Form Of Hypogonadism Research Articles

Testosterone deficiency in patients with chronic kidney disease: prevalence and clinical significance (literature review)

There is an increase in the prevalence of chronic kidney disease in the world. This is primarily due to the increase in the incidence of diabetes mellitus and arterial hypertension as the main etiological factors. A progressive decline in the excretory function of the kidneys is associated with metabolic disorders such as metabolic acidosis, hyperuricemia, hyperparathyroidism, oxidative and inflammatory stress, etc. This leads, in turn, to a decrease in the body weight of patients, primarily due to the loss of muscle mass. Such changes have an adverse effect, including on the synthesis of sex hormones, in particular, on the level of testosterone, the production of which decreases in the cohort of patients under discussion. Hormonal imbalance in the form of hypogonadism can play a significant role in increasing cardiovascular risk. Renal replacement therapy may be an independent risk factor for the development and progression of hypogonadism. At the same time, the problems of impaired regulation, synthesis and balance of sex hormones, as well as the issues of correction of secondary hypogonadism in patients with chronic kidney disease remain poorly understood and are of scientific interest.

Morphology of kisspeptin-producing nuclei in the rat hypothalamus

ВACKGROUND: The article is devoted to the stereo-morphological analysis of the nuclei of the hypothalamus, synthesizing proteins of the kisspeptin family, regulating sexual differentiation various parts of the extended kisspeptin-producing nuclei of the hypothalamus and the features of their asymmetry in mature rats. The morphology of various parts of extended kisspeptin-producing nuclei of the hypothalamus remains poorly understood, which significantly complicates the choice of their reference zone, from which planning and implementation of morphological studies should begin, related to the evaluation of the effectiveness of therapeutic correction of various forms of hypogonadism.
 AIM: Determination of the main source of regulatory peptides of the kisspeptin family based on the analysis of the number, area of neuron bodies and volumetric characteristics of the kisspeptin-producing nuclei of the hypothalamus.
 MATERIALS AND METHODS: We studied 50 frontal paraffin sections of KPNs of 8 intact sexually mature male rats obtained as a result of a standard technique for their preparation and staining by the Nissl method. As a result, we carried out volumetric reconstruction of the largest nucleus of the arcuate complex the medial arcuate nucleus and the large periventricular nucleus, after which the number and area of neurosecretory cell bodies were determined in 5 frontal planes of these nuclei. To determine the proportion of kisspeptin-producing neurons in the total number of neurons in the kisspeptin-producing nuclei of the hypothalamus, we also performed the subsequent quantitative and morphometric characterization of their kisspeptin-producing neurons (after immunohistochemical staining, the identification of kisspeptin-kisspeptin granules. Statistical data processing was performed using the GraphPad PRISM 6.0 program, determining and lower quartiles. Differences were considered significant at p 0.01.
 RESULTS: Subdivisions of the nuclei, which are the main source of these regulatory proteins, have been identified. The caudal part of the medial arcuate nucleus (at the level of bregma 3.6 mm) and the anterior part of the periventricular nucleus (at the level of bregma 0.2 mm) are subdivisions of the corresponding kisspeptin-producing nuclei of the hypothalamus of the kisspeptin-producing nuclei of the hypothalamus, containing the largest number of neurosecretory cells and the bodies of their largest largest area. The number and area of neurons in the left-sided and right-sided parts of the hypothalamic kisspeptin-producing nuclei of the hypothalamus did not differ significantly. In this regard, the listed left-sided and right-sided subdivisions of the kisspeptin-producing kisspeptin-producing nuclei of the hypothalamus of the were proposed as standards for their subsequent morphological studies, which are important for assessing the effectiveness of therapeutic correction of various forms of hypogonadism.
 CONCLUSIONS: The left-sided and right-sided caudal parts of the medial arcuate hypothalamic nucleus and the anterior parts of the periventricular hypothalamic nucleus are proposed as a reference for their subsequent morphological studies related to the evaluation of the effectiveness of therapeutic correction of various forms of hypogonadism. as the main sources of regulatory proteins of the kisspeptin family.

Diagnosis of hypogonadism in ageing men.

