Subnormal Testosterone Levels Research Articles

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Aims and objectives:-To assess the pattern of sexual dysfunction among male ocd patients attending at sms medical college Jaipur and its correlation with serum testosterone level.Methodology :-total 40 patients diagnosed with OCD by ICD-10 ,participated in the study after informed consent. Arizona sexual experience scale (ASEX) was applied for sexual dysfunction. Serum testosterone level was measured by laboratory test. After data collection ,data analyzed by spss software.Result :-Total 40 responses were recorded. Sexual dysfunction was seen 37 % of total participants. OCD patients attending the Opd were mostly from urban background. Decreased sex drive and dissatisfaction with orgasm were most common sexual dysfunctions. orgasmic dysfunction was least among the OCD patients, only 20 % show orgasmic dysfunction. Out of 40 OCD patients only 2 patients have below normal level of serum testosterone. out of them only one OCD patient with sexual dysfunction have subnormal testosterone level.Discussion :-about one third of participants had sexual dysfunctions. All patients with sexual dysfunctions have issue with decrease sexual desire.in this study with ocd patients all type of sexual dysfunctions could be present. There were no significant correlation of sexual dysfunction in ocd patients with serum testosterone level.Conclusion:-our study concluded that sexually dysfunctions is frequently seen in drug naïve ocd patients. Proper workup and psychoeducation is necessary before starting SSRI, because they also causes sexual dysfunctions. Our study doesn’t show any correlation of sexual dysfunctions in ocd patients with serum testosterone level.

Effect of long-term testosterone therapy on molecular regulators of skeletal muscle mass and fibre-type distribution in aging men with subnormal testosterone

BackgroundLong-term testosterone replacement therapy (TRT) increases muscle mass in elderly men with subnormal testosterone levels. However, the molecular mechanisms underlying this effect of TRT on protein balance in human skeletal muscle in vivo remain to be established. MethodsHere, we examined skeletal muscle biopsies obtained before and 24-h after the last dose of treatment with either testosterone gel (n = 12) or placebo (n = 13) for 6 months in aging men with subnormal bioavailable testosterone levels. The placebo-controlled, testosterone-induced changes (β-coefficients) in mRNA levels, protein expression and phosphorylation were examined by quantitative real-time PCR and western blotting. ResultsLong-term TRT increased muscle mass by β = 1.6 kg (p = 0.01) but had no significant effect on mRNA levels of genes involved in myostatin/activin/SMAD or IGF1/FOXO3 signalling, muscle-specific E3-ubiquitin ligases, upstream transcription factors (MEF2C, PPARGC1A-4) or myogenic factors. However, TRT caused a sustained decrease in protein expression of SMAD2 (β = −36%, p = 0.004) and SMAD3 (β = −32%, p = 0.001), which was accompanied by reduced protein expression of the muscle-specific E3-ubiquitin ligases, MuRF1 (β = −26%, p = 0.004) and Atrogin-1/MAFbx (β = −20%, p = 0.04), but with no changes in FOXO3 signalling. Importantly, TRT did not affect muscle fibre type distribution between slow-oxidative (type 1), fast-oxidative (type 2a) and fast-glycolytic (type 2×) muscle fibres. ConclusionsOur results indicate that long-term TRT of elderly men with subnormal testosterone levels increases muscle mass, at least in part, by decreasing protein breakdown through the ubiquitin proteasome pathway mediated by a sustained suppression of SMAD-signalling and muscle-specific E3-ubiquitin ligases.

Hypogonadism and effects on quality of life in previously treated germ cell tumor survivors: A single-centre, non-randomized, prospective observational study.

10079Background: Prior studies have shown that around 12% to 16% Germ Cell Tumour (GCT) survivors can have subnormal serum testosterone level as well as up to 15% reported decreased health related ...

Frequency of Hypogonadism and Erectile Dysfunction in Type-II Diabetic Patients.

