Hypogonadal Patients Research Articles

Fluid intelligence, traits of personality and personality disorders in a cohort of adult KS patients with the classic 47, XXY karyotype.

Klinefelter's syndrome (KS) is associated with specific neurobehavioral features and personality traits. The aim of our study was to investigate fluid intelligence, personality traits and personality disorders (PD) and possible correlations with testosterone in a cohort of adult KS patients. We analyzed 58 adult KS patients with the classic 47, XXY karyotype. The Structured Clinical Interview for axis II disorders was used to assess DSM IV personality disorders. Personality traits were assessed using MMPI-2. Fluid intelligence was tested by using Raven's Standard Progressive Matrices (SPM) Test. Testosterone blood concentration was measured by CMIA. PD prevalence was 31%. Four altered MMPI scales (Social Responsibility, Dominance, Ego Strength and Repression) were found in more than 40% of patients. Overcontrolled hostility and MacAndrew Alcoholism Scale-Revised scales were altered in the PD- group only. Biz-Odd Thinking and Post-Traumatic Stress Disorder scale were associated with the presence of personality disorder. The raw SPM score was 44±10.8 without any significant correlation with testosterone. No significant difference in mean age, SPM raw score and MMPI score was observed between eugonadal, hypogonadal and treated patients. Most KS patients had average fluid intelligence. PD prevalence was higher than in the general population. Testosterone was not correlated with fluid intelligence, personality traits or PD, but a reduction in marital distress was observed in treated patients. This could suggest that testosterone therapy can improve physical symptoms and this effect could also improve relationship abilities and wellness awareness.

Influence of vitamin D levels on the cardiovascular profile of hypogonadal men.

A large body of evidence suggests a role for vitamin D in conditioning cardiovascular risk. Therefore, it can be hypothesized that vitamin D might also play a role in influencing the metabolic profile of hypogonadal men. In this work, we aimed at evaluating if any relationship exists between vitamin D levels and cardiovascular parameters in male hypogonadism. Hypogonadal patients attending our andrology unit were retrospectively reviewed. Clinical and biochemical parameters were evaluated. 103 patients were studied (51 non-diabetic and 52 diabetic subjects). Mean age of the whole sample was 65years (standard error of the mean: 0.62). Significant correlations of age, total testosterone, parathyroid hormone (PTH), calcemia, and 25-OH vitamin D with the metabolic profile were found. In logistic regression models including age, total testosterone, PTH, calcemia and 25-OH vitamin D as independent variables, lower levels of 25-OH vitamin D were associated with high values of body mass index (BMI) [odds ratio (OR) 0.910, p 0.019], insulin (OR 0.918, p 0.034), homeostatic model assessment (HOMA) index (OR 0.918, p 0.030), total cholesterol (OR 0.819, p<0.001), triglycerides (OR 0.820, p<0.001), and low-density lipoprotein cholesterol (OR 0.923, p 0.034). In non-diabetic subjects, lower levels of 25-OH vitamin D were associated with high values of BMI, insulin, HOMA, triglycerides, systolic, and diastolic blood pressure. On the other hand, in diabetic subjects, lower levels of 25-OH vitamin D were associated with high values of total cholesterol and triglycerides. Our work shows the influence of vitamin D on cardiovascular profile in male hypogonadism. This effect seems to be more relevant in non-diabetic subjects. If these data were to be confirmed, vitamin D assessment might become mandatory in the clinical evaluation of cardiovascular profile in male hypogonadism.

