Andropause Research Articles

Hypogonadotropic hypogonadism as a cause of NOA and its treatment.

Hypogonadotropic hypogonadism (HH) represents a relatively rare cause of nonobstructive azoospermia (NOA), but its knowledge is crucial for the clinical andrologists, as it represents a condition that can be corrected with medical therapy in 3 quarters of cases. There are forms of congenital HH, whether or not associated with an absent sense of smell (anosmic HH or Kallmann syndrome, and normosmic HH, respectively), and forms of acquired HH. In congenital HH, complete absence of pubertal development is characteristic. On the other hand, if the deficit occurs after the time of pubertal development, as in acquired HH patients, infertility and typical symptoms of late-onset hypogonadism are the main reasons for seeking medical assistance. Gonadotropin-releasing hormone (GnRH) or gonadotropin replacement therapy is the mainstay of drug therapy and offers excellent results, although a small but significant proportion of patients do not achieve sufficient responses.

Anogenital distance and the risk of Late-onset hypogonadism

Objective: to investigate the association between anogenital distance (AGD) and the risk of Late-onset Hypogonadism (LOH). Methods: We prospectively recruited 145 consecutive patients referred for transrectal prostate biopsy due to prostate-specific antigen (PSA) elevation or abnormal digital rectal examination, between September 2019 and December 2021. Two variants of AGD, anus to scrotum base (AGDas) and anus to dorsal insertion of penis (AGDap) were measured. Serum total testosterone levels in fasting conditions between 07.00 and 11.00 h were determined. Patients filled out the Aging Males’ Symptoms (AMS) scale questionnaire. Results: LOH was diagnosed in 29% of the participants and presented both AGDs shorter than men without LOH, with an AGDap of 116.09 mm (9.02 mm) versus 128.71 (10.76), and an AGDas 29.70 (8.01) versus 39.93 (11.64); both p < 0.05. ANCOVA test showed a significant association between the presence of LOH and both AGD measurements. Besides, AGD measurements presented adequate accuracy for the diagnosis of LOH. Conclusions: This work adds to the scientific evidence that AGD—a biomarker of fetal exposure—could provide a non-invasive measure to address LOH, providing a potential useful clinical tool.

A PRDM16-driven signal regulates body composition in testosterone-treated hypogonadal men.

Testosterone (T) therapy increases lean mass and reduces total body and truncal fat mass in hypogonadal men. However, the underlying molecular mechanisms for the reciprocal changes in fat and lean mass in humans are not entirely clear. Secondary analysis of specimens obtained from a single-arm, open-label clinical trial on pharmacogenetics of response to T therapy in men with late-onset hypogonadism, conducted between 2011 and 2016 involving 105 men (40-74 years old), who were given intramuscular T cypionate 200 mg every 2 weeks for 18 months. Subcutaneous fat (SCF), peripheral blood mononuclear cells (PBMC) and serum were obtained from the participants at different time points of the study. We measured transcription factors for adipogenesis and myogenesis in the SCF, and PBMC, respectively, by real-time quantitative PCR at baseline and 6 months. Serum levels of FOLLISTATIN, PAX7, MYOSTATIN, ADIPSIN, and PRDM16 were measured by ELISA. As expected, there was a significant increase in T and estradiol levels after 6 months of T therapy. There was also a reduction in fat mass and an increase in lean mass after 6 months of T therapy. Gene-protein studies showed a significant reduction in the expression of the adipogenic markers PPARγ in SCF and ADIPSIN levels in the serum, together with a concomitant significant increase in the expression of myogenic markers, MYOD in PBMC and PAX7 and FOLLISTATIN levels in the serum after 6 months of T therapy compared to baseline. Interestingly, there was a significant increase in the adipo-myogenic switch, PRDM16, expression in SCF and PBMC, and in circulating protein levels in the serum after 6 months of T therapy, which is likely from increased estradiol. Our study supports that molecular shift from the adipogenic to the myogenic pathway in men with hypogonadism treated with T could be mediated directly or indirectly by enhanced PRDM16 activity, in turn a result from increased estradiol level. This might have led to the reduction in body fat and increase in lean mass commonly seen in hypogonadal men treated with T.

