Reduction In Total Testosterone Research Articles

Do statins decrease testosterone in men? Systematic review and meta-analysis.

Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the use of statin could cause a reduction in testosterone levels. The objective was to evaluate whether the continued use of statins in patients with hypercholesterolemia causes a deficiency in testosterone and other sex hormones. Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until May 2023; PROSPERO CRD42021270424protocol. Selection performed by two independent authors with subsequent conference in stages. Methodology based on PRISMA statement. There were selected comparative studies, prospective cohorts (CP), randomized clinical trials (RCT) and cross-sectional studies (CSS) with comparison of testosterone levels before and after statin administration and between groups. Bias analysis were evaluated with Cochrane Tool, The Newcastle-Ottawa Scale (NOS), and using the Assess the Quality of Cross-sectional studies (AXIS) tool. There were found on MedLine, Embase and Cochrane, after selected comparative studies, 10CP and 6RCT and 6CSS for the meta-analysis. In the Forrest plot with 6CSS, a correlation between patients with continuous use of statins and a reduction in total testosterone was evidenced with a statistically significant reduction of 55.02ng/dL (95%CI=[39.40,70.64],I²=91%,p<0.00001).In the analysis with 5RCT, a reduction in the mean total testosterone in patients who started continuous statin use was evidenced, with a statistical significance of 13.12ng/dL (95%CI=[1.16,25.08],I²=0%,p=0.03). Furthermore, the analysis of all prospective studies with 15 articles showed a statistically significant reduction in the mean total testosterone of 9.11 ng/dL (95%CI=[0.16,18.06],I²=37%,p=0.04). A reduction in total testosterone has been shown in most studies and in its accumulated analysis after statin use. However, this decrease was not enough to reach levels below normal. Statins use causes a decrease in total testosterone, not enough to cause a drop below the normal range and also determines increase in FSH levels. No differences were found in LH, Estradiol, SHBG and Free Testosterone analysis.

Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis.

Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men. In this systematic review and meta-analysis (SRMA), we searched articles in "PubMed" and "Scopus" exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis. Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI -5.6:15.8; p=0.35), LH (MD -2.96 IU/L, 95% CI -6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI -1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome. The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling.

FRI425 BIUXX

Abstract Disclosure: D.M. Macedo: None. J. Casanova: None. A. Guerra: None. R. Francisco: None. Title: Hyperandrogenism due to post-menopausal ovarian stromal hyperplasia. Introduction: Severe and rapidly progressive installation of hyperandrogenism in women after menopause should be carefully investigated. Stromal hyperplasia of the ovaries, which etiology is not completely understood, is a rare and benign cause of excess androgen production. In addition to hyperandrogenism, it is usually associated with hyperinsulinism, obesity, metabolic syndrome and acanthosis nigricans. Clinical case: A 60 year old overweight female patient with a history of type 2 diabetes mellitus, dyslipidemia, polycystic ovarian syndrome and menopause at 53 years old, reported the recent onset of hirsutism on the face and back, alopecia and increased libido. The laboratory evaluation revealed: total testosterone 89.6ng/dL (&amp;lt;35.9), free testosterone 5.13pg/mL (&amp;lt;4.2), sex hormone-binding globulin 22.9nmol/L (18-144), LH 21.3mIU/mL (14-52), FSH 27.4mIU/mL (26-135) and E2 &amp;lt;19.0pg/mL. The remaining androgens did not show alterations and hypercortisolism was excluded. Abdominal and pelvic ultrasound was performed and revealed enlarged ovaries with homogeneous echotexture and reduced echogenicity. A pelvic MRI was also performed and showed solid lesions in both ovaries, with moderate T1 and T2 hypointensity, suspicious of bilateral androgen-producing ovarian tumors. After multidisciplinary discussion, the patient underwent total hysterectomy with bilateral oophorectomy. Histopathology was compatible with bilateral stromal hyperplasia of the ovaries. Three months after surgery, the patient presented with a reduction of the facial and back hirsutism and slight improvement in alopecia. The laboratorial evaluation revealed a marked reduction in total testosterone (18.0ng/dL) and free testosterone (1.07pg/mL). Conclusions: New-onset hyperandrogenism in postmenopausal women is very uncommon and a diagnostic challenge. After excluding iatrogenic causes, hypercortisolism or adrenal tumor, the differential diagnosis between virilizing ovarian tumor and bilateral stromal hyperplasia is difficult to establish. Although the imaging distinction is possible, the definitive diagnosis is histopathologic and total hysterectomy with bilateral oophorectomy should be performed. In this case, although MRI was suspicious of bilateral ovarian tumors, the definitive diagnosis was stromal hyperplasia of the ovaries. Three months after surgery, the patient presented marked clinical and biochemical improvement. Presentation Date: Friday, June 16, 2023

