Testosterone Levels In Patients Research Articles

Efficacy and safety of letrozole in treatment of male children with disorders of sex development

To investigate the efficacy and safety of aromatase inhibitor letrozole in treatment of male children with disorders of sex development (DSD). Clinical data of 12 male DSD children with a mean age of 14.6±2.5 years admitted to Peking Union Medical College Hospital from January 2014 to January 2016 were retrospectively analyzed. The patients were treated with letrozole (1.25-2.5 mg, once a day) for 3 months or longer, and followed up for 0.5-2.5 years. Clinical manifestation and laboratory test findings were documented, and the efficacy and safety were evaluated. After half-year treatment, the blood luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels of patients increased (all P < 0.05), and estrogen levels decreased from baseline ( P < 0.05). After 1 year of treatment, the blood testosterone level was significantly higher ( P < 0.05); the LH and FSH levels tended to increase and the estrogen level tended to decrease, but there was no significant statistical difference ( P>0.05). Semen was routinely detected in 8 patients, and sperms were detected in semen of 3 patients with hypospadias. There were no significant changes in biochemical results after treatment, and no significant adverse event was observed during the treatment. Letrozole can effectively increase testosterone levels in patients with disorders of sex development and promote spermatogenesis, it has no significant adverse effects in short-term administration.

Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials

BackgroundPolycystic ovary syndrome (PCOS) is an endocrine disorder affecting about 10% of women in reproductive age and associated with a variety of hormonal abnormalities, including hyperandrogenemia and infertility, all of which could lead to PCOS. Statins were previously introduced as a therapeutic option for reducing testosterone levels in women with PCOS, either alone or in combination. The aim of this study is to evaluate the effectiveness of different statins alone or in combination with metformin in reducing testosterone levels in women with PCOS.MethodsMedline, Embase, and clinicaltrials.gov were searched for studies that investigated the efficacy of statins, metformin, spironolactone, or combined oral contraceptives (COCs), individually or in combination, in reducing the testosterone level in patients with PCOS. The search was limited to randomized clinical trials and conducted according to the preferred reporting items for systematic reviews and meta-analyses - extension statement for network meta-analyses (PRISMA-NMA). The quality of included studies was assessed using the Cochrane Collaboration risk of bias (RoB) assessment tool. A frequentist network meta-analysis using random-effects models was used to assess the efficacy in reducing testosterone level and were expressed as odds ratios (OR) and 95% credible interval (95%Crl). All statistical analyses were performed using netmeta Version 1.0 on R statistical package.ResultNine RCTs involving 613 patients were included. Atorvastatin showed greater reduction in testosterone level compared to COC (MD −2.78, 95%CrI −3.60, −1.97), spironolactone plus metformin (MD −2.83, 95%CrI −3.80, −1.87), simvastatin (MD −2.88, 95%CrI −3.85, −1.92), spironolactone (MD −2.90, 95%CI −3.77, −2.02), simvastatin plus metformin (MD −2.93, 95%CrI −3.79, −2.06), metformin (MD −2.97, 95%CrI −3.69, −2.25), lifestyle modification (MD −3.02, 95%CrI −3.87, −2.18), and placebo (MD −3.04, 95%CrI −3.56, −2.53).ConclusionAtorvastatin was found to be more effective than the other management strategies in reducing the total testosterone level for patients with PCOS. Future studies should focus on the optimal dose.

EFFECT OF A COMBINATION OF OMEGA-3 AND ORAL TESTOSTERONE UNDECANOATE ON SERUM TESTOSTERONE LEVELS IN PATIENTS WITH TESTOSTERONE DEFICIENCY

