Free Testosterone Levels Research Articles

Evaluation of the Incidence of Low Testosterone Levels in Young Male Adults with Moderate to Severe Obesity-Single-Centre Study from India.

With the increase in obesity epidemic among Asians, it is necessary to evaluate the impact of obesity on this population. Low testosterone levels are known to be associated with obesity. This is the 1st study from Asia to evaluate incidence and magnitude of hypotestosteronemia in young adults with BMI more than 32.5kg/m2 defined as moderate to severe obesity in Asians. One hundred thirty-four male patients with BMI more than 32.5kg/m2, between 18 and 30years old who visited a single bariatric facility between 2017 and 2020, were evaluated with BMI, total and free testosterone levels and clinical features of gynecomastia, hypogonadism, and thinning of pubic and armpit hair. Statistical analysis was performed using SPSS, Spearman's correlation coefficient, and ANOVA test. 60.4% of patients (84/134) had low testosterone levels (< 300ng/dl) and 23.9% (32/134) had levels between 300 and 400ng/dl. 89.6% patients (120/134 had gynecomastia, 60.4% (81/134) had thinning of pubic and arm pit hair, and 62.7% (84/134) had hypogonadism. Testosterone levels showed a decreasing trend with increasing BMI, but it was not statistically significant. Obesity is one of the important etiologies of hypotestosteronemia and its manifestations in young adults. The actual incidence may be significantly higher than what is reported in the literature. High-quality research is required to address questions of diagnosis and best treatment options.

The effect of gonadoliberin analog treatment in precocious puberty on polycystic ovarian syndrome prevalence in adulthood.

The study group consists of 24 women (median age 22 88 years, median BMI 23.5) treated with GnRHa for central precocious puberty in childhood. The control group includes 40 women (median age 23 years, median BMI 25.6) diagnosed with isolated premature thelarche and not using GnRHa in the childhood. Anthropometric measurements, ultrasound examination of minor pelvis and hormonal profile were performed. PCOS diagnosis was based on Rotterdam criteria. The study confirmed a higher prevalence of PCOS in the study group (50%) than in the control group (10%); p=0.0006. Significant, linear correlation between free testosterone levels and ovarian size was found in the study group (R=0.45 p= 0.03). GnRHa therapy during childhood may have a potential influence on incidence of PCOS in the adulthood. Therefore, in this group of patients long-term follow-up focused on screening for PCOS would seem beneficial.

The impact of oral isotretinoin on ovarian functions of acne patients complaining of polycystic ovarian syndrome: a prospective study

BackgroundWomen have polycystic ovarian syndrome (PCOS) at higher rates than any other endocrine condition with an average incidence rate of 6 to 8%. Acne is an immune mediate common condition frequently affecting adolescents and adults and is often associated with PCOS. The objective of the study was to assess the impact of oral isotretinoin on ovarian functions of acne patients suffering from PCOS. Forty women with a clinical diagnosis of acne as well as PCOS participated in this prospective clinical trial. Participants were given oral doses of isotretinoin ranging from 0.5 to 1 milligram per kilogram (mg/kg), for a total of 120 to 150 mg/kg. To establish baseline values of hormone levels, on days 2–5 of the menstrual cycle, venous blood samples were obtained. Moreover, global acne grading system (GAGS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment.ResultsA significant reduction in global acne score from pre-treatment levels to post-treatment levels was observed (11.58 ± 5.857 vs. 1.65 ± 1.369). Ovarian volume was significantly reduced from 10.26 ± 1.539 before treatment to 8.74 ± 1.436 after treatment on the right side (P < 0.001) and from 11.08 ± 1.564 before treatment to 9.36 ± 1.479 after treatment on the left side (P < 0.001). A significant reduction in free testosterone level and hirsutism scores were observed after treatment (P < 0.001; P < 0.01 respectively.ConclusionIsotretinoin may exert beneficial effects in hyperandrogenic women with PCOS and needs to be further evaluated by large multicentre controlled trials.

