Mean Total Testosterone Research Articles

Estimation of serum testosterone concentration in type 2 diabetic males

Background: A high incidence of hypogonadism in men with Type 2 Diabetes Mellitus has been globally reported. The present study was aimed at determining the frequency of hypogonadism in T2DM males. Screening and management of hypogonadism in Diabetic males should be done.Methods: In this case control study conducted from January 2018 to August 2019 at SGRDIMSR Sri Amritsar 100 Type 2 Diabetic males were taken as cases. 50 age matched nondiabetic males were taken as controls. Apart from BMI and waist hip ratio routine investigations, HbA1C, serum total and free testosterone levels were done. All the subjects were subjected to ADAM questionnaire to evaluate for hypogonadism.Results: Majority of subjects were in the age of 40-50 years. Mean Serum Total Testosterone levels in Study and Control Groups were 4.94±5.32 nmol/L and 6.63±4.54 nmol/L respectively (p=0.045). Mean Serum Free Testosterone levels in Study and Control Groups were 4.12±3.43 pg/ml and 6.05±3.24 pg/ml respectively (p=0.001). A statistically highly significant negative correlation was found between BMI and Serum Testosterone levels in both groups. Prevalence of hypogonadism (Total Testosterone <4.56 nmol/L) in Study and Control Groups was 73% and 58% respectively. Sensitivity and specificity of ADAM questionnaire was found to be 78.46% and 94.29 % respectively.Conclusions: Prevalence of hypogonadism among T2DM males is high. So, screening for hypogonadism should be done. ADAM questionnaire can be used as a screening tool, results must be confirmed with Serum Total Testosterone levels.

Serum testosterone levels in bipolar and unipolar depressed female patients and the role of medication status

Objective: to compare testosterone levels between female depressed patients and female bipolar patients.Methods: Sixty-one female patients with major depressive disorder (MDD) (n = 23) or bipolar disorder (BD) (n = 38) between 18 and 45 years old were included in the study. Participants were evaluated during a depressive or manic episode with the Hamilton depression rating scale (HDRS) or Young mania rating scale (YMRS), respectively. No patients in the MDD group were taken valproate while in the BD group 14 (36.84%) were taken valproate. Total testosterone (TT) and free testosterone (FT) levels were quantified during the early follicular phase of the cycle, with radioimmunoassay or solid phase enzyme-linked immunoassay. Data were collected from May 2016 to February 2017.Results: Mean TT serum levels were significantly higher in BD patients in comparison to MDD patients. Although age and diagnosis were related to TT levels, however when we added valproate use in the analysis, only the relation between TT and valproate use remained significant.Conclusions: In this sample, TT levels were related to valproate use in patients with BD. More studies regarding the role of testosterone in affective symptoms should be conducted to clarify the relation between testosterone, affective disorders, and medication.KeypointsWe observed that testosterone levels were significant higher in bipolar women compared to women with MDD.The use of valproate could be associated with the testosterone levels in female patients with BD.Evaluation of women suffering BD should include a testosterone levels determination, particularly when they are taking valproate.

Stretched penile length and total serum testosterone in term male neonates

Introductionthe reference values of stretched penile length vary with different ethnic group. There is paucity of data on the reference range of total serum testosterone in neonates especially in Africa. This study therefore was to determine the normal stretched penile length, total serum testosterone levels in term male newborns and to correlate them with anthropometric parameters.Methodsthis was a prospective cross-sectional study. One hundred and twenty-four consecutive healthy term male neonates were recruited in the first 72 hours of postnatal life. The stretched penile length (SPL) was measured with a rigid metric ruler. Weight, length and occipitofrontal circumference were also measured. Total serum testosterone level was determined using Enzyme Linked Immunoassay. Data were analysed using the Statistical Package for Social Sciences for Windows version 20.Resultsa total of 124 term male neonates were recruited. The postnatal age of recruited neonates was one to 70 hours with a mean of 22.8 ± 17.6 hours and the mean of estimated gestation age was 38.5 ± 1.3 weeks. The range of stretched penile length was from 2.1 to 3.9 cm with a mean of 3.2 ± 0.4 cm and SPL less than 2.2 cm was considered as micropenis. The mean total serum testosterone level was 357.4 ± 241.7 ng/dl. The SPL had a positive correlation with the birth weight, length and total serum testosterone. The total serum testosterone and birth length were predictors of stretched penile length.Conclusionamong the studied population the mean stretched penile length was 3.2 cm and mean total serum testosterone was 357.4 ng/dL.