Background and Objective Oral testosterone undecanoate (TU) is taken up by the intestinal lymphatic system. Thus, the dietary lipid content affects TU absorption. This study aimed to investigate the effect of combined omega-3 fatty acids (OMG3) and oral TU on serum testosterone levels in patients with testosterone deficiency (TD). Material and Methods Sixty consecutive patients with symptomatic TD and low serum total testosterone (TT) levels were enrolled and divided randomly into group 1, oral TU 80 mg twice daily for 30 days, and group 2, OMG3 and oral TU 80 mg twice daily for 30 days. Serum TT concentrations and male function scales were evaluated at baseline and 7 days and 1 month post-treatment. Dietary habits were investigated, and caloric and lipid intakes were measured during the treatment periods. Results The groups did not differ in terms of mean age, body mass index, comorbidities, initial serum TT concentrations, and IIEF/AMS scores. After 7 days and 1 month of treatment, serum TT concentrations were only significantly increased in group 2. The degree of increase in TT was higher in group 2 than in group 1 at 7 days and 1 month, although the difference was only significant at 1 month. Both groups exhibited significant improvements in IIEF and AMS scores at 1 month, with no significant inter-group difference. A diet diary study revealed that 23.3% and 20% of both groups did not eat breakfast and both groups consumed <12 g of lipids and <500 Kcals, without significance differences. Conclusion We observed a significant increase in serum TT concentration after 1 month of treatment with the combination of OMG3 and oral TU, compared to with oral TU monotherapy. Therefore, the combination of OMG3 and oral TU can be considered for the treatment of TD in Korean patients with irregular breakfast habits.

Serum estradiol and testosterone levels in patients with lung cancer: A meta-analysis

Sex hormones have been linked to cancer, although their relationship remains undefined. This study aimed to compare the serum blood levels of estradiol and testosterone among patients with lung cancer, those convalescing with benign pulmonary lesions, and healthy individuals. An electronic search was conducted for relevant studies that were published up to May 2019 and provided the mean and standard deviation of the serum blood levels of sex hormones. A random–effect model was utilized to achieve significant heterogeneity from the published data. Nineteen studies involving 961 patients with lung cancer, 262patients with benign pulmonary lesion, and 676 healthy individuals were analyzed. The meta–analysis showed that estradiol serum blood levels were higher in patients with lung cancer than in those with pulmonary lesion (standard mean difference [SMD]=4.58, 95% confidence interval [CI] [–0.61, 9.77], P=0.08) and healthy individuals (SMD=5.65, 95% CI [1.21, 10.08], P=0.01). By contrast, the testosterone serum blood levels were lower in patients with lung cancer than in those with pulmonary lesion (SMD=–0.97, 95% CI [–1.60, –0.33], P&lt; 0.01) and healthy individuals (SMD=–1.05, 95%CI [–1.50, –0.59], P&lt;0.01). Subgroup analysis showed that the above–mentioned observations were more pronounced in men than in women (P for interaction &lt;0.05). In Chinese population, higher estradiol serum blood levels but lower testosterone serum blood levels were found in patients with lung cancer compared with those of patients with benign lung lesion and healthy individuals. Our findings provided epidemiological support for the role of sex hormones in the pathogenesis of lung cancer. The generalizability of these findings to other populations must be further studied.

COMPARISON OF TESTOSTERONE LEVEL IN PATIENTS WITH MYOCARDIAL INFARCTION WITH CONTROL GROUP

Objective: To compare testosterone levels of patients with myocardial infarctionwith control group. Methodology: In this case control study, the testosterone levels of male patients withmyocardial infarction (cases) and men with coronary artery stenosis less than40% (control group measured by angiography) were compared with each other.This study was done at cardiovascular unit or CCU of Mehr and Aria hospital ofMashhad, Iran from 1st January to 31st December 2015. Serum levels oftestosterone of patients with myocardial infarction and control group wererecorded and compared with the normal level of testosterone. SPSSv.18 andStatistics V.10 were used, the meaningful level of test was considered less than5%. Results: This study consisted of 60 participants with 30 in each group. Weexamined serum samples for testosterone level, the mean serum level in controlsand patient groups were 6.7ngr and 2.8ngr/lit respectively. Patient group levelwas higher than the control group and between the two study groups, there wassignificant statistical difference (p=0.0001). In addition, significant differencesin the level of testosterone were observed in both groups according to agestratification. The results showed that 70% of the patients had lower levels oftestosterone, but in the control group all were normal. Conclusion: Due to lower testosterone levels in patients with myocardialinfarction compared with healthy subjects, it seems that reduced testosteronelevels, may be considered as an independent risk factor. Key Words: Myocardial ischemia, Myocardial infarction, Testosterone

Efficacy of Nasal Testosterone Gel (Natesto®) Stratified by Baseline Endogenous Testosterone Levels.

