Decrease In Total Testosterone Research Articles

Do statins decrease testosterone in men? Systematic review and meta-analysis.

Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the use of statin could cause a reduction in testosterone levels. The objective was to evaluate whether the continued use of statins in patients with hypercholesterolemia causes a deficiency in testosterone and other sex hormones. Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until May 2023; PROSPERO CRD42021270424protocol. Selection performed by two independent authors with subsequent conference in stages. Methodology based on PRISMA statement. There were selected comparative studies, prospective cohorts (CP), randomized clinical trials (RCT) and cross-sectional studies (CSS) with comparison of testosterone levels before and after statin administration and between groups. Bias analysis were evaluated with Cochrane Tool, The Newcastle-Ottawa Scale (NOS), and using the Assess the Quality of Cross-sectional studies (AXIS) tool. There were found on MedLine, Embase and Cochrane, after selected comparative studies, 10CP and 6RCT and 6CSS for the meta-analysis. In the Forrest plot with 6CSS, a correlation between patients with continuous use of statins and a reduction in total testosterone was evidenced with a statistically significant reduction of 55.02ng/dL (95%CI=[39.40,70.64],I²=91%,p<0.00001).In the analysis with 5RCT, a reduction in the mean total testosterone in patients who started continuous statin use was evidenced, with a statistical significance of 13.12ng/dL (95%CI=[1.16,25.08],I²=0%,p=0.03). Furthermore, the analysis of all prospective studies with 15 articles showed a statistically significant reduction in the mean total testosterone of 9.11 ng/dL (95%CI=[0.16,18.06],I²=37%,p=0.04). A reduction in total testosterone has been shown in most studies and in its accumulated analysis after statin use. However, this decrease was not enough to reach levels below normal. Statins use causes a decrease in total testosterone, not enough to cause a drop below the normal range and also determines increase in FSH levels. No differences were found in LH, Estradiol, SHBG and Free Testosterone analysis.

SAT364 A Rare Cause of Hyperandrogenism in a Premenopausal Woman

Abstract Disclosure: L. El Musa Penna: None. W. Medina-Torres: None. L.R. Sepulveda-Garcia: None. L.N. Madera Marin: None. A. Rosado-Burgos: None. M.A. Ortiz-Rivera: None. B. Torres Rivera: None. M. Alvarado: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. M. Marcos Martínez: None. M. Correa Rivas: None. N. Bracero, MD: None. Hyperandrogenism in premenopausal women is most commonly associated to polycystic ovarian syndrome (PCOS). Approximately 10% of females in reproductive age present with clinical and/or biochemical findings of androgen excess, such as hirsutism, acne, alopecia, oligo-amenorrhea or if hyperandrogenism is severe it can lead to extreme virilization. Androgen excess can also contribute to insulin resistance. In this case we discuss a patient with severe hyperandrogenism, extreme insulin resistance and a rare cause of androgen excess in a woman of childbearing age. 34-year-old female patient G0P0 with type 2 diabetes mellitus (T2DM) on continuous insulin infusion system (CIIS), familial partial lipodystrophy, PCOS and severe hyperandrogenism, who was referred to our clinics for management of uncontrolled T2DM. Patient was on CIIS with regular insulin U-500 using a total daily dose of 95 units. She referred amenorrhea for the past 12 years and significant progression of hirsutism, alopecia and acanthosis nigricans in the past two years. Patient had clinical findings of hyperandrogenism such as hirsutism evaluated with modified Ferriman-Gallwey scale with a score of 32, alopecia Ludwig class 3 and marked acanthosis nigricans in neck and abdomen.Pre-operative laboratories: hemoglobin (Hgb) level 15.13 g/dL, hematocrit (Ht) 44.59 %, total testosterone level 525 ng/dL (13-53 ng/dL) and DHEAS 113 ug/dL (95.8-511.7 ug/dL), suggesting an ovarian source of androgen excess. Transvaginal ovarian ultrasound showed at the posteromedial edge of right ovary a hyperechoic structure measuring 1.5 cm long x 1.0 cm AP representing a lesion of unknown etiology. After discussion with patient a decision for oophorectomy was made. Pathology report described the ovary negative for neoplasia with findings consistent with hyperthecosis. Laboratories two weeks post-operative showed significant decrease in total testosterone to 81 ng/dL and in Hgb/ Ht (12.50 g/dL and 37.8% respectively). Insulin requirement decreased and she was able to be transitioned to U-100 insulin lispro with a total daily dose of 100. Four weeks after surgery patient had her menstrual period. Ovarian hyperthecosis is a disorder where there is an increased tissue with luteinized theca cells in the ovarian stroma; these cells are ovarian interstitial cells that differentiate into steroidogenically active cells. It is most commonly observed in post-menopausal women, but it has been described in women of childbearing age presenting with worsening hirsutism, virilization and insulin resistance. Monitoring patterns and progression of androgen excess is important in premenopausal women with a diagnosis of PCOS. Severe biochemical or clinical presentation, as well as progression of hyperandrogenism should increase suspicion of additional pathological entities as it will improve patient’s quality of life with the appropriate management. Presentation Date: Saturday, June 17, 2023

