Serum Free Testosterone Levels Research Articles

Hypogonadism among HIV-positive men who have sex with men in Taiwan: prevalence and associated factors

BackgroundMale hypogonadism is not uncommon in people with HIV (PWH), with estimated prevalence ranging from 9% to 16%. Existing data are limited on the serum testosterone levels in PWH in Asian populations. MethodsWe enrolled HIV-positive men who have sex with men (MSM) and had been on stable antiretroviral therapy and MSM without HIV between February 2021 and November 2022. Serum free testosterone levels, sex hormone-binding globulins and other associated hormones were measured. Multiple linear regression analysis was performed to assess the association between serum free testosterone levels and clinical variables collected. ResultsA total of 447 MSM with HIV and 124 MSM without HIV were enrolled. Compared with MSM without HIV, MSM with HIV had a higher age (median, 41 versus 29.5 years) and prevalence of symptomatic hypogonadism (8.3% versus 1.6%). Among MSM who were aged <35 years, there were no significant differences in the serum free testosterone levels and prevalences of hypogonadism between the two groups. In multiple linear regression analysis, serum free testosterone level significantly decreased with advanced age (a decrease of 1.14 pg/mL per 1-year increase) and a higher body-mass index (BMI) (a decrease of 1.07 pg/mL per 1-kg/m2 increase), but was not associated with HIV serostatus. ConclusionWe found that MSM with HIV had a higher prevalence of symptomatic hypogonadism than MSM without HIV in Taiwan, which could be attributed to age difference. Serum free testosterone levels were negatively correlated with age and BMI, but did not show a significant correlation with HIV serostatus.

Clinical and Biochemical Evaluation of Hirsutism in Young, Lean Girls from Kirkuk City, Iraq: A Cross-Sectional Study

Background: An increase in terminal hair in androgen-dependent regions is known as hirsutism. It is not solely caused by hyperandrogenemia; idiopathic forms are also frequently seen. Objective: To examine the modified Ferriman Gallwey (mFG) cut-off score in female Iraqis as well as the etiological, biochemical, and clinical characteristics of hirsutism. Methods: This prospective cross-sectional study included one thousand young girls with a normal BMI. The features associated with clinical hirsutism were identified using the mFG scoring system. We eliminated eighty-eight young girls who were diagnosed with PCOS. Samples of blood were drawn for biochemical analyses. Results: 53.1%, 19.6%, and 1.2% of females had mild, moderate, or severe hirsutism, respectively. For the young females who participated in the study, their mean mFG scores were 7.07, 11.26, 16.26, and 29, respectively. Only 5% of girls with mild hirsutism had high serum free testosterone levels, despite a considerable difference in free testosterone levels between them and the normal girls. The chin, upper lip, and lower abdomen were the sites that contributed the most to mFGs. Of the girls who were moderately hirsute, 55% had a positive family history of hirsutism. Conclusion: Iraqi women do not need to consider the mFG score system's cut-off number of 8. The endocrine society's guidelines for hirsutism estimation should be adhered to by the examiner.

OR15-01 Overweight/Obese Pubertal Girls Have Higher Androgen Levels - Can Metabolomics Tell Us Why?