Androgenic condition and statins: contradictions in modern literature

Pathological age-related involution of the male reproductive system is characterized by combined clinical manifestations, which are designated by the terms age-related androgen deficiency syndrome, andropause, and male menopause. In modern foreign literature, the term “late hypogonadism” is more often used; in domestic literature, “age-related androgen deficiency” is utilized. The problem of late hypogonadism has gone beyond the scope of endocrinology and sexopathology. Currently, it has acquired an interdisciplinary character and gained attention from gerontologists, cardiologists, diabetologists, andrologists, and other specialists. The medical and social significance of age-related androgen deficiency syndrome is determined by the fact that it worsens the quality of life and is a risk factor for death, primarily from cardiovascular diseases. The review article presents modern ideas regarding the effect of statins on the androgen status of men with cardiac pathology and hypercholesterolemia.

Testomalacia.

In this communication, we introduce the descriptive diagnostic term 'testomalacia'. Testomalacia may suggest softness of the testes, both anatomic and/or functional, or may suggest malaise or illness related to testosterone secretion/function. While the term is not in vogue as of now, we feel that it describes functional androgen deficiency in an apt manner. Unlike other terms used to describe these symptoms, testomalacia can be used at any age, encompasses several etiologies and is just a single term rather than multiple complicated abbreviations.

Effect of testosterone replacement therapy on lower urinary tract symptoms: A systematic review and network meta-analysis.

In this study, we aimed to perform a network meta-analysis (NMA) to investigate the effects of different testosterone replacement therapy (TRT) administration routes on lower urinary tract symptoms (LUTS) in aging men with late-onset hypogonadism (LOH). A systematic search of PubMed, Embase, The Cochrane Library, CNKI, WanFang Data, and VIP was conducted to identify randomized controlled trials (RCTs) reporting data on International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) level, or prostate volume. NMA was performed, and subgroup analysis was conducted to assess the impact of TRT duration on outcomes. A total of 21 RCTs involving 2453 participants were included. For pairwise meta-analysis, p values for TRT delivered by transdermal, intramuscular, and oral routes were as follows: IPSS: 0.93, 0.20, and 0.76; PSA level: 0.20, 0.27, and 0.98; prostate volume: 0.18, 0.04, and 0.16. There were no significant differences in IPSS, PSA level, or prostate volume between TRT routes. In subgroup analysis, long-term intramuscular TRT significantly decreased IPSS (p=0.03), short-term transdermal TRT increased PSA levels (p<0.001), and short-term intramuscular TRT increased the prostate volume (p=0.04). Other forms of TRT showed no significant change in IPSS, PSA level, and prostate volume compared with the placebo. Indirect comparison of the three administration routes demonstrated no significant differences in IPSS, PSA level, and prostate volume. Nevertheless, surface under the cumulative ranking curve analysis indicated that intramuscular TRT had an 83% probability of being the best method for decreasing IPSS. The results demonstrate that TRT does not worsen LUTS regardless of the administration route. Intramuscular TRT may be the preferred treatment for aging men with LOH and LUTS. Intramuscular TRT may be the preferred treatment for men with LOH and LUTS. Further research is warranted to validate these findings and optimize TRT management strategies.

P-063 Effect of varicocelectomy on serum testosterone levels of hypogonadal men above 40 years of age