ОСОБЕННОСТИ ПРАКТИЧЕСКОГО ИСПОЛЬЗОВАНИЯ СПЕЦИАЛИЗИРОВАННЫХ РЕФЕРЕНТНЫХ ИНТЕРВАЛОВ ГОРМОНАЛЬНЫХ ПОКАЗАТЕЛЕЙ У НЕСОВЕРШЕННОЛЕТНИХ СПОРТСМЕНОВ ДЛЯ ДИАГНОСТИКИ ЭНДОКРИННОЙ ПАТОЛОГИИ

Results of hormonal tests of highly qualified athletes can differ significantly from the general population standards, which makes their interpretation difficult. The purpose of this research was to compare the prevalence of hormonal changes in adolescent athletes according to both the standard and the specialized reference intervals (RI). Materials and methods used: 2550 adolescent athletes, of which 1483 (58.1%) boys and 1067 (41.9%) girls from 28 kinds of sport aged 14 years to 17 years and 11 months old (ME: 16.1±1.1 y/o). All the young athletes have undergone the study of thyroid-stimulating hormone (TSH), free thyroxine (T4 test), cortisol, somatotropic hormone (STH) and total testosterone (chemiluminescent method with Lazurite automatic analyzer by Dynex Technologies Inc., USA) as part of an in-depth medical checkup of athletes in accordance with the Order of the Ministry of Healthcare of Russia No. 134n dated March 01, 2016, on the basis of the Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia (Moscow, Russia). The assessment of the hormonal profile was carried out according to both the standard RI and the specialized RI for young athletes. Results: when assessing the endocrine status of young athletes according to the standard RI, the frequency of hormonal changes was 30.6%, and 22.1% according to the specialized RI. When using specialized RI in male athletes, an increase in TSH and cortisol is recorded 2 times less often (p&lt;0.001 for both parameters), an increase and decrease in total testosterone is determined in isolated cases, and hypersecretion of growth hormone is detected 6.5 times more often (p&lt;0.0001). An increase in TSH when assessed using specialized RI in female athletes occurs 2 times less often (p&lt;0.001). Hypersecretion of cortisol and growth hormone is recorded 20% (p=0.34) and 51% (p=0.02) less frequently, respectively. Conclusion: the use of the new RI does allow reducing of the frequency of detection of hormonal changes in adolescent athletes by 8.5% (p=0.03). The use of specialized RI of hormonal parameters in adolescent athletes to interpret TSH levels does not contradict with the modern clinical guidelines when deciding about the appointment of hormone replacement therapy for young athletes with subclinical hypothyroidism. The level of total testosterone, equal to 2.84 nmol/l, in young male athletes aged 16 to 17 y/o cannot be considered as a variant of the norm. The diagnostic value of determining growth hormone and cortisol in highly qualified athletes in adolescence is doubtful due to the high variability of the studied parameters and the complexity of interpreting the results obtained for practical use by a pediatric endocrinologist.

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.

