desire. The paper presents the results of a thematic analysis of the 341 written answers to the latter question. The analysis identified three themes: a) harassment, such as mocking, bullying, or public humiliation; b) the pathologization of desire as a sexual disorder; and c) negative social classification with respect to gender, age, or sexual orientation. By investigating different types of negative social reactions that individuals experience with respect to their level of sexual desire, the paper critically questions an individualised notion of sexual distress that has often been the basis for biomedical and psychological interventions by highlighting social factors that produce distress in the first place.

Adverse Drug Reactions and Predictors of Medication Adherence in Patients with Prostate Cancer.

Adherence to therapy with prostate cancer medicines is critical for delaying the progression of disease and enhancing health outcomes. To determine patients' medication adherence, the predictors of adherence, and the frequency and types of adverse drug reactions (ADRs) in persons with prostate cancer. A serial entry-point cross-sectional study of patients with prostate cancer was conducted in 3 cancer hospitals in Nigeria over a 12-month period (January 7, 2022, to January 3, 2023). Data on medication adherence were self-reported by patients, and data on ADRs were obtained from hospital records. Descriptive and inferential statistical analyses were performed, and p less than 0.05 was considered statistically significant. Of the 133 study participants, most 112 (84.2%) reported high medication adherence. The cost of drugs was the most frequently reported potential barrier to adherence (n = 63, 47.4%). Adherence was significantly dependent on family history of cancer (df = 3, F = 4.557, p = 0.005) and health-related quality of life (HRQOL) (ß = 0.275, T = 2.170, p = 0.032) but not illness perception (ß = 0.046, T = 0.360, p = 0.72). Adverse events were observed in 36 participants (27.1%) and were deemed to be "possible ADRs" (n = 19, 53%) or "probable ADRs" (n = 17, 47%); all were nonpreventable and expected (100%), and most (n = 31, 86%) were within the level 1 category of severity. Loss of erection and low libido was the most frequently reported ADR (n = 14, 39%). In this study, medication adherence was high, with cost being a potential barrier to adherence. Family history of cancer and HRQOL significantly predicted medication adherence. The medications were well tolerated, and observed ADRs had minor severity. Policies targeting the reduction of cost-related factors for prostate cancer medications are essential.

6953 Bridging the Gender Gap: Sexually Dimorphic Brain Responses in Distressing Low Sexual Desire

Abstract Disclosure: J. Tsoutsouki: None. N. Ertl: None. E.G. Mills: None. M.B. Wall: None. L. Thurston: None. L. Yang: None. S. Suladze: None. T. Hunjan: None. M. Phylactou: None. B. Patel: None. J. Howard: None. A. Abbara: None. D. Golmeier: None. A.N. Comninos: None. W.S. Dhillo: None. Background: Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects 10% of women and 8% of men. The established ‘top-down’ neurofunctional model of HSDD in women suggests that in response to erotic cues, excessive activation of higher-level cognitive brain regions (involved in introspection/self-monitoring) suppresses lower-level sexual brain centres, thereby impeding normal sexual function. By contrast, the neurodysfunction in men with HSDD remains to be fully characterised and crucially unlike in women, there are currently no licensed therapies. Herein, we report the first direct comparison of the neural bases of HSDD in women and men. Methods: 32 premenopausal women with HSDD [mean age±SD (y) 29.2±6.7] and 32 men with HSDD [age 37.9±8.6] underwent a task-based functional MRI (fMRI) measuring sexual brain activity during erotic versus control (exercise) videos. Participants completed psychometric questionnaires before and after the fMRI scan, providing functional relevance for the brain activity changes. Results: Women displayed significantly greater activation in higher-level cortical regions (e.g. inferior frontal gyrus, superior frontal gyrus) and lower-level limbic brain regions (e.g. amygdala, striatum, thalamus) in response to erotic videos, compared to the men. Lower activation in lower-limbic sexual regions in women correlated with more severe HSDD, which along with a hyperactivation in the inferior-frontal gyrus relative to the men, supports the ‘top-down’ mechanism underlying HSDD in women. By contrast, men exhibited lower activation in both higher-cortical and lower-limbic regions, but greater activation than the women in the visual cortex in response to erotic videos. Hence, a heightened sensitivity to visual erotic cues in men might not be effectively relayed to the limbic system. In women only, hypothalamic hyperactivation in response to erotic videos correlated with ‘increased heartbeat’ (r=0.5, P=0.001), and ‘tingling all over’ (r=0.6, P&amp;lt;0.001), while higher striatal activation correlated with feeling more ‘stimulated’ (r=0.4, P=0.001) and ‘genital tingling’ (r=0.6, P&amp;lt;0.001) on the psychometric questionnaires. Crucially, these findings were specific to erotic stimuli as no differences were identified in the control comparison (exercise&amp;gt;baseline contrast). Discussion: This is the first study to directly compare the neural bases of distressing low sexual desire in women and men. While supporting the ‘top-down’ mechanism of HSDD in women, it suggests a different neurodysfunctional process in men with HSDD, highlighting a potential functional disconnection between sensory/attention and sexual centres. Our findings have key clinical implications as they identify a sexual dimorphism in the neural bases of low sexual desire relevant to the escalating development of therapeutics for patients with HSDD. Presentation: 6/3/2024

