Higher Serum Total Testosterone Research Articles

Preoperative high serum total testosterone levels predict preserved postoperative sexual function in patients after nerve‐sparing robot‐assisted radical prostatectomy

Preoperative high serum total testosterone levels predict preserved postoperative sexual function in patients after nerve‐sparing robot‐assisted radical prostatectomy

Dietary fat quality and serum androgen concentrations in middle-aged men

Background/ObjectivesAverage testosterone concentrations in men have declined over the last few decades. The reasons for this are not fully known, but changes in dietary fat quality have been suggested to have a role. This study aimed to investigate the associations of different dietary fatty acids with serum androgen concentrations.Subjects/MethodsA total of 2546 men with a mean age of 53 from the Kuopio Ischaemic Heart Disease Risk Factor Study were included in this cross-sectional study. Associations between dietary saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA) and trans (TFA) fatty acids and concentrations of serum total and free testosterone and steroid hormone binding globulin (SHBG) were analyzed with analysis of covariance and linear regression analysis. Associations of isocaloric replacement of nutrients and androgen concentrations were analyzed with multivariate nutrient-density models.ResultsAfter adjustment for age, examination year and energy intake, higher SFA intake was associated with higher serum total and free testosterone and SHBG concentrations, and higher PUFA intake with lower concentrations. However, the associations were attenuated and not statistically significant after further adjustments for potential confounders. MUFA and TFA intakes were not associated with androgen concentrations. In isocaloric substitution models, replacing dietary protein with SFA was associated with higher serum total testosterone and SHBG concentrations. After excluding men with history of CVD or diabetes (n = 1021), no statistically significant associations were found.ConclusionsDietary fat quality was not independently associated with serum androgen concentrations in middle-aged men. However, replacing protein with SFA may be associated with higher serum androgen concentrations.

Clinical and Hormonal Profile of Polycystic Ovary Syndrome Phenotypes

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous androgen-excess disorder with varying degrees of reproductive and metabolic abnormalities, whose diagnosis is based on anthropometric, biochemical, and radiological abnormalities. This study was conducted to observe the frequency of different phenotypes of PCOS and to observe the pattern of clinical profile and hormonal changes among them. Methods: This cross-sectional observational study was conducted at the Endocrinology and Obstetrics and Gynecology Outpatient Department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders over the period of 13 months, dated from April 2016 to April 2017. Eighty patients clinically diagnosed as a case of PCOS were included in this study as per inclusion and exclusion criteria. Patients were categorized into four different phenotypes based on the presence of oligo-anovulation (O), hyperandrogenism (H), and polycystic ovarian morphology (P): (i) Phenotype A (O + H + P), (ii) Phenotype B (O + H), (iii) Phenotype C (H + P), and (iv) Phenotype D (O + P). Demographic, clinical, anthropometric, and hormonal profiles were recorded and compared among phenotypes of PCOS by ANOVA and Chi-square test. Results: Most prevalent phenotype in the study population was Phenotype A (55%), followed by Phenotype D (22.5%), Phenotype B (15%), and Phenotype C (7.5%). Hirsutism, acne, acanthosis nigricans, and family history of diabetes mellitus were more common in Phenotype A and Phenotype B than in Phenotype C and Phenotype D (P < 0.001, P = 0.029, P = 0.008, and P = 0.048, respectively). Relatively, higher body mass index, waist circumference, and waist–hip ratio were found in Phenotypes A and B than in other phenotypes (P < 0.001, P < 0.001, and P < 0.001, respectively). Phenotypes A and B had higher serum total testosterone, luteinizing hormone (LH), free androgen index, and lower sex hormone-binding globulin than other phenotypes (P = 0.003, P = 0.007, P = 0.001, and P < 0.001, respectively). Follicle-stimulating hormone (FSH), LH/FSH ratio, prolactin, and thyroid-stimulating hormone were comparable in all phenotypes (P 0.445, 0.204, 0.748, and 0.811, respectively). Conclusions: The PCOS in certain subgroups such as Phenotypes A and B had higher hyperandrogenism and was associated with adverse anthropometric and clinical parameters. Clinical and hormonal findings are different in different phenotypes.

