Median Serum Testosterone Research Articles

Serum gonadal hormones levels and hypogonadism in ART naïve newly diagnosed HIV infected adult males in Mwanza, Tanzania

BackgroundHuman immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is an endemic chronic disease which is characterized with progressive depletion of CD4 T cells and increased susceptibility to opportunistic infections. Previous studies have associated HIV infection with increased hypogonadism. However, the prevalence of hypogonadism remained poorly defined and widely ranging in various studies. This study aims to evaluate the serum gonadal hormonal levels and hypogonadism in antiretroviral therapy (ART) naïve newly diagnosed HIV infected-males in Mwanza, Tanzania.MethodsThis was a comparison study involving 81 ART naïve newly diagnosed HIV-infected adult males as study group and 81 apparently healthy HIV-negative males as comparison group. The participants in the study group and comparison group were matched by body mass index and age. Serum hormones [Total testosterone (TT), follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E) were estimated. Serum testosterone < 300 ng/dl, or testosterone > 300 ng/dl with high LH and FSH (compensatory hypogonadism) were taken as markers of hypogonadism. Data were analyzed using STATA version 15.ResultsThe median serum testosterone level among ART naïve newly diagnosed HIV-infected adult males was significantly lower as compared to their comparison group (447 [259–534] versus 517 [396–605]; p = 0.0074) and shown to decrease with decreasing CD4 level. The median [IQR] serum FSH level among ART naïve newly diagnosed HIV-infected adult males was significantly higher than among their comparison group (3.8 [2.1–6.5] versus 2.6 [1.8–4.2]; p = 0.0086). The differences in serum LH and Estradiol were not statistically significant. Furthermore, the proportion of hypogonadism was significantly higher among ART naïve newly diagnosed HIV-infected adult males than in their comparison group (37.0% [30/81] versus 14.8% [12/81]; p = 0.0006). Out of these 30, 24 HIV-infected males had secondary hypogonadism, one had primary, and the remaining five had compensatory hypogonadism.ConclusionSerum testosterone was lower and follicle stimulating hormone was higher among ART naïve HIV-infected males as compared to the HIV negative controls. Hypogonadism, mainly secondary, is common endocrine abnormality among ART naïve HIV-infected male patients in this study. HIV is associated with variations in gonadal hormones which may lead to sexual dysfunction in infected individuals.

Differential effects of carbamazepine and levetiracetam monotherapy on reproductive endocrine function in Nigerian women with epilepsy

ObjectiveThis study is aimed at comparing differential effect of Levetiracetam (LTC) monotherapy and Carbamazepine (CZP) monotherapy in W omen with epilepsy (WWE) on gonadal hormone. Methods87 WWE were recruited comprising randomly of 46 and 41 on CZP and LTC group respectively with diagnosis and classification based on International League Against Epilepsy (ILAE). Reproductive hormones (Luteinizing Hormone (LH), Follicle stimulating hormone, progesterone, estradiol and testosterone) were assayed. National Hospital Seizure Severity Scale (NHSS) and Zung self-reporting depression scale (ZSRDS) were used to assess the seizure severity and the mood respectively. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. The Chi-square test was used to compare categorical variables while Student's t-test or its non-parametric equivalent where appropriate were used to compare continuous variables. ResultsClinical characteristics were comparable in both groups except for ZSRDS (p = 0.048), NHSS (p = 0.012) and hip circumference (p = 0.037). The CZP group had a higher ASEX score and proportion of WWE with clinically significant sexual dysfunction (p < 0.001). WWE on LTC had similar hormonal profiles with those on CZP except for a higher median serum testosterone level (p = 0.004), and lower median serum LH (p = 0.006). Age was negatively associated with serum testosterone level for the 25th, 50th, and 75th quartile. However, the differential effect for AED type was only significant for the 25th quartile; with higher values in LTC. ConclusionThe therapeutics implication of lower LH and testosterone levels in the LTC group compared to CZP group need to be explored.

Long-term prospective data on correlation between overall mortality and HADS (Hospital Anxiety and Depression Scale) assessed psychological distress in prostate cancer patients (11 year follow-up data).