6523 Kisspeptin Administration Does Not Induce Anxiety in Humans

Abstract Disclosure: E.G. Mills: None. L. Thurston: None. L. Yang: None. S. Suladze: None. T. Hunjan: None. M. Phylactou: None. B. Patel: None. S.A. Clarke: None. A.J. Shah: None. C. Izzi-Engbeaya: None. J. Tsoutsouki: None. P. Bech: None. N. Ertl: None. L. Demetriou: None. M.B. Wall: None. D. Goldmeier: None. A. Abbara: None. A.N. Comninos: None. W.S. Dhillo: None. Background: The neuropeptide kisspeptin is a critical endogenous activator of the reproductive system. Due to its key role in regulating reproductive and behavioural processes, there has been escalating interest in targeting kisspeptin-pathways to treat reproductive and psychosexual disorders. However, conflicting evidence from pre-clinical animal models proposes that kisspeptin can have an anxiolytic, anxiogenic or have no effects on anxiety. Given the rapid development of kisspeptin-based therapeutics, it is important to clarify kisspeptin’s effects on anxiety in humans. Herein, we report the largest study examining the effects of kisspeptin on psychometric measures of anxiety and circulating cortisol levels in humans. Methods: Ninety-three eugonadal participants (n=29 healthy men, n=32 men with low sexual desire, n=32 women with low sexual desire) completed a double-blind, randomised, placebo-controlled, crossover study. Participants attended twice: once for intravenous infusion of kisspeptin-54 (1nmol/kg/h) over 75mins and for a rate-matched placebo. Blood sampling took place at 15-minute intervals from -30 to 75mins to measure circulating kisspeptin, LH, testosterone and cortisol [in men] and oestradiol [in women]. The validated ‘State-Trait Anxiety Inventory (STAI) Y2-Trait’ was completed prior to the infusions to exclude abnormal anxiety traits, with all scores within normal limits. Participants also completed the ‘STAI Y1-State’ before and prior to the end of the infusions to assess for any dynamic effects of the infusions on anxiety. Results: Ninety-three participants (mean age ±SD 30.9±8.7yrs, BMI 24.0±3.7kg/m2) completed the study. Intravenous kisspeptin significantly increased serum LH to similar levels previously described using this administration protocol, confirming that the dose was biologically active (P&amp;lt;0.001). Importantly, state anxiety was unaltered by kisspeptin, compared to placebo (mean difference in ‘STAI Y1-State’ scores during the infusions: kisspeptin -0.03±8.11, placebo 0.77±8.08, P=0.43). Moreover, kisspeptin had no effect on circulating cortisol compared to placebo during the 75minute study period (P=0.92). As expected, kisspeptin had no significant effects on downstream sex-steroid levels during the 75minute study period, thereby excluding these as confounders. Discussion: This is the largest study demonstrating that a biologically active dose of kisspeptin to healthy volunteers and patients with psychosexual disorders does not affect psychometric measures of anxiety and associated circulating cortisol levels. Given that animal studies have yielded conflicting results, this provides important clinical data and reassurance that kisspeptin administration in humans does not induce anxiety and so informs the rapid development of kisspeptin-based therapeutics for reproductive and psychosexual disorders. Presentation: 6/3/2024