Rare virilizing tumor: ovarian steroid cell tumor, not otherwise specified: a case report

BackgroundOvarian steroid cell tumors, not otherwise specified is a rare sex cord-stromal tumor. Almost 60% of all steroid cell tumors are categorized as not otherwise specified and represent less than 0.1% of all ovarian neoplasm. Some of them are endocrinologically active, producing virilization signs in young women. The recommended treatment is primarily surgical.Case presentationWe present the case of a 20-year-old Mexican woman with secondary amenorrhea and virilization signs. She was treated with combined oral contraceptives from 13 years old, due to a misdiagnosis of polycystic ovarian syndrome. However, 4 months after stopping medication, amenorrhea and virilization signs worsened. Biochemically, she had high serum total testosterone and free testosterone levels, and a pelvic and transvaginal ultrasound followed by a pelvic tomography scan demonstrated a right adnexal tumor. She underwent right salpingo-oophorectomy and the histopathological and immunochemistry exams confirmed the diagnosis. The patient was followed for a year after surgery and until then, her menses were regular and she had no recurrence of virilization signs. ConclusionThe purpose of this case report is to alert physicians to rule out ovarian steroid cell tumor, not otherwise specified diagnosis in young women with increased testosterone after discarding common causes such as polycystic ovarian syndrome. A multidisciplinary team including a gynecologist, endocrinologist, radiologist, and pathologist should be involved for correct diagnosis at the proper time.

False high testosterone of unknown reason in a clinically inconspicuous female

Abstract Background This report investigates an unusual total testosterone result in a middle-aged female. Case presentation A 40-year-old female patient was found to have high serum total testosterone of 30.82 nmol/L on a Beckman Coulter UniCel® DxI800 automatic chemiluminescence immunoanalyzer without appropriate clinical appearance. Heterophile antibody interference was considered for elevated testosterone and investigated; reanalysis of the original serum sample and liquid chromatography with tandem mass spectrometry (LC-MS/MS) were performed. Reanalysis of the original serum sample using Roche® and Siemens® immunoassays both gave a normal total testosterone level. Beckman Coulter® also excluded the possibility of interference by heterophile antibodies. Finally, LC-MS/MS showed that the total testosterone level was in the normal range. Conclusions This report highlights the importance of ruling out the interfering factors for false high values of the analyte in laboratories.

False high testosterone of unknown reason in a clinically inconspicuous female

Abstract Background This report investigates an unusual total testosterone result in a middle-aged female. Case presentation A 40-year-old female patient was found to have high serum total testosterone of 30.82 nmol/L on a Beckman Coulter UniCel® DxI800 automatic chemiluminescence immunoanalyzer without appropriate clinical appearance. Heterophile antibody interference was considered for elevated testosterone and investigated; reanalysis of the original serum sample and liquid chromatography with tandem mass spectrometry (LC-MS/MS) were performed. Reanalysis of the original serum sample using Roche® and Siemens® immunoassays both gave a normal total testosterone level. Beckman Coulter® also excluded the possibility of interference by heterophile antibodies. Finally, LC-MS/MS showed that the total testosterone level was in the normal range. Conclusions This report highlights the importance of ruling out the interfering factors for false high values of the analyte in laboratories.

Testosterone, obesity, and waist circumference as determinants of metabolic syndrome in Saudi women.

BackgroundHigh serum total testosterone is associated with metabolic syndrome (MS). This study aimed to identify possible alterations in total testosterone and their relationship with plasma glucose, blood pressure, and serum lipid profile.MethodsOne hundred forty-two female subjects were selected to participate in this study, and they were recruited by consultant physicians from the Clinic and Medical Out-Patient, King Abdulaziz Hospital, Kingdom of Saudi Arabia. The anthropometric characteristics were obtained from questionnaires by using standard methods. Blood samples were obtained for the determination of glucose, triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein by using enzymatic methods. Total testosterone was determined by enzyme-linked immunosorbent assay for the quantitative measurement of testosterone in human serum.ResultsSignificantly higher concentrations of total testosterone, low-density lipoprotein, and glucose, but lower concentrations of high-density lipoprotein, were observed in subjects with MS compared with women without MS (P<0.05).ConclusionThis study suggests that high levels of total testosterone and disturbance in lipid profile were associated with MS in Saudi women.