To make the diagnosis of hypogonadism in an ageing man, in absence of rare organic cause often referred to as functional or late onset hypogonadism (LOH), he should present with a clinical syndrome suggestive of androgen deficiency and have consistently low serum testosterone (T) levels. This does not differ from the diagnosis of any other form of hypogonadism. Particular to LOH diagnostic are uncertainties surrounding this entity: signs and symptoms of androgen deficiency (including sexual symptoms) are nonspecific in older men; clinical significance of only moderately low T levels is uncertain; comorbidity plays a substantial role with potential for reversibility; the place of T therapy in these men is debatable. This context demands for a pragmatic, but appropriately conservative approach to diagnosis. Evaluation should be stepwise with clinical evaluation, if suggestive for androgen deficiency, followed by measurement of a fasting morning serum T, if unequivocally low to be confirmed in a separate morning sample by a second low T or, if initial T borderline low or in presence of factors known to affect SHBG, by a low calculated free T level. All other (free) T results make hypogonadism an unlikely cause of the patient's symptoms. In the absence of consensus cut-off levels for total and free T in the published clinical guidelines for diagnosis of hypogonadism, it seems appropriate in the context of LOH to use stringent criteria indicating a convincingly low serum T. The approach to the diagnosis of LOH is not fundamentally different from that of other forms of hypogonadism but should put extra weight on prioritizing the shunning of overdiagnosis above the risk of underdiagnosis.

Гіпопітуїтаризм у дітей. Сучасна лабораторна та генетична діагностика

У лекції наведені сучасні міжнародні рекомендації з діагностики гіпопітуїтаризму у дітей, зокрема правила проведення стимуляційних тестів для діагностики гіпосоматотропізму, вторинного гіпогонадизму й гіпокортицизму. Обґрунтовано використання антимюллерова гормона та інгібіну В у діагностиці різних форм гіпогонадизму. Рекомендовано впровадження генетичних методів дослідження з метою встановлення коректного діагнозу, призначення відповідного лікування й проведення медико-генетичної консультації членів сім’ї.

Чоловічий гіпогонадизм (Частина 1)

У першій частині лекції наведені сучасні дані про поширеність чоловічого гіпогонадизму, методи діагностики різних форм гіпогонадизму; описано клінічну характеристику найбільш поширених форм цієї патології.

Rates of hypogonadism forms in Klinefelter patients undergoing testicular sperm extraction: A multicenter cross-sectional study.

Adult patients with Klinefelter syndrome (KS) may present with testicular volume loss and a decrease in circulating testosterone (T) levels. However, the actual rate of hypogonadism in adult KS men is unknown. We aimed to (a) assess the prevalence of different forms of hypogonadism in a cohort of KS patients with non-obstructive azoospermia (NOA); and (b) investigate potential preoperative predictor of positive sperm retrieval (SR) at surgery in the same cohort of men. Complete data from 103 KS men with NOA who underwent testicular sperm extraction (TESE) between 2008 and 2019 at five centers were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients were categorized into four groups of hypogonadism as follows: eugonadism [normal total T (tT) (≥3.03ng/mL) and normal luteinizing hormone (LH) (≤9.4 mUI/mL)], secondary hypogonadism [low tT (≤3.03ng/mL) and low/normal LH (≤9.4 mUI/mL)], primary hypogonadism [low tT (≤3.03ng/mL) and elevated LH (≥9.4 mUI/mL)], and compensated hypogonadism [normal tT (≥3.03ng/mL) and elevated LH (≥9.4 mUI/mL)]. Descriptive statistics tested the association between clinical characteristics and laboratory values among the four groups. Median (IQR) patients age was 32 (24, 37) years. Baseline follicle-stimulating hormone and tT levels were 29.5 (19.9, 40.9) mUI/mL and 3.8 (2.5, 11.0) ng/mL, respectively. Eugonadism, primary hypogonadism, and compensated hypogonadism were found in 16 (15.6%), 34 (33.0%), and 53 (51.4%) men, respectively. No patients had secondary hypogonadism. Positive SR rate at TESE was 21.4% (22 patients); of 22, 15 (68.2%) patients underwent assisted reproductive technology and five (22.7%) ended in live birth children. Patients' age, BMI, CCI, FSH levels, and positive SR rates were comparable among hypogonadism groups. No preoperative parameters were associated with positive SR at logistic regressions analysis. Findings from this cross-sectional study showed that 15.6% of adult KS men have normal tT values at presentation in the real-life setting. Most KS patients presented with either compensated or primary hypogonadism. Sperm retrieval rates were not associated with different forms of hypogonadism.

Biomarkers of male hypogonadism in childhood and adolescence.