Relationship between Hypogonadal Symptoms, Sexual Dysfunction and Chronic Prostatitis in Middle-Aged Men by Self-Reported Questionnaires, even without Biochemical Testosterone Deficiency.

PurposeTo investigate the association of erectile dysfunction (ED), premature ejaculation (PE), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men with late-onset hypogonadism (LOH).Materials and MethodsWe reviewed the data of 408 enrolled men between January 2014 and January 2019. All participants completed the Androgen Deficiency in the Aging Male (ADAM), international index of erectile function-5 (IIEF-5), National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and premature ejaculation diagnostic tool (PEDT) questionnaires. Participants were divided by ADAM positive (ADAM+: Group 1) and ADAM negative (ADAM−: Group 2).ResultsTotal of 289 subjects were in Group 1 and 119 were in Group 2. The mean age was 53.8±7.8 years. The mean total testosterone was 4.8±1.2 ng/dL and showed no differences between the groups (p=0.839). In Groups 1 and 2, ED (IIEF≤21) was identified in 233 (80.6%) versus 37 (31.1%), respectively (p<0.001). The prevalence of PE (PEDT≥9) was 112 (38.7%) versus 13 (10.9%) in Groups 1 and 2, respectively (p<0.001). However, PE (intravaginal ejaculation latency time<5 minutes) showed no differences between the groups (p=0.863). The incidence of chronic prostatitis (NIH-CPSI pain score≥4) showed significant differences with 49 (17.0%) versus 8 (6.7%) in Groups 1 and 2, respectively (p=0.007). IIEF-5 total score showed the significantly highest negative correlation (r=−0.313, p<0.001).ConclusionsThose who complained of LOH symptoms and positive results in the ADAM questionnaire need to be assessed concurrently with the above questionnaires. This could aid useful to detect of ED, PE, and chronic prostatitis co-occurrence.

Prevalence of low serum testosterone levels among men with type 2 diabetes mellitus attending two outpatient diabetes clinics in KwaZulu-Natal Province, South Africa.

The reported prevalence of low testosterone among men with type 2 diabetes mellitus (T2DM) is high. However, there is a dearth of information on the prevalence of androgen deficiency symptoms and low serum testosterone levels in men with T2DM from sub-Saharan Africa. Scanty data are available from Nigeria, Ghana and South Africa (SA). To determine the prevalence of low serum testosterone and associated risk factors and the prevalence of androgen deficiency symptoms in men with T2DM. In a cross-sectional observational study, androgen deficiency symptoms in men with T2DM attending two outpatient diabetes clinics in Durban, KwaZulu-Natal Province, SA, were assessed using the Ageing Males' Symptoms Scale (AMS) questionnaire and direct enquiry. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), luteinising hormone (LH), fructosamine, serum lipids and glycated haemoglobin (HbA1c) were measured and free testosterone (FT) was calculated. TT, SHBG and FT levels were measured in control subjects with no history of diabetes. There were 148 men with T2DM in the study group and 50 control subjects in the control group. In the study group, the majority were black Africans (58.8%); Indians (39.2%) and whites (2.0%) constituted the remainder. The mean (standard deviation (SD)) age was 57.5 (11.2) years, the mean duration of diabetes 11.4 (8.9) years and the mean HbA1c 8.6% (1.9%). Of the study group, 85.8% had metabolic syndrome. Mean TT, SHBG and FT and median LH (interquartile range) in the study group were within normal ranges. However, mean (SD) serum TT and FT were lower in the study group than in the control subjects (14.5 (5.8) v. 18.8 (7.2) nmol/L; p&lt;0.001 and 265.9 (90.4) v. 351.7 (127.3) pmol/L; p&lt;0.001, respectively). The prevalence of low serum total testosterone (LSTT) and low serum free testosterone (LSFT) in the study group was 35.8% and 16.2%, respectively. The prevalence of androgen deficiency symptoms using the AMS questionnaire was 74.5% and correlated poorly with LSTT or LSFT. In multivariate analysis, LSFT was significantly associated with age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.02 - 1.218; p=0.043) and waist circumference (WC) (OR 1.033, 95% CI 0.999 - 1.068; p=0.059). LSTT was associated with body mass index (BMI) only (OR 1.138, 95% CI 1.063 - 1.218; p&lt;0.0001). TT correlated inversely with BMI, WC and the number of metabolic syndrome criteria. FT correlated inversely with BMI, WC and WHR. There was a high prevalence of LSTT, LSFT and androgen deficiency symptoms in this study. Serum TT and FT were lower in men with T2DM than in control subjects. Risk factors associated with LSFT or LSTT included higher BMI and WC and older age. The AMS score was a poor predictor of low testosterone. More research is required locally before any screening policy can be recommended.