Abstract Study question Can varicocelectomy be indicated for the treatment of hypogonadism in men above 40 years of age? Summary answer Varicocelectomy improves serum testosterone (T) levels in men with preoperative hypogonadism. This improvement can be anticipated in men above the age of 40 years. What is known already Varicocele ligation is a common intervention used to restore male fertility potential and enhance conception rates. Few studies reported a favorable effect for varicocelectomy on serum T levels stirring some scientists to indicate treatment for men with late onset hypogonadism. Nonetheless, data is still scarce for such a recommendation highlighting the importance of this work Study design, size, duration The charts of 1696 patients who underwent microsurgical subinguinal varicocelectomy for clinically palpable disease between 2011-2023 were retrospectively reviewed. Patients with available pre- and post-operative serum hormone levels were included in the study while those receiving any form of androgen replacement or induction treatment or with known secondary causes of hypogonadism were excluded. Participants/materials, setting, methods Medical charts were reviewed to collect demographic and clinical data. Patients were classified into 2 groups according to preoperative T levels: hypogonadism group (serum T &amp;lt; 10.4 nmol/L) (n = 226) and eugonadal group (serum T ≥ 10.4 nmol/L) (n = 1469). The hypogonadism group was subclassified according to age into less (n = 161) or ≥ (n=66) 40 years of age. Changes in hormone levels were analyzed using Wilcoxon Signed Ranked. A p value &amp;lt;0.05 was considered significant. Main results and the role of chance The patients mean age was 33.6 ± 8.5 years. Their mean BMI was 27.2 ± 5.8 Kg/m2, mean left testis size was 13.4 ± 3.5 cm3 and right testis size 14.4 ± 4.5 cm3. The maximum left and right vein diameters was 3.9 ± 1.3 mm and 2.46 ± 0.73 mm. Unilateral and bilateral microsurgical varicocelectomy were performed in 82% and 18% of cases, respectively. Post-operatively, no significant changes were observed in hormone levels in comparison to preoperative values in the eugonadal group. However, patients with preoperative hypogonadism had significant increase in serum T (7.7±2.2 vs 11.7±6.6, p &amp;lt; 0.001) and E2 (72.5±31.3 vs 94.8±42, p &amp;lt; 0.001) levels following the intervention. These significant improvements were observed in both men &amp;lt; 40 years of age (p &amp;lt; 0.001 for both T and E2) and ≥ 40 years of age (T: p = 0.027, E2: p = 0.024). Limitations, reasons for caution Results were obtained from a retrospective chart review. The majority of these patients performed surgery for fertility reasons and data regarding hypogonadism symptoms is lacking. Wider implications of the findings Results of this study further confirm that an increase in serum testosterone is likely to be anticipated in patients undergoing varicocelectomy who have low serum testosterone levels pre-operatively Trial registration number not applicable

O-263 The risk of hypogonadism after microdissection testicular sperm extraction (micro TESE) in non-obstructive azoospermia (NOA) patients with various etiologies

Abstract Study question What is the risk factor of hypogonadism after micro TESE in NOA patients? Summary answer Klinefelter syndrome (KS), past history of cryptorchidism, preoperative testicular volume &amp;lt;8 ml or testosterone &amp;lt;287 ng/dL are significant risk factors of hypogonadism after micro TESE. What is known already Micro TESE combined with intracytoplasmic sperm injection (ICSI) is currently standard procedure to treat infertility in cases of NOA. Although many studies have reported the effectiveness of the treatment concerning about sperm retrieval rates (SRR) and the live birth rates, data on safety, especially on the risk of hypogonadism, are limited. Most previous studies, including our past study, regarding the risk of hypogonadism after TESE have been limited to relatively few in number of patients and the investigations only of the changes of mean serum testosterone levels. Study design, size, duration This study retrospectively investigated 535 NOA patients including 336 cases of unexplained NOA, 91 KS, 16 other chromosomal abnormalities, 31 azoospermia factor (AZF)c deletions, 31 past history of cryptorchidism, and 30 post anticancer chemotherapy, who had undergone micro TESE at our institution from September 2013 to August 2018. All of them had been examined serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels before and at least once in 1-3 months after micro TESE. Participants/materials, setting, methods In this study, hypogonadism was defined as total testosterone &amp;lt;250 ng/dL, which is established by the Japanese Society of Men’s Health as diagnostic criteria for late onset hypogonadism syndrome, and/or starting testosterone replacement therapy (TRT). We assessed risk factors of hypogonadism after micro TESE using indicators such as age, preoperative testicular volume and testosterone levels, past medical history, unilateral or bilateral, first time or not micro TESE. Main results and the role of chance In total of 535 men, FSH and LH after micro TESE significantly increased vs baseline (26.2 vs 29.9 IU/L, 9.6 vs 12.8 IU/L, respectively). On the other hand, testosterone levels significantly decreased after surgery (351.2 vs 297.5 ng/dL). Although postoperative hypogonadism was found in 42% (227/535), many of whom were cases of KS or preoperative testosterone levels &amp;lt;250 ng/dL. Sixteen men with KS, 3 men with unexplained NOA, and 2 men with past history of cryptorchidism started TRT because they complained clinical symptoms after micro TESE. Of the 21 men who started TRT, only 5 had new-onset low testosterone levels after micro TESE. According to the assessment of any association of various indicators and low postoperative total testosterone levels using multiple logistic regression analysis, significant risk factors of hypogonadism early after micro TESE were cases of KS (OR 11.4, 95% CI 4.4-29.9), preoperative testosterone levels &amp;lt;287 ng/dL (OR 7.5, 95% CI 4.7-12.0), preoperative testicular volume &amp;lt;8 ml (OR 3.9, 95% CI 2.3-6.4), past history of cryptorchidism (OR 2.9, 95% CI 1.1-7.8). Limitations, reasons for caution Most examinations of postoperative hormone levels were performed in short-term period after micro TESE, so we could only assess the risk of postoperative hypogonadism in a short time course in this cohort study. Wider implications of the findings The strength of the current study is that the risk factors of hypogonadism after micro TESE was assessed in a large population of NOA men with various etiologies. The results of this study provide useful clinical information about the risk of postoperative hypogonadism for NOA patients considering micro TESE. Trial registration number not applicable