The objective of this review was to characterize the use of biomarkers of male hypogonadism in childhood and adolescence. The hypothalamic-pituitary-gonadal (HPG) axis is active during fetal life and over the first months of postnatal life. The pituitary gland secretes follicle stimulating hormone (FSH) and luteinizing hormone (LH), whereas the testes induce Leydig cells to produce testosterone and insulin-like factor 3 (INSL), and drive Sertoli cells to secrete anti-Müllerian hormone (AMH) and inhibin B. During childhood, serum levels of gonadotropins, testosterone and insulin-like 3 (INSL3) decline to undetectable levels, whereas levels of AMH and inhibin B remain high. During puberty, the production of gonadotropins, testosterone, and INSL3 is reactivated, inhibin B increases, and AMH decreases as a sign of Sertoli cell maturation. Based on our knowledge of the developmental physiology of the HPG axis, these biomarkers can be used in clinical practice to interpret the physiopathology of hypogonadism. Additionally, these markers can have diagnostic value in different forms of hypogonadism that may appear during childhood and adolescence.

RF9: May it be a new therapeutic option for hypogonadotropic hypogonadism?

Hypogonadotropic hypogonadism (secondary hypogonadism), congenital or acquired, is a form of hypogonadism that is due to problems with either the hypothalamus or pituitary gland affecting gonadotropin levels. Pulsatile secretion of gonadotropin-releasing hormone (GnRH) by hypothalamus is a primer step to initiate the release of pituitary gonadotropins. Kisspeptin and gonadotropin-inhibitory hormone (GnIH) are accepted as two major players in the activation and inhibition of GnRH regarding the neuroendocrine functioning of the hypothalamic pituitary gonadal axis. Kisspeptin is known as the most potent activator of GnRH. Regarding the inhibition of GnRH, RF-amide-related peptide-3 (RFRP-3) is accepted as the mammalian orthologue of GnIH in avian species. RF9 (1-adamantane carbonyl-Arg-Phe-NH2) is an antagonist of RFRP-3/GnIH receptor (neuropeptide FF receptor 1 (NPFFR1; also termed as GPR147). In recent years, several studies have indicated that RF9 activates GnRH neurons and gonadotropins in a kisspeptin receptor (Kiss1r, formerly known as GPR54) dependent manner. These results suggest that RF9 may have a bimodal function as both an RFRP-3 antagonist and a kisspeptin agonist or it may be a kiss1r agonist rather than an RFRP-3/GnIH receptor antagonist. These interactions are possible because Kisspeptin and GnIH are members of the RF-amide family, and both possibilities are not far from explaining the potent gonadotropin stimulating effects of RF9. Therefore, we hypothesize that RF9 may be a new therapeutic option for the hypogonadotropic hypogonadism due to its potent GnRH stimulating effects. A constant or repeated administration of RF9 provides a sustained increase in plasma gonadotrophin levels. However, applications in the same way with GnRH analogues and kisspeptin may result in desensitization of the gonadotropic axis. The reasons reported above contribute to our hypothesis that RF9 may be a good option in the GnRH stimulating as a kisspeptin agonist. We suggest that further studies are needed to elucidate the potential effects of RF9 in the treatment of the hypogonadotropic hypogonadism.

FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism

FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism

Oxytocin intranasal administration as a new hope for hypogonadotropic hypogonadism patients

Hypogonadotropic hypogonadism (HH) is a form of hypogonadism which also known as secondary or central hypogonadism. Congenital HH can occur due to defect in gonadotropin releasing hormone (GnRH) neurons, upstream regulators of GnRH neurons or pituitary gonadotropic cells. Testosterone or gonadotropins therapy are widely used to treat HH patients, however both have undesirable effects and GnRH treatment for HH patients is time and cost consuming. Direct delivery of therapeutics to the brain via the nasal route is located in the center of attention during the last decade and trial application of intranasal oxytocin as a method of enhancing social interactions are reported. It has been delineated that oxytocin stimulates GnRH release from the rat hypothalamic explants and intranasal applied oxytocin up-regulates GnRH expression in the male rat hypothalamus. Therefore application of intranasal oxytocin might be a new strategy to cure HH patients.