8319 Pituitary Apoplexy Leads to the Spontaneous Resolution of Hypercortisolism Secondary to Cushing Disease: A Clinical Case

Abstract Disclosure: N. Sweis: None. J. Sanchez Perez: None. M. Fariduddin: None. R.M. Sargis: None. D.J. Toft: None. S. Reutrakul: None. Background: Pituitary apoplexy is a potentially fatal condition involving the infarction or hemorrhage of the pituitary gland. Rarely, it can occur in the setting of an ACTH-secreting pituitary adenoma. Clinical Case: A 27-year-old female with a past medical history of obesity, spontaneous miscarriages, and amenorrhea presented to the ER with an acute onset frontal headache of throbbing quality, associated with nausea and vomiting. The headache began two days prior, rapidly intensified, and did not improve with oral acetaminophen. CT of the head revealed an enlarged pituitary gland, while neurovascular imaging showed no abnormalities. Her neurologic examination was normal. She denied visual changes, photophobia, neck rigidity, fevers, chills, or recent infections. Furthermore, she endorsed a weight gain of about 40 pounds over the past year despite no change in dietary habits. This was accompanied by amenorrhea, hair thinning, itchy comedonal acne, hirsutism, and a loss of libido. Her physical examination was remarkable for the presence of cushingoid features including violaceous abdominal striae, facial acne, moon facies, a dorsal fat pad, and acanthosis nigricans around the neck and axillae. Pituitary MRI with and without contrast showed an enlarged sellar and suprasellar macroadenoma measuring approximately 2.1x1.4x1.2 cm abutting the optic chiasm. The visualized lesion contained hemorrhagic products, suggesting pituitary apoplexy. Biochemical testing on admission included a low morning plasma cortisol of 6.5 ug/dL (ref. range: 6.7-22.6 ug/dL), a 24-hour urine free cortisol of 12.0 (&amp;lt;=45.0 ug/24 hour), and an elevated ACTH of 145.0 pg/mL (7.2 - 63.3 pg/mL). A1c was 5.8% (&amp;lt;5.7%). Serum levels of prolactin, IGF1, GH, LH, FSH, TSH, Free T4, estradiol, total and bioavailable testosterone were within normal limits. She was evaluated with an ACTH stimulation test, which showed a morning cortisol level of 1.2 ug/dL at baseline, lower from prior. Cortisol levels were adequately increased at 19.6 ug/dL and 22.6 ug/dL, 30 and 60 minutes after the administration of Cosyntropin 250 mcg, respectively (&amp;gt;=18 ug/dL after 30-60 mins). The level of ACTH at the time was also decreased to 76.6 pg/mL. The patient was therefore started on steroid replacement therapy with hydrocortisone and later underwent transsphenoidal resection of the pituitary mass without complications. Histopathological examination of the resected mass showed pituitary adenoma cells with diffuse weak to moderate ACTH staining, most consistent with a sparsely granulated corticotroph pituitary adenoma. Conclusion: We report an interesting case of Cushing disease that spontaneously resolved after pituitary apoplexy. Our case underlines the importance of close monitoring of such patients who may rapidly undergo a period of adrenal insufficiency after hypercortisolism. Presentation: 6/3/2024