Effect of SHBG Polymorphism on the Levels of Bioavailable Testosterone and Lipid Metabolism in Older Men of the Kazakh Population

This study is aimed at investigating the effect of SHBG (rs727428; rs10822184) and LPL (rs754493647) single nucleotide polymorphisms on the concentration of the bioavailable fraction of testosterone in older men.&#x0D; Materials and methods To study gene mutations, 417 residents of the East Kazakhstan region of Kazakh nationality were examined. The main group included 135 men with signs of hypogonadism (AMS 37-49), and the control group consisted of 282 healthy men (AMS 17-26) of the corresponding age (p = 0.5). Single nucleotide polymorphisms rs 727428 [C / T]; rs10822184 [T / C]; rs754493647 [T / C], was determined by the TaqMan method.&#x0D; Results Analysis of the rs727428 polymorphism has revealed that the TT allele (rs727428) has a lower level of albumin (p = 0.03), bioavailable testosterone (p = 0.04), and free testosterone (p = 0.6) than in carriers of the CC and CT genotypes. Also, it has shown a decrease in total testosterone (p = 0.001) and an increase in SHBG levels (p = 0.07) in men with the TT genotype of the rs727428 gene polymorphism. The rs10822184 polymorphism demonstrated an increase in triglyceride and LDL levels in TT genotype (p ≤ 0.04), in comparison with CC and CT genotypes.&#x0D; Conclusion It has been proven that rs727428 (p = 0.001) is associated with testosterone levels and therefore can determine the concentration of bioavailable testosterone. Decreased levels of bioavailable testosterone are a sign of male hypogonadism. This study confirms the effect of rs10822184 on LDL (p = 0.01) and triglyceride (p = 0.04) levels, but its association with androgen levels has not been proven. Our results may be of interest for understanding the etiology of early development of hypogonadism and lipid metabolism disorders in men. To confirm the conclusions, a more detailed study with a large sample of men from the Kazakh population may be required.

Do statins cause testosterone deficiency in men? Systematic review and meta analysis

ABSTRACT Introduction Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the precursor of the steroidogenesis pathway, the use of statin could cause a reduction in testosterone levels. Testosterone is essential in biological functions and its reduction can cause negative effects, such as symptoms of hypogonadism. Objective Evaluate whether the continued use of statins causes testosterone deficiency in men. Methods Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until April 2021; protocol was submitted to PROSPERO. Selection performed by two independent authors with subsequent conference in stages. There were selected comparative studies, prospective cohorts or clinical trials with comparison of testosterone levels before and after the use of statin. Bias analysis were evaluated with Cochrane Tool. Results Threre found 717 papers on MedLine, 1352 on Embase and 143 on Cochrane. After removal of duplicates, 833 articles remained. Comparative studies, 10 prospective cohorts and 6 randomized clinical trials were selected for meta-analysis. In the forrest plot with the 16 articles, a reduction in the mean testosterone in patients after the use of statins of 13.61 (95% CI=3.99-23.23, I²=41%, p=0.006) was evidenced, demonstrating statistical significance. In the sub-analysis with the Clinical Trials, a reduction in the mean testosterone levels in patients after the use of statins of 27.45 (95% CI=13.85-41.06, I²=14%, p&amp;lt;0.0001) was evidenced, demonstrating statistical significance. On the other hand, in the sub-analysis of the Prospective Cohorts, an increase in the mean testosterone in patients after the use of statins of 0.25 was evidenced, without statistical significance, of 0.25 (95% CI=-13.87-13.36 I²=38%, p=0.97). A reduction in total testosterone was evaluated in all studies after statin use. However, with the exception of Kannat 2009, all studies showed testosterone levels above the normal level (normal up to 300). In the Kannat study, testosterone levels below this value were already presented before the use of the statin. Conclusion Statins cause a decrease in total testosterone, not enough to cause a significant deficiency. Disclosure Work supported by industry: no.

Effect of calcium and vitamin D supplementation on the clinical, hormonal, and metabolic profile in non-obese women with polycystic ovary syndrome

In this study, we investigated the effect of calcium and vitamin D (Ca/Vit D) supplementation on the clinical, hormonal, and metabolic profile of patients with low vitamin D levels. In addition, we investigated the effect of Ca/Vit D supplementation on asymmetric dimethylarginine (ADMA) level in patients with polycystic ovary syndrome (PCOS). In total, 75 patients aged 19-35years, with a normal body mass index and a diagnosis of PCOS and Vit D deficiency/insufficiency, were included in the study. Patients received 50,000IU of vitamin D3 once a week for 8weeks. Afterward, 2500mg calcium carbonate equivalent to 1000mg calcium ion and 9.68mg cholecalciferol equivalent to 880IU vitamin D3 were administered orally as a maintenance treatment once a day. The mean age of the patients was 21.7 ± 3.5. After Ca/Vit D supplementation, Vit D levels significantly increased compared to baseline (8.6ng/ml) levels. An increase in SHBG levels (p < 0.001), a decrease in total testosterone, FAI (p = 0.042), and ADMA levels (p < 0.001) were observed in the first and third months compared to the onset. Significant improvement compared to baseline was observed in menstrual irregularity and median mFG score. Ca/Vit D supplementation can improve PCOS symptoms such as menstrual dysfunction, hirsutism, and hyperandrogenism. It may be effective in reducing the risk of cardiovascular disease in patients with PCOS later in life by decreasing ADMA levels, which is an indicator of endothelial dysfunction.