MP47-06 CHARACTERISTICS OF SECONDARY, PRIMARY, AND COMPENSATED HYPOGONADISM IN CAUCASIAN-EUROPEAN MEN PRESENTING FOR NEW ONSET ERECTILE DYSFUNCTION - RESULTS OF A CROSS-SECTIONAL SURVEY

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation1 Apr 2016MP47-06 CHARACTERISTICS OF SECONDARY, PRIMARY, AND COMPENSATED HYPOGONADISM IN CAUCASIAN-EUROPEAN MEN PRESENTING FOR NEW ONSET ERECTILE DYSFUNCTION - RESULTS OF A CROSS-SECTIONAL SURVEY Eugenio Ventimiglia, Paolo Capogrosso, Luca Boeri, Andrea Russo, Silvia Ippolito, Donatella Moretti, Roberta Scano, Rayan Matloob, Lina Bua, Luca Villa, Franco Gaboardi, Francesco Montorsi, and Andrea Salonia Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Andrea RussoAndrea Russo More articles by this author , Silvia IppolitoSilvia Ippolito More articles by this author , Donatella MorettiDonatella Moretti More articles by this author , Roberta ScanoRoberta Scano More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Lina BuaLina Bua More articles by this author , Luca VillaLuca Villa More articles by this author , Franco GaboardiFranco Gaboardi More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An association between erectile dysfunction (ED) and testosterone deficiency (TD) has been variously described in the literature, with mixed results in terms of effectiveness of the combination therapy for both conditions. We sought whether different forms of hypogonadism can be distinguished among Caucasian-European men presenting for new-onset ED. METHODS Complete demographic, clinical and laboratory data from the last 303 consecutive patients seeking medical help for ED at the same academic outpatient clinic were analyzed. Four groups of individuals were defined according to Tajar et al. (J Clin Endocrinol Metab. 2010;95:1810-8): eugonadal [normal testosterone (T ≥ 3.03 ng/mL) and normal LH (≤9.4 mUI/mL)], secondary (low T and low/normal LH), primary (low T and elevated LH), and compensated (normal T and elevated LH) hypogonadism. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs ≥2). Testicular volume was assessed with a Prader orchidometer. Patients were invited to complete both the IPSS and the IIEF questionnaires. Descriptive statistics tested differences among the aforementioned groups. RESULTS Of all, eugonadism, secondary, primary, and compensated hypogonadism were found in 233 (76.4%), 45 (14.8%), 8 (2.6%), and 19 (6.2%) men, respectively. Despite being younger, primary hypogonadal men were the least healthy (CCI defined) group, having higher BMI, waist circumference, IPSS score, and lower IIEF sexual desire score (all p<0.03). Overall, health status, waist circumference, BMI, and CCI worsened according to the defined gonadal status, with a less favorable profile in primary and secondary hypogonadal men as compared to compensated ones (all p<0.01). Among IIEF domains, sexual desire was the only one negatively influenced by the gonadal status (p=0.03); conversely, erectile function domain did not vary significantly among the analyzed groups. Interestingly, LUTS severity (as for IPSS scores) worsened according to the gonadal status (p=0.01). CONCLUSIONS Overall, the prevalence of TD was 23.6% within our cohort of Caucasian-European men presenting for new-onset ED. Clinical, endocrine and metabolic characteristics significantly worsen according to the defined gonadal status. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e628-e629 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eugenio Ventimiglia More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Andrea Russo More articles by this author Silvia Ippolito More articles by this author Donatella Moretti More articles by this author Roberta Scano More articles by this author Rayan Matloob More articles by this author Lina Bua More articles by this author Luca Villa More articles by this author Franco Gaboardi More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Violation of spermatogenesis and outcomesof assisted reproductive technologies in various forms of hypogonadism

This article provides an overview of domestic and foreign literature on the hormonal regulation of spermatogenesis, endocrine disorders, leading to hypogonadism, on effectiveness of assisted reproductive technology in patients with Klinefelter’s syndrome, Kallmann syndrome and syndrome of testicular feminization (androgen insensitivity syndrome).

TRANSITION IN ENDOCRINOLOGY: Hypogonadism in adolescence.

Puberty is a remarkable developmental process with the activation of the hypothalamic-pituitary-gonadal axis culminating in reproductive capacity. It is accompanied by cognitive, psychological, emotional, and sociocultural changes. There is wide variation in the timing of pubertal onset, and this process is affected by genetic and environmental influences. Disrupted puberty (delayed or absent) leading to hypogonadism may be caused by congenital or acquired etiologies and can have significant impact on both physical and psychosocial well-being. While adolescence is a time of growing autonomy and independence, it is also a time of vulnerability and thus, the impact of hypogonadism can have lasting effects. This review highlights the various forms of hypogonadism in adolescence and the clinical challenges in differentiating normal variants of puberty from pathological states. In addition, hormonal treatment, concerns regarding fertility, emotional support, and effective transition to adult care are discussed.