12091 Background: We prospectively assessed whether Psychological factors such as anxiety and depression can have a detrimental effect on long term overall survival of prostate cancer patients (pts). Methods: Prostate cancer pts participating in an ethics Committee approved, Prospective study evaluating an Andropause rating scale. All pts had radical radiotherapy with androgen deprivation therapy. Pts completed a baseline HADS questionnaire before any treatment was initiated &amp; at 3mths &amp; after completion of hormone therapy. Patient characteristics: Median age: 69 yrs (50 to 78 yrs). Charlson Comorbidity Index (CCI) prevalence at baseline as follows CCI-I 6.1%; CCI-II: 33.8%; CCI-III: 37.2%; CCI-IV: 14.2%; CCI-V: 6.1% and CCI-VI: 2.7%.; At the survival update in Feb 2023, 49.3% of patients have died [n = 148]; Gleeson grade was Low risk in 7.2%; Intermediate in 53.4% and high risk in 39.2%; Baseline PSA was &lt; 10 ug/L in 45.3%; 10-20 ug/L in 33.1% and &gt; 20 ug/L in 21.6% ; Tumour stage was T1 in 8.1% ; T2 in 63.5% and T3 in 28.4%. Baseline Median serum testosterone was 11.9 nmol/l (min 2.6 and max 26.7). Hormone duration was &lt; 3 mths in 22.3%; 3-6mths in 35.8% ; 6 to &lt; 36mths in 19.6% and &gt; 36mths in 22.3%. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) of overall mortality, while controlling for the following covariates (Age, T stage, Gleeson risk category, PSA Category, Baseline Serum Testosterone, ADT duration category and Charlson Comorbidity index). Results: Higher anxiety at time of diagnosis had a statistically significant adverse effect on overall survival (table); Higher depression symptoms at baseline did not affect survival but depressive symptoms after completing cancer treatment did affect all-cause mortality in this mature dataset with a median follow up of more than 11 years. Conclusions: Higher anxiety and depression symptoms in prostate cancer patients are associated with significantly higher long-term all-cause mortality. [Table: see text]

Effect of a subcutaneous implant of deslorelin acetate on serum testosterone concentrations in male Hermann's (Testudo hermanni sp.) and Greek (Testudo graeca sp.) tortoises.

Deslorelin acetate is a gonadotropin-releasing hormone agonist formulated in a controlled-release subcutaneous implant and designed for reversible suppression of testosterone production in dogs. It has also been demonstrated to be effective in other animal species, but no data on its effectiveness in male land tortoises are available. This study aimed to evaluate the effect of a 4.7-mg deslorelin acetate implant on serum testosterone concentrations in male Hermann's (Testudo hermanni sp.) and Greek (Testudo graeca sp.) tortoises. Twenty adult male tortoises housed under the same environmental conditions were enrolled for the study and randomly assigned to a treatment (D, n = 10) or a control (C, n = 10) group. Starting in May, males from the D group were implanted with a 4.7-mg deslorelin acetate device, whereas males from the C group did not receive any treatment. Blood samples were collected once immediately before implant application (S0-May) and at 15 days (S1-June), 2 (S2-July), and 5 (S3-October) months after application. Serum testosterone at each sampling time was measured through a solid-phase, enzyme-labeled, competitive chemiluminescent immunoassay. Median serum testosterone concentrations were not significantly different between the two groups in all sampling times, and no interaction between treatment and sampling time was observed. The present study, therefore, suggests that a single treatment with a 4.7-mg deslorelin acetate implant has no effect on testosterone circulation in male Hermann's and Greek tortoises during the following 5 months.