Does anogenital distance change with age?

It was known that in animals, anogenital distance (AGD), an indicator of prenatal androgen environment, was a stabile phenotype that persists throughout life. However, it is not known whether this applies to humans. In this study, we aimed to investigate whether anogenital distance is stable or not in males. We evaluated a total of 130 men targeted for group 1 (fathers) and group 2 (sons) in each 65 participants. AGD, the distance from anus to the posterior base of the scrotum, was measured with digital calipers. Anthropometric characteristics and testosterone levels of groups were recorded. We studied anogenital index (AGI), by dividing AGD by BMI to control bias of the weight and height, which could influence the measurement of AGD. The mean age of fathers was 61.5±10.2 and that of children was 32.1±5.48 (p=.00). The mean AGD scores were 55.46±10.36 vs. 60.21±10.04 (p=.09) and the mean total testosterone levels were 3.6±1.47 vs. 5.45±2.3 (p=.00) in group 1 and 2 respectively. There was no significant difference in height and weight between the two groups. AGD decreases with age, but further longitudinal studies are needed.

Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie’s Disease

IntroductionThere are some data suggesting that there is a relationship between the magnitude of Peyronie’s disease (PD)–associated penile curvature and low serum testosterone. AimTo evaluate the relationship between PD associated penile deformity and total testosterone (TT) and free testosterone (FT) levels. MethodsWe identified patients diagnosed with PD who had early morning TT measurements. Because laboratories have different reference values, we analyzed testosterone values 2 ways, as raw values and as standardized values (TT and FT values converted into z-scores for each laboratory). Deformity assessment was conducted during an intracavernosal injection–induced rigid erection. The association between T levels and magnitude of penile curvature was analyzed in a number of ways. First, an independent measure t-test tested differences in curvature degree by TT groups (low T: <300 ng/dL; normal T: ≥300 ng/dL). Second, an association was sought between T levels based on quartiles of the normal range (<300, 300–450, 450–600, and >600 ng/dL). These analyses were conducted for both TT and FT levels and using both raw and standardized T values. Third, multivariable analysis using multiple linear regression was performed in an attempt to define predictors of the degree of penile curvature. Factors entered into the model included: TT level, FT level, patient age, race (white vs other), number of co-morbidities, body mass index, presence of erectile dysfunction, duration of PD, and prostatectomy (yes vs no). Main Outcome MeasuresThe relationship between T levels and the magnitude of penile curvature. Results184 subjects met all study criteria. Average age was 54 ± 12 years. Mean TT level was 425 ± 176 ng/dL, and mean curvature magnitude was 35° ± 19°. The percent of subjects in the first through fourth TT quartiles was 26%, 34%, 24%, and 16%. As a continuous variable, there was no association between TT levels (r = −0.01, P = .95) or FT levels (r = −0.08, P = .30) and the curvature magnitude. When examining TT groups, there was no difference in mean curvature between the low TT group and the normal TT group (35.4° ± 17° vs 34° ± 20°, P = .70). When analyzing the TT and FT levels standardized into z-scores, there was no association between degree of curvature and TT z-scores (r = −0.003, P = .95) and FT z-scores (r = −0.08, P = .43). There was also no association between testosterone levels and degree of curvature in the multivariable model. ConclusionsThere does not appear to be any association between testosterone levels and the magnitude of PD-associated penile deformity.Mulhall JP, Matsushita K, Nelson CJ. Testosterone Levels Are Not Associated With Magnitude of Deformity in Men With Peyronie’s Disease. J Sex Med 2019;16:1283–1289.

Testosterone levels in men with chronic migraine.