Erectile function in men with COVID-19 six months after recovery

Background. Based on the results of epidemiological studies, it was found that coronavirus disease 2019 (COVID-19) affects men more often than women. Among COVID-19 complications, erectile dysfunction is considered a marker of endothelial dysfunction and one of the main factors for the development of cardiovascular diseases. Lower total and free testosterone levels are predictors of adverse prognosis in males with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Testosterone deficiency syndrome is considered an independent risk factor of cardiometabolic disorders. The purpose of the study is to investigate the state of erectile function in men who suffered from COVID-19 six months after recovery. Materials and methods. Seventy-two men suffering from COVID-19 and being treated in an infectious disease hospital were examined 6.90 ± 0.29 months after recovery. Their average age was 45.23 ± 3.01 years. The control group included 18 conditionally healthy men aged 43.18 ± 2.90 years. The state of erectile function was assessed using the International Index of Erectile Function (IIEF). The concentration of testosterone was determined by the enzyme-linked immunosorbent assay with DRG (Germany) and DiaMetra (Italy) kits. All measurements were performed on the Stat Fax 3200 analyzer. Statistical comparison of the obtained results between groups was performed according to the Student’s test. A value of p &lt; 0.05 was considered to be signifi­cant. Results. In addition to erectile dysfunction, as evidenced by a reduced corresponding integrative indicator “erectile function” of IIEF-15 in men with COVID-19, a decrease in sexual desire was found, as well as a deterioration of sensations in the form of a decrease in ejaculation frequency and orgasmic sensations during sex contacts. The average serum level of total testosterone was 10.9 nmol/l and was significantly reduced compared to that in the control group. Analysis of individual indicators showed that testosterone level was decreased in 10 patients and was within the normal range in 13 men with COVID-19. The average serum concentration of total testosterone in the examined men after the disease was 10.73 ± 1.07 nmol/l and was significantly reduced compared to that of the control group. Conclusions. There was an erectile dysfunction in men who suffered COVID-19, it was confirmed by a probable decrease in IIEF-15 score and integrative indicators of erectile function. A significant decrease in the blood concentration of total testosterone was detected in the examined men, which may be one of the causes of erectile dysfunction. Large-scale prospective, randomized, controlled trials in patients infected with SARS-CoV-2 are needed to provide an understanding of the molecular mechanisms that cause erectile dysfunction.

Association between ethylene oxide exposure and sex steroid hormone levels in male adults in the United States

Sex steroid hormones play important roles in maintaining our health systems, including reproductive function and developmental health. Ethylene oxide (EtO) is a reactive organic compound that is widely used in the gas sterilization of materials such as foods, spices, and medical devices. Previous studies have suggested that EtO exposure is associated with carcinogenic risk, neurotoxicity, and reproductive toxicity. However, no studies focusing on the relationship between EtO exposure and changes in sex steroid hormone levels have been performed in human. The present study investigated the association between blood EtO levels and serum sex steroid hormone levels in 1,635 adult men from the NHANES 2013-2016. Multivariate linear regression analyses, a positive correlation between blood EtO and total testosterone levels, and the testosterone to estradiol ratio. Moderate EtO exposure was associated with a decrease in estradiol levels, but no relationship was found at the highest exposure range. No significant associations were observed between EtO exposure and free testosterone, bioavailable testosterone, or sex hormone-binding globulin levels. These findings suggest EtO exposure could impact human sex steroid hormone production, although analysis in females and further verification through prospective studies should be performed.

Analytical performance of free testosterone calculated by direct immunoluminometric method compared with the Vermeulen equation: results from a clinical series.

Testosterone (T) is a hormone that is crucial for primary and secondary sexual development in both males and females. Free testosterone (FT) represents the biologically active form of T, and its measurement is of great importance in clinical practice. While application of either equilibrium dialysis or ultrafiltration is considered to be the gold standard for FT assessment, these methods are expensive and not widely accessible. As an alternative, the Vermeulen formula is a commonly utilized calculated method. This clinical study, including 190 consecutive patients, was carried out to compare FT levels obtained through direct immunoluminometric assay and the Vermeulen formula. The comparison was performed using Passing-Bablok and Deming regression as well as the Bland-Altman plot. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were assessed. The calculated method employing the Vermeulen formula was considered the gold standard. Passing-Bablok regression indicated a good agreement between the two methods, with slopes close to 1 for the whole series. Although the Bland-Altman plot demonstrated overall agreement, a potential proportional bias was observed in females. Deming regression confirmed excellent agreement and reliable estimates. Sensitivity and specificity analysis revealed that the direct method had a sensitivity of 75.0% and a specificity of 93.4% in all patients. However, sensitivity improved to 81.0% in males and dropped to 18.2% in females likely due to the low number of true positive cases. The direct method exhibited comparable performance to the calculated method, but caution should be exercised when interpreting results, particularly in females. Further studies are necessary to validate its sensitivity and specificity in larger series.