MP27-05 ANDROGEN RECEPTOR SIGNALING IN THE HUMAN PENIS IS SIMILAR REGARDLESS OF SERUM TESTOSTERONE LEVEL

You have accessJournal of UrologyCME1 Apr 2023MP27-05 ANDROGEN RECEPTOR SIGNALING IN THE HUMAN PENIS IS SIMILAR REGARDLESS OF SERUM TESTOSTERONE LEVEL Katherine Campbell, Alexandra Dullea, Braian Ledesma, Kajal Khodamoradi, Himanshu Arora, and Ranjith Ramasamy Katherine CampbellKatherine Campbell More articles by this author , Alexandra DulleaAlexandra Dullea More articles by this author , Braian LedesmaBraian Ledesma More articles by this author , Kajal KhodamoradiKajal Khodamoradi More articles by this author , Himanshu AroraHimanshu Arora More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testosterone (T) plays an important role in the proper development and maintenance of male reproductive tissues. The normal serum testosterone levels can vary between 300 to 1000 ng/dL. However, it is unclear whether androgen receptor (AR) signaling varies based on serum T levels. The aim of this study was to assess the impact of varied serum testosterone levels on AR signaling in Human Corpus Cavernosum tissue. Based on our previous work on the Androgen Saturation hypothesis, we hypothesized that above 200 ng/dL, AR signaling would not vary. METHODS: We obtained corpus spongiosum biopsies from men undergoing inflatable penile prosthesis placement for high grade erectile dysfunction. After mechanical dispersion of tissue with a homogenizer, the total protein was extracted using RIPA buffer. Quantitative detection of VEGF (Vascular endothelial growth factor), an androgen receptor marker, and AR (Androgen Receptor) expression was evaluated by western blot. The density of the bands in all the blots was quantified using densitometry analysis with ImageJ software. RESULTS: The median age of participants was 60.7 (57.6, 65.9) years. The median serum testosterone level was 378 (257, 419) ng/dl. The western blot results (Figure 1) showed no association in the expression level of VEGF or AR regardless of the serum testosterone level. CONCLUSIONS: Even with a wide range of serum testosterone levels (209-1478 ng/dl), androgen receptor signaling was similar in penile tissue. The results of this study support our previous work to demonstrate that AR signaling may be similar regardless of T level above 200 ng/dL. This suggests that serum testosterone levels might not reflect downstream androgen receptor signaling within the penile tissue. Understanding the AR saturation hypothesis provides important context necessary for appropriate prescribing of exogenous testosterone replacement therapy to optimize patient outcomes. Markers of androgen receptor signaling in tissue could be similar regardless of serum testosterone levels. Therefore, the utility of only serum testosterone levels in considering the effect of testosterone therapy needs to be re-evaluated. Source of Funding: This work was supported by: NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to Ranjith Ramasamy, SMSNA Sexual Medicine Grant to Kajal Khodamoradi © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e363 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Campbell More articles by this author Alexandra Dullea More articles by this author Braian Ledesma More articles by this author Kajal Khodamoradi More articles by this author Himanshu Arora More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of basal serum testosterone level on the ovarian response and the cumulative live birth rate in infertile women undergoing in vitro fertilization.

To evaluate the effect of basal serum testosterone levels on the ovarian response and the cumulative live birth rate of infertile women undergoing in vitro fertilization (IVF). It is a retrospective study in a university-affiliated assisted reproduction center in Hong Kong. Infertile women undergoing the first IVF cycle in the center between December 2012 and November 2016 with archived serum samples and available information on cumulative live birth were included for the analysis. A total of 1122 women were included for analysis. The median basal serum testosterone level was 0.53 (25-75th percentile: 0.40-0.67) nmol/L. Women with higher basal serum testosterone levels required a lower total dosage of gonadotrophin and a shorter duration of stimulation and had more oocytes retrieved. The cumulative live birth rates did not differ among women with serum testosterone levels in the four quartiles. Basal serum testosterone level was not a significant independent predictor of the cumulative live birth after adjusted for the women's age and number of normally fertilized oocytes in a binary logistic regression. The areas under the receiver operative characteristics (ROC) curves in predicting low or high ovarian response and the cumulative live birth were all below 0.6. Higher basal serum testosterone levels were associated with a better ovarian response but had no effect on the cumulative live birth rate of infertile women undergoing IVF.

A Prospective Study of the Relationship Between Clinical Outcomes After Enzalutamide and Serum Androgen Levels Measured via Liquid Chromatography-tandem Mass Spectrometry in Patients with Castration-resistant Prostate Cancer

BackgroundEnzalutamide (ENZ) is used to treat patients with castration-resistant prostate cancer (CRPC). However, the kinetics of serum androgens before and after ENZ treatment are unknown. ObjectiveTo elucidate the kinetics of serum androgens and explore the possibility of identifying a useful marker for predicting the effects of ENZ. Design, setting, and participantsWe conducted a prospective study from 2014 to 2018 at Gunma University Hospital and related facilities. Data were analyzed for 104 patients with CRPC treated with ENZ. Outcome measurements and statistical analysisWe measured serum androgen levels using liquid chromatography-tandem mass spectrometry. Relationships with outcomes were assessed using multivariable Cox regression and log-rank analyses. Results and limitationsThe median age of the patients was 73 yr. Median serum testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone sulfate levels were 49.0, 5.8, 222.2, and 326.3 pg/ml, respectively. We performed multivariate analysis using Cox regression to predict prostate-specific antigen progression–free survival (PSA-PFS) and overall survival (OS). Hemoglobin level (≥12.5 vs <12.5 g/dl), docetaxel treatment history (no vs yes), and DHT level (≥5.9 vs <5.9 pg/ml) were significant predictors of PSA-PFS (p < 0.05). Eastern Cooperative Oncology Group performance status (0 vs. 1–2), hemoglobin level (≥12.5 vs <12.5 g/dl), presence of visceral metastasis (no vs yes), amount of bone metastasis (extent of disease 0–2 vs 3–4), and docetaxel treatment history (no vs yes) were significant predictors of OS (p < 0.05). Binomial logistic analysis of the predictors of any grade of anorexia, malaise, and fatigue showed that the presence of visceral metastasis and a low DHT level (<5.9 pg/ml) were significant. ConclusionsOur results suggest that serum androgen levels before ENZ treatment may be useful for predicting efficacy, prognosis, and the incidence of adverse events. Patient summaryWe measured blood levels of testosterone and other male hormones before treatment with enzalutamide among men with prostate cancer resistant to castration. We found that the levels of these hormones may be useful for predicting the efficacy of enzalutamide treatment, prognosis, and the occurrence of adverse side effects.