Beneficial Effects of a Novel Fenugreek Seed Extract (Trigonella foenum-graecum, Furocyst®) in Women with Polycystic Ovary Syndrome (PCOS): A Follow-up Compliance Clinical Investigation

Introduction Polycystic Ovary Syndrome (PCOS) is an endocrine disorder which accounts for infertility around the world. The disease is characterized by elevated secretion of androgens in the women which results in enlargement of ovaries with accumulation of fluid filled cysts, irregular menstrual cycles, and hirsutism. This study reports the efficacy of a patented, standardized Trigonella foenum-graecum extract (Furocyst®) as an effective phytotherapeutic for effective management of PCOS. Objective This randomized one-arm study assessed the efficacy of Furocyst® in 107 female volunteers over a period of 12 consecutive weeks. Method Following approvals of the Institutional Ethical Committee and clinicaltrials.gov, 107 female volunteers (age: 18-45 years) were recruited. Subjects consumed Furocyst® capsules (1,000 mg/day p.o.) over a period of 12 consecutive weeks. Physical (Sonographic scan, Hirsutism Score, Menstrual cycle, Body Weight, BMI, Height, Waist Circumference and Blood Pressure) and biochemical parameters (LH/FSH ratio, TSH, Prolactin, Fasting insulin, Fasting Glucose, triglyceride, cholesterol, HOMA Index, free and total testosterone, 2-hour GTT, DHEAS) were assessed at the beginning of the study as well as at intervals of 4 weeks till 12 weeks to determine the efficacy of Furocyst® on PCOS induced damage on reproductive and endocrine system. Results Furocyst® treatment induced >40% reduction of mean cyst sizes in both ovaries with corresponding reduction of in ovarian volumes. LH:FSH ratio was also significantly improved with corresponding reduction in total testosterone and prolactin levels. As a result of improvement in endocrine function, menstrual cycle became regular in the subjects. Furocyst® also reduced the severity of other associated ailments such as insulin resistance, dyslipidemia, and improved liver function significantly. Conclusions This study reinstated the efficacy of Furocyst® as a safe phytotherapeutic to reverse the effects of PCOS inflicted damage on the female reproductive system without any adverse events.

Do statins cause testosterone deficiency in men? Systematic review and meta analysis

ABSTRACT Introduction Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the precursor of the steroidogenesis pathway, the use of statin could cause a reduction in testosterone levels. Testosterone is essential in biological functions and its reduction can cause negative effects, such as symptoms of hypogonadism. Objective Evaluate whether the continued use of statins causes testosterone deficiency in men. Methods Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until April 2021; protocol was submitted to PROSPERO. Selection performed by two independent authors with subsequent conference in stages. There were selected comparative studies, prospective cohorts or clinical trials with comparison of testosterone levels before and after the use of statin. Bias analysis were evaluated with Cochrane Tool. Results Threre found 717 papers on MedLine, 1352 on Embase and 143 on Cochrane. After removal of duplicates, 833 articles remained. Comparative studies, 10 prospective cohorts and 6 randomized clinical trials were selected for meta-analysis. In the forrest plot with the 16 articles, a reduction in the mean testosterone in patients after the use of statins of 13.61 (95% CI=3.99-23.23, I²=41%, p=0.006) was evidenced, demonstrating statistical significance. In the sub-analysis with the Clinical Trials, a reduction in the mean testosterone levels in patients after the use of statins of 27.45 (95% CI=13.85-41.06, I²=14%, p&amp;lt;0.0001) was evidenced, demonstrating statistical significance. On the other hand, in the sub-analysis of the Prospective Cohorts, an increase in the mean testosterone in patients after the use of statins of 0.25 was evidenced, without statistical significance, of 0.25 (95% CI=-13.87-13.36 I²=38%, p=0.97). A reduction in total testosterone was evaluated in all studies after statin use. However, with the exception of Kannat 2009, all studies showed testosterone levels above the normal level (normal up to 300). In the Kannat study, testosterone levels below this value were already presented before the use of the statin. Conclusion Statins cause a decrease in total testosterone, not enough to cause a significant deficiency. Disclosure Work supported by industry: no.