Abstract Disclosure: M. Calvert: None. S. Molsberry: None. A.K. Jarmusch: None. K.E. Overdahl: None. N. Shaw: None. Introduction: The Body Weight and Puberty Study (BWPS) was a 4-year longitudinal study of 90 healthy pubertal, pre-menarchal girls consisting of dual-energy x-ray absorptiometry to calculate total body fat (TBF), Tanner staging, breast ultrasound, and hormone tests. We observed that with time, girls with higher TBF demonstrated higher serum total and free testosterone and androstenedione levels. The cause of this association is unknown but is hypothesized to relate to greater insulin resistance. Methods: To investigate the association between higher androgens and higher TBF in late pubertal girls, we conducted an untargeted metabolomics study using our BWPS collection of 158 blood and 178 urine samples. Samples were run on an ultra-high performance liquid chromatograph (Vanquish, Thermo Scientific) coupled to a high-resolution mass spectrometer (Orbitrap Fusion Tribrid, Thermo Scientific) and analyzed in positive and negative ionization modes. We investigated the association between TBF or BMI Z-score and metabolites and the association between metabolites and serum androgen levels. All associations were examined cross-sectionally and lagged by one visit using linear generalized estimating equation models, adjusting for breast morphological stage and age at baseline, race, and time between visits. Benjamini-Hochberg false discovery rate (FDR) adjusted p-values were calculated to account for multiple testing. RaMP DB (Relational database of Metabolomic Pathways) was used to conduct enriched pathway analyses among metabolites nominally associated with body composition or hormone levels. Results: 70 participants (aged 10.9 ± 1.39 SD years; 60% White, 24% Black, 16% Other; 63% normal weight, 37% overweight/obese) contributed an average of 2.39 blood and 2.54 urine samples over the course of 1.15 ± 0.47 SD years of follow-up. While few metabolites were significantly associated with body composition or androgen levels after strict multiple testing correction, RaMP DB enriched pathway analyses identified several pathways linking TBF and androgen levels: 1) in lagged analyses of urinary metabolites, overall amino acid metabolism, arginine and proline metabolism, and the urea cycle linked TBF with androstenedione; 2) in cross-sectional analyses of serum metabolites, bile acid synthesis and metabolism, VEGF or extra-nuclear estrogen signaling (related to the metabolite, sphingosine-1-phosphate), and tryptophan metabolism linked TBF with androstenedione. Conclusions: Metabolomic analyses of samples from pubertal girls did not uncover signatures of insulin resistance (e.g., branched chain amino acids or C3- and C5-acyclcarnitines) to explain the association between higher androgens and TBF. Instead, we identified potential novel signaling pathways that may involve amino acid, bile acid, or sphingosine-1-phosphate action at the ovary and/or adrenal gland. Presentation: Friday, June 16, 2023

A-048 Accurate Measurement of Free Testosterone in Serum using Equilibrium Dialysis Coupled with ID-UHPLC-MS/MS

Abstract Background Assessment of free testosterone (FT) has been recommended in recent clinical practice guidelines as a biomarker for diagnosis and management of testosterone related disorders such as male testosterone deficiency due to hypogonadism and female androgen excess due to polycystic ovary syndrome (PCOS). FT is currently measured using direct commercial immunoassays, assays using equilibrium dialysis (ED) or other separation techniques. Though the ED approach is recognized as the recommended approach, it is laborious and technically challenging for routine clinical use. The CDC Clinical Standardization Program is developing a high throughput automated method using the ED procedure coupled with isotope dilution ultra-high-performance liquid chromatography tandem mass spectrometry (ID-UHPLC-MS/MS) that is suitable for routine patient care and large-scale epidemiologic studies. Methods Serum samples are dialyzed in a custom-designed multi-well plate against a protein-free HEPES buffer (pH 7.4) at 37 °C until equilibrium. After isolating endogenous FT from protein-bound testosterone by ED, isotope-labeled internal standard (13C3-testosterone) was added to the dialysate for quantification. Certified pure primary reference material (National Measurement Institute-M914) was used to prepare calibrators, enabling traceability and ensuring measurement trueness. FT was further isolated from the dialysate matrix using supported liquid extraction and a chromatographic separation from interfering compounds and quantitation by tandem MS. Results The measurement ranges covered 0.2–1000 ng/dL for testosterone, with the bias within ±5% and precision less than 10% CV. A total of 45 samples with a wide range of total testosterone (TT, 21–912 ng/dL) and SHBG (11–129 nmol/L) were analyzed and showed the suitability of this assay to measure the serum free testosterone levels in normal, hypogonadal males as well as in the majority of normal females and females with androgen excess. The application of 48-well format plate and automated liquid handler system significantly improves the throughput of sample preparation. In addition, comparison of the TT results measured with the presented TT method with calculated TT concentrations, suggest that on average calculation overestimates TT concentration by 34%. Conclusion The described high throughput method for FT allows for sufficiently accurate and precise measurement for routine applications including large epidemiologic studies to help with establishing reference intervals.