Risk Factors Associated with Hypogonadism in β–Thalassemia Major Patients: Predictors for a Frequent Complication of a Rare Disease

Background: β-Thalassemia major (BTM) is a rare disease that challenges clinicians because of the high prevalence of complications despite progress in the development of new therapeutic methods. The aim of this study was to identify clinical and hematological parameters associated with hypogonadism, the most frequent iron overload-related complication found in Romanian patients. Methods: Patients with BTM were evaluated in the Endocrinology Department of Elias Hospital between February 2004 and December 2013. Only patients who provided written informed consent were included in the study. A complete physical and hormonal evaluation was performed on all patients, and data regarding treatment of the hematological disease were collected. Results: Of the evaluable patients, 85 were included in the study (median age, 21[10] years; range, 13–36 years). We found that 30.6% of the study participants (26 of 85) had normal gonadal status, 54.1% (46 of 85) had early forms of hypogonadism (delayed or arrested puberty), and 15.3% (n = 13) developed hypogonadism after complete sexual maturation. Patients with any form of hypogonadism were older (median age 22 vs 16.5 years, P = 0.047), had significantly lower average hemoglobin levels (P = 0.003), and had higher levels of serum ferritin (P = 0.006) versus patients without hypogonadism. Patients with delayed puberty were associated with increased average serum ferritin levels (P = 0.007), decreased hemoglobin levels (P = 0.001), and increased age at initiation of iron chelation therapy (P < 0.01). We found no significant differences between patients with early forms of hypogonadism and those with hypogonadism after complete sexual maturation, with respect to the analyzed parameters. Patients with adult hypogonadism were significantly older (median age 26 vs 16.5 years, P = 0.007) and tended to have higher serum ferritin levels (P = 0.056) compared with patients without hypogonadism. Conclusion: Our data show that hypogonadism is highly prevalent among Romanian patients with BTM, its presence being associated with higher iron overload and lower hemoglobin values. The late start of iron chelation therapy was particularly associated with pubertal abnormalities.

Syndrome of hypogonadism in males

Hypogonadism in men - a clinical and laboratory syndrome caused by decreased secretion of testosterone by the testes. Depending on the level of destruction of the hypothalamic-pituitary-gonadal axis we distinguish two main forms of hypogonadism: hypergonadotrophic or primary hypogonadism and hypogonadotropic or secondary hypogonadism, clinical manifestations, diagnosis and treatment of which are presented in this clinical lecture. Keywords: hypogonadism, testosterone, hypergonadotrophic hypogonadism, hypogonadotropic hypogonadism, treatment.

Characteristics of Secondary, Primary, and Compensated Hypogonadism in Aging Men: Evidence from the European Male Ageing Study

The diagnosis of late-onset hypogonadism (LOH) in older men with age-related declines in testosterone (T) is currently not well characterized. Our objective was to investigate whether different forms of hypogonadism can be distinguished among aging men. The study was a cross-sectional survey on 3369 community-dwelling men aged 40-79 yr in eight European centers. Four groups of subjects were defined: eugonadal (normal T and normal LH), secondary (low T and low/normal LH), primary (low T and elevated LH), and compensated (normal T and elevated LH) hypogonadism. Relationships between the defined gonadal status with potential risk factors and clinical symptoms were investigated by multilevel regression models. Among the men, 11.8, 2.0, and 9.5% were classified into the secondary, primary, and compensated hypogonadism categories, respectively. Older men were more likely to have primary [relative risk ratio (RRR) = 3.04; P < 0.001] and compensated (RRR = 2.41; P < 0.001) hypogonadism. Body mass index of 30 kg/m(2) or higher was associated with secondary hypogonadism (RRR = 8.74; P < 0.001). Comorbidity was associated with both secondary and primary hypogonadism. Sexual symptoms were more prevalent in secondary and primary hypogonadism, whereas physical symptoms were more likely in compensated hypogonadism. Symptomatic elderly men considered to have LOH can be differentiated on the basis of endocrine and clinical features and predisposing risk factors. Secondary hypogonadism is associated with obesity and primary hypogonadism predominately with age. Compensated hypogonadism can be considered a distinct clinical state associated with aging. Classification of LOH into different categories by combining LH with T may improve the diagnosis and management of LOH.