Introduction: The persistent state of hyperglycemia in diabetes mellitus predisposes diabetic patients to suffer from neuropathy, vasculopathy, and endocrinological changes. Hypogonadism and erectile dysfunction are commonly observed in diabetic patients secondary to androgen deficiency. In the developing world, patients usually under-report their sexual dysfunction. We conducted this study to determine the frequency of hypogonadism and erectile dysfunction and the associated risk factors in type-II diabetic male patients presenting in the outpatient department of a tertiary care hospital in Pakistan.Methods: This was an observational, cross-sectional hospital-based study conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan from April 2017 to October 2017. One hundred and sixty type-II diabetic patients meeting the inclusion criteria were enrolled in the study after informed consent. All patients were given the International Index of Erectile Function (IIEF) questionnaire to determine the severity of erectile dysfunction. Patients were tested for serum total testosterone levels and hypogonadism labeled if the serum testosterone level came out to be less than 8 nmol/L with or without symptoms of hypogonadism or with a testosterone level of 8-12 nmol/L and symptoms of hypogonadism.Results: The mean age of the patients was 51.2 ± 11.5 years (range: 31 – 60 years). The mean duration of type-II diabetes mellitus was 8.3 ± 5.1 years. The frequency of erectile dysfunction was found to be 62.5%. Mild erectile dysfunction was seen in 19 patients (11.9%), mild to moderate in 15 patients (9.4%), moderate in 42 patients (26.2%), and severe in 24 patients (15.0%) with an IIEF score of 17-21, 12-16, 8-11, and 1-7, respectively. More severe erectile dysfunction was seen in patients with a prolonged history of diabetes (p-value <0.0001). The mean testosterone level was 18.1 + 8.4 (range: 0.31-38.1) nmol/L. Based on our criteria, hypogonadism was seen in 61 patients (38.1%) with 29 (18.1%) and 32 (20.0%) suffering from severe and mild forms of hypogonadism, respectively. Forty percent of the patients with erectile dysfunction suffered from some form of hypogonadism with subnormal testosterone levels. The difference in the testosterone level of patients with and without erectile dysfunction was statistically significant (p-value: 0.0001).Conclusion: Patients suffering from type-II diabetes mellitus had a significantly greater frequency of erectile dysfunction and hypogonadism. Diabetic patients should be counseled and treated for these issues to improve their quality of life, especially in under-developed countries where sexual health problems are seldom reported.

High prevalence of hypogonadism and associated impaired metabolic and bone mineral status in subfertile men.

It is yet unknown to which degree young subfertile men present with signs of hypogonadism and whether low testosterone concentration, like in older men, is associated with risk of osteoporosis and metabolic derangements in those subjects. The objective was therefore to investigate the prevalence of hypogonadism and its association with metabolic and bone parameters in young subfertile men. Cross-sectional case-control study. Men from infertile couples (n = 192); 18-50 years; sperm concentration <20 × 10(6) /ml and population-based age-matched controls (n = 199). Blood sampling, anthropometrics, blood pressure, ankle-brachial index and assessment by dual-energy X-ray absorptiometry were undertaken. Odds ratios of biochemical hypogonadism (total testosterone <8·0 nmol/l and/or luteinizing hormone ≥8·6 IU/l and/or ongoing androgen replacement therapy) were calculated. Serum concentrations of sex hormones, lipids, glucose, insulin and HbA1c were assessed and bone mineral density (BMD) evaluated. Compared to controls, the risk of hypogonadism was increased among subfertile men (OR 10; 95% CI, 5·1, 22), being highest in those with nonobstructive azoospermia. Hypogonadal men had higher HbA1c concentration (mean diff. 2·8 mmol/mol; 95% CI, 0·64, 4·9; P = 0·011) and lower lumbar spine BMD (mean diff. 0·05 g/cm(2) ; 95% CI, 0·01, 0·10; P = 0·032) compared to eugonadal subfertile men, even more pronounced in subfertile men with subnormal testosterone levels. Young subfertile men have 10 times increased OR of hypogonadism, which is linked to increased HbA1c and decreased bone mineralization. Endocrine assessment and, if needed, measures to prevent metabolic sequelae and osteoporosis should be included in the routine management of men from infertile couples.

Effects of long-term testosterone replacement therapy, with a temporary intermission, on glycemic control of nine hypogonadal men with type 1 diabetes mellitus – a series of case reports

Type 2 diabetes mellitus (T2DM) is often associated with obesity and subnormal serum testosterone (T) levels. Until 5 years ago there was no indication that men with type 1 diabetes mellitus (T1DM) had subnormal serum T. But recent studies indicate that about 10% of men with T1DM suffer from hypogonadism, as a rule aged men and men with obesity. While hypogonadal men with T2DM benefit from normalization of their serum T, this has not been investigated in men with T1DM. Nine men with T1DM, erectile dysfunction and hypogonadism (total testosterone ≤ 12 nmol/L) received testosterone replacement therapy (TRT). In seven men TRT was intermitted: one man with prostate malignancy and six men because of problems of reimbursement. Incidentally, this provided an opportunity to monitor the effects of withdrawal and of the reinstatement of TRT. In all men, glycemic control (serum glucose and HbA1c), weight, waist circumference, lipid profiles and erectile function improved upon TRT. The seven men whose TRT was intermitted showed a deterioration which improved again upon reinstatement of TRT. The data suggest that aging and obese men with T1DM might have subnormal T levels and that their glycemic control, lipid profiles and erectile function might benefit from TRT.