Состояние сексуальной функции у пациентов с новообразованием яичка до проведения специализированных методов лечения. Клиническое исследование

Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment. Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated. Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p &lt; 0.05), satisfaction with sexual intercourse (p &lt; 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).

Association of serum free testosterone level in men with erectile dysfunction

Association of serum free testosterone level in men with erectile dysfunction

The injectable contraceptives depot medroxyprogesterone acetate and norethisterone enanthate substantially and differentially decrease testosterone and sex hormone binding globulin levels: A secondary study from the WHICH randomized clinical trial.

HIV acquisition risk with norethisterone (NET) enanthate (NET-EN) is reportedly less than for depo-medroxyprogesterone acetate intramuscular (DMPA-IM). We investigated the effects of these progestin-only injectable contraceptives on serum testosterone and sex hormone binding globulin (SHBG) levels, since these may play a role in sexual behavior and HIV acquisition. The open-label WHICH clinical trial, conducted at two sites in South Africa from 2018-2019, randomized HIV-negative women aged 18-40 years to 150 mg DMPA-IM 12-weekly (n = 262) or 200 mg NET-EN 8-weekly (n = 259). We measured testosterone by UHPLC-MS/MS and SHBG by immunoassay in matched pairs of serum samples collected at baseline (D0) and at peak serum progestin levels at 25 weeks post initiation (25W) (n = 214-218 pairs). Both contraceptives substantially decreased, from D0 to 25W, the total testosterone [DMPA-IM D0 0.560, 25W 0.423 nmol/L, -24.3% (p < 0.0001); NET-EN D0 0.551, 25W 0.253 nmol/L, -54.1%, (p < 0.0001)], SHBG [DMPA-IM D0 45.0, 25W 32.7 nmol/L, -29.8% (p < 0.0001); NET-EN D0 50.2, 25W 17.6 nmol/L, -65.1% (p < 0.0001)], and calculated free testosterone levels [DMPA-IM D0 6.87, 25W 5.38 pmol/L, -17.2% (p = 0.0371); NET-EN D0 6.00, 25W 3.70, -40.0% (p < 0.0001)]. After adjusting for change from D0, the total testosterone, SHBG and calculated free testosterone levels were significantly higher for DMPA-IM than NET-EN (64.9%, p < 0.0001; 101.2%, p < 0.0001; and 38.0%, p = 0.0120, respectively). The substantial and differential decrease in testosterone and SHBG levels does not explain our previous finding of no detected decrease in risky sexual behavior or sexual function for DMPA-IM or NET-EN users from D0 to 25W. Medroxyprogesterone (MPA) and NET are androgenic and are both present in molar excess over testosterone and SHBG concentrations at 25W. Any within or between contraceptive group androgenic effects on behavior in the brain are likely dominated by the androgenic activities of MPA and NET and not by the decreased endogenous testosterone levels. The clinical trial was registered with the Pan African Clinical Trials Registry (PACTR 202009758229976).

Trigonelline Chloride Ameliorated Triphenyltin-Induced Testicular Autophagy, Inflammation, and Apoptosis: Role of Recovery.

Triphenyltin chloride (TPT-Cl) is an organometallic organotin. This study aimed to investigate the role of trigonelline (TG) along with the impact of TPT withdrawal on the testicular toxicity induced by TPT-Cl. Thirty-six adult male albino rats were divided into control, TG (40 mg/kg/day), TPT-Cl (0.5 mg/kg/day), TG + TPT-Cl, and recovery groups. Animals were daily gavaged for 12 weeks. Both TG and TPT-Cl withdrawal improved TPT-Cl-induced testicular toxicity features involving testis and relative testis weight reduction, luteinizing hormone, follicular stimulating hormone, and sex hormone-binding globulin elevation, reduction of inhibin B, free testosterone levels, and sperm count reduction with increased abnormal sperm forms. Moreover, both TG and TPT-Cl withdrawal reduced inflammatory activin A, follistatin, tumor necrosis factor α, interleukin-1β, and proapoptotic Bax and elevated antiapoptotic Bcl2 in testicular tissues mediated by TPT-Cl. TG and TPT-Cl withdrawal restored the excessive autophagy triggered by TPT-Cl via elevation of mTOR, AKT, PI3K, and P62/SQSTM1 and reduction of AMPK, ULK1, Beclin1, and LC3 mRNA gene expressions and regained the deteriorated testicular structure. In conclusion, TG and TPT-Cl withdrawal had an ameliorative role in partially reversing TPT-Cl-induced testicular toxicity. However, the findings indicated that the use of TG as an adjunctive factor is more favorable than TPT-Cl withdrawal, suggesting the capability of the testis for partial self-improvement.