Evaluation of Sex hormones in male and female Egyptian population naturally exposed to Dibutyl phthalate: a cross-sectional study

Endocrine-disrupting chemicals (EDC) an exogenous chemical or mixture of chemicals, which can interfere with hormonal action. The phthalates and their metabolism like Dibutyl phthalate (DBP) are considered EDCs disturb the action of reproductive hormones. A cross-sectional study was conducted on 84 selected adult volunteers from both genders to assess the association between serum DBP concentration and sex hormone levels in adult Egyptians. Serum DBP was measured by Gas chromatography-mass spectrometer. Serum sex hormones, sex hormone- binding globulin (SHBG), and Thyroid-stimulating hormone (TSH) were measured by enzyme-linked immunosorbent assay. In males, there was a significant decrease in total testosterone (T), Free testosterone (FT), Bioavailable testosterone (BT), Free Androgen Index (FAI) between low and high exposure to DBP, while Estradiol (E2) was significantly increased. In the female, there were significant increases in total E2, Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), and significant reduction in progesterone in high exposure group compared to low exposure to DBP. This study showed that there was a significant strong correlation between DBP with T, T/ E2 in males while female subjects showed a significant strong positive correlation with LH and FSH. There is increasing evidence that DBP has an impact on human sex hormones which can cause many physiological disturbances and many diseases in Egyptian adults. It is recommended that reduce human exposure to DBP in the food supply.

Hypothalamic-pituitary-gonadal axis and sexual functioning in metformin-treated men after discontinuation of testosterone replacement therapy: A pilot study.

Metformin was found to reduce elevated gonadotropin levels. The aim of the present study was to determine whether metformin modulates the impact of discontinuation of testosterone therapy on hypothalamic-pituitary-gonadal axis activity and sexual function in men with low testosterone levels. The study included 28men with late-onset hypogonadism (defined according to the criteria of the European Male Aging Study group) receiving testosterone undecanoate (120mg in three equal doses), 12 of whom had been treated with oral metformin (1.7-3g daily). Both testosterone and metformin had been administered for at least six months before enrolment. In all patients, testosterone replacement required to be discontinued. The control group included 16 testosterone- and metformin-treated men with late-onset hypogonadism who during the entire study period continued their treatment. Glucose homeostasis markers, as well as plasma levels of insulin, gonadotropins, testosterone, calculated bioavailable testosterone, dehydroepiandrosterone-sulphate, oestradiol, thyrotropin, free thyroxine, prolactin, insulin-growth factor-1 and cortisol were measured at the beginning of the study and four months later. Moreover, at the beginning and the end of the study, all enrolled patients completed a questionnaire assessing their sexual functioning (IIEF-15). Discontinuation of testosterone therapy resulted in a decrease in total testosterone and bioavailable testosterone (by 42% and 45% in metformin-treated patients, and by 52% and 54% in metformin-naïve patients), as well as impaired all aspects of male sexual function. Changes in bioavailable testosterone, as well as in erectile function, orgasmic function and sexual desire were less pronounced if subjects received metformin. Only in metformin-naïve men, follow-up FSH and LH levels were higher than at baseline (by 75% and 62%). Moreover, discontinuation of testosterone therapy in metformin-naïve men increased glycated haemoglobin, as well as worsened insulin sensitivity. There were no differences between baseline and follow-up levels of the remaining hormones. In metformin-naïve subjects, the increase in gonadotropin levels correlated with the changes in testosterone levels and insulin sensitivity. No effect on glucose homeostasis markers, hormone levels and sexual functioning was observed in the control group. The obtained results suggest that metformin treatment mitigates the unfavourable effect of discontinuation of testosterone treatment on hypothalamic-pituitary-testicular axis activity and sexual function in men with late-onset hypogonadism.