MicroRNA-361-5p Alleviates Leydig Cell Apoptosis and Promotes Cell Growth by Targeting PIAS1 in Late-Onset Hypogonadism

MicroRNA-361-5p Alleviates Leydig Cell Apoptosis and Promotes Cell Growth by Targeting PIAS1 in Late-Onset Hypogonadism

Prevention of Male Late-Onset Hypogonadism by Natural Polyphenolic Antioxidants.

Androgen production primarily occurs in Leydig cells located in the interstitial compartment of the testis. In aging males, testosterone is crucial for maintaining muscle mass and strength, bone density, sexual function, metabolic health, energy levels, cognitive function, as well as overall well-being. As men age, testosterone production by Leydig cells of the testes begins to decline at a rate of approximately 1% per year starting from their 30s. This review highlights recent findings concerning the use of natural polyphenolics compounds, such as flavonoids, resveratrol, and phenolic acids, to enhance testosterone production, thereby preventing age-related degenerative conditions associated with testosterone insufficiency. Interestingly, most of the natural polyphenolic antioxidants having beneficial effects on testosterone production tend to enhance the expression of the steroidogenic acute regulatory protein (Star) gene in Leydig cells. The STAR protein facilitates the entry of the steroid precursor cholesterol inside mitochondria, a rate-limiting step for androgen biosynthesis. Natural polyphenolic compounds can also improve the activities of steroidogenic enzymes, hypothalamus-pituitary gland axis signaling, and testosterone bioavailability. Thus, many polyphenolic compounds such as luteolin, quercetin, resveratrol, ferulic acid phenethyl ester or gigantol may be promising in delaying the initiation of late-onset hypogonadism accompanying aging in males.

Association of salivary testosterone levels during the post-awakening period with age and symptoms suggestive of late-onset hypogonadism in men

Background The lack of association between serum testosterone levels and symptoms suggestive of hypogonadism is a significant barrier in the determination of late-onset hypogonadism (LOH) in men. This study explored whether testosterone levels increase after morning awakening, likewise the cortisol awakening response (CAR) in the hypothalamic–pituitary–adrenal (HPA) axis, and whether testosterone levels during the post-awakening period are associated with age and symptoms suggestive of late-onset hypogonadism (LOH) in men. Methods Testosterone and cortisol levels were determined in saliva samples collected immediately upon awakening and 30 and 60 min after awakening, and scores of the Aging Males’ Symptoms (AMS) questionnaire were obtained from 225 healthy adult men. Results A typical CAR (an increase in cortisol level ≥ 2.5 nmol/L above individual baseline) was observed in 155 participants (the subgroup exhibiting typical CAR). In the subgroup exhibiting CAR, testosterone levels sharply increased during the post-awakening period, showing a significant negative correlation with age, total AMS score, and the scores of 11 items on the somatic, psychological, and sexual AMS subscales. Of these items, three sexual items (AMS items #15–17) were correlated with age. Meanwhile, there was no notable increase in testosterone levels and no significant correlation of testosterone levels with age and AMS score in the subgroup exhibiting no typical CAR (n = 70). Conclusions The results indicate that the hypothalamus-pituitary-gonad (HPG) axis responds to morning awakening, and determining testosterone levels during the post-awakening period in men with typical CAR may be useful for assessing HPG axis function and LOH.