Early Postnatal Experience Modifies Activation of the Pituitary Testicular Complex in Male House Mice (Mus Musculus) Exposed to the Odor of Receptive Con- and Heterospecific Females

For the first time, it was shown that activation of the pituitary–testicular complex in male house mice exposed to the odor of receptive females of their own and closely related species was modified under the influence of early postnatal experience and the maternal environment. We have confirmed associated formation of behavioral and physiological mechanisms of precopulatory isolation in early ontogenesis. The serum levels of free testosterone in males of closely related species M. spicilegus and M. m. wagneri differ, it is significantly lower in mound-building mice. In males fostered by a conspecific female, the level of free testosterone was significantly lower when exposed to a heterospecific female odor in comparison with a conspecific odor. The rearing of M. m. wagneri males by females of a closely related species led to a decrease in the testosterone response caused by exposure to female chemosignals (both con- and heterospecific) and to the absence of differences in the serum level of free testosterone when exposed to the odor of a female of their own or closely related species. These results indicate that the rearing conditions had a significant influence on the formation of hormonal mechanisms of reproductive isolation.

Relation between athletic club affiliation from school age and future serum free testosterone levels in Japan: A cross-sectional study.

Testosterone deficiency is often related to geriatric syndrome including erectile dysfunction, osteo-porosis, depression, cognitive impairment, cardiovascular diseases and frailty. Despite the existence of many studies on short-term exercise and serum testosterone levels, few research have focused on exercise habits from young age and testosterone values in middle-aged male. In this study, we investigated whether belonging to an athletic club from school age could predict serum-free testosterone (FT) levels. The subjects were 1609 middle-aged male outpatients aged 40 years or older (median: 61 years, interquartile range: 54-69) who visited our hospital. Participants had their FT values measured in the morning hours during the period from December 2007 to June 2009. A questionnaire survey on exercise habits was conducted at the same time as the measurements. The exercise habit questionnaire was created based on whether the patients belonged to an athletic club in (a) elementary school, (b) junior high school, (c) high school, (d) college, (e) adult life, and (f) at the time of the test. There was only one positive response to the questionnaire among 456 patients (28% of total), followed by zero for 358 patients (22% of total). The number of patients with low-testosterone levels (FT < 8.5 pg/mL) according to the Japanese diagnostic criteria for late-onset of hypogonadism was 839 (52.1%). In multivariate analysis, it was shown that with low-testosterone levels (FT < 8.5 pg/mL), age (odds ratio [OR]: 1.065, 95% confidence interval [CI]: 1.052-1.079; p < 0.001), hypertension (OR: 3.489, 95% CI: 2.728-4.462; p < 0.001), type-2 diabetes (OR: 3.035, 95% CI: 2.296-4.01; p < 0.001), and dyslipidemia (OR: 2.039, 95% CI: 1.558-2.668; p < 0.001) were risk factors, and more than two positive responses to the questionnaire (OR: 0.886, 95% CI: 0.802-0.980; p = 0.018) were also a significant independent factor. A sports club membership during school years may affect future testosterone levels.

EARLY POSTNATAL EXPERIENCE MODIFIES ACTIVATION OF THE PITUITARY-TESTICULAR COMPLEX IN MALE HOUSE MICE (&lt;i&gt;MUS MUSCULUS)&lt;/i&gt; EXPOSED TO THE ODOR OF RECEPTIVE CON- AND HETEROSPECIFIC FEMALES

For the first time, data were obtained proving the modification of the activation of the pituitary-testicular complex of male house mice under the influence of early postnatal experience and the maternal environment when exposed to the odor of receptive females of their own and closely related species. We have confirmed the conjugacy of the formation of behavioral and physiological mechanisms of precopulatory isolation in early ontogenesis. The serum level of free testosterone in males of closely related species M. spicilegus and M. m. wagneri differ, it is significantly lower in mound-building mice. The level of free testosterone of males fostered by a conspecific female was significantly lower when they exposed a heterospecific in comparison with a conspecific female odor. The rearing of M. m. wagneri males by females of a closely related species caused a decrease in the testosterone response of males to the exposure of chemosignals from a female (both con-and heterospecific) and led to the absence of differences in the serum level of free testosterone when they exposed to the odor of a female of their own or closely related species. The data obtained indicate a significant influence of the rearing conditions on the formation of hormonal mechanisms of reproductive isolation.

Sex Hormones associated with Temporomandibular Pain on Palpation in Male Adolescents - Results of the Epidemiologic LIFE Child Study.