Role of Serum Total Testosterone and High Sensitivity C-Reactive Protein Levels in Type 2 Diabetic Males

Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder associated with low level of Total Testosterone (TT) and Hypogonadism. Estimation of High sensitivity C-Reactive Protein (Hs-CRP) is useful for assessing the cardiovascular risk. Aim: To estimate serum TT and Hs-CRP levels in Diabetic patients and hence, the association of Diabetes with Erectile Dysfunction (ED) and Cardiovascular risk. Materials and Methods: This was a case-control study with a case-control design, conducted at a tertiary care centre on 100 subjects,60 DM males as cases and 40 healthy male volunteers of same age, as controls, from June 2016 to May 2017. All the relevant demographic and clinical details i.e. age, height, weight, body mass index (BMI), Systolic and Diastolic Blood Pressure were noted for all subjects. All relevant tests i.e. serum TT by Electrochemiluminescence immunoassay analyser Enzyme Chemiluminescence Immunoassay (ECLIA) method, serum Hs-CRP by immunoturbidimetry method, fasting and post-prandial glucose measurements, HbA1c were all done and results were tabulated and analysed. Chi-square test was used to calculate p-value. Analysis of Variance (ANOVA) descriptive analysis was used to find out the mean, standard deviation, standard error and 95% confidence interval. Results: The mean of HbA1c among the case group was 8.185% and 5.004% among the controls. The mean value of TT among cases was 3.891 ng/dL, which was significantly reduced (p-value &lt;0.005) as compared to healthy controls i.e. 5.339 ng/dL. Low level of TT (below 3.5 ng/dL) was seen in 45% of the cases among the diabetic study population which was statistically significant (p-value &lt;0.0001). Seventy five percent of diabetics had erectile dysfunction. The mean value of Hs-CRP among diabetic population was 3.875 and controls were 1.457 mg/L (p-value 0.001). Based on Hs-CRP values, the subjects were sub-categorised into low, intermediate and high risk for CVD. A 31.7% of diabetics were in the intermediate group and 68.3% were in the high risk group for CVD. Conclusion: There was significant reduction in TT in Type 2 Diabetic men. Patients with low TT had increased Hs-CRP value among which 75% falling under high risk category and 25% under intermediate risk category. All the cases had serum Hs- CRP value of either intermediate or high risk category. Low level of TT was also associated with ED and PME.

Does a restricted energy low glycemic index diet have a different effect on overweight women with or without polycystic ovary syndrome?