Switching Patients With Prostate Cancer from GnRH Antagonist to Long-acting LHRH Agonist for Androgen Deprivation: Reducing Hospital Visits During the Coronavirus Pandemic.

To reduce the frequency of the need for hospital visits for patients with prostate cancer (PCa) taking androgen-deprivation therapy during the SARS-CoV-2 (COVID-19) pandemic, we switched them from gonadotropin-releasing hormone (GnRH) antagonist to a long-acting luteinizing hormone-releasing hormone (LH-RH) agonist. Here, we confirmed the efficacy and safety profile of this switching. We analyzed the medical records of 32 patients with PCa who received ADT and switched from GnRH antagonist to a long-acting LH-RH agonist during the COVID-19 pandemic, evaluating hematological and serological variables, including serum testosterone and prostate-specific antigen. Before and after the switching from GnRH antagonist to LH-RH agonist, the median serum testosterone levels were 0.22 and 0.18 ng/ml, respectively, and the median serum prostate-specific antigen levels were 0.18 and 0.11 ng/ml, respectively. No changes in the rates of flare-ups of conditions or adverse events were observed. Switching from GnRH antagonist to a long-acting LH-RH agonist appears to be a reasonable option that does not diminish efficacy or exacerbate adverse events.

LOCAL REACTIONS OF LUTEINIZING HORMONE-RELEASING HORMONE AGENTS AND ITS EFFECTS ON CLINICAL OUTCOMES IN PROSTATE CANCER PATIENTS

(Background) Currently, luteinizing hormone-releasing hormone (LH-RH) agonists and antagonists are used for androgen-deprivation therapy (ADT). However, they are associated with subcutaneous granuloma, rubor, dolor, calor, and eventual ulcer and/or abscess formation. The prevalence of these adverse effects, causes and mechanisms, and effects on serum testosterone levels and clinical outcomes are poorly understood. (Method) We collected the clinical records of men with pathologically diagnosed prostate cancer who were followed in our hospital. The primary aim of the study was to determine the prevalence of granuloma formation, its causes, and the mechanisms involved. The secondary aim was to analyze the effects of subcutaneous induration on serum testosterone levels and clinical outcomes. (Results) Overall, 185 men using leuprorelin (n=161; median age, 75 years), degarelix (n=21; median age, 76), or goserelin (n=3; median age, 76) were analyzed. In the leuprorelin cohort, 51 patients (33.5%) had subjective and/or objective subcutaneous induration and 2 (1.2%) had a large lesion (diameter > 3.0 cm). In the degarelix cohort, 18 patients (85.7%) developed induration and 8 (38%) had a large lesion. One month after the start of ADT, patients in the leuprorelin and degarelix cohorts had median serum testosterone levels that reached the same level as that after castration. There was no significant difference in the overall survival rate between the leuprorelin and degarelix cohorts. There was no significant difference in the serum testosterone level or overall survival rate between patients with or without induration. (Conclusions) The local adverse effects of LH-RH agents are prevalent, but we can regulate the adverse effects by understanding the mechanism involved. The formation of subcutaneous induration did not affect the serum testosterone level or clinical outcome.

Prostate-Specific Antigen Concentrations in Response to Testosterone Treatment of Severely Hypogonadal Men.