ObjectivePharmacokinetic and efficacy data from a phase 3 testosterone nasal gel (TNG) study were stratified by baseline endogenous testosterone level in patients with testosterone deficiency. Total testosterone (TT), LH, and FSH levels, as well as erectile function, mood, and lean body mass for each group were compared. In a subset of patients with very low baseline endogenous testosterone levels (<100 ng/dL), we investigated whether TNG is a suitable treatment option.Materials and MethodsPatients with testosterone deficiency (serum TT <300 ng/dL) were treated with TNG for 3 months, followed by safety extension periods of 90 and/or 180 days. Pharmacokinetic parameters were calculated from serum hormone levels on days 30 and 90, along with efficacy measurements, which were analyzed by comparison with baseline values. Baseline and/or predose TT values were used for patient stratification.ResultsPrestudy and predose endogenous testosterone concentrations correlated. The maximal concentration of TT was nearly identical across all cohorts at days 30 and 90, whereas the average concentration over 24 hours had a slight positive dependence relative to predose levels. LH levels remained in the normal range but were decreased more in patients with higher starting baseline levels. These findings indicate that TNG works with an active hypothalamic-pituitary-gonadal axis that responds to each dose of TNG throughout the treatment period. Patients with the lowest endogenous testosterone levels received maximum exposure impact from each TNG dose. Patients with severe testosterone deficiency had similar efficacy improvements as the remainder of the study population.ConclusionAll testosterone-deficient cohorts were successfully treated with TNG.

Prognostic value of total testosterone levels in patients with acute coronary syndromes.

Endogenous testosterone levels decrease in men with aging. Controversies persist regarding the screening and treatment of low testosterone levels in patients with acute coronary syndromes (ACS). Total serum testosterone levels were measured in 1054 men hospitalized for ACS that were part of a Swiss prospective cohort. Total testosterone levels were classified first in tertiles and using the cut-off of 300 ng/dL. Primary endpoint was all-cause mortality at one year. Cox regression models adjusting for the GRACE score (composite of age, heart rate systolic blood pressure, creatinine, cardiac arrest at admission, ST segment deviation, abnormal troponin enzyme and Killip classification), preexisting diabetes and inflammation (high-sensitivity C-reactive protein). A total of 430 men (40.8%) had total testosterone levels ≤300 ng/dL. Low total testosterone levels were correlated with lower high-density lipoprotein cholesterol and higher triglycerides, high-sensitivity C-reactive protein, high-sensitivity troponin T, N-terminal-pro B-type natriuretic peptide and glucose levels (all p < 0.01). Patients in the lowest testosterone tertile had a mortality rate at one-year of 5.4% compared with 2.9% in the highest tertile with an unadjusted hazard ratio of 1.92 (95% confidence interval 0.96-1.90, p = 0.095) and adjusted hazard ratio of 1.26 (95% confidence interval 0.57-2.78, p = 0.565). In an exploratory analysis, the highest mortality rate (10.3%) was observed in men aged >65 years old belonging to the lowest testosterone tertile. In this large population of men with ACS, we found a prevalence of low total endogenous testosterone levels of almost 40%. However, low testosterone levels were not significantly associated with mortality after adjustment for high-risk confounders.

The impact of hyperbaric oxygen therapy on erectile functions and serum testosterone levels in patients with erectile dysfunction