Epidemiological investigation of sex hormones and their metabolism-related gene single nucleotide polymorphisms (SNPs) in patients with benign prostatic hyperplasia complicated with late-onset hypogonadism: A retrospective cohort study

Background: Benign prostatic hyperplasia (BPH) is a common disease in middle-aged and elderly men, and its etiology is not completely clear. Late-onset hypogonadism (LOH) is a relatively common disease in the aging process of men. BPH is often accompanied by varying degrees of LOH, and the pathogenesis and progression of the two diseases are related. Sex hormone metabolism-related genes affect sex hormone metabolism, to determine androgen, estrogen, androgen/estrogen ratio, and their single nucleotide polymorphisms (SNPs) are common in the population. The relationship between BPH combined with LOH (LOH-BPH) and SNPs in genes related to sex hormone metabolism is still unclear. In this study, we hope to clarify the relationship between them through epidemiological investigation. Objective: To investigate the association between LOH-BPH and SNPs of sex hormone metabolism-related genes. Materials and Methods: A total of 821 middle-aged and elderly men from January 1, 2017, to December 31, 2022, were retrospectively analyzed. According to the diagnosis of LOH-BPH, the patients were divided into LOH-BPH group and non-LOH-BPH group, and the related parameters of the two groups were compared. The parameters included age, total testosterone (tT), estradiol (E2), testosterone/estradiol ratio (T/E), dihydrotestosterone (DHT), sex hormone-binding globulin (SHBG), parameters associated with metabolic syndrome, parameters related to BPH, the International Index of Erectile Function 5 (IIEF-5) and erectile dysfunction (ED), and SNPs of genes related to sex hormone metabolism. Results: 68 participants were excluded from this study, and 753 eventually completed the study. ED accounted for 48.21%, LOH-BPH accounted for 41.30%, and non-LOH-BPH accounted for 58.70%. tT decreased with age and was negatively correlated with age (r=−0.68, P&lt;0.0001). E2 increased with age and was positively correlated with age (r=0.61, P=0.032). T/E decreased with age and was negatively correlated with age (r=−0.71, P&lt;0.0001). After adjusting for age, LOH-BPH is significantly correlated with tT (r=−0.754, OR=0.071, 95% CI: 0.0048-0.105, P&lt;0.0001), E2 (r=0.765, OR=3.855, 95% CI: 1.828-5.833, P&lt;0.0001), T/E (r=−0.751, OR=0.000, 95% CI: 0.000-0.000, P&lt;0.0001) and ED (r=0.973, OR=5.02, 95% CI: 4.898-6.578, P=0.001). At the same time, the AA genotype of rs1843090 (r=−0.613, OR=0.052, 95% CI: 0.006-0.44, P=0.007), the CC genotype of rs2279357 (r=0.636, OR=20.963, 95% CI: 2.268-93.793, P=0.004), the GG genotype of rs743572 (r=0.681, OR=7.642, 95% CI: 5.005-11.668, P&lt;0.0001), the AA genotype of rs712221 (r=−0.012, OR=0.468, 95% CI: 0.220-0.881, P=0.018), and the TT genotype of rs700518 (r=0.699, OR=26.04, 95% CI: 16.142-42.008, P&lt;0.0001) were significantly associated with LOH-BPH. Conclusions: The morbidity of LOH-BPH can be associated with SNPs of genes related to sex hormone metabolism.

Physical exercise as a sustainability tool in men affected with metabolic syndrome-related late-onset central hypogonadism: role of endocrine-metabolic and neurovegetative outcomes

Physical exercise as a sustainability tool in men affected with metabolic syndrome-related late-onset central hypogonadism: role of endocrine-metabolic and neurovegetative outcomes

Testosterone Therapy for Late-Onset Hypogonadism: A Clinical, Biological, and Analytical Approach Using Compounded Testosterone 0.5-20% Topical Gels.