MP36-03 LOW TESTOSTERONE LEVELS PREDISPOSE TO URETHRAL ATROPHY DUE TO DECREASED URETHRAL VASCULARITY VIA AN ANDROGEN RECEPTOR-MEDIATED PROCESS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2017MP36-03 LOW TESTOSTERONE LEVELS PREDISPOSE TO URETHRAL ATROPHY DUE TO DECREASED URETHRAL VASCULARITY VIA AN ANDROGEN RECEPTOR-MEDIATED PROCESS Matthias D Hofer, Payal Kapur, Billy H Cordon, Farrah Hamoun, David Russell, Jeremy M Scott, Claus G Roehrborn, and Allen F Morey Matthias D HoferMatthias D Hofer More articles by this author , Payal KapurPayal Kapur More articles by this author , Billy H CordonBilly H Cordon More articles by this author , Farrah HamounFarrah Hamoun More articles by this author , David RussellDavid Russell More articles by this author , Jeremy M ScottJeremy M Scott More articles by this author , Claus G RoehrbornClaus G Roehrborn More articles by this author , and Allen F MoreyAllen F Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1114AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We recently identified that hypogonadism predisposes to artificial urinary sphincter (AUS) erosion. The aim of this study was to compare histologic features of human periurethral tissue among eugonadal and hypogonadal patients in order to identify pathologic mechanisms for this predisposition. METHODS Among a cohort of over 1200 men having urethroplasty at our institution, we retrospectively identified 11 patients who had serum testosterone levels drawn within 2 years of surgery and who had tissue samples available. Low serum testosterone was defined as <280 ng/dl. Tissue samples were analyzed by immunohistochemistry to determine expression of androgen receptor (AR), TIE-2 (a downstream target of activated AR linking it to angiogenesis), and CD31 (to highlight vessels). Microscopic images were objectively evaluated for protein expression and vessel counts using Image J software. RESULTS We found a significant decrease of AR expression (1.11%HPF vs. 1.62, p=0.016), TIE-2 expression (1.84%HPF vs. 3.08, p=0.006), and vessel counts (44.47 vessels/HPF vs. 98.33, p=0.004) in men with low serum testosterone. Expression levels of AR and TIE-2 were directly correlated to serum testosterone levels (rho 0.685, p=0.029, and rho 0.773, p=0.005, respectively). We did not find a difference in age, prior radiation, co-morbidities such as coronary artery disease or hypertension among patients with normal or low testosterone levels with the exception of higher body mass index in patients with low testosterone levels. CONCLUSIONS Men with low serum testosterone levels demonstrate decreased expression of AR and TIE-2 and lower vessel count in periurethral tissues. Our results provide a rationale for a mechanistic relationship between low testosterone levels and subsequent decreased periurethral vascularity. We believe that this results in urethral atrophy conferring a higher risk of AUS erosion. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e466-e467 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Matthias D Hofer More articles by this author Payal Kapur More articles by this author Billy H Cordon More articles by this author Farrah Hamoun More articles by this author David Russell More articles by this author Jeremy M Scott More articles by this author Claus G Roehrborn More articles by this author Allen F Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD33-10 PREOPERATIVE SEX HORMONES PROFILES AND PATHOLOGICAL FEATURES OF LOCALIZED PROSTATE CANCER ARE RELATED TO BOTH TOTAL AND BIOAVAILABLE TESTOSTERONE