Chronic migraine is a frequent and debilitating condition affecting 14% of the general population. This prospective observational pilot study investigated whether men with chronic migraine have lower than expected total serum testosterone levels. We identified 14 men ages 26-51 at our Institution who fulfilled the ICHD-3b criteria for chronic migraine and obtained serum total testosterone levels. The mean total testosterone level in our 14 patients was 322 ng/dL (range: 120-542 ng/dL) which is in the lower 5% of the reference range for our laboratory (300-1080 ng/dL). Men with chronic migraine had lower total testosterone levels compared to published agematched normative median values by a median difference of 62 ng/dL (P=0.0494). This finding suggests that hypothalamic regulation is altered in patients with chronic migraine. Further studies are warranted to determine whether testosterone supplementation in men with chronic migraine reduces the number of headaches or the associated symptoms of hypogonadism.

Is there a relationship between varicocele and testosterone levels?

Objectives The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood. Methods A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis. Results A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group (p = .91), while free testosterone levels were 69.81 and 73.24 pg/mL (p = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, p < .001) and low free testosterone (OR: 2.01, p = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, p < .001). Conclusions We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.

SUN-228 Opioid Use Is Not Associated with Clinical Hypogonadism in Men with Chronic Non-Cancer Pain

Introduction: Opioid analgesia is widely used in the management of chronic pain despite lacking a strong evidence base of efficacy and concerns about adverse effects. Opioid use has been associated with hypogonadotrophic hypogonadism in a limited number of small chronic pain studies. Aim: To determine the prevalence and degree of hypogonadism in men with chronic non-malignant pain treated with or without opioid analgesia. Method: A cross-sectional study of community dwelling Australian men over the age of 18yrs with chronic non-cancer pain of at least 6 months duration attending a single multidisciplinary pain clinic between February 2016 to August 2017, and who were managed either with or without opioid therapy for a minimum of 6 weeks. Men with known pituitary or testicular causes of hypogonadism, previous or current testosterone use, and men treated with androgen deprivation therapy were excluded. Men completed questionnaires about sexual function (International Index of Erectile Function-5), pain (Brief Pain Inventory (BPI)) and mood (Depression, Anxiety and Stress Scale (DASS21)). Medications, age and BMI were recorded. Blood was obtained to assess serum total testosterone (TT), FSH, LH and prolactin (mean ± SD) between the two groups. TT levels were measured using gold standard liquid chromatography-tandem mass spectrometry. Results: Participants were 50 men treated with oral or transdermal opioids (oral morphine equivalent daily dose (oMEDD) 100 ± 92mg) and 37 men managed without opioids. Age (48.8 ± 11.5 vs 51 ± 16.3 yrs) and BMI (28.7 ± 5.0 vs 27.8 ± 4.5) were similar. Mean serum TT levels were within the normal range for both groups although were lower in the opioid vs non-opioid group (13.3 ± 6.1 vs 15.9 ± 5.5 nmol/L [383 ± 175.6 vs 457.9 ± 158.4 ng/dL], p=0.04). TT was < 8nmol/L [<230 ng/dL] in 9/50 men from the opioid group and 3/37 men from the non-opioid group. TT was negatively correlated with BMI in both groups. There was no difference in the opioid vs non-opioid treated men in serum FSH (6.6 ± 3.5 vs 6.3 ± 3.2 IU/L, p=0.63), LH (4.0 ± 2.2 vs 4.8 ± 1.9 IU/L, p=0.06) or prolactin (193 ± 97 vs 178 ± 98 mIU/L, p=0.48). TT levels did not correlate with oMEDD across the group nor in the subset of men (n=17) on oMEDD > 100mg per day. Sexual function scores were similar between the groups and did not correlate with TT. Men taking opioids reported higher severity and intensity of pain (BPI), and higher anxiety, depression and stress levels (DASS21). Discussion: There was no clinically significant association between opioid use or dose and TT in this cohort of men with chronic non-cancer pain. Previous smaller studies of men with chronic non-cancer pain documenting lower testosterone levels have utilised significantly higher oMEDD suggesting a possible threshold dose effect. Although opioid use may contribute to hypogonadism in some men, this should not preclude endocrine evaluation to identify other causes.

Prevalence of Age-Associated Testosterone Deficiency Syndrome in Indian Population.