This study aimed to investigate whether the sex steroid precursor hormone dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), and testosterone (TT) are associated with temporomandibular (TM) pain on palpation in male adolescents. Out of the LIFE Child study dataset containing 1,022 children and adolescents aged 10 to 18 years (496 males, 48.5%), we used a subsample of 273 male adolescents (mean age: 13.8 ± 2.3 years) in advanced pubertal development (PD) to analyze the association between hormones and TM pain. The Tanner scale was applied to describe the stage of PD. Pain on palpation of the temporalis and masseter muscles and the TM joints (palpation pain) was assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum levels of sex hormones (DHEA-S, SHBG, TT) were determined using standardized laboratory analyses. Free TT was estimated from the ratio between TT and SHBG (free androgen index = FAI). We calculated the risk of perceived positive palpation pain for male participants as a function of hormone levels (DHEA-S, FAI) taking into account age and body mass index (BMI). Among more developed (Tanner stage 4-5) male adolescents, 22.7% (n=62) reported palpation pain in the TM region. In these participants, FAI levels were approximately half that of individuals without such pain (p<0.01). DHEA-S levels were about 30% lower in the pain group (p<0.01). In multivariable regression analyses, the odds ratio (OR) for pain on palpation decreased to 0.75 (95% confidence interval [CI]: 0.57-0.98) per 10 units of FAI level compared to those without pain, after controlling for the effects of age and adjusted BMI. We observed the same effect for this subgroup per unit of DHEA-S serum level (OR=0.71; 95% CI: 0.53-0.94). At subclinical lower levels of serum free TT and DHEA-S, male adolescents are more likely to report pain on standardized palpation of the masticatory muscles and/or TM joints. This finding supports the hypothesis that sex hormones may influence pain reporting.

The possible protective effect of the nuclear factor kappa B inhibitor pyrrolidine dithiocarbamate on tramadol-induced testicular damage in rats

BackgroundTramadol provokes oxidative stress that gives rise to apoptosis with alterations in the cellular structure and adversely influences male fertility. A specific inhibitor of nuclear factor kappa B (NF-κB), pyrrolidine dithiocarbamate (PDTC), has observable antioxidant and anti-inflammatory characteristics and enhances the improvement of organs damage caused by various agents. The impact of PDTC on testicular damage caused by tramadol has not been previously examined.ObjectiveThis study was designed to investigate the potential impact of pyrrolidine dithiocarbamate on testicular damage provoked by chronic tramadol usage.Materials and methodsForty healthy adult male albino rats were included in this study. Rats were randomly and equally divided into 4 groups: group (I), control group; group (II), pyrrolidine dithiocarbamate (PDTC) group; group (III), tramadol (Tr) group; and group (IV), Tr + PDTC group. This study measured serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and free testosterone levels. Testicular malondialdehyde (MDA), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) levels, and superoxide dismutase (SOD), glutathione peroxidase (GPX), and caspase-8 and caspase-3 activities were also detected. Immuno-histochemical evaluation of inducible NOS (iNOS) expression in testicular tissue along with histopathological examination of testicular tissue has been studied.ResultsTramadol caused a significant reduction in serum FSH, LH and testosterone levels, epididymal sperm count, and motility, as well as testicular GPX and SOD activities. On the other hand, a significant elevation of testicular MDA, IL-1β, IL-6, and TNF-α levels and caspase-8 and caspase-3 activities were found. However, PDTC administration with tramadol showed significantly increased sperm production and motility and alleviated tramadol-induced disturbance in other measured parameters in the Tr + PDTC group compared to the Tr group. Moreover, co-administration of PDTC with tramadol significantly alleviated the histopathological structure of testicular tissue and the increased iNOS expressions noticed in the tramadol-treated group.ConclusionConsidering the protective effects of PDTC against the reproductive toxicity induced by tramadol, this compound can be used as a possible protective and treating target for tramadol-induced reproductive toxicity.