You have accessJournal of UrologyProstate Cancer: Basic Research & Pathophysiology I1 Apr 2017PD33-10 PREOPERATIVE SEX HORMONES PROFILES AND PATHOLOGICAL FEATURES OF LOCALIZED PROSTATE CANCER ARE RELATED TO BOTH TOTAL AND BIOAVAILABLE TESTOSTERONE Henry Botto, Yann Neuzillet, Marc Schneider, Morgan Rouprêt, Sarah Drouin, Marc Galiano, Xavier Cathelineau, Vincent Molinié, Camelia Radulescu, Eva Comperat, Frank Giton, Jean Fiet, Thierry Lebret, and Jean-Pierre Raynaud Henry BottoHenry Botto More articles by this author , Yann NeuzilletYann Neuzillet More articles by this author , Marc SchneiderMarc Schneider More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , Sarah DrouinSarah Drouin More articles by this author , Marc GalianoMarc Galiano More articles by this author , Xavier CathelineauXavier Cathelineau More articles by this author , Vincent MoliniéVincent Molinié More articles by this author , Camelia RadulescuCamelia Radulescu More articles by this author , Eva ComperatEva Comperat More articles by this author , Frank GitonFrank Giton More articles by this author , Jean FietJean Fiet More articles by this author , Thierry LebretThierry Lebret More articles by this author , and Jean-Pierre RaynaudJean-Pierre Raynaud More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3324AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In localized prostate cancer (PCa), impact of biochemical hypogonadism on cancer emergence and progression is still controversial. We aim to compare preoperative sex hormones plasma profiles and pathological features in localized PCa patients according to gonadal status assessed by total (TT) and bioavailable (BT). METHODS A new large prospective cohort study of 1125 (age 63.9, height 175 cm, weight 82,2 kg, BMI 26.8 30 kg/m2, waist circumference 101cm) localized PCa patients were recruited in 4 urological centre in France, from 6/2013-6/2016. Metabolic syndrome (MetS) parameters were collected. Assay of TT, BT, DHT, E1, and E2 were performed by GC-MS. A centralized cross- checked review of pathological data (Predominant Gleason pattern 4 (PrdGP4), stage) was done. RESULTS The cohort has been divided in 4 groups; the 1st group consists of patients with T and BT in the normal range (= 3 ng/ml and BT = 0,8 ng/ml), a low T in the 2nd, a low BT in the 3rd and both low T and BT in the 4th. The percentages of PrdGP4 and pT=3a were one-third in the normal gonadal patients going statistically up to one half in the hypogonadal. A 10% weight increase, due to fat, occurred in the low T patients, while no change occurred in the low BT, indicating a dichotomy in the action of T and BT. A dramatic difference in SHBG concentration between low BT and low T concentrations was observed, conferring to SHBG a key role in selecting patients at a high risk of an aggressive PCa. In fact, when considering hypogonadal patients by a threshold of TT= 3 ng/ml only, we miss 90 patients (8%) that had low BT, because of a high SHBG, no Mets but, a high %PrdG4. CONCLUSIONS Thus, a serum low BT delineate a population of aggressive PCa risk more than obesity. Consequently, for treatment decision-making, in addition to TT and obesity, BT should be assessed in the arsenal for the management of localized PCa. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e597 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Henry Botto More articles by this author Yann Neuzillet More articles by this author Marc Schneider More articles by this author Morgan Rouprêt More articles by this author Sarah Drouin More articles by this author Marc Galiano More articles by this author Xavier Cathelineau More articles by this author Vincent Molinié More articles by this author Camelia Radulescu More articles by this author Eva Comperat More articles by this author Frank Giton More articles by this author Jean Fiet More articles by this author Thierry Lebret More articles by this author Jean-Pierre Raynaud More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Testosterone therapy has positive effects on anthropometric measures, metabolic syndrome components (obesity, lipid profile, Diabetes Mellitus control), blood indices, liver enzymes, and prostate health indicators in elderly hypogonadal men.

To alleviate late-onset hypogonadism, testosterone treatment is offered to suitable patients. Although testosterone treatment is commonly given to late-onset hypogonadism patients, there remains uncertainty about the metabolic effects during follow-ups. We assessed the associations between testosterone treatment and wide range of characteristics that included hormonal, anthropometric, biochemical features. Patients received intramuscular 1,000mg testosterone undecanoate for 1year. Patient anthropometric measurements were undertaken at baseline and at each visit, and blood samples were drawn at each visit, prior to the next testosterone undecanoate. Eighty-eight patients (51.1±13.0years) completed the follow-up period. Testosterone treatment was associated with significant increase in serum testosterone levels and significant stepladder decrease in body mass index, total cholesterol, triglycerides and glycated haemoglobin from baseline values among all patients. There was no significant increase in liver enzymes. There was an increase in haemoglobin and haematocrit, as well as in prostate-specific antigen and prostate volume, but no prostate biopsy intervention was needed for study patients during 1-year testosterone treatment follow-up. Testosterone treatment with long-acting testosterone undecanoate improved the constituents of metabolic syndrome and improved glycated haemoglobin in a stepladder fashion, with no adverse effects.

Is there a protective role of testosterone against high-grade prostate cancer? Incidence and severity of prostate cancer in 553 patients undergoing prostate biopsy in a prospective data register.