SEASONAL DYNAMICS OF ENDOCRINE REGULATION OF METABOLIC RATE, BLOOD OXYGEN TRANSPORT SYSTEM AND PHYSICAL PERFORMANCE OF MIDDLE OB REGION ATHLETES FROM CYCLIC WINTER SPORTS

Aim. The paper aims to study the seasonal dynamics of endocrine regulation of metabolic rate, blood oxygen transport system and physical performance of Middle Ob region athletes from cyclic winter sports. Materials and methods. A comprehensive two-stage study of the endocrine system, blood oxygen transport system and physical performance was carried out among elite cross country skiers and biathletes aged from 15 to 18 years during the periods of the year with pronounced daylight variability. The research methods included enzyme-linked immunoassay (ELISA) with the measurements of total triiodothyronine, total thyroxine, thyroid-stimulating hormone, total testosterone and growth hormone; analysis of peripheral blood with the measurements of red blood cells, hemoglobin, hematocrit and red blood cell indices; cardiopulmonary exercise testing with ergospirometry and assessment of maximum oxygen consumption, physical work capacity, oxygen pulse and anaerobic threshold. Results. Statistical analysis revealed significant (p &lt; 0.05) seasonal changes in the endocrine system, blood oxygen transport system and physical performance of Middle Ob region athletes. Namely, during the short daylight period there was a significant increase in total triiodothyronine and cortisol, a decrease in total testosterone, red blood cells, hemoglobin, hematocrit and the average volume of red blood cells, an increase in absolute and relative values of maximum oxygen consumption, oxygen pulse, physical work capacity and a decrease in anaerobic threshold. Conclusion. The results of the research characterize the features of athletes’ adaptation to specific climatic factors of the Northern region against the background of intense physical exertion.

Age-related hypogonadism and cardiovascular disease risk

Aim. To study the relationship between age-related androgen deficiency and the level of cardiovascular risk in healthy middle-aged men.Materials and Methods. We enrolled 200 men of 44-55 (median 48.44, interquartile range 45.02- 52.50) years who underwent a routine medical examination, having additionally measured age-related androgen deficiency.Results. A decrease in total testosterone of &lt; 12.1 nmol/L indicative of age-related hypogonadism was detected in 98 (49.0%) men. In 42 (42.8%) men, a decrease in total testosterone was accompanied by loss of libido and erectile dysfunction. Relatively high prevalence of lipid metabolism disorders and subclinical atherosclerosis was diagnosed in men without established cardiovascular disease. Analysis according to the SCORE scale showed a predominance of patients with moderately increased risk, with only a small number of high-risk patients. Notably, all high-risk cases were identified in the age-related hypogonadism group. The distribution of cardiovascular risk score significantly differed in groups with and without age-related androgen deficiency.Conclusion. We demonstrate a relatively high prevalence of age-related testosterone deficiency, which is also associated with increased cardiovascular risk, among healthy middle-aged men.

How does body mass index affect semen parameters and reproductive hormones in infertile males?

The aim of this study was to invastigate the effect of body mass index (BMI) on semen parameters and reproductive hormone levels in infertile males. Overall, 858 infertile male patients, aged between 18 and 55 years, referred to our infertility clinic were included in the study. Patients without risk factors, besides obesity, that could affect semen parameters or reproductive hormones were evaluated. Patients were separated into the following three groups: non-obese (<25 kg/m2), overweight (25-29.9 kg/m2), and obese (≥30 kg/m2). Age, semen parameters, and reproductive hormones were evaluated and compared among the groups. In addition, subgroups based on sperm concentration were compared. Total testosterone and testosterone-estradiol ratio negatively correlated with BMI (p<0.001). A positive correlation was observed between BMI and age (p<0.001). Even when adjusted for age, the decrease in total testosterone was significant in all groups parallel to the increase in BMI. Although age, prolactin level, and total testosterone had a significant relationship in univariate analysis, the only significant parameters were prolactin and total testosterone according to multivariate analysis. There were no significant differences between BMI and semen parameters. No significant difference related to BMI was observed among the infertile groups [severe oligospermia (34.3%), oligospermia (18.2%), and normospermia (47.6%)]. A significant negative correlation was observed between increasing BMI and total testosterone. No relationship was observed between BMI and semen parameters except progressive motility. Nevertheless, prospective longitudinal clinical trials with larger sample sizes involving weight loss are needed to understand the precise relationship of BMI with reproductive hormones and semen parameters in the same individual.