Does Baseline Serum Androgen Levels Have an Impact on Ovulation Induction Cycle Outcomes by Using Clomifene Citrate Among Infertile Women with Polycystic Ovary Syndrome? A Retrospective Cohort Study

OBJECTIVE: Hyperandrogenism is one of the diagnostic criteria for polycystic ovary syndrome. Women with polycystic ovary syndrome suffer from infertility due to anovulation. Hyperandrogenism results in follicular arrest at the antral stage during folliculogenesis. baseline intrinsic hyperandrogenism affects the success of ovulation induction or not. The relationship between baseline serum androgen levels and ovulation induction cycle outcomes by using clomifene citrate among infertile women with polycystic ovary syndrome has not been investigated thoroughly. STUDY DESIGN: Ovulation induction cycle outcomes of 35 infertile women diagnosed with polycystic ovary syndrome according to Rotterdam criteria who have received 50-100 mg/day clomifene citrate have been evaluated retrospectively. Menstrual cycle day 2-5 serum levels for gonadotropins, androgens, metabolic parameters, and ovulation induction cycle outcomes have been compared between women who have and have not achieved clinical pregnancy following treatment. RESULTS: Serum basal follicular stimulating hormone, LH, E2, fasting cholesterol, glucose, and HOMA-IR levels were comparable between these two groups of patients. Unlike other serum androgens, baseline serum-free testosterone level is significantly lower for patients who have achieved clinical pregnancy following ovulation induction with clomifene citrate. The baseline serum cut-off level for free testosterone to predict clinical pregnancy was 1.94 pg/ml with 75% sensitivity and 67% specificity rates. CONCLUSION: Lower or higher levels of androgenic milieu within the ovaries result in defective folliculogenesis and ovulation failure. Increased serum levels of free testosterone which is a proxy for ovarian androgen production might be a detrimental factor for clinical pregnancy rates of women with polycystic ovary syndrome by impairing proper folliculogenesis.

Age-Dependent Relationships Between Disease Risk and Testosterone Levels: Relevance to COVID-19 Disease.

Testosterone levels in men appear to be prognostic of a number of disease outcomes, including severe COVID-19 disease. Testosterone levels naturally decline with age and are lower in individuals with a number of comorbidities and chronic conditions. Low testosterone may therefore be both a cause and a consequence of illness, including COVID-19 disease. The present project examines whether preexisting conditions for severe COVID-19 disease were themselves related to serum-free testosterone levels in men who had not been infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. A clinical risk score for severe COVID-19 disease was computed based on the results of previously published meta-analyses and cohort studies, and relationships between this score and testosterone levels were tested in 142 men ages 19 to 82 years. Greater burden of preexisting conditions for severe COVID-19 disease was related to lower testosterone levels among men younger than 40 years of age. In older men, the decrease in testosterone that accompanies aging attenuated the effect of the clinical risk score on free testosterone levels. Given that older age itself is a predictor of COVID-19 disease severity, these results together suggest that the presence of preexisting conditions may confound the relationship between testosterone levels and COVID-19 disease outcomes in men. Future research examining relationships among testosterone and outcomes related to infectious and chronic diseases should consider potential confounds, such as the role of preexisting conditions.

Abstract 2563: Beneficial effects of Furosap® - A novel fenugreek seed extract, in improving lean body mass, fat free mass and serum testosterone level: A randomized, placebo-controlled, double blind clinical investigation

Abstract 2563: Beneficial effects of Furosap® - A novel fenugreek seed extract, in improving lean body mass, fat free mass and serum testosterone level: A randomized, placebo-controlled, double blind clinical investigation

Rare virilizing tumor: ovarian steroid cell tumor, not otherwise specified: a case report

BackgroundOvarian steroid cell tumors, not otherwise specified is a rare sex cord-stromal tumor. Almost 60% of all steroid cell tumors are categorized as not otherwise specified and represent less than 0.1% of all ovarian neoplasm. Some of them are endocrinologically active, producing virilization signs in young women. The recommended treatment is primarily surgical.Case presentationWe present the case of a 20-year-old Mexican woman with secondary amenorrhea and virilization signs. She was treated with combined oral contraceptives from 13 years old, due to a misdiagnosis of polycystic ovarian syndrome. However, 4 months after stopping medication, amenorrhea and virilization signs worsened. Biochemically, she had high serum total testosterone and free testosterone levels, and a pelvic and transvaginal ultrasound followed by a pelvic tomography scan demonstrated a right adnexal tumor. She underwent right salpingo-oophorectomy and the histopathological and immunochemistry exams confirmed the diagnosis. The patient was followed for a year after surgery and until then, her menses were regular and she had no recurrence of virilization signs. ConclusionThe purpose of this case report is to alert physicians to rule out ovarian steroid cell tumor, not otherwise specified diagnosis in young women with increased testosterone after discarding common causes such as polycystic ovarian syndrome. A multidisciplinary team including a gynecologist, endocrinologist, radiologist, and pathologist should be involved for correct diagnosis at the proper time.