Testosterone deficiency syndrome (TDS) is a gradual age-related phenomenon that occurs in a large proportion of the aging male population. This current prospective study was done with the objective to estimate the prevalence of age-associated TDS in India and its clinical profile. A total of 800 male patients aged ≥40 year were approached to participate in the study. A brief history and focused examination was done. Based on our exclusion criteria, 55 patients were excluded. Androgen deficiency in aging male (ADAM) questionnaire was administered to all remaining 745 patients. Out of these 745 patients, ADAM-positive (symptomatic TDS) patients were found to be 359 and enrolled in the study. In all ADAM-positive patients, serum testosterone levels were measured. Prevalence of symptomatic TDS in study population was found to be 48.18%. Mean total and free testosterone level of symptomatic TDS population were 3.287 ± 1.494 ng/ml (1.12–9.61) and 7.476 ± 2.902 pg/ml (2.18–21.76), respectively. Prevalence of biochemically confirmed TDS among symptomatic TDS population was 60.17%. Prevalence of TDS increases progressively with each decade of life (p=0.034). Prevalence was higher in patients with diabetes, hypertension, coronary artery disease, obesity, and metabolic syndrome. TDS is a real phenomenon with a prevalence of 28.99% in our study population.

Association of Waist-Height-Ratio, Waist Circumference, and Body Mass Index with Serum Testosterone Level in Apparently Healthy Men

Previous studies have shown that waist circumference (WC) may be a better predictor of serum testosterone level than body mass index (BMI). The determination of the waist-to-height ratio (WHt ratio) is reported to have certain advantages over other adiposity measures. Our study thus aimed at examining the utility of WHt ratio in addition to WC and BMI in determining their association with testosterone level. The case-control study involved apparently healthy male participants aged between 40 to 60 years. The study participants were divided into normal and abnormal groups according to WC, BMI, WHt ratio with their mean total testosterone level compared. The correlations of total testosterone and adiposity measures along with age adjustments were also determined. Individuals with WC>100cm had a significant low (P=0.003) testosterone level compared to their counterparts with WC<100cm. A significantly lowered (P=0.042) testosterone was observed in the study group with BMI>25kg/m² compared to the group with <25kg/m². The study group with a WHt ratio of >0.5 had a significantly lower (P=0.012) testosterone than the group with <0.5. An inverse correlation of testosterone was observed with age (r=-0.567), BMI (r=-0.265), WC (r=-0.406), and WHt ratio (r=-0.412) in the apparently healthy Men studied. After adjustment for age, the correlation observed between testosterone and BMI (P=0.010), testosterone and WC (P=0.004), testosterone and WHt ratio (P=0.014) remained significant. After height adjustment, the correlation between testosterone and WHt ratio (P=0.002) also remained significant. In conclusion, the WHt ratio and WC independent of age were the best predictors of the total testosterone level in men.

Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial.

Testosterone and its binding protein sex hormone-binding globulin have been associated with cardiovascular disease and dysglycaemia. However, information on the prognostic implication in patients at high cardiovascular risk with dysglycaemia is inconsistent. The study objective was to determine whether testosterone and/or sex hormone-binding globulin predict cardiovascular events or death in dysglycaemic patients. Dysglycaemic males at high cardiovascular risk ( n = 5553) who participated in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial and provided baseline blood samples were studied. Testosterone and sex hormone-binding globulin were measured at baseline and used to estimate free testosterone. Low levels of total and free testosterone were defined as ≤300 ng/dl and ≤7 ng/dl, respectively. Patients were followed for six years for cardiovascular events (defined as the composite of cardiovascular death, non-fatal myocardial infarction or stroke) and all-cause mortality. The mean total and free testosterone levels were 416.6 ng/dl and 8.4 ng/dl, and low levels were present in 13% and 37% of the patients. The median sex hormone-binding globulin level was 35 nmol/l. In Cox regression models adjusted for age, previous diseases and pharmacological treatment, neither total nor free testosterone predicted cardiovascular events. However, a one-standard-deviation increase in sex hormone-binding globulin predicted both cardiovascular events (hazard ratio 1.07; 95% confidence interval 1.00-1.14; p = 0.03) and all-cause mortality (hazard ratio 1.13; 95% confidence interval 1.06-1.21; p < 0.01). Sex hormone-binding globulin, but not total testosterone, predicts cardiovascular disease and all-cause mortality in dysglycaemic males at high cardiovascular risk.