ContextClinical guidelines recommend measurement of the serum prostate-specific antigen (PSA) concentration during testosterone treatment of hypogonadal men to determine whether the increase is sufficiently high to warrant urologic referral. Prior studies of the effect of testosterone treatment on PSA concentrations have been conducted in men who were mildly to moderately hypogonadal.ObjectiveThe objective of this work is to determine the PSA response to testosterone treatment of men who are severely hypogonadal.Design and SettingThis retrospective cohort study was conducted at a single academic medical center.ParticipantsEighty-five men participated who were severely hypogonadal as a result hypothalamic-pituitary or testicular disease.Main Outcome MeasureChanges in serum PSA concentrations were measured during testosterone treatment for up to 18 months.ResultsTestosterone treatment increased the median serum testosterone concentration from 36 ng/dL (interquartile range [IQR], 20-91 ng/dL) at baseline to 395 ng/dL (IQR, 266-542 ng/dL) at 6 to 18 months. This treatment resulted in a median increment in PSA above baseline of 0.70 ng/mL (IQR, 0.10-1.85 ng/mL) at 6 to 18 months. Apropos current Endocrine Society clinical guidelines, 31% of the men experienced a PSA increase above baseline greater than 1.4 ng/mL, and 13% reached an absolute PSA concentration of greater than 4.0 ng/mL. Four men were diagnosed with prostate cancer.ConclusionsThe PSA response to testosterone replacement in men who are severely hypogonadal as a result of pituitary or testicular disease is greater than that previously reported in men with mild to moderate hypogonadism. These results suggest the magnitude of the PSA response to testosterone replacement is related to the degree of hypogonadism.

A prospective study of the relationship between clinical outcomes of enzalutamide and serum androgen levels measured by LC-MS/MS in patients with CRPC.

146 Background: Enzalutamide (ENZ) is commonly used to treat patients with castration resistant prostate cancer (CRPC). However, the kinetics of serum androgen levels before and after ENZ treatment are unknown. We elucidated the kinetics of serum androgens and explored the possibility of identifying a useful marker for predicting the effects of ENZ. Methods: We conducted a prospective study from 2014 to 2018 at Gunma University Hospital and related facilities. 104 CRPC patients treated with ENZ were analyzed. We investigated the PSA reduction rate (50%, 90%), PSA-progression-free survival (PFS), and overall survival (OS) after administration. To measure levels of androgens accurately we measured serum androgen levels using LC-MS/MS. OS and PSA-PFS were assessed according to the PCWG 2 criteria. This study was approved by the Institutional Review Board of Gunma University Hospital (No. 1177). Results: The 50% and 90% PSA decline rates were 62.5% and 25.0%, respectively. Median serum testosterone (T), dihydrotestosterone (DHT), androstenedione (A-dione), and dehydroepiandrosterone-sulfate levels were 49.0, 5.8, 222.2, and 326.3 pg/ml, respectively. Mean serum levels of T, DHT, and A-dione increased significantly 12 and 24 weeks after compared to before treatment (p &lt; 0.05). We performed a multivariate analysis using a Cox regression to predict OS and PSA-PFS. ECOG PS (0 vs. 1–2), hemoglobin (Hb ≥ 12.5 vs. &lt; 12.5 g/dL), albumin (≥ 3.9 vs. &lt; 3.9 g/dL), visceral metastasis (no vs. yes), EOD (0–2 vs. 3–4), docetaxel treatment (no vs. yes), and DHT level (≥11.25 vs. &lt; 11.25 pg/mL, 11.25 was third quartile) were significant predictors of OS (p &lt; 0.05). Hb (≥12.5 vs. &lt; 12.5 g/dL), docetaxel treatment (no vs. yes), and level of DHT (≥ 5.9 vs. &lt; 5.9 pg/mL) were significant predictors of PSA-PFS (p &lt; 0.05). As a result of the binomial logistic analysis of the predictors of fatigue and decreased appetite, the presence of visceral metastasis (yes) and low DHT (&lt;5.9 pg/mL) were significant predictors of expression. Conclusions: These results suggest that serum androgen levels before ENZ treatment may be useful for predicting efficacy, prognosis, and the incidence of adverse events.

Sperm retrieval success and testicular histopathology in idiopathic nonobstructive azoospermia.