Testosterone is integral to men's sexual and overall health, but there is a gradual decline in the ageing male. The topical administration of testosterone is a valuable option as a supplement (replacement) therapy to alleviate hypogonadal symptoms. The clinical efficacy of a compounded testosterone 5% topical gel was assessed retrospectively in a male patient in his seventies by evaluating the laboratory testing of the serum total testosterone and the results of a validated androgen deficiency questionnaire. After treatment, the patient's hypogonadal symptoms improved and the serum total testosterone level achieved was considered clinically optimal. The skin permeation of the testosterone topical gel (biological testing) was evaluated in vitro using the Franz finite dose model and human cadaver skin, and it is shown that testosterone can penetrate into and through ex vivo human skin. Testosterone therapy is often prescribed for extended periods, and consequently, it is crucial to determine the beyond-use date of the compounded formulations. The analytical testing involved a valid, stability-indicating assay method for compounded testosterone 0.5% and 20% topical gels. This multidisciplinary study shows evidence supporting topically applied testosterone's clinical efficacy and the compounded formulations' extended stability. Personalized, topical testosterone therapy is a promising alternative in current therapeutics for hypogonadal patients.

Gonadal efficacy of Thymus quinquecostatus Celakovski: Regulation of testosterone levels in aging mouse models

Late-onset hypogonadism (LOH) is an age-related disease in men characterized by decreased testosterone levels with symptoms such as decreased libido, erectile dysfunction, and depression. Thymus quinquecostatus Celakovski (TQC) is a plant used as a volatile oil in traditional medicine, and its bioactive compounds have anti-inflammatory potential. Based on this knowledge, the present study aimed to investigate the effects of TQC extract (TE) on LOH in TM3 Leydig cells and in an in vivo aging mouse model. The aqueous extract of T. quinquecostatus Celakovski (12.5, 25, and 50 µg/mL concentrations) was used to measure parameters such as cell viability, testosterone level, body weight, and gene expression, via in vivo studies. Interestingly, TE increased testosterone levels in TM3 cells in a dose-dependent manner without affecting cell viability. Furthermore, TE significantly increased the expression of genes involved in the cytochrome P450 family (Cyp11a1, Cyp17a1, Cyp19a1, and Srd5a2), which regulate testosterone biosynthesis. In aging mouse models, TE increased testosterone levels without affecting body weight and testicular tissue weight tissue of an aging animal group. In addition, the high-dose TE-treated group (50 mg/kg) showed significantly increased expression of the cytochrome p450 enzymes, similar to the in vitro results. Furthermore, HPLC-MS analysis confirmed the presence of caffeic acid and rosmarinic acid as bioactive compounds in TE. Thus, the results obtained in the present study confirmed that TQC and its bioactive compounds can be used for LOH treatment to enhance testosterone production.

Sertoli cell lysosomes and late-onset hypogonadism.

Sertoli cell lysosomes and late-onset hypogonadism.

Targeting dysregulated phago-/auto-lysosomes in Sertoli cells to ameliorate late-onset hypogonadism.

Age-related changes in testicular function can impact health and well-being. The mechanisms underlying age-related testicular dysfunction, such as late-onset hypogonadism (LOH), remain incompletely understood. Using single-cell RNA sequencing on human testes with LOH, we delineated Sertoli cells (SCs) as pivotal metabolic coordinators within the testicular microenvironment. In particular, lysosomal acidity probing revealed compromised degradative capacity in aged SCs, hindering autophagy and phagocytic flux. Consequently, SCs accumulated metabolites, including cholesterol, and have increased inflammatory gene expression; thus, we termed these cells as phago-/auto-lysosomal deregulated SCs. Exposure to a high-fat diet-induced phago-/auto-lysosomal dysregulated-like SCs, recapitulating LOH features in mice. Notably, efferent ductular injection and systemic TRPML1 agonist administration restored lysosomal function, normalizing testosterone deficiency and associated abnormalities in high-fat diet-induced LOH mice. Our findings underscore the central role of SCs in testis aging, presenting a promising therapeutic avenue for LOH.