Long-term efficacy of metformin in overweight-obese PCOS: longitudinal follow-up of retrospective cohort.

ObjectiveLong-term efficacy of metformin in polycystic ovarian syndrome (PCOS) apart from in those with impaired glucose tolerance or diabetes remains unproven. We aimed to evaluate the impact of metformin in overweight-obese patients with PCOS and normal baseline glycemic homeostasis.MethodsA 10-year longitudinal follow-up of a retrospective cohort comprising 159 patients with PCOS defined by Rotterdam criteria, BMI ≥25 kg/m2 and normal initial glucose homeostasis (age 28.4 ± 6.4 years, BMI 34.9 ± 6.6 kg/m2) that had been receiving metformin 1000 mg BID. Collection data contained 6085 time-points including anthropometric, hormonal and metabolic parameters.ResultsAfter the first year body mass (BM) decreased for 3.9 ± 6.8 kg (P < 0.001) and remained stable during the following 3 years. Menstrual frequency (MF) increased to 3.0 ± 3.9 bleeds/year (P < 0.001) after first year to over 11 bleeds/year in the following years. The total testosterone and androstenedione decreased to 15.4 ± 47.9% and 11.3 ± 46.4% within first year, with further decrease in total testosterone and androstenedione to 37.8 ± 61.8 and 24.8 ± 40.5% at the fifth year of the follow-up. The total conversion rate to prediabetes and diabetes was extremely low throughout observation period. Less than 25% of patients continued with metformin for more than 5 years with further dropout to only 6% on metformin therapy at the tenth year of follow-up.ConclusionsLong-term metformin treatment of overweight-obese women with PCOS and normal baseline glycemic homeostasis resulted in reduction and stabilization of BM, improvements of MF and androgen profile and low conversion rate to diabetes.

2071-P: Changes in Serum Uric Acid Correlated with Sex Hormones Variations for Chinese Obese Patients Undergoing Sleeve Gastrectomy

Background: Hyperuricemia (HUA) and sex hormone imbalance in obese patients can be reversed by bariatric surgery. However, the relationships between changes in serum uric acid (SUA) and sex hormones variations after bariatric surgery is unexplored. We aimed to investigate the correlations between changes in SUA and sex hormones variations after laparoscopic sleeve gastrectomy (LSG) in Chinese obese patients in relation to gender. Methods: We enrolled 133 severely obese patients who underwent LSG in this study. SUA, sex hormones, and relevant metabolic parameters were compared pre- and 12 months post-LSG. Results: At baseline, HUA was more common in males than in females. Twelve months after LSG, significant improvements in BMI and glucolipid metabolic indices were noted. SUA levels and the prevalence of HUA were declined significantly in both gender while the changes in SUA and percentage of SUA variations were significantly greater in females than in males (all P&amp;lt;0.01). In addition, we observed significant increase in estradiol (E2) and decrease in total testosterone (TT) in females and increase in TT in males (P=0.018, P=0.006, P &amp;lt;0.001, respectively). In a multiple regression model, after adjusting for age and changes in BMI, fasting insulin (FINS), and HOMA-IR, SUA reduction correlated significantly with increased E2 (β=-0.645, P=0.001) and decreased TT (β=0.503, P=0.014) in females, and increased TT (β=-0.909, P=0.008) in males. Conclusion: LSG promotes more profound improvement of SUA levels in female obese patients than in males, and SUA reduction after surgery correlated significantly with different sex hormones changes in males and females. Disclosure C. Zhu: None. J. Gao: None. F. Mei: None. X. Wang: None. D. Zhou: None. S. Qu: None. Funding Shanghai Municipal Science and Technology Commission (17DZ1910603); Fundamental Research Funds for the Central Universities (1501219107); National Natural Science Foundation of China (81500650, 81700752, 81570782)

The patient's comorbidity burden correlates with the erectile dysfunction severity

ObjectiveTo explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson comorbidity index (CCI). Material and methodsCross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. ResultsThe study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R2=.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204). ConclusionsThe CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.