Improvement of attention deficit/hyperactivity disorder (ADHD) in three adult men during testosterone treatment: a case series

BackgroundAttention deficit/hyperactivity disorder (ADHD) entails inattention, impulsivity, and restlessness at a disabling level. The pharmacological treatment of ADHD rests on the use of centrally acting stimulants, such as methylphenidate and D-amphetamine. In some patients, these drugs cause side effects that preclude their use.Case presentationWe present three adult male, Caucasian, ADHD patients (24, 37, and 43 years old) whose ADHD symptoms improved during treatment with testosterone. The first patient experienced loss of libido during treatment with methylphenidate; for this, he was offered a trial of testosterone. Unexpectedly, his ADHD symptoms improved with testosterone treatment, and this effect continued with testosterone as monotherapy. The two other patients, who also had side effects from centrally acting stimulants, received testosterone monotherapy with similar results. The effect has now continued for 4.5–5 years at the same doses: 10–60 mg testosterone/day, administered as a skin gel. Prior to testosterone treatment, the patients had serum levels of testosterone in the low–normal range: 12–16 nmol/L (age-specific reference range: 10.4–32.6 nmol/L). The testosterone/sex hormone-binding globulin ratio was low in two patients (0.32 and 0.34; age-specific reference range: 0.38–1.1), suggesting low free serum levels of testosterone. Serum testosterone levels and testosterone/sex hormone-binding globulin ratios increased with testosterone treatment in all patients, but remained within reference values.ConclusionThese cases suggest that a moderately reduced serum level of free testosterone may contribute to the ADHD symptoms of some adult male ADHD patients, and that testosterone treatment may be of value for these patients.

Randomized clinical trial: effect of low-dose flutamide on abdominal adipogenic function in normal-weight women with polycystic ovary syndrome

To examine whether low-dose flutamide administration to normal-weight women with polycystic ovary syndrome (PCOS) reduces abdominal fat deposition, attenuates accelerated lipid accumulation in newly formed adipocytes derived from subcutaneous (SC) abdominal adipose stem cells (ASCs), and/or alters glucose-lipid metabolism. A double-blind, placebo-controlled randomized clinical trial. An academic medical center. Twelve normal-weight women with PCOS and 12 age- and body mass index-matched controls. Women underwent circulating hormonal and metabolic determinations, intravenous glucose tolerance testing, total body dual-energy roentgenogram absorptiometry, and SC abdominal fat biopsy. Interventions were repeated in women with PCOS after 6-month administration of flutamide (125 mg orally daily) vs. placebo. Clinical parameters and lipid accumulation in newly formed adipocytes derived from SC abdominal ASCs invitro were compared between controls and the women with PCOS receiving flutamide vs. placebo. Serum luteinizing hormone and androgen levels as well as lipid accumulation in newly formed SC abdominal adipocytes were greater in the women with PCOS than controls. Flutamide vs. placebo reduced percent android fat, lowered serum log low-density lipoprotein and log non-high-density lipoprotein levels, and increased fasting circulating glucose levels. In all women with PCOS, changes in percent android fat positively correlated with serum log non-high-density lipoprotein and log low-density lipoprotein levels, with correlations influenced by serum free testosterone levels. Flutamide vs. placebo also attenuated lipid accumulation in newly-formed PCOS SC abdominal adipocytes invitro relative to controls, which was unrelated to serum lipid levels. Low-dose flutamide administration to normal-weight PCOS women reduces preferential abdominal fat deposition, attenuates accelerated lipid accumulation in newly-formed adipocytes derived from SC abdominal ASCs invitro, and alters glucose-lipid homeostasis. NCT01889199 (URL, clinicaltrials.gov; date of registration, 6/28/2013; enrollment date of first subject, 6/28/2013).