128 Background: Major concern regarding testosterone therapy (TRT) in middle-aged and elderly men is still prostate safety or cancer Methods: 553 prostate biopsies (2008-2013) were performed at our institute. 22 patients refused biopsy. We investigated incidence and severity of PCa in three groups: hypogonadal (T ≤ 350 ng/dl) men receiving TRT, hypogonadal untreated, and eugonadal men. All groups underwent similar screening intensity of at least once per year. Biopsies were performed when indicated according to EAU guidelines. Results: In 42 hypogonadal men receiving TRT, 7 (16.7%) had a positive biopsy. Of these, 5 had a Gleason score ≤ 6 (71.4%) and 2 subjects a Gleason score &gt; 6 (28.6%). Predominant Gleason score was 3 in all 7 men (100%). Tumor grade was II in 6 (85.7%) and II-III in 1 (14.3%) men. 162 untreated hypogonadal men, 84 (51.9%) had a positive biopsy. Of these, 34 had a Gleason score ≤ 6 (40.5%) and 50 a Gleason score &gt; 6 (59.5%). Predominant Gleason score was 3 in 65 (77.4%), 4 in 17 (20.2%) and 5 in 2 (2.4%) men. Tumor grade was II in 35 (41.7%), II-III in 10 (11.9%), III in 34 (40.5%) and IV in 5 (6.0%) men. In 349 eugonadal men, 132 (37.8%) had a positive biopsy. Of these, 56 had a Gleason score ≤ 6 (42.4%) and 76 a Gleason score &gt; 6 (57.6%). Predominant Gleason score was 3 in 109 (82.6%), 4 in 22 (16.7%) and 5 in 1 (0.1%) men. Tumor grade was II in 59 (44.7%), II-III in 6 (4.5%), III in 63 (47.7%) and IV in 4 (3.0%) men. Conclusions: The incidence of positive prostate biopsies was lowest in hypogonadal men receiving TRT. The severity of PCa – in terms of Staging and Grading - was significantly lower in hypogonadal patients receiving TRT. TRT may protect against high-grade PCa. Protective role of TRT against PCa must be discussed and considered in larger studies.

Testosterone and Gonadotropins in Infertile Men with Sertoli Cell Only Syndrome from Gaza Strip

Aim: To assess serum testosterone and gonadotropins in Sertoli cell only syndrome patients from Gaza Strip.Methods: Based on testicular biopsy, a cross section of 74 Sertoli cell only syndrome patients were enrolled in the study. Age matched 44 fertile men were served as controls. Patients and controls were questioned for their medical history. Blood samples were drawn and serum testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were determined by enzyme-linked immunosorbent assay. Data were computer analyzed using SPSS/PC, version 18.0.Results: Varicocele and hormonal problems were significantly more frequent among patients than controls (P&lt;0.05). Serum testosterone was significantly lower in patients compared to controls (1.7±1.3 versus 5.0±2.2 ng/ml, P=0.000). In contrast, LH and FSH were significantly higher in patients than controls (12.8±9.7 and 20.8±14.8 mlU/ml versus 6.3±3.1 and 7.7±3.9 mlU/ml, P=0.000, respectively). Hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism patients showed lower levels of testosterone compared to the normal reference value (0.9±0.5 and 0.5±0.4 ng/ml versus 2.0-7.0 ng/ml). Higher levels of LH and FSH were recorded in hypergonadotrophic hypogonadism (24.5±2.6 and 37.4±6.7 mlU/ml) compared to the reference values of 2.0-13.0 and 2.5-10.0 mlU/ml, respectively whereas LH and FSH levels were lower in hypogonadotrophic hypogonadism (0.6±0.4 and 0.6±0.5 mlU/ml, respectively). In this context, all hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism patients showed abnormal levels of testosterone, LH and FSH.Conclusions: Abnormal levels of serum testosterone, LH and FSH, particularly in hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism were identified in infertile men with Sertoli cell only syndrome from Gaza Strip.J MEDICINE January 2017; 18 (1) : 21-26

Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis

BackgroundTestosterone deficiency (hypogonadism) is common among men undergoing haemodialysis, but its clinical implications are not well characterized. Testosterone is an anabolic hormone that induces erythrocytosis and muscle synthesis. We hypothesized that testosterone deficiency would be associated with low muscle mass, physical inactivity and higher dosages of erythropoietin-stimulating agents (ESA). MethodsSingle-center cross-sectional study of 57 male haemodialysis patients. None of the patients was undergoing testosterone replacement therapy. Total testosterone was measured in serum. Body composition (by bioelectrical impedance analysis) and physical activity (by the use of pedometers) were assessed. Patients with testosterone levels below the normal range were considered hypogonadal. ResultsMean testosterone level was 321±146ng/dL; 20 patients (35%) were hypogonadal. Hypogonadal patients were older and had lower mean arterial blood pressure, higher interleukin-6 levels, lower lean body mass and higher fat body mass. A negative association between testosterone and normalized ESA dose was found in uni- and multivariate regression analyses. Testosterone levels directly correlated with lean body mass regardless of confounders. Hypogonadal patients had lower physical activity than their counterparts [2753±1784 vs. 4291±3225steps/day (p=0.04)]. The relationship between testosterone and physical activity was independent of age, comorbidities and inflammatory markers, but dependent on the proportion of muscle mass. ConclusionHypogonadism is common in our male haemodialysis population and is associated with higher ESA doses, reduced muscle mass and lower physical activity. The link between low testosterone levels and physical inactivity may conceivably relate to reduced muscle mass due to inadequate muscle protein synthesis.