BackgroundObese women with polycystic ovary syndrome (PCOS) may face additional barriers in achieving weight loss. We aimed to compare the effects of the hypocaloric low glycemic index (LGI) diet on anthropometric variables and insulin resistance in women with and without PCOS and investigate the effect of this diet on the clinical and hormonal features of PCOS women.MethodsThis interventional study was carried out at the Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Of 108 women invited for the purpose of the present study, 62 participants (PCOS = 28, non-PCOS = 34) followed a 24-week energy restricted LGI diet. Anthropometric, biochemical, hormonal and clinical measurements were documented at baseline, 12 weeks and 24 weeks with intervention.ResultsThe percentages of weight loss achieved by both the PCOS and non-PCOS groups did not differ significantly (PCOS: -8.04% vs. non-PCOS: -8.09%). No significant difference in decrease of homeostatic model assessment of insulin resistance (HOMA-IR) was observed between the two groups (PCOS = − 0.83 ± 0.33, non PCOS = − 0.79 ± 0.28, P = 0.83). In PCOS women, significant reduction in total testosterone (− 0.91 ± 0.33 nmol/L, P = 0.006), FAI (− 4.47 ± 1.1, P < 0.001) and increase in SHBG (38.98 ± 11.02 nmol/L, P < 0.001) were observed. Menstrual irregularity was improved in 80% of women with PCOS and a significant decrease (32.1%) in occurrence of acne was reported.ConclusionsThis diet has equally beneficial effects on anthropometric and metabolic characteristics of overweight women with and without PCOS.Trial registrationThis study is registered in the Iranian Randomized Clinical Trials Registry (IRCT, code: IRCT2016092129909N1).

ENURESIS IN ADOLESCENTS AND CONSCRIPTS: MODERN APPROACHES TO DIAGNOSTICS

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

A 1,408 km bicycle tour with prostate cancer patients—results of a pilot study

Abstract Negative psychological and physical effects of prostate cancer and its medical treatment may persist many years after diagnosis. The influence of a long cycling tour on rehabilitative or health-related effects with prostate cancer patients has not yet been studied. In practice, physicians and therapists rarely recommend cycling to prostate cancer. In May 2010, eight prostate cancer patients rode their bikes for over 1,408 km from Cologne to Marseille within 5 weeks. Endurance test, blood examinations (prostate-specific antigen (PSA), total testosterone, interleukin-6, oxidative stress, and antioxidant capacity) and quality of life questionnaires were completed before and after the tour. All eight subjects reached Marseille. Significant improvements could be observed in physical performance and certain quality of life scores (p = 0.008), as well as a reduction of total testosterone (p = 0.19). PSA levels did not change. This pilot study suggests that long bicycle tours with prostate cancer patients are feasible. Due to the missing control group and the small sample size, the results of this pilot study are limited.

The effects of metformin or orlistat on obese women with polycystic ovary syndrome: a prospective randomized open-label study

Comparing the effects of metformin or orlistat on hormone, lipid profile and ovulation status in obese women with polycystic ovary syndrome. A total of 80 women were prospectively recruited to receive either metformin (n = 40) or orlistat (n = 40). Weight, BMI, waist, serum LH, total serum testosterone and lipid profile were assessed at baseline and after 3 months. The subjects' ovulatory status was assessed after 3 months. There was no significant difference in ovulation between the two treatment groups (30% vs 15%). Treatment with either drug showed a significant decline in body weight, BMI (Body Mass Index), and waist circumference, but the degree of decline in both groups was the same. Patients who were treated with orlistat, showed a significant reduction in total testosterone and serum lipid. Women in metformin group showed a significant reduction in serum LH. Both metformin and orlistat showed a similar effect on weight loss and ovulation rates.

Chronic hepatitis C infection and sex hormone levels: effect of disease severity and recombinant interferon‐α therapy

We aimed to investigate the associations between androgen status and markers of liver disease severity and to determine the effect of interferon-alpha (IFN-alpha) treatment on sex hormone levels in the context of hepatitis C infection. We audited liver biopsy and sex hormone data from 35 men with chronic hepatitis C and a separate group of 11 men with hepatitis C who received IFN-alpha treatment at Fremantle Hospital. We found that men with low fibrosis scores (0-2) on the modified Knodell histological activity index were more likely to have lower sex hormone-binding globulin (SHBG) levels (38.2 +/- 13.2 vs 66.6 +/- 43.3 nmol/L, P < 0.001) and higher free testosterone levels (380.4 +/- 102.0 vs 255.9 +/-83.0 pmol/L, P = 0.01) than those with higher fibrosis scores (3-6). SHBG directly correlated with fibrosis scores (r = 0.37, P = 0.032). Free testosterone levels inversely correlated with liver fibrosis scores (r = -0.43, P = 0.011). A transient reduction in total testosterone of 5.7 +/- 4.2 nmol/L (P = 0.014) occurred within the first 6 months of IFN-alpha therapy although free testosterone was unaffected. More severe liver disease was associated with lower free testosterone and higher SHBG. IFN-alpha therapy reduced total testosterone but not to hypogonadal levels, with no decline in free testosterone. These data suggest that liver disease in hepatitis C infection modulates androgen status indirectly via increased SHBG. Screening for androgen deficiency in the context of hepatitis C infection should selectively target men with more severe liver disease or documented higher grade fibrosis.