AB19. Testosterone replacement therapy: how safe is it?

AB19. Testosterone replacement therapy: how safe is it?

UP-03.046 Testosterone Administration Effects on Sexual Function in Aging Males With Symptoms of Late-Onset Hypogonadism and Normal or Subnormal Testosterone Level: A Comparative Analysis

Although testosterone replacement can reverse many symptoms of androgen deficiency, the testosterone administration effects on sexual function of patients with normal testosterone level and clinical symptoms of hypogonadism have not been understood yet. Aim of the study was to further evaluate and compare the impact of testosterone administration on the sexual function of elderly men with sexual symptoms of late-onset hypogonadism (LOH) and normal or subnormal testosterone level.

Low Testosterone in Men with Type 2 Diabetes: Significance and Treatment

The relationship between testosterone and diabetes in men is an important issue, given that one third of U.S. men aged 65 yr or older have diabetes, with a similar percentage having low testosterone levels. The medical literature from 1970 to March 2011 was reviewed for key articles. In population-based studies, low testosterone is commonly associated with type 2 diabetes and the metabolic syndrome, and it identifies men with an adverse metabolic profile. The difference in testosterone levels between men with diabetes compared to men without diabetes is moderate and comparable in magnitude to the effects of other chronic diseases, suggesting that low testosterone may be a marker of poor health. Although the inverse association of testosterone with diabetes is partially mediated by SHBG, low testosterone is linked to diabetes via a bidirectional relationship with visceral fat, muscle, and possibly bone. There is consistent evidence from randomized trials that testosterone therapy alters body composition in a metabolically favorable manner, but changes are modest and have not consistently translated into reductions in insulin resistance or improvements in glucose metabolism. The key response to the aging, overweight man with type 2 diabetes and subnormal testosterone levels should be implementation of lifestyle measures such as weight loss and exercise, which, if successful, raise testosterone and provide multiple health benefits. Although approved therapy for diabetes should be used, testosterone therapy should not be given to such men until benefits and risks are clarified by adequately powered clinical trials.

Differing levels of testosterone and the prostate: a physiological interplay

The controversies surrounding testosterone replacement therapy (TRT) have been addressed in the past few years. Although the androgenic effects of TRT on normal and malignant prostate cells have been studied for over 70 years, little clinical prospective research exists on the physiological responses of prostate tissues to a wide range of serum testosterone levels. The prostate is both an androgen-dependent and an androgen-sensitive organ; active processes are triggered at a 'threshold' or 'saturation' level of testosterone. Despite decades of research, no compelling evidence exists that increasing testosterone beyond this threshold level has a causative role in prostate cancer, or indeed changes the biology of the prostate. Testosterone deficiency has marked physiological and clinical effects on men in middle age and beyond. With subnormal testosterone levels, the potential positive benefits of TRT on factors such as muscle mass, libido or erectile function are likely a dose-response phenomenon, and should be considered differently than the threshold influence on the prostate. This Review will re-examine classic androgen research and reflect on whether testosterone actually stimulates prostatic cellular growth and progression in a 'threshold' or a 'dose-response' (or both) manner, as well as discuss the influence of testosterone on prostate cells in the hypogonadal and eugonadal states.