ODP418 Late-Onset Hypogonadism Detected in Young Male Patients Suffering From Post COVID-19 Condition

Abstract At least one-third of post COVID-19 patients suffer from various chronic symptoms, defined by WHO as "post COVID-19 condition". However, the pathogenesis of post COVID-19 condition and its clinical course remain unclear. In February 2021, we set up an outpatient clinic specialized for COVID-19 after care (CAC) in Okayama University Hospital in Japan and we have investigated the clinical characteristics of patients with post COVID-19 condition. Our recent study revealed that general fatigue is the most common symptom in the post COVID-19 condition. Direct effects of viruses on each organ and conditions such as post-intensive care syndrome, post-traumatic stress disorder, and myalgic encephalomyelitis / chronic fatigue syndrome have been considered as possible etiologies. Recently, it has been suggested that endocrine disruption including the hypothalamic damage might be involved in the underlying mechanism. In the present study, we focused on male hypogonadism, called late-onset hypogonadism (LOH) syndrome. LOH syndrome causes fatigue and metabolic syndrome in middle-aged males. The aim of this study was to clarify the clinical characteristics of patients with LOH syndrome who visited our CAC outpatient clinic. We retrospectively reviewed medical records of all 39 male patients in whom serum free testosterone (FT) level was measured between February 2021 and November 2021 in our CAC outpatient clinic. As a result, 19 patients (48.7%) met the criteria for LOH syndrome (FT &amp;lt; 8.5 pg/mL; LOH group), and 14 (73.6%) of those patients were under the age of 50 years. A weak negative correlation was found between age and serum FT level (R=-0.301, p=0. 0624). A comparison of the LOH group with the non-LOH group showed that there were no significant differences in the patients’ background factors including age (36. 0 vs. 37.5 years), acute hospitalization (9 patients, 47.4% vs. 5 patients, 25. 0%), and number of days between COVID-19 onset and CAC outpatient clinic visitation (71 vs. 81 days). There were also no significant differences in various laboratory parameters between the two groups. However, symptoms including anxiety, cough and hair loss were more frequent in the LOH group. Compared to the incidence of LOH syndrome in the general population, the present study revealed that there is a relatively high incidence of LOH syndrome in young patients with post COVID-19 condition. Although it is known that gonadal functions are impaired in the acute phase of COVID-19, hypogonadism is also thought to be related to the chronic phase of COVID-19. Leydig cells in the testis may be susceptible to damage by SARS-CoV-2 virus because of the high level of ACE2 receptor expression; however, the underlying mechanisms of LOH syndrome due to post COVID-19 condition have yet to be elucidated. Presentation: No date and time listed

PREVALENCE OF LOW FREE TESTOSTERONE LEVEL IN MEN WITH TYPE 2 DIABETES MELLITUS

Background &#x0D; Prevalence of low serum free testosterone levels in men with type2 diabetes mellitus has been reported worldwide.&#x0D; Objectives &#x0D; To find the prevalence of low free testosterone levels in type2 diabetic men.&#x0D; Patients and Methods&#x0D; A cross-sectional study was carried out in (the Diabetic and Endocrine Center) in Sulaimani from the 5th of April, 2017, to the 3rd of January, 2018. Eighty-eight male patients of type two diabetes mellitus who attended the centre for regular follow-up are included. After taking consent and history from the patient, a questionnaire was taken on Sociodemographic data and diabetic characteristics (duration &amp;type of treatment), body mass index, and statin use. In addition, blood tests, including; free testosterone, were measured from morning samples using the ELISA kit (bioactive diagnostic, free testosterone ELISA kit), blood sugar (fasting), HbA1c, serum cholesterol, and serum triglyceride were done for all patients.&#x0D; Results&#x0D; There was little relation (correlation coefficient =0.07) (p-value 0.49) between free testosterone and HbA1c% concentration, and serum HbA1c% does not seem to contribute significantly to the free testosterone level variation. Duration of diabetes does not affect free testosterone levels. &#x0D; Conclusion&#x0D; The level of free testosterone in type2 diabetic men was average; there was no correlation between serum HbA1c concentration and serum-free testosterone.