7071 Cushing disease presenting with Dilated Cardiomyopathy

Abstract Disclosure: H. Majeed: None. C. Nguyen: None. R. Galagan: None. D. Lovre: None. Background: Hypercortisolism manifests with numerous ways due to the wide distribution of glucocorticoid receptors. Here we describe a case of Cushing’s disease presenting with reversible non-ischemic cardiomyopathy. Case Presentation: A 30-year-old male presented to ER with palpitations, dyspnea, and atypical chest pain. His exam was notable for a BMI of 30.26 kg/m2, HR 76 bpm and BP of 200/110 mm Hg. His EKG revealed Left ventricular hypertrophy. Echocardiogram (ECHO) showed an EF of 25-30% with diffuse hypokinesis. An angiogram demonstrated normal coronary anatomy. He was started on Lisinopril, Carvedilol, and Spironolactone for non-ischemic cardiomyopathy. He also complained of a 40 lb weight gain, loss of libido, hot flashes and breast tenderness. He was referred to endocrinology. Initial evaluation demonstrated total testosterone (TT) of 171 ng/dl (286-1511 ng/dl), FSH 3.8 IU/L (2-12 IU/L), LH 5.6 IU/L (2-9 IU/L) consistent with secondary hypogonadism. Further pituitary workup revealed AM cortisol level 31.22 mcg/dl (4.3-22.4mcg/dl), ACTH 79 pg/ml (7.2 - 63.3pg/ml), IGF-1 257 ng/mL (88-246 ng/mL), Prolactin 23.7 ng/dl (2.1- 17.7ng/dl), TSH 0.54 mIU/l (0.35-3.74mIU/l) and FT4 0.6 ng/dl (0.76-1.46 ng/dl). A 24hr urine cortisol was 167 ug(0-50ug/24h) and midnight salivary cortisol 0.160 ug/dl (&amp;lt;0.010-0.090 ug/dl). An overnight 1mg dexamethasone suppression test (DST) resulted in AM cortisol of 20.95 mcg/dl (&amp;lt;1.8mcg/dl) and 8mg DST cortisol fell from 34 mcg/dl to 4.16 mcg/dl. A pituitary MRI revealed a left 6 mm x 4 mm microadenoma. He was treated with levothyroxine pre-op for central hypothyroidism. He underwent transsphenoidal resection of the pituitary adenoma. Post-op AM cortisol was 1.1 mcg/dl. His steroid withdrawal syndrome was treated with a prolonged course of tapered hydrocortisone. Two months post-op ECHO showed EF of 55-60%. His BP normalized on carvedilol alone. Eighteen months post-op he no longer required any hormone replacement. Repeat ACTH 24.4 pg/ml, Total Testosterone 584ng/dl, TSH 0.57 mIU/l and FT4 0.93 and 24hr urine cortisol was 24ug/dl, MN salivary cortisol &amp;lt;0.10 ug/dl confirming remission of his cushing's disease and resolution of secondary hypogonadism and hypothyroidism. Conclusion: Prolonged hypercortisolism can cause abnormal cardiac remodeling resulting in cardiomyopathy. Surgical remission of Cushing’s disease reverses hypercortisolism which may restore normal cardiac function. Presentation: 6/2/2024