Occurrence, patterns & predictors of hypogonadism in patients with HIV infection in India.

Background & objectives:Data on hypogonadism among human immunodeficiency virus (HIV)-infected Indians are not available. This study was aimed to evaluate the occurrence, pattern and predictors of hypogonadism in HIV-infected Indians.Methods:Consecutive stable HIV-infected patients, 18-70 yr age, without any severe comorbid state, having at least one year follow up data at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays.Results:From initially screened 527 patients, 359 patients (225 males; 134 females), having disease duration of 61.44±39.42 months, 88.58 per cent on highly active antiretroviral therapy (HAART), 40.67 per cent having tuberculosis history and 89.69 per cent with vitamin D insufficiency were analyzed. Testosterone <300 ng/dl was documented in 39.11 per cent males. Primary, hypogonadotropic hypogonadism (HypoH) and compensated hypogonadism were observed in 7.56, 31.56 and 12.44 per cent males, respectively. Males with hypogonadism were significantly older (P=0.009), and had higher opportunistic infections (P<0.001) with longer disease duration (P=0.05). Menstrual abnormalities were observed in 40.3 per cent females, who were significantly older (P<0.001), had lower CD4 count (P=0.038) and higher tuberculosis history (P=0.005). Nearly 46.3, 16.2 and 13 per cent women with menstrual abnormalities were in peri-/post-menopausal state, premature ovarian insufficiency (POI) and HypoH, respectively. Age, CD4 count at diagnosis and 25(OH)D were best predictors of male hypogonadism. Age and CD4 count increment in first 6-12 months following HAART were the best predictors of POI.Interpretation & conclusions:Hypogonadism was observed to be a significant problem in HIV-infected men and women in India, affecting 39 and 29 per cent patients, respectively. HypoH was the most common form in males whereas ovarian failure being the most common cause in females.

Resolution Of Seasonal Allergies By Testosterone Replacement Therapy In A Hypogonadal Male Patient: A Case Report

ABSTRACT Objective: To describe a case of hypogonadism where testosterone replacement therapy relieved seasonal allergy signs and symptoms, eliminating the need for steroid treatment. Methods: We present the clinical and laboratory findings of a patient with hypogonadism (primary testicular failure) in which seasonal allergy symptoms and signs were resolved by testosterone replacement therapy. The report tries to explain the mechanism by which testosterone treatment in a hypogonadal patient can resolve seasonal allergies. Results: A 50-year-old male patient with past medical history of vitamin D deficiency, hyperlipidemia, and seasonal allergies for 20 years was referred with diagnosis of primary testicular failure. Testosterone replacement therapy with AndroGel normalized his testosterone level and resolved his testicular failure symptoms and, in addition, led to the resolution of his seasonal allergies in a follow-up at 2 years. The authors conjecture that testosterone therapy in this patient contribute...

Assessment of Hypogonadism in Men With Type 2 Diabetes: A Cross-Sectional Study From Saudi Arabia.