Effect of exposure to second-hand smoke from husbands on biochemical hyperandrogenism, metabolic syndrome and conception rates in women with polycystic ovary syndrome undergoing ovulation induction.

Does second-hand smoke (SHS) exposure from husbands have adverse effects on sex hormones, metabolic profiles, clinical phenotypes and fertility outcomes in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction? SHS exposure is associated with worsened biochemical hyperandrogenism, higher incidence of metabolic syndrome and reduced conception rates in women with PCOS. Smoking in women impairs fecundity at some stages of the reproductive process including folliculogenesis, embryo transport, endometrial angiogenesis and uterine blood flow. Yet little is known about the hazard of SHS exposure in women with PCOS. This study was a secondary analysis of the Polycystic Ovary Syndrome Acupuncture and Clomiphene Trial (PCOSAct), a large randomized controlled trial conducted at 27 hospitals from 2012 to 2015 in mainland China. Out of 1000 women with PCOS, SHS exposure status were available in 500 women, of whom 271 women were non-exposed and 229 exposed to cigarette smoke (170 women ≤10 cigarettes per day as low-SHS exposed and 59 women >10 cigarettes per day as high-SHS exposed). We compared circulating sex steroids, glucose and lipid metabolism, metabolic syndrome and phenotypes, fertility and obstetric outcomes between non-exposed and exposed women. Women exposed to SHS, compared to non-exposed women, had a higher serum total testosterone (1.7 vs 1.5 nmol/L, P = 0.01), free androgen index (5.7 vs 4.0, P = 0.001) and lower sex hormone binding globulin (30.1 vs 35.6 nmol/L, P = 0.03). Metabolic syndrome, but not other phenotypes, was more frequent in exposed women as compared to non-exposed women (21.8 vs 13.3%, adjusted odds ratio (OR)=1.66; 95% CI, 1.02-2.71, P = 0.04). Ovulation rates between exposed and non-exposed groups were not significantly different (76.9 vs 82.9%, adjusted OR=0.72; 95% CI, 0.45-1.15, P = 0.17). Conception rates were significant lower in the exposed group (26.6 vs 36.9%; adjusted OR=0.61; 95% CI, 0.41-0.91; P = 0.01), while clinical pregnancy and live birth rates showed a similar trend that was not statistically significant. Gestational age, birth weight and other obstetric outcomes were not affected by SHS exposure. Data on SHS exposure were missing in 50% of the women. We did not assay serum nicotine or cotinine levels to quantify the SHS exposure status. These data suggest that smoking partners of infertile women with PCOS who seek treatment should be advised to quit smoking. Funding was provided by the National Public Welfare Projects for Chinese Medicine (201107005 and 200807002) and the National Clinical Trial Base in Chinese Medicine Special Projects (JDZX2012036 and 2015B009). There are no conflicts of interest. ClinicalTrial.gov number: NCT01573858 and chictr.org.cn number: ChiCTR-TRC-12002081.

Both High and Low Serum Total Testosterone Levels Indicate Poor Prognosis in Patients with Prostate Cancer.