Prior studies have investigated sperm retrieval rates in men with nonobstructive azoospermia (NOA) secondary to specific etiologies, yet most cases of NOA are idiopathic. We compared sperm retrieval rates and testicular histopathology in idiopathic NOA (iNOA) and nonidiopathic NOA (niNOA). We performed a retrospective review of men with NOA who underwent microdissection testicular sperm extraction (microTESE) between 2000 and 2016. Men with no history of malignancy or cryptorchidism and negative genetic evaluation were considered idiopathic. Multivariable regression determined the association between idiopathic etiology and primary outcomes of sperm retrieval and active spermatogenesis on histopathology. Among 224 men, 86 (38.4%) were idiopathic, 75 (33.5%) were nonidiopathic, and 63 (28.1%) did not undergo genetic testing. Median age and serum testosterone were higher among iNOA or no testing versus niNOA. Median follicle-stimulating hormone (FSH) was lower among iNOA or no testing versus niNOA. A higher proportion of iNOA or no testing versus niNOA had a clinical varicocele. Sperm retrieval rates were similar between iNOA, niNOA, and no testing (41.8% vs 48.0% vs 55.6%, respectively; P = 0.255). Active spermatogenesis was seen in a higher proportion of iNOA or no testing versus niNOA (31.4% and 27.0% vs 16.0%, P = 0.073). On multivariable analysis, iNOA was not associated with sperm retrieval or spermatogenesis (P = 0.430 and P = 0.078, respectively). Rates of sperm retrieval and spermatogenesis on testis pathology were similar in men with iNOA and niNOA. These data will be useful to clinicians in preoperative counseling for men with NOA and negative genetic evaluation.

The Association of Serum Testosterone Levels With Recurrence and Mortality After Acute Ischemic Stroke in Males.

The current study aimed to investigate whether low testosterone predicted the recurrence and clinical outcomes after acute ischemic stroke (AIS) in males. From June 2015 through August 2017, the study prospectively enrolled 110 male AIS patients. All received detailed evaluations at admission and were followed for at least 1 year. The cumulative incidence, overall survival, length of hospital stay, and the percentage of previous stroke were compared between subjects with testosterone <440 ng/dl and >440 ng/dl. The median age was 62 years (range, 35–93 years). The median serum testosterone at admission was 438 [203] ng/dl (range, 44–816 ng/dl); 55 patients (50%) had testosterone <440 ng/dl and were considered as low testosterone. The median follow-up was 23 months. During the period, 12 recurrences and 10 deaths occurred. The 1-year and 3-year cumulative recurrence rate were 8.3% and 11.9%, respectively; the 1-year and 3-year overall survival were 96.3% and 84.6%, respectively. The cumulative recurrence rates were similar between the two testosterone groups (log-rank test, p = .88). Low testosterone was associated with poor survival with marginal significance (log-rank test, p = .079). Men with low testosterone had a higher percentage of previous stroke (29.1% versus 12.7%, p = .035). The mean lengths of hospital stay were similar between the two testosterone groups (16.6 ± 15.8 days versus 14.0 ± 10.6, p = .31). Total testosterone at admission fails to predict stroke recurrence. However, men with low testosterone at admission are more likely to have previous stroke and may have a higher all-cause mortality rate after AIS.

Serum Testosterone 60 Months after Passive-Scatter Proton Therapy for Localized Prostate Cancer

Studies demonstrate a decline of ∼10% in serum testosterone (ST) level after X-ray radiotherapy for prostate cancer. We evaluated changes in ST for patients with low- and intermediate-risk prostate cancer receiving 70-82Gy(RBE) using passive-scatter proton therapy (PT). ST was checked at baseline (n = 358) and at 60+ months after PT (n = 166). The median baseline ST was 363.3 ng/dl (range, 82.0–974.0). The median ST 5 years after PT was 391.5 ng/dl (range, 108.0–1061.0). The difference was not statistically significant (p = 0.9341). Passive-scatter PT was not associated with testosterone suppression at 5 years, suggesting that protons may cause less out-of-field scatter radiation than X-rays.

Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey

Testosterone deficiency has been linked to several adverse health outcomes and recent data have suggested that abnormal sleep quality may result in lower testosterone levels. We assessed the effect of self-reported sleep patterns on serum testosterone while controlling for co-morbidities, and baseline demographics. Using data collected from the 2011-2012 National Health and Nutrition Examination Survey (NHANES), we extracted serum total testosterone level, sleep duration, demographic, and co-morbidities for men aged 16years and older. Univariate and multivariate linear regression was used to estimate the association of number of hours slept, co-morbidities, and demographics with serum testosterone. Among the 9756 individuals in the NHANES dataset, 2295 (23.5%) were males 16years and older with a median (interquartile range) age of 46years (29-62) who also had serum testosterone levels drawn. Median serum testosterone level was 377ng/dL (IQR: 279-492ng/dL). Median number of hours slept was 7h (IQR: 6-8h). On multivariate linear regression, we found serum testosterone decreased by 0.49ng/dL per year of age (p = 0.04), 5.85ng/dL per hour loss of sleep (p < 0.01) and 6.18ng/dL per unit of body mass index (BMI) increase (p < 0.01). Among men aged 16-80 in the United States, we found increasing age, impaired sleep and elevated BMI is associated with low testosterone. It is important, therefore, that evaluation and treatment of reduced serum testosterone should also include improving sleep duration in combination with weight management.