Consequences of Anabolic Androgenic Steroids Abuse in Males, Sexual Hepatic and Metabolic Perspective

Abstract&#x0D; Background: anabolic androgenic steroids (AASs) are becoming increasingly popular between bodybuilders and people who want to enhance their physiques. However, according to the rise of the Internet and laws prohibiting sales of these substances without prescription, the route of obtaining and administration practices have become more and more dangerous.&#x0D; Objective: Anabolic-androgenic steroids represents a group of synthetic testosterone derivatives its play an important role in clinical treatment. These group of drugs are widely abused among the general public to increase lean body weight and improve athletic performance. It has been reported that AAS use can cause many adverse effects. Although there are many related studies, the current study was to review the effect of AAS on serum levels of LH, FSH, prolactin, free testosterone, ALT, AST, T3, T4, TSH, haemoglobin and platelet in bodybuilders using these hormones and compare the results with control group.&#x0D; Method: A 50 body builders were using gym routinely and were using AASs for at least 2 months interviewed and collect blood sample to measure certain lab data and see the effects of AAS on these lab data and compare results with control group who were using gym routinely but never use AAS before.&#x0D; Results: The levels of eight parameters were significantly (P-value&lt; 0.05) different according to the participating groups (AAS users vs control): LH, FSH, Prolactin, ALT, T3, TSH, haemoglobin and platelets. Five of the measured parameters were significantly (P-value&lt; 0.05) lower in the group of AAS users compared to the control (non-user) group: LH, FSH, T3, TSH, and platelets. In contrast, the other three parameters (prolactin, ALT and haemoglobin) were significantly (P-value&lt; 0.05) higher in the AAS user group compared to control group.&#x0D; Conclusion: the anabolic androgenic steroids had a harmful effect on multi physiological functions leading to hormonal disturbances.

Changes of biochemical parameters in normal weight and overweight/obese women with polycystic ovary Syndrome

Objectives: Polycystic ovary syndrome (PCOS) is an endocrine disease in reproductiveage women, which interferes with fertility, menstruation, and body composition. Some biochemical parameters change in women with PCOS, a feature which can be a consequence of the disease itself or of the accompanying obesity. This study investigated the glucose and lipid profiles, sex hormones, and hsCRP in normal weight and overweight/ obese Iranian women with and without PCOS.&#x0D; Methods: 314 women with PCOS and 138 healthy and fertile women were recruited for the study. The patients and controls were divided according to body mass index (BMI) into two groups as follows: BMI&lt;25 Kg/m2 and BMI≥ 25 Kg/m2 . Blood samples were collected from all participants to assess fasting blood glucose, fasting insulin, lipid profile, FSH, LH, free testosterone, and hs-CRP levels. The homeostasis model of insulin resistance (HOMA-IR) was calculated for assessing insulin sensitivity.&#x0D; Results: BMI, fasting insulin, HOMA-IR, triglyceride, FT, LH, and hs-CRP levels were significantly higher in the PCOS group, while lower levels of FSH were observed in comparison to non-PCOS women. Among overweight PCOS women, hs-CRP levels were significantly elevated compared to normal-weight PCOS women. However, there was no significant difference in circulating hs-CRP levels between normal-weight and overweight participants in the control group.&#x0D; Conclusion: The study results suggest that both insulin resistance and an increase in hs-CRP may be relevant to PCOS. Moreover, the findings indicated that chronic inflammation in PCOS is not solely dependent on the pathogenesis of the disease but may be exacerbated by increased body weight.