Androgen-androgen receptor (AR) signal is known as a powerful driver of prostate cancer progression. We previously reported the limitation of prostate-specific antigen (PSA) at diagnosis as a prognostic biomarker of prostate cancer. Although serum total testosterone (TT) level has been reported as a prognostic biomarker for prostate cancer, its usability is still controversial. We examined the potential and characteristics of TT as a biomarker. Serum TT levels of patients who underwent prostate biopsy were measured, and prostate cancer-specific survival (PCaSS), overall survival (OS), and the correlation between staging and serum TT level were analyzed. Of 379 biopsied patients, 255 were diagnosed with prostate cancer. The patients were divided into five groups according to their serum TT levels; patients with serum TT levels of <2 or ≥8 ng/ml (ENDs) had worse PCaSS and OS compared with those with middle serum TT levels between 2 and 8 ng/ml (MIDs). Moreover, ENDs showed a tendency of having castration-resistant cancer with advanced stage (T4 or N1 or M1). The TNM stage in ENDs was significantly higher than in MIDs. Although low serum TT level has been reported to indicate worse outcome in patients with prostate cancer, this study showed that both low as well as high serum TT levels indicate poor prognosis.

Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: systematic review and meta-analysis.

Non-alcoholic fatty liver disease (NAFLD) is an insidious pathologic condition that can manifest from simple steatosis to steatohepatitis (NASH) with potential progression to cirrhosis. Like the polycystic ovary syndrome (PCOS), NAFLD is associated with obesity, diabetes mellitus, insulin resistance and metabolic syndrome. PCOS women have an increased risk of NAFLD, but it is debatable which features of PCOS, either specific (androgen excess) or unspecific (metabolic derangements) affect the NAFLD risk. We performed a systematic review and meta-analysis of studies that addressed the association of PCOS and NAFLD. We selected 17 studies published between 2007 and 2017 that included 2734 PCOS patients and 2561 controls of similar age and body mass index (BMI). PCOS patients have increased prevalence of NAFLD (odds ratio 2.54, 95% confidence interval 2.19-2.95). PCOS women with hyperandrogenism (classic phenotype) have a higher prevalence of NAFLD compared to women with PCOS without hyperandrogenism, even after correction for confounding variables. Among women with PCOS, those with NAFLD have higher serum total testosterone (mean difference 0.40 nmol/L, 95% CI 0.29-0.50 nmol/L) and free androgen index (mean difference 4.46, 95% CI 3.53-5.39) than those without NAFLD. The studies that used multivariate analysis controlling for age, BMI, triglycerides, and insulin resistance index confirmed that serum androgens are independent predictors of NAFLD in women with PCOS. The prevalence of NAFLD is increased in women with PCOS and the presence of NAFLD is associated with high serum androgen levels, in addition to obesity and insulin resistance.

Association of sex hormones with risk of coronary heart disease in postmenopausal women of Hans and Uygurs

Objective To explore the association between serum sex hormones and the risk of coronary heart disease (CHD) in postmenopausal women of Hans and Uygurs in Xinjiang.Methods Postmenopausal women were selected during January 2006 to February 2012 from cardiology center of the First Affiliated Hospital of Xinjiang Medical University.They were assigned to Uygur case group (n =138),Uygur control group (n =141),Han case group(n =138),and Han control group (n =151).Blood samples were collected to determine total testosterone,estradiol,aromatase,fasting glucose,and lipid profile.Results Postmenopausal women of Han with CHD had lower estradiol(P＜0.05) and higher total testosterone (P＜0.05) than those in the controls.Multiple Logistic regression revealed that serum estradiol was independent protective factors for CHD (OR =0.94,P ＜ 0.01),and total testosterone were independent influencing factors for CHD (OR =6.43,P＜0.05).Postmenopausal women of Uyghur with CHD had lower estradiol (P＜0.05) and slightly higher serum total testosterone (P＞0.05) than those of control group.After adjusting confounding factors,high level of serum estradiol was an independent protective factor for CHD (OR=0.94,P＜0.01).In quantitatively adjusted models,Q4 vs Q3 in Hans(OR =3.02,95％ CI 1.21-7.52,P＜0.05),Q4 vs Q3 in Uyghurs(OR =2.4,95％ CI 1.04-5.70,P＜0.05) were calculated.Both in Hans and Uyghurs,total testosterone/estradiol ratio in Q4 group was greater than that in other 3 groups (P＜0.05),while aromatase was lowered as compared with other 3 groups(P＜0.05).Conclusion Different levels of serum sex hormone may play an important role in the development of CHD in Uyghur and Han postmenopausal women.And the relationship between ethnic differences may exist.The aromatase activity may reduce the relationship between testosterone and estradiol. Key words: Sex hormone ; Coronary heart disease; Postmenopausal women ; Han ; Uyghur