Re: Low Serum Testosterone is Present in Nearly Half of Men Undergoing Artificial Urinary Sphincter Placement.

Objectives To report the prevalence of low serum testosterone (LST) in men undergoing artificial urinary sphincter (AUS) placement at a single high-volume institution. Methods We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from January 2015 to January 2018 to identify men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. Patients with only posttreatment testosterone levels were excluded. Demographic characteristics and clinical outcomes were compared between men with and without LST. Results Among 113 patients who underwent AUS with pretreatment serum testosterone levels drawn an average of 2.2 months before AUS surgery, 45.1% (51 of 113) met criteria for LST, including 18 patients on androgen deprivation therapy. The rate of primary LST was 34.7% (33 of 95). The median total serum testosterone level among men with LST was 118 ng/dL (interquartile range 6-211), and 413 mg/dL (interquartile range 333-550) in the normal serum testosterone group. There were no differences in patient age, history of radiation, erectile dysfunction, or other comorbidities between the groups. Body mass index was higher in the LST group compared to normal serum testosterone (30 vs 27 kg/m2, P = .001). Cuff size and rates of transcorporal cuff placement were similar between groups. Conclusion Nearly one-half of men with stress urinary incontinence undergoing AUS placement present with LST. While AUS cuff erosion appears to be more common in men with LST, further study is needed to determine if treating LST will reduce cuff erosion rates.

Low Serum Testosterone is Present in Nearly Half of Men Undergoing Artificial Urinary Sphincter Placement

To report the prevalence of low serum testosterone (LST) in men undergoing artificial urinary sphincter (AUS) placement at a single high-volume institution. We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from January 2015 to January 2018 to identify men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. Patients with only posttreatment testosterone levels were excluded. Demographic characteristics and clinical outcomes were compared between men with and without LST. Among 113 patients who underwent AUS with pretreatment serum testosterone levels drawn an average of 2.2 months before AUS surgery, 45.1% (51 of 113) met criteria for LST, including 18 patients on androgen deprivation therapy. The rate of primary LST was 34.7% (33 of 95). The median total serum testosterone level among men with LST was 118 ng/dL (interquartile range 6-211), and 413 mg/dL (interquartile range 333-550) in the normal serum testosterone group. There were no differences in patient age, history of radiation, erectile dysfunction, or other comorbidities between the groups. Body mass index was higher in the LST group compared to normal serum testosterone (30 vs 27 kg/m2, P = .001). Cuff size and rates of transcorporal cuff placement were similar between groups. Nearly one-half of men with stress urinary incontinence undergoing AUS placement present with LST. While AUS cuff erosion appears to be more common in men with LST, further study is needed to determine if treating LST will reduce cuff erosion rates.

Androgen-responsive non-coding small RNAs extend the potential of HCG stimulation to act as a bioassay of androgen sufficiency.

It is unclear whether a short-term change in circulating androgens is associated with changes in the transcriptome of the peripheral blood mononuclear cells (PBMC). To explore the effect of hCG stimulation on the PBMC transcriptome, 12 boys with a median age (range) of 0.7 years (0.3, 11.2) who received intramuscular hCG 1500u on 3 consecutive days as part of their investigations underwent transcriptomic array analysis on RNA extracted from peripheral blood mononuclear cells before and after hCG stimulation. Median pre- and post-hCG testosterone for the overall group was 0.7 nmol/L (<0.5, 6) and 7.9 nmol/L (<0.5, 31.5), respectively. Of the 12 boys, 3 (25%) did not respond to hCG stimulation with a pre and post median serum testosterone of <0.5 nmol/L and <0.5 nmol/L, respectively. When corrected for gene expression changes in the non-responders to exclude hCG effects, all 9 of the hCG responders consistently demonstrated a 20% or greater increase in the expression of piR-37153 and piR-39248, non-coding PIWI-interacting RNAs (piRNAs). In addition, of the 9 responders, 8, 6 and 4 demonstrated a 30, 40 and 50% rise, respectively, in a total of 2 further piRNAs. In addition, 3 of the responders showed a 50% or greater rise in the expression of another small RNA, SNORD5. On comparing fold-change in serum testosterone with fold-change in the above transcripts, a positive correlation was detected for SNORD5 (P = 0.01). The identification of a dynamic and androgen-responsive PBMC transcriptome extends the potential value of the hCG test for the assessment of androgen sufficiency.