8138 Pituitary Stalk Interruption Syndrome (PSIS) in a patient with Isolated Hypogonadotropic Hypogonadism

Abstract Disclosure: A. Thomson: None. R. Osman: None. Pituitary Stalk Interruption Syndrome in a Patient with Isolated Hypogonadotropic Hypogonadism Pituitary Stalk Interruption syndrome (PSIS) is a rare cause of hypopituitarism, characterized by a radiologic constellation of thin or interrupted pituitary stalk, hypoplasia, or aplasia of the anterior lobe and with the presence of an ectopic posterior pituitary (EPP). It is most commonly associated with isolated growth hormone deficiency (IGHD) and is often diagnosed in childhood. We present one case of a patient with isolated hypogonadotropic hypogonadism in adulthood, subsequently found to have an PSIS on MRI. A 45 year old male patient presented to our clinic with hypogonadism. He gradually started developing decreasing libido, fatigue, and loss of erections. He had normal puberty and childhood growth, and has fathered one child. He denied history of anosmia or visual symptoms. Subsequent hormonal testing showed: morning Total Testosterone: 145 ng/dl (normal 264-916 ng/dl), Free testosterone 1.5 pg/ml (normal 6.8-21.5 pg/ml), LH 1.1 mIU/ml (normal 1.7-8.6 mIU/ml) and FSH of 3.6 mIU/ml (normal 1.5-12.4 mIU/ml). Prolactin was minimally elevated at 21 ng/ml (normal 4.0 - 15.2 ng/ml). Thyroid, IGF-1, cortisol, and ferritin levels were within normal limits. Repeat levels showed similar findings. He denied ever taking any form of exogenous testosterone. His pituitary MRI revealed a small volume of anterior pituitary tissue, measuring 0.2cm x 0.7cm x 0.7cm, without discrete pituitary adenoma, a hypoplastic midline stalk measuring 1.3 mm in AP diameter (nl 2-3 mm), with a T1 hyperintense nodularity measuring 0.6cm x 0.4cm along the posterior aspect of the sella turcica consistent with EPP. No additional structural abnormality or any mass lesions were identified. He was subsequently started on replacement testosterone therapy and his symptoms resolved. PSIS usually presents in childhood with IGHD. Patients may have other pituitary hormone deficiencies and congenital central nervous system defects, although panhypopituitarism is rare. There have been reports in children with delayed puberty and isolated hypogonadotropic hypogonadism who have been found to have PSIS. Only one othercase of an adult female patient exhibiting hypogonadotropic hypogonadism as the only manifestation of PSIS has been documented in the literature. Our case highlights the potential for an adult male to present later in life with hypogonadotropic hypogonadism as a manifestation of PSIS. The marginally elevated prolactin level may be due to lack of inhibition of hypothalamic dopamine on lactotroph cells within the pituitary caused by the EPP, although it is doubtful that this has clinical significance. This is a rare presentation of PSIS, clinicians should be mindful ofthis radiological constellation and the potential for isolated hypogonadotropic hypogonadism presenting unusually in the adulthood. Presentation: 6/3/2024

Effect of antidepressants on ejaculation dysfunction in patients with depression and anxiety: A systematic review and network meta-analysis.

Antidepressants may lead to a series of sexual adverse effects (SAEs), among which ejaculation dysfunction (EjD) is often overlooked by clinicians. The purpose of the present network meta-analysis was to assist drug adjustment by comparing and ranking the incidence of EjD among various antidepressants. Relevant studies were retrieved from PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov, and other additional records. Eligible randomized controlled trials (RCTs) assessed the rate of EjD in patients with major depressive disorder (MDD) and anxiety disorder after taking anti-depressants. The incidences of EjD, erectile dysfunction (ED), decreased libido (DL), adverse events (AE), withdrawal due to adverse events (WDAE) and withdrawal due to lack of efficacy (WDLE) were pooled using odds ratio (OR) with their 95% confidence intervals (CI). The values of surface under the cumulative ranking curve (SUCRA) helped to rank the risk of each outcome in different antidepressants. Thirty RCTs comprising 18,157 patients were included. Results of all node-splitting analysis demonstrated no statistical inconsistency (all P>0.05). Clomipramine (OR 42.11, 95% CI [9.90, 179.08]), WS5570 (OR 28.99, 95% CI [1.48, 568.97]) and paroxetine (OR 18.63, 95% CI [9.33, 37.23]) had significant risk of EjD comparing to placebo. Additionally, duloxetine (OR 7.37, 95% CI [2.61, 20.78]), clomipramine (OR 5.29, 95% CI [1.72, 16.25]), paroxetine (OR 3.75, 95% CI [1.37, 10.26]) and escitalopram (OR 3.04, 95% CI [1.20, 7.71]) presented higher risk of ED comparing to placebo. Agomelatine, levomilnacipran, vortioxetine, trazodone, vilazodone, fluvoxamine and imipramine exhibited similar incidence of EjD with placebo (all P>0.05). Besides, trazodone, vilazodone and vortioxetine had the top-five SUCRA values in each of SAEs (EjD, ED and DL), and agomelatine might be alternative in EjD and DL. Considering about AE, WDAE and WDLE, vilazodone appeared to offer more satisfactory performance across all these aspects. For patients undergoing SAEs following the administration of antidepressants, trazodone, vortioxetine, vilazodone and agomelatine are alternative antidepressants.