ERECTILE DYSFUNCTION TREATMENT USING SUBCUTANEOUS IMPLANTS WITH A LONG-TERM EFFECT

Introduction. The article describes a new method of improving erectile function by incerting long-acting subcutaneous implants with the phosphodiesterase 5 (PDE 5) inhibitor.&#x0D; The aim of the study: To evaluate the effectiveness of tadalafil in the treatment of erectile dysfunction using bioidentical pellets.&#x0D; Materials and methods: The study included 10 men under 65 years of age who had suffered from erectile dysfunction for more than 1 year.&#x0D; For the examination before and 4 months after the intervention, the following were performed: filling out the MIEF-5 questionnaire, phical examination, Doppler of penile vessels, «Erection Hardness Scale», laboratory examination (general and biochemical blood tests, general urine analysis and hormonal testing, including determination of the levels of total testosterone, free testosterone, prolactin, estradiol and dehydroepiandrosterone sulfate.&#x0D; All patients received implants with bioidentical tadalafil 75 mg. The pellet was inserted in a sterile operating room through a 3 mm skin incision in the outer quadrant of the gluteal region and inserting the substance into the subcutaneous fat.&#x0D; Results: All patients showed an improvement in MIEF-5 from 14.7 ± 2.75 to 20.7 ± 1.49, an increase in systolic blood flow velocity and penile rigidity at the tenth minute after prostaglandin E1 injection on Doppler vascular examination.&#x0D; Conclusion: This study demonstrated the efficacy of tadalafil by pellet administration in the treatment of erectile dysfunction in men younger than 65 years.

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

Is testosterone deficiency a predictive factor for recurrence of urethral stricture?

Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. Recurrence was observed in 41.4% of the cases (n=48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p=0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p=0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p=0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p=0.051). Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.

Clinical and Biochemical Evaluation of Hirsutism in Young, Lean Girls from Kirkuk City, Iraq: A Cross-Sectional Study

Background: An increase in terminal hair in androgen-dependent regions is known as hirsutism. It is not solely caused by hyperandrogenemia; idiopathic forms are also frequently seen. Objective: To examine the modified Ferriman Gallwey (mFG) cut-off score in female Iraqis as well as the etiological, biochemical, and clinical characteristics of hirsutism. Methods: This prospective cross-sectional study included one thousand young girls with a normal BMI. The features associated with clinical hirsutism were identified using the mFG scoring system. We eliminated eighty-eight young girls who were diagnosed with PCOS. Samples of blood were drawn for biochemical analyses. Results: 53.1%, 19.6%, and 1.2% of females had mild, moderate, or severe hirsutism, respectively. For the young females who participated in the study, their mean mFG scores were 7.07, 11.26, 16.26, and 29, respectively. Only 5% of girls with mild hirsutism had high serum free testosterone levels, despite a considerable difference in free testosterone levels between them and the normal girls. The chin, upper lip, and lower abdomen were the sites that contributed the most to mFGs. Of the girls who were moderately hirsute, 55% had a positive family history of hirsutism. Conclusion: Iraqi women do not need to consider the mFG score system's cut-off number of 8. The endocrine society's guidelines for hirsutism estimation should be adhered to by the examiner.

The association of testosterone with sarcopenia and frailty in chronic liver disease.

Testosterone is an important anabolic hormone responsible for maintaining body composition and muscle mass and circulates mostly albumin-bound, or sex hormone binding globulin (SHBG)-bound or free in the plasma. Of these fractions, the latter is bioactive and exerts the androgenic effects on male population. Liver cirrhosis, the advanced stage of any chronic liver disease characterized by permanent distortions to the hepatic architecture, disrupts the hypothalamic-pituitary-gonadal axis, leading to diminished levels of free testosterone and hypogonadism. We retrieved the PubMed database to provide a synopsis of testosterone's physiology and action and summarize the effect of sarcopenia in pre-cirrhotic and cirrhotic patients. Moreover, we scoped to provide insight into the relationship of testosterone levels with sarcopenia, frailty and survival in cirrhotic and non-cirrhotic population as well as to discuss the efficacy of exogenous testosterone supplementation on the anthropometric parameters and survival of those patients. Low testosterone levels have been associated with sarcopenia, reduced body lean mass, decreased bone mineral density and frailty, thus leading to increased morbidity and mortality especially among cirrhotic patients. Furthermore, exogenous testosterone administration significantly ameliorated body composition on patients with chronic hepatic disease, without significant adverse effects. However, the current literature does not suggest any significant effect on survival of those patients. Moreover, the long-term safety of testosterone use remains an open question. Low serum testosterone is strongly correlated with sarcopenia, frailty, higher rate of hepatic decompensation and mortality. Nonetheless, exogenous supplementation of testosterone did not ameliorate the liver-related outcomes and complications.