MP46-04 HIGH PREVALENCE OF LOW SERUM TESTOSTERONE LEVELS AMONG ARTIFICIAL URINARY SPHINCTER PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-04 HIGH PREVALENCE OF LOW SERUM TESTOSTERONE LEVELS AMONG ARTIFICIAL URINARY SPHINCTER PATIENTS Travis Pagliara, Jeremy Scott, Boyd Viers, and Allen Morey Travis PagliaraTravis Pagliara More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Boyd ViersBoyd Viers More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent evidence suggests that low serum testosterone (LST) may be associated with artificial urinary sphincter (AUS) cuff erosion. While the role of androgen replacement therapy is currently poorly defined among men receiving AUS placement surgery, the prevalence of LST among AUS patients is also unknown. We report the prevalence of LST relative to other associated risk factors among a large group of men undergoing AUS placement at a single high-volume institution. METHODS We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from 2012-2016 to identify those men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. All low serum testosterone levels underwent confirmatory testing. Clinical characteristics were compared between men with and without LST levels. RESULTS Among 85 AUS patients having pretreatment serum testosterone levels available for review, nearly half (41/85, 48%) met criteria for LST. After excluding those patients on androgen deprivation therapy (N=13), 28 of 72 (29%) had primary LST levels. AUS cuff erosion was more common among men with LST levels (38% vs 9%, p=0.01). The median total serum testosterone level among men undergoing AUS placement was 331ng/dL (IQR 192-447). Testosterone levels were drawn at a median 1.5 months (IQR 0-5.8) before AUS surgery. Men with LST levels were more likely to have a history of coronary artery disease (88% vs 30%, p=0.002) and a trend in greater body mass index (mean 31 vs 28, p=0.09) relative to those with normal serum testosterone levels. There was no difference in patient age, history of radiation, time from cancer therapy, erectile dysfunction, or other comorbidities. CONCLUSIONS Approximately one-half of men with stress urinary incontinence undergoing AUS placement present with LST levels. Accordingly, given the association between LST and AUS cuff erosion, men with risk factors for LST should undergo further evaluation prior to SUI surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e620 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Travis Pagliara More articles by this author Jeremy Scott More articles by this author Boyd Viers More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of Testosterone Suppression with Sustained-Release Triptorelin in Advanced Prostate Cancer

IntroductionAndrogen deprivation therapy (ADT) is a mainstay of treatment against advanced prostate cancer (PC). As a treatment goal, suppression of plasma testosterone levels to <50 ng/dl has been established over decades. Evidence is growing though that suppression to even lower levels may add further clinical benefit. Therefore, we undertook a pooled retrospective analysis on the efficacy of 1-, 3-, and 6-month sustained-release (SR) formulations of the gonadotropin-releasing hormone (GnRH) agonist triptorelin to suppress serum testosterone concentrations beyond current standards.MethodsData of 920 male patients with PC enrolled in 9 prospective studies using testosterone serum concentrations as primary endpoint were pooled. Patients aged 42–96 years had to be eligible for ADT and to be either naïve to hormonal treatment or have undergone appropriate washout prior to enrolment. Patients were treated with triptorelin SR formulations for 2–12 months. Primary endpoints of this analysis were serum testosterone concentrations under treatment and success rates overall and per formulation, based on a testosterone target threshold of 20 ng/dl.ResultsAfter 1, 3, 6, 9, and 12 months of treatment, 79%, 92%, 93%, 90%, and 91% of patients reached testosterone levels <20 ng/dl, respectively. For the 1-, 3-, and 6-month formulations success rates ranged from 80–92%, from 83–93%, and from 65–97% with median (interquartile range) serum testosterone values of 2.9 (2.9–6.5), 5.0 (2.9–8.7), and 8.7 (5.8–14.1) ng/dl at study end, respectively.ConclusionIn the large majority of patients, triptorelin SR formulations suppressed serum testosterone concentrations to even <20 ng/dl. Testosterone should be routinely monitored in PC patients on ADT although further studies on the clinical benefit of very low testosterone levels and the target concentrations are still warranted.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0466-7) contains supplementary material, which is available to authorized users.