BACKGROUND/OBJECTIVESA high incidence of hypogonadism in men with type 2 diabetes (T2D) has been globally reported. This study aimed to determining the frequency of hypogonadism and related risk factors among men with T2D in a single-site hospital in Saudi Arabia.DESIGN AND METHODSA cross-sectional study was performed on 157 men with T2D (between 30 and 70 years of age). Using a prestructured questionnaire, the demographic features of these patients were gathered and their medical records were referred to gather information regarding the duration of the diabetes, smoking habits, and the presence of retinopathy, neuropathy, and nephropathy. Besides these, the biochemical parameters, total testosterone (TT), free testosterone, sex hormone–binding globulin, follicle-stimulating hormone, luteinizing hormone, prolactin, serum lipids, and glycosylated hemoglobin were also recorded. All the patients submitted the fully completed Androgen Deficiency in Aging Male (ADAM) questionnaire. The combination of symptoms (positive ADAM score) plus a TT level ⩽8 nmol/L constituted the condition of hypogonadism.RESULTSThe total frequency of hypogonadism was 22.9% (36/157). Of the 157 total patients, 123 (78.3%) were shown to be ADAM positive, and of these, 90 (73.2%) exhibited decreased libido, 116 (94.3%) had weak erections, and 99 (80.5%) reported more than 3 symptoms of ADAM. Of these hypogonadic patients, 22.2% (n = 8) revealed primary hypogonadism, whereas 77.8% (n = 28) showed secondary hypogonadism. From the univariate analysis conducted, significant relationship was observed between treatment type, body mass index (BMI), and hypogonadism. The regression analysis showed BMI acting an independent risk factor of hypogonadism.CONCLUSIONSSaudi men with T2D revealed a high incidence of hypogonadism. Body mass index was identified as an independent risk factor for hypogonadism.

Clomiphene citrate treatment for late onset hypogonadism: rise and fall.

ABSTRACTObjective:Previous series have demonstrated that Clomiphene Citrate (CC) is an effective treatment to increase Total Testosterone (TT) in Late Onset Hypogonadism (LOH) patients. However, what happens to TT levels after ending CC treatment is still debatable. The objective of this study is to evaluate TT levels 3 months after the discontinuation of CC in patients with LOH who were previously successfully treated with the same drug.Materials and Methods:Twenty-seven patients with LOH that were successfully treated (achieved TT levels >11nmol/l) with CC 50mgs daily for 50 days were prospectively recruited in our Andrological outpatient clinic. CC was then stopped for 3 months and TT levels were measured at the end of this period.Results:Mean TT level before discontinuation of CC was 22.7±8.1nmol/L (mean±SD). Three months after discontinuation, mean TT level significantly decreased in all patients, 10.2±3.9nmol/l (p<0.01). Twenty-one patients (78%) decreased TT levels under 11nmol/L. Six patients (22%) had TT levels that remained within the normal recommended range (≥11nmol/l). No statistical significant differences were observed between both groups.Conclusion:In the short term LOH does not seem to be a reversible condition in most patients after CC treatment. More studies with longer follow-up are needed to evaluate the kinetics of TT in LOH.

Bulbocavernosus muscle area as a novel marker for hypogonadism

ObjectiveLate-onset hypogonadism, or androgen deficiency in the aging male, is a significant cause of morbidity in older men. Many men in the low normal or equivocal range for low testosterone level exhibit signs and symptoms of hypogonadism. Serum testosterone is an imperfect maker for hypogonadism as symptoms vary greatly within the low to low normal range in addition to variations among testosterone assays. Perineal ultrasound can be effectively used to examine the bulbocavernosus muscle (BCM), an androgenized tissue that may be impacted by androgen receptor activity. MethodsThis study was a retrospective analysis of men who underwent perineal ultrasound for hypogonadism. The ultrasound data were used to calculate the area of the BCM and correlate it with indices of hypogonadismin symptomatic men including free and total testosterone and dual-energy X-ray absorptiometry (DEXA). ResultsThe results demonstrate that there is a significant correlation between total and free testosterone and BCM area in hypogonadal patients. Comparison between BCM area and total testosterone showed R2 = 0.061 and p = 0.0187 and comparison between BCM area and free testosterone showed R2 = 0.0957 and p = 0.0034. In addition, low BCM was also correlated with DEXA results showing osteoporosis and osteopenia (R2 = 0.2239, p = 0.0027). ConclusionThere has been recent controversy over the safety of testosterone replacement therapy. This might be particularly important in men with hypogonadal symptoms but a low normal testosterone level. Our study investigated the use of perineal ultrasound to measure BCM as a surrogate marker for poor androgenized men presenting with hypogonadism.

Hormonal treatment with transdermal testosterone in patients with male accessory gland inflammation (MAGI): Effects on sperm parameters.