Precocious puberty due to human chorionic gonadotropin secreting germinoma

This study aims to report a rare case of precocious puberty (PP) due to a human chorionic gonadotropin (hCG)-producing germinoma located in the suprasellar region. A 10-year-old male patient presented with sexual precocity, headache, drowsiness, loss of appetite, and papilledema. Significant acceleration of bone age in relation to chronological age, high serum total testosterone levels, and hypopituitarism (unresponsiveness to stimulation test) were observed. Magnetic resonance imaging (MRI) of the brain showed a large suprasellar tumor and triventricular dilatation. High hCG levels were found in both blood and cerebrospinal fluid. Hormone replacement therapy and transcranial surgery associated with radiotherapy were performed, with complete regression of sexual characteristics and normal laboratory tests post-operatively. Clinical and laboratory findings, in addition to MRI scans, led to the diagnosis of an hCG-producing tumor and PP, which represents a rare report in the literature.

Normal delivery following resection of an androgen-secreting adrenal carcinoma.

A 31-year-old female presented to a gynecological clinic complaining of amenorrhea and virilism over a 2-month period. Blood tests revealed high serum total testosterone and free testosterone levels. A left adrenal tumor was identified following computed tomography and she was referred to our clinic where a laparoscopic left adrenalectomy was performed. The tumor weighed 98 g and the pathological diagnosis according to Weiss' criteria was adrenocortical carcinoma. The post-operative course was uneventful; her serum free testosterone level normalized and regular menstruation was observed 1 month post-operatively. The patient became pregnant 1 year later, resulting in the normal delivery of a girl.

Do differences in age specific androgenic steroid hormone levels account for differing prostate cancer rates between Arabs and Caucasians?

Factors responsible for the low incidence of clinical prostate cancer in the Arab population remain unclear, but may be related to differences in androgenic steroid hormone metabolism between Arabs and other populations, especially as prostate cancer is believed to be androgen dependent. We therefore measured the levels of serum androgenic steroids and their binding proteins in Arab men and compared results obtained with values reported for Caucasian populations to determine if any differences could at least partially account for differences in incidence of prostate cancer rates between the two populations. Venous blood samples were obtained from 327 unselected apparently healthy indigenous Arab men (Kuwaitis and Omanis) aged 15-79 years. Samples were also obtained from 30 Arab men with newly diagnosed prostate cancer. Serum levels of total testosterone (TT), sex hormone binding globulin (SHBG), derived free androgen index (FAI); adrenal C19 -steroids, dehydroepiandrosterone sulfate (DHEAS) and androstenedione (ADT) were determined by chemiluminescent immunoassay. Age specific reference intervals, mean and median for each analyte were determined. Frequency distribution pattern for each hormone was plotted. The reference range for hormones with normal distribution was mean +/- 2SD and 2.5-97.5% for those with non-normal distribution. The mean serum levels of the hormones in Arab men with prostate cancer were compared with values in healthy age-matched Arab men. There was a significant decrease between the 21-29 years age group and the 70-79 years age group for TT (-38.77%), DHEAS (-70%), ADT (-36%) and FAI (-63.25%), and an increase for SHBG (+64%). The calculated reference ranges are TT (2.73-30.45 nmol/L), SHBG (6.45-65.67 nmol/L), FAI (14.51-180.34), DHEAS (0.9-11.0 micromol/L) and ADT (0.54-4.26 ng/mL). The mean TT, SHBG, DHEAS and ADT in Arab men were significantly lower than those reported for Caucasians especially in the 21-29 years age group. Arab men with newly diagnosed prostate cancer had higher serum TT (P < 0.7), ADT (P < 0.2), SHBG (P < 0.2) and lower DHEAS (P < 0.008) compared to aged matched controls. Serum TT, SHBG, DHEAS and ADT levels are significantly lower in Arab men compared to those reported for Caucasian men, especially in early adulthood. Arab men with newly diagnosed prostate cancer have higher circulating androgens compared to healthy controls. We suggest that low circulating androgens and their adrenal precursors in Arab men when compared to Caucasians may partially account for the relatively lower risk for prostate cancer among Arab men.