Long-term follow-up of gonadal dysfunction in morbidly obese adolescent boys after bariatric surgery.

Background Elevated body mass index (BMI) is associated with hypogonadism in men but this is not well described in adolescents. The aim is to evaluate gonadal dysfunction and the effects of weight loss after gastric banding in obese adolescent boys. Methods Thirty-seven of 54 boys (age 16.2±1.2 years, mean BMI 48.2 kg/m2) enrolled at the Center for Adolescent Bariatric Surgery at Columbia University Medical Center had low total testosterone for Tanner 5 <350 ng/dL. Sixteen had long-term hormonal data for analysis at baseline (T0), 1 year (T1) and 2 years (T2) post-surgery. T-tests, chi-squared (χ2) tests, correlation and linear mixed models were performed. Results At T0, the hypogonadal group had higher systolic blood pressure (SBP) (75th vs. 57th percentile, p=0.02), fasting insulin (19 vs. 9 μIU/mL, p=0.0008) and homeostatic index of insulin resistance (HOMA-IR) (4.2 vs. 1.9, p=0.009) compared to control group. Total testosterone was negatively correlated with fasting insulin and HOMA-IR. In the long-term analysis, BMI, weight, waist circumference (WC), and % excess weight decreased at T1 and T2 compared to T0. Mean total testosterone at T0, T1 and T2 were 268, 304 and 368 ng/dL, respectively (p=0.07). There was a statistically significant negative correlation between BMI and testosterone after 2 years (r=-0.81, p=0.003). Conclusions Low testosterone levels but unaltered gonadotropins are common in this group and associated with insulin resistance. While a significant increase in testosterone was not found over time, the negative relationship between BMI and testosterone persisted, suggesting there may be an optimal threshold for testosterone production with respect to BMI. Long-term studies are needed.

Free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone.

Erectile dysfunction (ED) due to androgen deficiency is rare in the young population. We retrospectively evaluated in this study men aged 18-40 years presenting with ED from 2015 to 2017. The International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Grade Scores (EHGS) were used to assess erectile function. Total testosterone (TT), sex hormone-binding globulin (SHBG), lipid profile, and glycometabolic indicators were tested in fasting blood sample. TT and SHBG were detected by electrochemiluminescence immunoassay, and free (FT) and bio-available testosterone (BT) were calculated from a validated formula. Linear regression was used to analyze the data. In total, 140 cases (30.56 ± 4.81 years) with a mean TT levels of 6.15 ± 2.17 ng/ml were enrolled. Decreased levels of FT were associated with lower IIEF-5 scores(β = 0.176, P = 0.048) and EHGS (β = 0.198, P = 0.026) after adjustment for age, body mass index (BMI), smoking, comorbidities, high-sensitive C-reactive protein (hsCRP), uric acid, fructosamine, and quantitative insulin sensitivity check index (QUICKI). TT was only associated with EHGS in the crude model (β = 0.177, P = 0.037) and some single factor adjustment models, whereas BT and SHBG were not related with erectile function in any model. Low FT level, even in the presence of normal TT, is associated with ED severity in young men. FT levels should be screened in ED patient even with normal total testosterone.

A 52-Week Study of Dose-Adjusted Subcutaneous Testosterone Enanthate in Oil Self-Administered via Disposable Auto-injector

PurposeThis open-label, single-arm, dose-blinded, 52-week, registration-phase study evaluated the efficacy and safety of subcutaneous testosterone enanthate auto-injector (SCTE-AI) administered weekly to men with hypogonadism. MethodsPatients (N=150) were initiated on 75 mg SCTE-AI self-administered weekly. Dose adjustments were made at week 7 to 50, 75, or 100 mg testosterone enanthate (TE) based on week 6 total testosterone (TT) trough concentration. If required, dose adjustments continued through the extended treatment phase. Pharmacokinetic (PK) and clinical laboratory parameters, treatment-emergent adverse events (TEAEs), and injection site reactions were captured. ResultsThe primary endpoint was met: 92.7% of patients achieved an average TT concentration of 300–1100 ng/dL (553.3 ± 127.29 ng/dL, mean ± SD) at week 12. A Cmax of <1500 ng/dL was achieved by 91.3% of patients, and no patients had levels >1800 ng/dL at week 12. Mean TT Ctrough was 487.2 ± 153.33 ng/dL at week 52. Most patients (>95%) reported no injection-related pain. The most frequently-reported TEAEs were increased hematocrit, hypertension, and increased prostate-specific antigen, which led to discontinuation in 30 men. There were no study drug-related serious AEs. DiscussionDose-adjusted SCTE-AI demonstrated a steady serum TT PK profile, with small peak and trough fluctuations. SCTE-AI was safe, well tolerated, and virtually painless, indicating that SCTE-AI offers a testosterone delivery system that is a convenient weekly option for treatment of testosterone deficiency.