Recently, it has been reported that treatment with testosterone (T) could have favourable effects on prostate inflammation; however, the data appear inconsistent. The main evidences concern experimental studies, and there is lower information obtainable from clinical studies. This study was conducted on patients with diagnosis of male accessory gland infection (MAGI) and a concomitant hormonal condition of acquired hypergonadotropic hypogonadism and has evaluated the effects on sperm parameters of the administration of a transdermal formulation of T gel for 3months. The treated patients showed a significantly increased percentage of spermatozoa with normal form and progressive motility (p<.05 vs baseline), a significant reduction of CD45pos leucocytes in the semen (p<.05 vs baseline) and finally a significant increase of the seminal concentrations of zinc, fructose and alpha-glucosidase (p<.05 vs baseline) identified as key parameters associated to secretory function of the male accessory glands. The results of this study suggest the use of transdermal T in hypogonadal patients with MAGI for favourable effects on sperm parameters.

Testosterone (T) Nasal Gel (Natesto™) Improves Erectile Function and Mood in Hypogonadal Men

Introduction: Natesto™ testosterone (T) gel is an approved testosterone replacement therapy (TRT). It is applied in a few seconds with no hand contact, so transference is highly unlikely. Natesto™ restored normal serum T levels and demonstrated statistical improvement in erectile function and mood in hypogonadal patients in the pivotal phase 3 study.

Kisspeptin levels in idiopathic hypogonadotropic hypogonadism diagnosed male patients and its relation with glucose-insulin dynamic

Male hypogonadism is defined as the deficiency of testosterone or sperm production synthesized by testicles or the deficiency of both. The reasons for hypogonadism may be primary, meaning testicular or secondary, meaning hypothalamohypophyseal. In hypogonadotropic hypogonadism (HH), there is indeficiency in gonadotropic hormones due to hypothalamic or hypophyseal reasons. Gonadotropin-releasing hormone (GnRH) is an important stimulant in releasing follicular stimulant hormone (FSH), mainly luteinizing hormone (LH). GnRH omitted is under the effect of many hormonal or stimulating factors. Kisspeptin is present in many places of the body, mostly in hypothalamic anteroventral periventricular nucleus and arcuate nucleus. Kisspeptin has a suppressor effect on the metastasis of many tumors such as breast cancer and malign melanoma metastases, and is called “metastin” for this reason. Kisspeptin is a strong stimulant of GnRH. In idiopathic hypogonadotropic hypogonadism (IHH) etiology, there is gonadotropic hormone release indeficiency which cannot be clearly described.A total of 30 male hypogonatropic hypogonadism diagnosed patients over 30 years of age who have applied to Haydarpasa Education Hospital Endocrinology and Metabolic Diseases Service were included in the study. Compared to the control group, the effect of kisspeptin on male patients with hypogonatropic hypogonadism and on insulin resistance developing in hypogonadism patients was investigated in our study.A statistically significant difference was detected between average kisspeptin measurements of the groups (p < 0.01). Kisspeptin measurement of the cases in the patient group were detected significantly high. No statistically significant relation was detected among kisspeptin and LH/FSH levels. Although a positive low relation was detected between kisspeptin measurements of patient group cases and homeostasis model assessment of insulin resistance (HOMA-IR) measurements, this relation was statistically insignificant. When the patient and control groups were compared for HOMA-IR, no statistically significant difference was detected.The reason for high kisspeptin levels in the patient group compared to the control group makes us consider that there may be a GPR54 resistance or GnRH neuronal transfer pathway defect. When patients and control groups were compared for HOMA-IR, the difference was not statistically significant. It is considered that kisspeptin is one of the reasons for hypogonatropic hypogonadism and has less effect on insulin resistance.

Testosterone to estradiol ratio correlates with sperm concentration improvement in hypogonadal oligozoosermic patients treated with anastrozole

Testosterone to estradiol ratio correlates with sperm concentration improvement in hypogonadal oligozoosermic patients treated with anastrozole

Mesenchymal stem cells from human umbilical cord ameliorate testicular dysfunction in a male rat hypogonadism model.