Associations of endogenous testosterone and SHBG with glycated haemoglobin in middle-aged and older men

Low circulating levels of testosterone and sex-hormone-binding globulin (SHBG) are associated with increased cardiovascular risk in men. This association may be partially mediated through changes in glucose metabolism, but relatively few data are available on the relationship between sex hormones and markers of long-term glycaemia. We assessed the associations of endogenous testosterone and SHBG with glycated haemoglobin (HbA(1c) ) in men. Cross-sectional study of 1292 men from the Norfolk population of European Prospective Investigation into Cancer (EPIC-Norfolk). Glycated haemoglobin, total testosterone (TT) and SHBG levels were measured, and free testosterone (FT) levels were calculated. Multiple linear regression models were used to assess the associations of TT, SHBG and FT with HbA(1c). Men with diabetes had lower testosterone and SHBG levels. In non-diabetic men, HbA(1c) levels were inversely associated with TT and calculated FT independently of age, body mass index, smoking, alcohol consumption and physical activity. The adjusted change in HbA(1c) was 0·055 (95% CI 0·025; 0·085) per standard deviation (SD) decrease in TT and 0·041 (95% CI 0·010; 0·073) per SD decrease in calculated FT, respectively. SHBG levels were inversely associated with HbA(1c) after multivariable adjustment (β = 0·038 per SD decrease (95% CI 0·004; 0·071)). In middle-aged and older men, low endogenous testosterone and SHBG levels are associated with glycaemia, even below the threshold for diabetes. Further studies are needed to determine the effects of interventions that raise testosterone levels in men having increased HbA(1c) and subnormal testosterone levels.

Postprandial triglyceride metabolism in elderly men with subnormal testosterone levels

To investigate the level of postprandial triglycerides (TG)s in elderly men with subnormal testosterone level (< or = 11.0 nmol/L) compared to men with normal testosterone level (> 11.0 nmol/L). Thirty-seven men with subnormal and 41 men with normal testosterone aged 60-80 years underwent an oral fat load and TG levels were measured fasting and 2, 4, 6 and 8 h afterwards. Men with subnormal testosterone had significantly higher body mass index (BMI) and waist circumference (P < 0.001) than men with normal testosterone. They had significantly higher area under curve (AUC, P = 0.037), incremental area under curve (AUCi, P = 0.035) and TG response (TGR, P = 0.014) for serum-TG and significantly higher AUC (P = 0.023), AUCi (P = 0.023) and TGR (P = 0.014) for chylomicron-TG compared to men with normal testosterone level. Adjusting for waist circumference erased the significant differences between the groups in postprandial triglyceridemia. Men with subnormal testosterone have increased postprandial TG levels indicating an impaired metabolism of postprandial TG-rich lipoproteins (TRL), which may add to an unfavourable lipid profile and promote development of atherosclerosis.

Testosterone treatment in elderly men with subnormal testosterone levels improves body composition and BMD in the hip

Our intention was to examine if subnormal testosterone levels in older men were associated with a reduction in quality of life and physical and mental health, and secondly to examine if testosterone treatment could improve these conditions. We performed a nested case-control study and a 1-year testosterone intervention study. Men with subnormal testosterone had significantly higher weight, fat mass and abdominal adipose tissue. They also had significantly higher glucose and insulin levels, and they had higher triglyceride levels. Testosterone treatment had a large impact on body composition with reduced fat mass and abdominal adipose tissue and increased fat-free mass, but it did not affect weight and glucose and lipid metabolism. Bone mineral density in the hip was significantly higher after the testosterone treatment. Older men with subnormal testosterone levels had an unfavorable metabolic profile. Testosterone treatment improved body composition, but it did not reverse the unfavorable metabolic profile.

Impact of testosterone treatment on postprandial triglyceride metabolism in elderly men with subnormal testosterone levels

Objective. To investigate the impact of testosterone supplementation on postprandial triglycerides in elderly men with subnormal endogenous testosterone. Material and methods. Twenty‐six men with subnormal testosterone levels (⩽11.0 nmol/L) were randomly assigned to treatment with intramuscular testosterone or placebo for one year in a double‐blinded study. The participants underwent an oral fat load before and after the treatment period, and serum and chylomicron triglyceride levels were measured fasting and 2, 4, 6 and 8 h afterwards, together with total fat mass and fat‐free mass. Results. Total testosterone rose to low‐normal levels in the testosterone‐treated group. No differences in waist circumference, body mass index, serum levels of total cholesterol, low‐density lipoprotein cholesterol, high density lipoprotein cholesterol, fasting triglyceride concentrations or lipase activity between the groups were observed during testosterone treatment. Testosterone treatment did not affect postprandial serum and chylomicron triglyceride levels assessed by area under the curve, incremental area under the curve or triglyceride response. Total fat mass was significantly reduced (p<0.001) while fat‐free mass was significantly increased (p<0.001) in the testosterone‐treated group. Conclusion. Normalizing testosterone levels in elderly men does not seem to affect the postprandial lipid metabolism to any great extent, but has favourable effects on body composition.