Association Between Serum Testosterone and Serum PSA Among Men With and Without Partial Androgen Deficiency.

Serum prostatic specific antigen (PSA) and serum testosterone levels share an undefined relationship with each other, with many conflicting studies showing both positive and negative correlation between them. Our aim was to assess association between serum PSA and serum testosterone in healthy men with normal testosterone levels and men with partial androgen deficiency (PADAM). A cross sectional study was conducted at a teaching hospital setting where serum testosterone and aging male symptom scale(AMS) scores along with PSA were studied in 255 men (> 50years) with and without PADAM. Mean total testosterone and serum PSA was 9.35 ± 1.33nmol/L, 1.96 ± 0.76ng/mL in males with PADAM and 15.30 ± 1.95nmol/L, 1.85 ± 0.73ng/mL respectively in males without PADAM. No significant relationship was observed between serum PSA and serum testosterone levels among healthy males irrespective of PADAM in the study population. We suggest, there is no need to adjust PSA values for biopsy decisions according to testosterone levels.

Prevalence of low androgen levels among middle and old age men attending Outpatient Clinics

Introduction: Tiredness is a common symptom of hypogonadism, which can be profound, but there are many medical practitioners who do not include the assessment of testosterone levels in the clinical workup of this symptom. Although male hypogonadism is an established clinical condition, which can be treated, many men experiencing it are undiagnosed.Aim:The aim was to assess the prevalence of low androgen level among middle and old age men in a cohort of patients attending Kasr Elaini hospital outpatient clinics.Patients and Methods: A total of 265 male patients older than 40 years attending the outpatient clinics in different specialty were included. All included men were subjected to full history taking and complete general and local examinations. All participants were interviewed personally face to face using Arabic generic version of full aging male scale (AMS) questionnaire. Venous blood samples were withdrawn between 8 and 10 a.m. after a 12-h overnight fast for measurements of total and free testosterone levels.Results: The mean total testosterone level was 4.0 ± 2.6 ng/ml, ranging from 0.4 to 16.4 ng/ml. The mean free testosterone level was 6.9 ± 2.4 pg/ml, with range between 1.4 and 18.5 pg/ml. Low androgen level was founded in 19.2% of the participants based on total testosterone and in 36.2% when adding the participants with low free testosterone levels. AMS score showed statistically significant difference between age groups (P<0.001). Age is negatively correlated with total and free testosterone levels (r=-0.226 and -0.242, respectively), but the correlation is weak. Total testosterone level shows strong positive correlation with free testosterone level and weak negative correlation with AMS score (r=0.732 and -0.240, respectively).Conclusion: The prevalence of hypogonadism among middle and old age males seeking medical consultation in different specialties may be high.