The Management of Hypogonadism in Aging Male Patients

This article focuses on the evaluation and management of hypogonadism in aging male patients in the light of recent guidelines. The benefits of treating severe hypogonadism resulting from identifiable pituitary or primary gonadal disease are well established. Milder forms of hypogonadism in the aging male, known as andropause, are common, and constitute an expanding area of clinical interest and research. Several studies indicate that testosterone replacement therapy may produce a wide range of benefits for men with hypogonadism, including improvement in libido, bone density, muscle mass, body composition, mood, and cognition. Currently available data are insufficient to permit a definitive verdict on the balance between risks and benefits of testosterone replacement therapy in aging males.

Andrologische Diagnostik

Andrology was included as a further subject for continuing education in the Model Ordinance on Continuing Education at the 106th German Physicians Meeting in Cologne in 2003. In addition to fertility disorders, this discipline comprises medical care for men with fertility disorders, erectile dysfunction, disorders of libido, ejaculation and coitus, various forms of hypogonadism, and delayed puberty. Furthermore, this field also covers questions concerning male contraception, gynecomastia, and male senescence. Diagnostic procedures in andrology require close interdisciplinary cooperation between gynecologists, human geneticists, and specialists in psychosomatic medicine. They include medical history, clinical examination, and laboratory analyses. Except for confirming azoospermia, it is not possible to make a definitive prognosis of fertility based on semen analysis. Functional tests allow a better assessment of the spermatozoa's fertility since 25-30% of men desiring a child exhibit reduced spermatozoan functions which cannot be verified on routine semen analysis.

Testosterone replacement therapy in male hypogonadism is not associated with increase of endothelin‐1 levels

Differences in endothelin-1 (ET-1) blood plasma levels were established between healthy men and women. Little is known about vascular effects of testosterone and the interactions between sex hormones and endothelin. In order to study the relationship between ET-1 and testosterone in more detail, we have investigated 33 male patients with various forms of hypogonadism (13 with hypergonadotropic hypogonadism and 20 with hypogonadotropic hypogonadism). Fourteen age-matched healthy males served as controls. The basal ET-1 levels in patients with hypogonadism (0.96 +/- 0.12 fmol/mL) (mean +/- SEM) were significantly higher in comparison with the controls (0.44 +/- 0.04 fmol/mL), p < 0.01. Fifteen individuals of these patients were studied during the therapy with testosterone depot 250 mg i.m. The ET-1 levels decreased in this group from 0.99 +/- 0.22 to 0.78 +/- 0.14 fmol/mL at the third and to 0.76 +/- 0.25 fmol/mL at the sixth month of the medication, respectively. The differences were not significant compared with the initial levels, but the concentrations at the sixth month of the treatment were not statistically different in comparison with the ET-1 levels of the controls. There was no significant difference in lipid data between patients before and during testosterone medication, except for the high-density lipoprotein cholesterol, which decreased at the third month of the treatment. Our results show that plasma ET-1 levels in males with hypogonadism are elevated with a tendency to decrease after testosterone administration. The optimum testosterone is not associated with enhanced cardiovascular risk as far as ET-1 plasma levels and lipids are concerned.

Association of carotene rich diet with hypogonadism in a male athlete

To report on a unique case of hypogonadism associated with excessive carotene intake in a young male athlete. A 20-year-old patient presented with a gradual decline in muscular and physical activity, sexual interest and erectile ability associated with a high in carotene and low in animal fat diet of his own design a year prior to the clinical manifestations. Clinically, he presented with very overt signs of carotene excess: his palms and soles were yellow. Moreover, 2 weeks after normalization of his diet, carotene B levels were at the upper end of the normal range. Repeated stimulation tests of hypothalamic, pituitary and testicular function were performed before and at 3, 6 and 12 months after the introduction of a balanced diet. Very low basal and stimulated values for gonadotropins and gonadal steroids were found at the initial evaluation with a progressive recovery shown after months of a balanced diet and carotene B restoration. Complete androgen secretion and sexual response recovery were observed only after 9-12 months from diagnosis. This is the first report associating excessive carotene intake with a hypothalamic form of hypogonadism in a young man.