Comparison of different drug for reducing testosterone levels in women with polycystic ovary syndrome: A systematic review and network meta-analysis.

The optimal drug for treatment with polycystic ovary syndrome (PCOS) was in debate. We did this network meta-analysis to assess the efficacy and safety of different drugs for reducing testosterone levels in women with PCOS. We searched studies from inception until January 10, 2023, through PubMed, Embase, and Cochrane Library database. All studies comparing different drugs for reducing testosterone levels in women with polycystic ovary syndrome were included in this network meta-analysis. Outcomes were total testosterone levels, free testosterone levels, and withdraw due to adverse events. We calculated the surface under the cumulative ranking curve (SUCRA) for each treatment. Finally, a total of 13 studies were finally included in this network meta-analysis. In head-to-head comparison, atorvastatin (WMD -3.1, 95% CrI: -3.7 to -2.5), metformin (WMD -2.6, 95% CrI: -3.5 to -1.6), metformin + simvastatin (WMD -2.8, 95% CrI: -4.1 to -1.5), simvastatin (WMD -2.7, 95% CrI: -4.2 to -1.3), spironolactone (WMD -3.1, 95% CrI: -4.3 to -1.9), spironolactone + metformin (WMD -3.2, 95% CrI: -4.5 to -2.0) were all more effective than the placebo, and the difference was statistically significant (P < .05). The SUCRA shows that spironolactone + metformin ranked first (SUCRA, 85.0%), Atorvastatin ranked second (SUCRA, 77.7%), Spironolactone ranked third (SUCRA, 77.2%), and metformin + simvastatin ranked the fourth. The SUCRA of different drugs for free testosterone levels shows that atorvastatin ranked first (SUCRA, 75.0%), spironolactone + metformin ranked second (SUCRA, 5.3%), metformin + simvastain ranked third (SUCRA, 62.6%), and spironolactone ranked the fourth (SUCRA, 56.4%). No statistically significant differences were found between the 2 treatment groups for withdrawn due to adverse events (P > .05). Considering the network meta-analysis and rankings, atorvastatin was recommended to be the optimal drug for treatment PCOS. However, the optimal dose of atorvastatin was unknown and should be verified by more randomized controlled trials.

SAT384 Is This A Case of Androgen-Secreting Endometrial Cancer in A Postmenopausal Woman?

Abstract Disclosure: V. Taqi: None. P. rimal: None. J.L. Gilden: None. Background: Hirsutism (HIR) is a common disorder of women of reproductive age, often due to polycystic ovary syndrome (PCOS). During post menopause (PM), there is usually diminishment of androgenizing hormone levels and symptoms associated with PCOS. However, rapidly progressive HIR and symptoms of virilization in PM women should always raise the question of androgen-secreting tumors, whether of ovarian or adrenal origin. Other rare causes include ovarian hyperthecosis and Leydig cell hyperplasia. We present a rare case of hyperandrogenism with endometrial carcinoma, associated with increasing hirsutism and normal ovarian imaging and pathology. Clinical case: A 56-year-old woman G3P3 PM for 2 yrs, with Type 2 Diabetes, obesity, HTN, hypercholesterolemia, IBS, Factor S Leiden, menarche at age 12-13 yrs, and PCOS s/p laser HIR removal, and previous regular menses, was referred to endocrine clinic for increasing HIR with diffuse hair loss for 6 months and suprapubic/abdominal discomfort. She also had prior corneal melanoma treated with radiation and cardiac ablation for arrhythmia. Her paternal grandmother had uterine cancer. Physical Exam: VS BP=121/78; HR=66; BMI=31 Kg/m²: (Ferriman-Gallwey score 16/36) with HIR on face, abdomen, chest and back, but no other virilization or cushingoid signs. Initial labs: elevated total and free testosterone (59 ng/dl, n&amp;lt;45), (9.3 pg/ml, n&amp;lt;6.4) respectively, unconjugated DHEA (55 ng/dL, n 77-85) low DHEA-S (29 mcg/dl, n 35- 430 mcg/dl) 17-OHP (50 ng/dL, repeat 44 (n≤ 45) with normal prolactin (5.4 ng/mL, n 0.7-31.6) ACTH (7 pg/mL, n 0-47), salivary cortisol &amp;lt;0.03 mcg/dL, FSH (50.3 mIU/mL ;n=5.9-72.8), LH (29.7 mIU/ml, n 1.1-52.4), estradiol (21.71 pg/mL (n &amp;lt;11-32.2). CT abdomen-hepatic steatosis, normal adrenals. US- heterogenous mass uterine fundus 1.1 x 1.0 x 1.0 cm with subendometrial calcifications, subcm follicles in ovaries. MRI-hypoechoic 0.7X0.8X0.7 cm uterine lesion, normal ovaries; Endometrial biopsy-disordered proliferative endometrium. Hysteroscopy with biopsy confirmed grade I endometrial adenocarcinoma. A total laparoscopic abdominal hysterectomy with bilateral oophorectomy (TAH/BSO) was performed. Pathology-endometrial carcinoma, endometroid type F1GO stage 1A with positive estrogen and progesterone receptors, normal ovaries. By 3 months postop, the HIR significantly decreased with normalized total and free testosterone levels (14 ng/dl), (1.8 pg/ml). Conclusion: This is a rare case of hyperandrogenism associated with endometrial cancer in a postmenopausal woman causing hirsutism with the resolution of symptoms and normalization of androgen levels following TAH/BSO. Clinicians should be aware to thoroughly evaluate postmenopausal women who develop sudden increasing signs of androgenization, particularly if it is of recent onset, and consider other rare diagnoses. Presentation Date: Saturday, June 17, 2023