Association between Smoking and Symptoms of Late-Onset Hypogonadism in Korean Men

Association between Smoking and Symptoms of Late-Onset Hypogonadism in Korean Men

(192) Evaluating Effect of hCG and hCG+rFSH Therapy on Ejaculation Disorders in Middle-Aged Men: A Case Study

Abstract Introduction The prevalence of various ejaculation disorders affecting middle-aged and older men has gained increasing attention due to their significant impact on quality of life. One of them, Late-Onset Hypogonadism (LOH) syndrome, can result in a decline in overall well-being. Testosterone replacement therapy (TRT) is commonly used to address LOH; however, it presents challenges such as diminishing endogenous testosterone secretion and incomplete symptom relief. Objective This study aimed to investigate the effects of human chorionic gonadotropin (hCG) or hCG plus recombinant follicle-stimulating hormone (rFSH) therapy in patients experiencing ejaculation disorders characterized by low semen volume and decreased pleasure during ejaculation. Methods Four male patients, aged 55 to 59 years, complaining of decreased ejaculatory pleasure and low semen volume, were enrolled in the study. One patient received hCG+rFSH therapy, while three patients received hCG alone. The initial dose of hCG was 5,000 units administered twice a week, and if deemed insufficient, it was increased to three times a week. rFSH was administered at a dosage of 150 units three times a week. Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol (E2) were measured monthly. Anastrozole (1 mg) was added for patients exhibiting elevated E2 levels. Results Case 1: A 58-year-old male. Prior to treatment, testosterone and E2 levels were 4.84 ng/mL and 34.2 pg/mL, respectively. hCG+rFSH therapy resulted in increased testosterone levels (10.2 ng/mL) and elevated E2 levels (109.0 pg/mL) after three months of treatment. Addition of anastrozole resulted in testosterone levels of 10.90 ng/mL and E2 levels of 57.9 pg/mL in the following month. The patient experienced improved sexual desire, increased semen volume, and hair loss as a side effect. Treatment was discontinued after six months. Case 2: A 57-year-old male with diabetes mellitus. Pre-treatment testosterone and E2 levels were 2.19 ng-mL and 21.9 pg/mL, respectively. After changing the hCG dosage to 5,000 units three times a week, testosterone levels reached 5.33 ng/mL and E2 levels increased to 72.8 pg/mL after two months. With the addition of anastrozole four months into treatment, E2 levels were 44.4 pg/mL after five months. The patient reported improved morning erections, increased libido, increased semen volume, and improved glycemic control (HbA1c decreased from 9.0 to 7.0). Case 3: A 55-year-old male. Pre-treatment testosterone and E2 levels were 4.99 ng/mL and 32.3 pg/mL, respectively. In the first month of hCG therapy, testosterone levels increased to 13.6 ng/mL, while E2 levels rose to 75.5 pg/mL. Then, despite testosterone remaining in the 9.0–10.0 ng/mL range, E2 levels increased to 100 pg/mL. With the addition of anastrozole in the fifth month, the patient reported increased semen volume thereafter. Case 4: A 59-year-old male with a history of bipolar disorder. Prior to treatment, testosterone and E2 levels were 2.45 ng/mL and 23.0 pg/mL, respectively. hCG therapy resulted in testosterone levels of 6.71 ng/ml and E2 levels of 51.0 pg/mL after two months. Conclusions This case study highlights the outcomes of hCG or hCG+rFSH therapy in middle-aged men experiencing ejaculation disorders. Disclosure No.

Male Menopause: Concept Challenges and Coping Strategies

Men’s health is globally in crisis and worsening due to limited healthcare policies, and under-developed societal awareness and education. Men frequently realize reproductive health services as being meant for females because of this they do not see a place for themselves in those services. Male menopause, or more accurately, testosterone deficiency syndrome (TDS) is one of the new issues which can affect the quality of life in older men. It is a natural phenomenon that occurs with age in men and is diagnosed by clinical manifestation and a decrease in serum testosterone levels; it affects the performance of many systems of the body from the head to toe. Moreover, age-related comorbid diseases such as diabetes, heart disease, renal disease, obesity, metabolic syndrome, and some medications such as glucocorticoids, cigarettes and alcohol also contribute to the decline in testosterone levels. There are numerous challenges faced by men in Africa during the climacteric period and they are accentuated by several intermediating factors which range from ignorance, to cultural taboos and even lack of adequate facilities to cater for their health needs. If these middle-aged men continue to experience the challenges of male menopause without effective coping strategies, their quality of life is at stake. This paper therefore stresses challenges of male menopause and recommends lifestyle changes, healthy emotion focused coping strategies and other relaxation techniques to improve the quality of life of elderly men experiencing male menopause.