Association between serum fructose level and insulin resistance in women with polycystic ovary syndrome: The effect of obesity

Background: Polycystic ovary syndrome (PCOS) women's most prevalent endocrinology condition is a mixture of environmentally and genetically adduced causing PCOS. The relationship between monosaccharide and PCOS is largely unknown. Objective: This research was designed to investigate the relationship between blood levels of fructose, insulin resistance, and androgen hormone in women with PCOS, and the effect of obesity on the obtained result, as well as to study the efficacy of serum fructose as a biomarker in the diagnosis of PCOS. Cases and methods: This case-control research study was conducted at the Gynecology Clinic and Infertility Center, in Baghdad Teaching Hospital / Medical City between November 2021 to March 2022. It involved 120 women between the ages of 18-40 year. Fifty-nine women (cases) were newly diagnosed with PCOS by a gynecologist and 61 age and BMI matched healthy women (controls). PCOS women were subdivided according to their body mass index into four groups: lean, normal weight, overweight and obese. Investigations included serum measurements of fructose, luteinizing hormone (LH), follicular stimulating hormone (FSH), free testosterone, insulin, glucose, and calculated homeostasis model assessment- insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). Results: The mean ±SD values of serum fructose, glucose, insulin and HOMA-IR were significantly augmented in PCOS women as compared to controls (p&lt; 0.001), while mean value of QUICKI was significantly decreased (p&lt;0.0001). There was a significant positive correlation between BMI values and fructose levels in PCOS women. The result showed that serum fructose and free testosterone levels had the highest sensitivity and specificity in the differentiation between the PCOS group and the controls, with the area under curve values for free testosterone higher than area under curve values for fructose. Conclusions: The fructose level can be used as an alternative biomarker for women with PCOS independent of insulin resistance. The majority of PCOS women are obese and overweight, and a minority are lean who are severely complicated by insulin resistance.

The Association Between Serum Testosterone Levels and Coronary Artery Disease in Men

Background: Death due to coronary artery disease (CAD) is twice higher in men than women, and older men are more susceptible to the disease. Serum testosterone levels decrease with increasing age. Objectives: In this study, we aim to study the association between serum testosterone levels and Gensini scores in men. Methods: This cross-sectional study was conducted on 60 men above 40 years who had undergone coronary angiography. Thirty of them had normal coronary vessels, and 30 had coronary artery disease. For each group, the Gensini score was calculated. Results: Serum testosterone levels in the CAD group and the control group were 4.04 ± 2.56 and 5.59 ± 2.20 ng/mL, respectively (P &lt; 0.05), and free testosterone levels in the CAD patients and the control groups were 7.32 ± 5.24 and 12.91 ± 3.27 pg/mL respectively (P &lt; 0.001). Sex hormone binding globulin (SHBG) levels in the CAD and the control groups were 28.88 ± 15.30 and 38.2 ± 19.9 nmol/mL, respectively (P = 0.04). Univariate analysis showed a significant association between Gensini score and total and free testosterone levels. The receiver operating characteristic curve (ROC) showed that the cut-off point of 7.97 had a sensitivity of 73.3% and specificity of 90% in predicting a high Gensini score (AUC = 0.799, P &lt; 0.001). Conclusions: Findings of our study demonstrated that serum free testosterone levels have a significant correlation with Gensini score and CAD severity.

Association Between the Levels of Serum Free Testosterone and Lifestylerelated Diseases in People Living with HIV.

Recently, male hypogonadism was reported to be prevalent in people living with HIV (PLWH), even in cases diagnosed based on the serum free testosterone level (fTST). However, studies on the management of PLWH showing the relationship between male hypogonadism and lifestyle-associated diseases, are sparse. This study evaluated the relationship between serum fTST levels and lifestyle-related diseases in virologically stable PLWH. This study was a retrospective cohort single-center study. The study included HIVinfected men on antiretroviral therapy, with available data on serum fTST levels at Teikyo University Hospital between June 2020 and September 2020. Clinical information was collected at the time of fTST measurement. A simple regression analysis was used to identify continuous variables significantly associated with serum fTST levels. Student's t-test and Mann-Whitney U test were also used to identify non-continuous variables that were significantly correlated with serum fTST levels. Sixty male patients were evaluated. The median age was 47 (40-62) years. Low serum fTST levels were significantly associated with old age, low hemoglobin and total cholesterol levels, and high hemoglobin A1c levels. Non-use of INSTI and comorbid hypertension were also significantly associated with low serum fTST levels. Hypertension and the serum hemoglobin A1c level as a standard parameter for diabetes was significantly associated with low serum fTST levels in Japanese male PLWH. This study suggested that sex-hormone replacement therapy could be a preferred option for PLWH with low serum fTST levels to manage their long-term complications.