Frailty and its relationship to late onset hypogonadism

The vulnerable health status usually preceding the onset of overt disability is often referred to as frailty. A stringent definition is elusive, but it may be viewed as a physiological syndrome, characterised by decreased reserve and diminished resistance to stressors, resulting from cumulative decline across multiple physiological systems and causing vulnerability to adverse outcomes. Many elements of frailty are related to the neurological system, metabolism, joints, bones and muscles. Central to frailty is the dramatic decline in muscle mass and strength with ageing. Therefore, sarcopenia seems to be the major determinant of frailty. Several components of the frailty syndrome are related to the physiological actions of testosterone. Testosterone also has effects on psychological functioning. Testosterone (or its aromatisation product oestradiol) is required for the maintenance of bone mineral density. Testosterone also stimulates red blood cell formation. Testosterone thus has a profound effect on body composition. A significant characteristic of ageing and a factor in frailty is the loss of muscle mass and the increase in fat mass. Androgens promote differentiation of mesenchymal multipotent cells into the myogenic lineage and inhibit their adipogenic differentiation, thus reversing the development of a downward spiral of loss of muscle mass and increase in fat mass. Skeletal muscles of older men are as responsive to the anabolic effects of testosterone as those of younger men, indicating that age as such should not be an impediment to elderly men benefiting from the anabolic effects of testosterone. So, while frailty is obviously a complex syndrome, some elements are androgen-associated and these may improve in men with subnormal testosterone levels.

P.3.b.011 Associations of 5HT2A receptor gene polymorphisms with the age of onset and baseline symptomatology in schizophrenia

Late-onset hypogonadism is associated with relatively mild testosterone deficiencies. This study investigated the effects of restoring testosterone levels to normal in men with complaints of low sexual desire and erectile dysfunction.Sexual function was assessed with the International Index of Erectile Function (IIEF) at baseline and after 24 weeks of testosterone administration.Twenty-two hypogonadal men (mean age 58 years) with erectile dysfunction were studied. Fifteen patients had serum testosterone below 6.9 nmol/L, and seven between 7.2 and 11.7 nmol/L (reference values in our laboratory ≥12.0 nmol/L); there were considerable comorbidities. The duration of sexual complaints was on average 3.8 years. Patients received intramuscular long-acting testosterone undecanoate.In all patients, serum testosterone levels were restored to normal within 6–8 weeks. Twelve patients reported a significant improvement in the sexual desire domain (from 4.5 to 8.4) and experienced an improvement in the erectile function domain (from 12 to 25 [Questions 1–5 plus 15)], following treatment with this long-acting testosterone; in 9 of 12 patients, this occurred only after at least 12–24 weeks. The remaining 10 patients reported an improvement of sexual desire (from 4.5 to 7.5), but no significant improvement in the erectile function domain (from 12 to 14). No changes in serum prostate-specific antigen or prostate volume were noticed while receiving this long-acting testosterone preparation.Restoring testosterone levels to normal in men with proven subnormal testosterone levels improves libido in most subjects, and erectile function in more than 50% of these men. It may take 12–24 weeks before the effects of testosterone become manifest. Yassin AA, and Saad F. Improvement of sexual function in men with late-onset hypogonadism treated with testosterone only.

ORIGINAL RESEARCH—ENDOCRINOLOGY: Improvement of Sexual Function in Men with Late-Onset Hypogonadism Treated with Testosterone Only

Late-onset hypogonadism is associated with relatively mild testosterone deficiencies. This study investigated the effects of restoring testosterone levels to normal in men with complaints of low sexual desire and erectile dysfunction. Sexual function was assessed with the International Index of Erectile Function (IIEF) at baseline and after 24 weeks of testosterone administration. Twenty-two hypogonadal men (mean age 58 years) with erectile dysfunction were studied. Fifteen patients had serum testosterone below 6.9 nmol/L, and seven between 7.2 and 11.7 nmol/L (reference values in our laboratory >/=12.0 nmol/L); there were considerable comorbidities. The duration of sexual complaints was on average 3.8 years. Patients received intramuscular long-acting testosterone undecanoate. In all patients, serum testosterone levels were restored to normal within 6-8 weeks. Twelve patients reported a significant improvement in the sexual desire domain (from 4.5 to 8.4) and experienced an improvement in the erectile function domain (from 12 to 25 [Questions 1-5 plus 15)], following treatment with this long-acting testosterone; in 9 of 12 patients, this occurred only after at least 12-24 weeks. The remaining 10 patients reported an improvement of sexual desire (from 4.5 to 7.5), but no significant improvement in the erectile function domain (from 12 to 14). No changes in serum prostate-specific antigen or prostate volume were noticed while receiving this long-acting testosterone preparation. Restoring testosterone levels to normal in men with proven subnormal testosterone levels improves libido in most subjects, and erectile function in more than 50% of these men. It may take 12-24 weeks before the effects of testosterone become manifest.