Prevalence of an immunological LH β‐subunit variant in a UK population of healthy women and women with polycystic ovary syndrome

An immunological LH beta-subunit variant has been described, which is undetectable using monoclonal antibodies directed to the intact LH molecule alone. Subjects have been found homozygous or heterozygous for nucleotide mutations within codons 8 and 15 in the LH beta-subunit gene. The prevalence of the variant LH beta-subunit has been estimated in a healthy UK population of women of reproductive age and in women with polycystic ovary syndrome (PCOS). The relationship of the variant molecule to the clinical and hormonal parameters of the subjects has been evaluated. The control and PCOS subjects were screened for the presence of the mutation by using a ratio of two immunofluorometric assays using monoclonal antibodies (Mab). One assay, not detecting the LH variant, uses a Mab directed to the intact LH molecule and a beta-specific Mab. The other assay, detecting both the variant and wild-type LH, uses two beta-subunit specific Mabs. The mutations in the LH beta-subunit gene were confirmed by restriction fragment length polymorphism. The relationship of the presence of the variant to the clinical and hormonal parameters was assessed by ANOVA. Two hundred and twelve normal ovulatory women, of whom 66 (31%) were obese (body mass index > 25) and 146 (69%) non-obese, and 153 women with PCOS, 115 (75%) obese and 38 (25%) non-obese participated in the study. The variant LH was detected in 31 (15%) controls and 32 (21%) PCOS subjects (P = 0.124) using specific Mab. Obese PCOS had a higher incidence of the heterozygous LH variant compared to obese controls (odds ratio 2.5, P = 0.03), and compared to non-obese PCOS (odds ratio 6.3, P = 0.01). The previously described two mutations in codon 8 and codon 15 were present in all subjects detected to be mutant hetero of homo-zygous by RFLP. There was no relationship between the presence of the variant LH and the clinical and hormonal parameter in the PCOS subjects; however, in the controls the presence of the variant LH was associated with a higher serum total testosterone (P = 0.046), oestradiol (P = 0.03) and SHBG (P = 0.002). The results of this study show that the variant LH beta-subunit is a common polymorphism occurring in 15% of a healthy UK population of women. The prevalence was not higher in women with PCOS, though it was over represented in obese women with PCOS. The presence of the variant did not alter the clinical or hormonal expression of the disorder in women with PCOS. Its presence in the controls was however associated with higher serum oestradiol and probably secondary elevation of SHBG and testosterone, suggesting that the variant form of LH may be associated with subtle changes in the function of the hypothalamic-pituitary-gonadal axis.

Endocrine Features in Eutestosteronemic Women with Polycystic Ovaries

We attempted to assess the association between hyperandrogenemia and inappropriate gonadotropin secretion in women with polycystic ovaries (PCO). Thirty-one patients diagnosed as PCO by ultrasonography were divided into two subgroups: 17 with high serum total testosterone (T) level (> or = 0.5 ng/ml) and 14 with normal serum total T level (< 0.5 ng/ml). Both subgroups presented for the complaints of oligomenorrhea and/or hirsutism. The control group consisted of 15 women with regular ovulation for reference data collection. The PCO subjects with normal T, but not those with high T, revealed remarkable depletion of sex hormone binding globulin (SHBG), as compared with control. The PCO subject groups with high and normal serum T did not differ with respect to estrogen level, androgen level, follicle-stimulating hormone and prolactin levels, and SHBG concentration. Solely serum luteinizing hormone (LH) level was observed to be higher in those with high T, as typical features, than another subgroup or control. These data suggest that an increase in bioactive T as a result of decrease in serum SHBG or LH elevation may contribute to ovarian dysfunction in the patient with PCO.