El peso de la comorbilidad del paciente se correlaciona con la gravedad de la disfunción eréctil

ObjectiveTo explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI). Material and methodsCross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. ResultsThe study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R2=.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204). ConclusionsThe CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.

THE AMELIORATIVE EFFECT OF TOMATO JUICE ON THE FERTILITY OF HYPERTENSIVE MALE ALBINO RATS

Red ripened tomatoes have a powerful antioxidant effects. The aim of the present study was to evaluate the protective effect of tomato juice on the fertility as a one of the major complications of the hypertension in male albino rats. The present study investigated the effect of tomato juice, rich with lycopene on some biomarkers of male reproductive functions in hypertensive rats induced by N-Nitro-L-arginine methyl ester (L-NAME). Forty male rats divided into four groups, the first one served as a control, the 2ⁿ group received orally a daily dose of tomato juice (2ml/kg b.w) for 4 weeks, the 3rd group received a daily dose of L-NAME (80 mg/kg b.w.) and the 4th group received a daily dose of tomato juice and L-NAME as the 2ⁿ and 3rd groups. The data recorded a significant increase in systolic blood pressure as well as sperm abnormality, but a significant decrease in total testosterone, free testosterone, sperm count, and sperm viability in L-NAME treated rats group. Concomitantly, a significant decrease in the activities of enzymatic antioxidant superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX), in addition to the non-enzymatic antioxidant glutathione (GSH) concntration was recorded in the same group, while a significant increase in end product of lipid peroxidation malondaldehyde (MDA) was noticed. On the other hand, the most of these parameters seemed to be normalized by oral administration of tomato juice, which indicating the ameliorative effect of tomato juice against L-NAME induced hypertension in male rats.

Oestrogen receptors beta genotype in infertile Egyptian men with nonobstructive azoospermia.

In a prospective study, the polymorphism of oestrogen receptor β gene was investigated in nonobstructive azoospermia patients. Ninety infertile patients with nonobstructive azoospermia diagnosed after two semen analysis, 2weeks apart and negative testicular sperm extraction during intracytoplasmic sperm injection, and 60 fertile men as controls were enrolled in the study. Semen analysis, hormonal profile and allele-specific PCR reaction were performed to detect variants of the RsaI polymorphism of the oestrogen receptor β gene for all patients and controls. The mean patient's age was significantly lower than the mean age of the controls (P<0.05). There was a significant increase in the mean serum levels of FSH, LH, free testosterone and E2 and significant decrease in total testosterone in patients than controls (P<0.05). In the patients, the frequency of the homozygous GG, heterozygous AG and homozygous AA genotype was 83.3%, 14.3% and 3.3% respectively, whereas their frequencies in the controls were 95%, 5% and 0% respectively (odds ratio 3.8). There is no significant correlation between ERß polymorphisms and patient's age or pituitary and sex hormones (P>0.05). Our findings suggested that in Egyptian population, genetic mutation in ERß is associated with the risk of nonobstructive azoospermia.

Choice of method of diagnosis hypogonadism in obesity and metabolic syndrome in men

Nowadays, obesity and metabolic syndrome are considered as symptoms of male hypogonadism, which underlines the need for hormonal screening in these patients. However, remain unsolved some questions of laboratory diagnostics testosterone deficiency. In particular, there are contradictions in the choice of research method of free testosterone. The objectives of our work was to conduct a comparative evaluation of methods for studying androgen status of young and middle-aged men with obesity and metabolic syndrome, and determining the relationship between hormonal indicators and metabolic profile, blood pressure, anthropometric characteristics of obesity. The study included 51 patients with symptoms of obesity and metabolic syndrome, aged from 20 to 50 years, the control group consisted of 19 equal-age men with normal body weight. A significant decrease in total testosterone in men with metabolic syndrome was revealed. The dependence of the concentration of total testosterone with age and content sex-steroid-binding globulin was found. The role of free testosterone in the formation of the metabolic syndrome was shown. It was found that free saliva testosterone significantly correlated with the level of calculated serum free testosterone. In patients with obesity and metabolic syndrome there are a statistically significant increase in saliva testosterone indicators compared to calculated serum free testosterone, while at normal body weight differences are absent. It is concluded that saliva testosterone is more sensitive and appropriate marker for obesity and metabolic syndrome.

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.