Androgen deficiency is a physical disorder that not only affects adults but can also jeopardize children's health. Because there are many disadvantages to using traditional androgen replacement therapy, we have herein attempted to explore the use of human umbilical cord mesenchymal stem cells for the treatment of androgen deficiency. We transplanted CM-Dil-labeled human umbilical cord mesenchymal stem cells into the testes of an ethane dimethanesulfonate (EDS)-induced male rat hypogonadism model. Twenty-one days after transplantation, we found that blood testosterone levels in the therapy group were higher than that of the control group (P = 0.037), and using immunohistochemistry and flow cytometry, we observed that some of the CM-Dil-labeled cells expressed Leydig cell markers for cytochrome P450, family 11, subfamily A, polypeptide 1, and 3-β-hydroxysteroid dehydrogenase. We then recovered these cells and observed that they were still able to proliferate in vitro. The present study shows that mesenchymal stem cells from human umbilical cord may constitute a promising therapeutic modality for the treatment of male hypogonadism patients.

Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis

BackgroundTestosterone deficiency (hypogonadism) is common among men undergoing haemodialysis, but its clinical implications are not well characterized. Testosterone is an anabolic hormone that induces erythrocytosis and muscle synthesis. We hypothesized that testosterone deficiency would be associated with low muscle mass, physical inactivity and higher dosages of erythropoietin-stimulating agents (ESA). MethodsSingle-center cross-sectional study of 57 male haemodialysis patients. None of the patients was undergoing testosterone replacement therapy. Total testosterone was measured in serum. Body composition (by bioelectrical impedance analysis) and physical activity (by the use of pedometers) were assessed. Patients with testosterone levels below the normal range were considered hypogonadal. ResultsMean testosterone level was 321±146ng/dL; 20 patients (35%) were hypogonadal. Hypogonadal patients were older and had lower mean arterial blood pressure, higher interleukin-6 levels, lower lean body mass and higher fat body mass. A negative association between testosterone and normalized ESA dose was found in uni- and multivariate regression analyses. Testosterone levels directly correlated with lean body mass regardless of confounders. Hypogonadal patients had lower physical activity than their counterparts [2753±1784 vs. 4291±3225steps/day (p=0.04)]. The relationship between testosterone and physical activity was independent of age, comorbidities and inflammatory markers, but dependent on the proportion of muscle mass. ConclusionHypogonadism is common in our male haemodialysis population and is associated with higher ESA doses, reduced muscle mass and lower physical activity. The link between low testosterone levels and physical inactivity may conceivably relate to reduced muscle mass due to inadequate muscle protein synthesis.

The Role of Somatic Symptoms in Sexual Medicine: Somatization as Important Contextual Factor in Male Sexual Dysfunction

IntroductionAn important feature of somatic symptom disorder is the subjective perception of the physical symptoms and its maladaptive interpretation. Considering that psychological distress is often expressed through somatic symptoms, it is possible that they underlie at least a part of the symptoms in subjects complaining of sexual dysfunction. Nevertheless, studies on the impact of somatoform disorders in sexual dysfunction are scanty. AimTo define the psychological, relational, and organic correlates of somatic symptoms in a large sample of patients complaining of sexual problems. MethodsA consecutive series of 2833 men (mean age 50.2 ± 13.5 years) was retrospectively studied. Main Outcome MeasuresSomatic symptoms were assessed using the “somatized anxiety symptoms” subscale of the Middlesex Hospital Questionnaire (MHQ-S). Several clinical, biochemical, psychological, and relational parameters were studied. Patients were interviewed with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). ResultsAmong the 2833 patients studied, subjects scoring higher on somatic symptoms were older, more obese, reporting unhealthy lifestyle (current smoking, alcohol consumption), and a lower education (all P < .05). Moreover, they reported a general impairment of their sexuality more often, including erectile problems (spontaneous or sexual-related), low sexual desire, decreased frequency of intercourse, and perceived reduction of ejaculate volume (all P < .005). Interestingly, we observed a significant association between MHQ-S scoring with a reduced testosterone level and hypogonadism symptoms (both P < .05). Finally, we found a significant association between somatic symptoms and both SIEDY Scales 1 (organic domain of ED) and 3 (intrapsychic domain of ED) (both P < .0001). ConclusionThe present study demonstrates that the presence of somatic symptoms can represent an important contextual factor in the determination of or in the exacerbation of male sexual dysfunction. High levels of somatic symptoms in subjects with sexual dysfunction can be related to the sexual symptom itself. The consequences of this pattern have great clinical relevance in a sexual medicine setting, considering their severe impact on sexuality.