Opioids in non-cancer pain: Opioid Induced Androgen Deficiency in men (OPIAD): An estimate of the potential patient population in the U.S. and Canada

In men with chronic non-malignant pain, the use of long-acting opioid preparations of methadone, morphine sulfate, oxycodone and fentanyl frequently results in a syndrome of opioid induced androgen deficiency (OPIAD) (Daniell 2002). This syndrome is characterized by decreased serum levels of testosterone, decreased libido, erectile dysfunction, fatigue, depressed mood and hot flushes. Low testosterone levels decrease nociceptive threshold in animal models (Forman 1989, Pednekar 1995) and may also influence functional outcomes in men (Gruenewald 2003). Because of its clinical implications we have estimated the size of the potential patient population with OPIAD in the U.S. and Canada. We derived our U.S. estimate as follows: U.S. Population of Men age 18 and above: 101,000,000 (US Census 2000); 9–17% of U.S. Adults (age 18 and above) report having chronic non-malignant pain (CNMP) (multiple surveys); 3.4–39% of patients with CNMP are prescribed opioids, presumed to be of the long-acting type (Fanciullo et al. 2002; Potter et al. 2001); 74% of men prescribed long-acting opioids have subnormal testosterone levels (Daniell 2002). Based on these numbers, the estimated size of the potential OPIAD population in the US ranges from 229,000 to 5,000,000 men. Using the survey data of Moulin et al. 2002, the size of the OPIAD population in Canada is estimated to be approximately 154,000 men. In view of the rapidly increasing frequency with which opioids are being prescribed for chronic non-malignant pain (Joransen et al. 2000), we believe that our estimates are conservative. Nevertheless, the estimates presented here suggest that the potential patient population of men with OPIAD is sizeable, and that OPIAD is a syndrome that merits clinical evaluation and treatment.

Subnormal androgen levels in young female bone marrow transplant recipients with ovarian dysfunction, chronic GVHD and receiving glucocorticoid therapy.

Ovarian function and sex hormone production with special focus on androgens (testosterone, androstenedione, dehydroepiandrosterone and its sulfate, DHEAS) was followed up during 1.5-20 (mean 9) years after bone marrow transplantation (BMT) in 24 female subjects aged 16-33 (mean 21) years at the last follow-up. All patients had received TBI and high-dose chemotherapy as the preparative regimen. A total of 24 female patients with conventionally treated pediatric hematologic malignancies served as controls. Four of 24 transplanted patients had spontaneous menstruation several years post transplantation, but in only one of them were serum FSH levels normal. Androgen levels of the BMT patients were lower than those of the conventionally treated patients. Subnormal testosterone levels were observed in 43% of BMT patients and subnormal DHEAS levels in 34% of BMT patients, the latter being a constant finding during glucocorticoid therapy for chronic GVHD (cGVHD). These results indicate that ovarian damage is a common late effect in patients transplanted at a young age, still having a seemingly normal pubertal development. Ovarian damage and cGVHD with glucocorticoid therapy are strongly associated with subnormal androgen levels. The clinical consequences of these changes and possible benefits of putative androgen replacement therapy remain to be elucidated.

Síndrome de Klinefelter associada a lupus eritematoso sistêmico: Interferência dos esteróides sexuais

A associação de síndrome de Klinefelter e lupus eritematoso sistêmico (LES) é muito rara, com cerca de 21 casos descritos na literatura. Relatamos um caso com desenvolvimento de pericardite, artrite, anemia e alopécia. O uso irregular de testosterona resultou em níveis séricos subnormais deste hormônio, que coincidiram com a abertura do quadro de LES, bem como com duas recidivas. O caso está em consonância com a literatura, que fortalece a hipótese de que os esteróides sexuais tenham um papel relevante sobre o desencadeamento de doenças autoimunes, especialmente o LES.