Abstract C053: Racial differences in adverse sexual symptoms and implications for quality of life and adjuvant endocrine therapy adherence among women with early-stage breast cancer

Abstract Background Adjuvant endocrine therapy (AET) is effective at reducing breast cancer recurrence risk. It is associated with adverse symptoms, including sexual symptoms (e.g., vaginal dryness, reduced libido, dyspareunia), that can contribute to medication nonadherence and poor quality of life (QoL). Black women are least likely to start and maintain AET. We conducted post hoc analysis of a randomized clinical trial (RCT) to examine racial differences in how sexual symptoms affect sexual satisfaction and how these contribute to differences in AET adherence for Black and White women with early-stage breast cancer. Methods We used data from a nonblinded RCT of women diagnosed with early-stage (Stage I-III), hormone receptor-positive breast cancer and prescribed AET at a regional cancer center in the U.S. Mid-South. We restricted to Black and White participants who completed surveys at enrollment, 6-, and 12-months (N=275). The Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES) captured sexual symptoms (e.g., vaginal itchiness, bleeding, dryness, discharge, change in interest in sex, and pain with intercourse) and PROMIS Sexual Function and Satisfaction captured changes in sexual satisfaction with 5-item options ranging from “not at all” to “very much.” The 12-item Short Form Health Survey measured QoL with physical and mental health component summaries (higher scores indicated better QoL). AET adherence, captured by an electronically monitored pillbox, was measured as the proportion of days participants took their medication as prescribed over the 1-year follow-up. We conducted race-stratified linear regressions to examine associations of sexual symptoms with QoL and adherence. Results Among 275 participants, 102 (37%) were Black. Black women reported greater severity of vaginal discharge and that loss of sexual satisfaction was due to sexual symptoms at 6- and 12-months (p&amp;lt;0.05). Vaginal itchiness, vaginal discharge, painful intercourse, and loss of interest in sex were associated with lower mental QoL for Black and White women at all three time points. However, loss of interest in sex was associated with lower physical QoL at all three time points for Black women only. Worsening vaginal dryness was associated with lower 6-month AET adherence for Black (p=0.018) but not for White women (p=0.90). Similarly, lower sexual interest and lower sexual satisfaction was associated with lower 12-month AET adherence for Black women (p&amp;lt;0.05) but not for White (p=0.21 and p=0.13, respectively). Conclusion Women with early-stage breast cancer on AET reported adverse sexual symptoms with associated reductions in their sexual satisfaction and physical and mental QoL. Vaginal dryness, reduced libido, and lowered sexual satisfaction are associated with AET nonadherence among Black women, a group with known adherence barriers and recurrence risks. Our findings suggest that adverse sexual symptoms and sexual health challenges contribute to racial disparities in AET adherence and QoL. Oncosexuality care interventions for Black women are needed. Citation Format: Janeane N. Anderson, Freddie Yang, Xin Hu, Gregory A. Vidal, Ilana Graetz. Racial differences in adverse sexual symptoms and implications for quality of life and adjuvant endocrine therapy adherence among women with early-stage breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C053.