FRI430 A Case Of Elevated Sex Hormone-binding Globulin Secondary To Variegate Porphyria In A Patient With Hypogonadotropic Hypogonadism

Abstract Disclosure: J. Law: None. C. Yip: Research Investigator; Self; Eli Lilly &amp; Company. Background: Acute porphyria is a group of disorders characterized by enzymatic defects in the heme biosynthetic pathway. The liver is the source of both acute intermittent porphyria (AIP) and variegate porphyria. AIP is known to cause an elevation in sex hormone-binding globulin (SHBG) levels, likely secondary to impaired hepatic function and hepatocyte abnormalities1. We describe a case of elevated SHBG secondary to variegate porphyria, in a male with hypogonadotropic hypogonadism. Case Report: A 44-year-old male presented with an elevated SHBG and symptoms of hypogonadism with low libido, weakness, and fatigue. Fasting morning bloodwork revealed an elevated SHBG at 89 nmol/l (13.5- 71.0), a normal total testosterone level at 12.95 nmol/l (8-32), and a low bioavailable testosterone at 0.82 nmol/l (2.5-10), with confirmatory repeat blood work. His history was significant for longstanding variegate porphyria, manifesting as frequent attacks of abdominal pain. He was on opioids for greater then 10 years for his chronic pain, as well as metoclopramide. On assessment of causes for his elevated SHBG, his TSH was normal at 1.49 mIU/L (0.35-4.30). He did not have cirrhosis, hepatitis, hereditary hemochromatosis, and was not on anticonvulsants. No other cause was found, and his elevated SHBG was deemed secondary to his variegate porphyria. His normal total testosterone level was due to his elevated SHBG, but as mentioned, his bioavailable testosterone was low. His LH and FSH were both inappropriately normal, with his LH being 4.67 IU/L (0.6-12.0) and his FSH 4.7 IU/L (1.0-12.0), in keeping with hypogonadotropic hypogonadism. He went through normal pubertal development and had no anosmia. Workup revealed an elevated prolactin level of 73.8 ug/l (3.5-19.4). He had no galactorrhea or gynecomastia and an MRI sella revealed a normal pituitary gland. His elevated prolactin level was determined to be secondary to his opioid medication and/or metoclopramide use. His hypogonadotropic hypogonadism was deemed secondary to his opioid medications and/or hyperprolactinemia. Conclusion: This case demonstrated variegate porphyria as a likely cause of elevated SHBG, similar to AIP. In patients with variegate porphyria and symptoms of hypogonadism, the SHBG should be measured and if it is elevated, the bioavailable or free testosterone levels should be used in assess instead of relying on the total testosterone levels. As has been previously shown, this case also illustrated the use of opioid medications as a cause of hypogonadotropic hypogonadism.