Orlistat Is as Beneficial as Metformin in the Treatment of Polycystic Ovarian Syndrome

The objective of this study was to evaluate and compare the effect of treatment with orlistat vs. metformin on the hormonal and biochemical features of patients with polycystic ovarian syndrome (PCOS). Twenty-one Caucasian women with PCOS [mean (+/-SEM) age 27 +/- 0.9 yr and body mass index 36.7 +/- 3.3 kg/m(2)] participated in this prospective, randomized, open-labeled study. All subjects had an 8-wk run-in period of dietary modification and then randomized to receive either metformin (500 mg three times daily) or orlistat (120 mg three times daily) for 3 months. Weight, blood pressure, and fasting blood samples were taken at screening, randomization, and on completion. Insulin resistance (IR) was calculated using the homeostasis model of assessment (HOMA)-IR method [HOMA-IR = (insulin x glucose)/22.5]. The results are expressed as mean +/- SEM. When compared with baseline, treatment with both orlistat [93.5 +/- 11.5 ng/dl (3.24 +/- 0.4 nmol/liter) vs. 114.5 +/- 11.5 ng/dl (3.97 +/- 0.4 nmol/liter), P = 0.039] and metformin [97.2 +/- 11.5 ng/dl (3.37 +/- 0.4 nmol/liter) vs. 120.0 +/- 8.7 ng/dl (4.16 +/- 0.3 nmol/liter), P = 0.048] produced a significant reduction in total testosterone. Treatment with orlistat produced a 4.69% reduction in weight (99.0 +/- 6.0 vs. 94.6 +/- 6.1 kg, P = 0.002), and this reduction was more significant than the reduction produced by metformin (4.69 vs. 1.02%, P = 0.006). There was no significant reduction seen after either treatment group for fasting insulin, HOMA-IR, SHBG, or any of the lipid parameters studied. In this study, orlistat produced a significant reduction in weight and total testosterone. The reduction in total testosterone was similar to that seen after treatment with metformin. Therefore, orlistat may prove to be a useful adjunct in the treatment of PCOS.

Divergent effects of two low-dose oral contraceptives on sex hormone-binding globulin and free testosterone

The effect of a triphasic combination of ethinyl estradiol and levonorgestrel on the serum concentrations of total testosterone, free testosterone, and sex hormone-binding globulin as measured directly by radioimmunoassay and on the binding capacity of sex hormone-binding globulin was compared with that of a preparation containing ethinyl estradiol and desogestrel. Blood samples were taken on days 6, 11, 21, and 28 of a control cycle, the third cycle of treatment with either ethinyl estradiol-levonorgestrel or ethinyl estradiol-desogestrel (11 volunteers each), the third cycle of a 3-month washout period, and the third treatment cycle after crossover change of the preparations. There was a significant reduction in total testosterone by 16% during treatment with both preparations. Ethinyl estradiol-desogestrel increased the concentration (+175%) and bindig capacity (+330%) of sex hormone-binding globulin to a much greater extent than with ethinyl estradiol-levonorgestrel (+92% and +160%). Contrary to this, a significant suppression of non-protein-bound testosterone by 35% was found during treatment with both oral contraceptives. The results demonstrate that an excessive elevation of the levels of sex hormone-binding globulin above the normal range does not cause a corresponding suppression of free testosterone. It is assumed that the decrease in the apparent binding affinity of high sex hormone-binding globulin concentrations to testosterone may be due to protein-protein interactions.