What should we be studying? Research priorities according to women and gender-diverse individuals with sexual interest/arousal disorder and their partners.

Sexual interest/arousal disorder (SIAD) is one of the most common sexual problems for women. In clinical research, there are often misalignments between the research priorities of patients and researchers, which can negatively impact care, and gender-diverse individuals are often excluded from research. Inclusion of patient perspectives when establishing research priorities may help to reduce these gaps; however, the research priorities of couples coping with SIAD remain unclear. Identify the research priorities of women and gender-diverse individuals with SIAD and their partners. In an online survey, couples coping with SIAD provided consent and responded to an open-ended question asking them to list the top 3 things they think are important for researchers to focus on related to couples coping with low sexual desire. A team-based content analysis was conducted to identify themes and their frequency of endorsement. An author-developed open-ended question. Analysis of 1279 responses (n = 667 from women and gender-diverse individuals with SIAD, n =612 from partners) resulted in our identification of 6 main themes: general causes, general treatment and coping, biophysiological, relationship, psychological, and environmental/contextual. Additionally, we identified 4 sub-themes within each of the latter 4 main themes: general, cause, treatment, and impact. For women and gender-diverse individuals with SIAD, their partners, and specifically gender-diverse participants, the 3 most endorsed themes were psychological general factors (24.3%, 21.2%, 24.3%; eg, stress and the link between SIAD and anxiety), relationship general factors (15.7%, 13.2%, 18.6%; eg, relationship length and communication on sexual desire), and biophysiological general factors (12.3%, 12.4%, 14.3%; eg, research on medications and hormones). Clinical researchers should consider the research priorities of couples coping with SIAD to ensure their work aligns with the needs of the affected population. This study is the first to identify the research priorities of both women and gender-diverse individuals with SIAD and their partners. Most participants identified as heterosexual, North American, and of middle to high socioeconomic status; results may not generalize. Responses were sometimes brief and/or vague; interpretation of these responses was therefore limited and may have required more contextual information. Findings suggest that women and gender-diverse individuals with SIAD, their partners, and gender-diverse participants have similar research priorities that are consistent with a biopsychosocial approach to research. Heterogeneity of responses across themes supports a multidisciplinary, patient-oriented approach to SIAD research.

Placebo-controlled effect of topical Qust (Costus) oil on postmenopausal women's sexual desire disorder: a double-blind, randomized clinical trial.

Decreased libido and anorgasmia are common problems for women after menopause that reduce the quality of life of couples. This study examined the effect of topical Qust oil on sexual desire disorder in postmenopausal women. In this double-blind, randomized, clinical trial, 110 postmenopausal women with decreased sexual desire visiting a Traditional Medicine Center and Hazrat Rasool Akram Hospital (affiliated to Iran University of Medical Sciences) were selected by convenience consecutive sampling and randomly assigned to experimental and control groups. The experimental group received qust oil, while the control group was given a placebo (liquid paraffin); they were instructed to massage the product topically on their pubic area and perineum daily. The sexual function of both groups was assessed and compared before the intervention and four weeks after the intervention using the Female Sexual Function Index. The mean and standard deviation of the improvement of sexual function post-intervention were 37.66±32.52% and 11.96±11.18% in the experimental and control groups, respectively (p<0.001). In terms of the improvement of components of sexual function, a significant difference was observed between the two groups in the sub-scales of sexual desire [57.05±42.99% vs. 21.25±27.85%, p<0.001], arousal, orgasm, and satisfaction (p<0.001 for all); however, no significant difference was observed in terms of lubrication (p=0.25) and pain during intercourse (p=0.776). In postmenopausal women with sexual dysfunction, massaging the pubic area and perineum with qust oil for at least four weeks significantly improves desire, arousal, orgasm, and sexual satisfaction.