Effect of Long-term Elite Military Training and Operations on Hormonal Profile

Chronic exposure to multifactorial stress, such as that endured by elite military operators, may lead to overtraining syndrome and negatively impact hormonal regulation. In acute settings (<6 mos), military training has been shown to lead to hormonal dysfunction; however, less is known about the consequences of long-term military training. PURPOSE: The purpose of this study was to determine the chronic effects of military operations and training on the hormone profile of elite military operators. METHODS: Active-duty elite US military operators (n = 65, age = 29.8 ± 1.0 yrs, height = 178.4 ± 0.7 cm, weight = 85.1 ± 2.0 kg) concomitantly engaged in rigorous physical training were recruited to participate in the study. Basal plasma concentrations of luteinizing hormone (LH), total testosterone (TT), free testosterone (FT), sex-hormone binding globulin (SHBG), cortisol, thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were obtained between 0600-1000 hrs. Data were analyzed for correlations and compared against normative reference values; all data are presented as mean ± SE. RESULTS: Mean LH, TT, FT, SHBG, cortisol, TSH, T3, and T4 for all subjects were: 3.4 ± 0.2 IU · L-1, 13.5 ± 0.9 nmol · L-1, 28.2 ± 1.2 pmol · L-1, 94.2 ± 6.4 nmol · L-1, 441.3 ± 26.4 nmol · L-1, 3.5 ± 0.7 mIU · L-1, 150 ± 9.0 ng · dL-1, and 7.8 ± 0.2 μg · dL-1, respectively. There was a significant positive correlation between TT and cortisol (R2 = 0.07; y = 0.0093x + 9.4364; P < 0.05). In addition, 43% of the participants (n = 28) had TT below age-based normative reference ranges. Those with lower than normal TT (8.2 ± 0.3 vs. 17.6 ± 1.3 nmol· L-1; P < 0.01), also had lower FT (24.4 ± 1.9 vs. 31.1 ± 1.4 pmol · L-1, P < 0.01), cortisol (367.4 ± 39.1 vs 497.2 ± 33.2 nmol· L-1; P < 0.05) and T3 (121.1 ± 5.4 vs. 164.0 ± 14.3 ng · dL-1; P < 0.01). CONCLUSION: These results indicate that military operations and training may place a large burden on the operators and depress or alter the hypothalamic pituitary, adrenal, gonadal and thyroid axes. Further research need be conducted to determine what, if any, consequences these differences may cause.

MP74-05 SERUM PSA AS A PREDICTOR OF SYMPTOMATIC HYPOGONADISM PARTICULARLY IN RELATION TO PSYCHOLOGICAL SYMPTOMS

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II1 Apr 2018MP74-05 SERUM PSA AS A PREDICTOR OF SYMPTOMATIC HYPOGONADISM PARTICULARLY IN RELATION TO PSYCHOLOGICAL SYMPTOMS Kazuhito Matsushita, Akira Tsujimura, and Shigeo Horie Kazuhito MatsushitaKazuhito Matsushita More articles by this author , Akira TsujimuraAkira Tsujimura More articles by this author , and Shigeo HorieShigeo Horie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We often see low levels of PSA in men with symptomatic hypogonadism (HG). The relationship between serum PSA and testosterone level is still controversial. According to the saturation hypothesis, a significant relationship is apparent only in the low testosterone range. We hypothesized that PSA might represent a surrogate marker for symptomatic HG. METHODS Patients presenting to our academic men′s health clinic reported hypogonadal symptoms using the Aging Male′s Symptoms (AMS) scale which grades each hypogonadal symptom on a 5-point Likert scale. Several hormonal and biochemical parameters were measured the same day the survey was completed. The clinical values of total and free testosterone, and PSA for the detection of severe HG were compared using receiver operating characteristic (ROC) curves. Furthermore, relationships between each of the three AMS subscales (psychological, somatic, sexual) and the biochemical parameters were investigated. RESULTS 759 men were included for analysis (mean age=51y±10). At baseline, mean AMS scale was 43±12, mean total testosterone (TT) was 5.01±1.95 ng/mL, mean free testosterone (FT) was 9.53±3.9 pg/mL, and mean PSA was 1.07±0.64ng/mL. We tested the efficacy of PSA, TT, and FT in detecting severe HG, defined as AMS score ≥50. ROC curve analysis for PSA showed an accuracy (area under the curve, AUC) of 0.649±0.033 (p<0.01) in predicting severe HG. When a threshold of 0.7 ng/mL was chosen, sensitivity and specificity for severe HG was 70.1% and 52.8%, respectively. ROC curve analysis for TT and FT showed an AUC of 0.543 (p=0.229) and 0.554 (p=0.126), respectively. When the AMS scale was divided into the three subscales, psychological and somatic factors, while marginal, showed significant correlation with PSA. Multivariable analysis showed that only psychological factor was significantly associated with PSA levels (p=0.013). CONCLUSIONS Our data demonstrated that PSA levels were more accurate for the prediction of severe HG compared to testosterone levels. It was found that psychological factors were more strongly correlated than sexual factors. These results suggest that low PSA levels may represent a new marker for detecting severe HG. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1001-e1002 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kazuhito Matsushita More articles by this author Akira Tsujimura More articles by this author Shigeo Horie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...