Objective: To evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile functions and serum testosterone levels in patients with erectile dysfunction (ED).Methods: The patients treated by HBOT for several diseases between July 2017–May 2018 and had erectile dysfunction were included in the study. All patients filled the International Index of Erectile Function (IIEF) questionnaire form; serum total testosterone (TT) and free testosterone (FT) levels were examined before the first day and after the last day of HBOT. The effects of demographic characteristics of patients on erectile functions were evaluated. Patients were categorized according to the risk factors. The IIEF scores, TT and FT levels of patients in first day and after last day of HBOT were compared.Results: Totally 43 patients were included in the study. The mean post-HBOT IIEF-EF score was significantly higher than the mean pre-HBOT IIEF-EF score of patients (25.4 ± 5.3 vs 20.6 ± 5.1; p < .001). There was no statistical difference between the pre-HBOT and post-HBOT serum TT and FT levels of patients (4.0 ± 2.3 ng/ml vs 4.1 ± 2.0 ng/ml, p = .797; 8.6 ± 3.8 pg/ml vs 8.9 ± 3.5 pg/ml, p = .658).Conclusions: HBOT improved the erectile functions in ED patients however we cannot detect any effect on testosterone levels in our study.

1068 - The association between structural brain alterations and serum testosterone levels in patients with type 2 diabetes mellitus

1068 - The association between structural brain alterations and serum testosterone levels in patients with type 2 diabetes mellitus

Comparative Study of the Endocrine Disorders of Βeta-Thalassemia Major Patients and Control Group in Duhok Province

Beta- thalassemia major is a type of inherited blood disorder, characterized by impaired synthesis of the beta chains. Currently, blood transfusion and sufficient iron chelation therapy are important for treatment and follow up of thalassemia patients. Unfortunately, repeated blood transfusion causes the progressive iron overload. Consequently, the excess iron is deposited as hemosiderin and ferritin in the tissues and multiple endocrine complications. In comparison with healthy control group, the results indicated significant (p&lt;0.05) increased TSH level (3.86 ± 2.7 1µIU/ml), whereas the serum level of T4 hormone did not significantly differ between the two groups. In the thalassemia patients, 23.68% (9/38) had subclinical hypothyroidism. The mean level of estradiol in patients (30.60± 14.68pg/ml) is high significant (p&lt; 0.01) decreased that compared with the control persons (13.83 ± 9.06 pg/ml) more than 13 years. Testosterone level in patients was significantly different (P&lt; 0.001) respectively from the control group. The mean of testosterone level was 1.22± 0.83 ng/ml in thalassemia patients and 3.71± 1.32ng/ml in control group more than 14 years. These results indicate high prevalence hypothyroidism and puberty defection. Endocrine drugs supplementation is a safe for patients which have each type of endocrine disorders.

The prevalence of low serum free testosterone and the short-term effect of anti-retroviral therapy in male Japanese treatment-naïve HIV patients.

The prevalence of hypogonadism in HIV patients is still a matter of debate. Today, serum free testosterone (fTST) is thought to be more important than serum testosterone in the diagnosis of hypogonadism in patients with HIV. This study aimed to determine the prevalence of low fTST levels and the effects of anti-retroviral therapy (ART) on fTST levels in treatment-naïve male Japanese patients with HIV. Patients who visited Teikyo University Hospital, Japan between 2010 and 2016 were enrolled. Patients' fTST levels were evaluated twice with a radioimmunoassay in the morning, at the onset of ART and one year later. Clinical factors were also reviewed. The patients were divided into two groups ('hypogonadism' and 'normal') based on Japanese criteria. To determine factors related to low fTST in treatment-naïve patients, the Mann-Whitney U test and a multiple-regression analysis were used. Changes in fTST levels after ART initiation were evaluated with a paired t-test. Data from 25 patients were collected. Their median age was 36.0 years, and the median fTST level was 8.00pg/ml in the treatment-naïve state. Thirteen patients (52%) were in the hypogonadism group. Low levels of fibroblast growth factor 23 were significantly related to low fTST levels. After the start of ART, fTST levels increased significantly (median 8.00 interquartile range [6.40-9.70] to 9.60 [7.60-13.10] pg/ml, p=0.0081). Subnormal fTST levels occurred frequently among the present study patients in treatment-naïve settings. Free testosterone levels in patients with HIV were significantly increased one year after the start of ART.

Low Testosterone Level as a Predictor of Poststroke Emotional Disturbances: Anger Proneness and Emotional Incontinence

BackgroundThe role of sex hormones in poststroke mood and emotional disturbances is unclear. We aimed to evaluate the impact of sex hormones on poststroke emotional disturbance, especially anger proneness (AP) and emotional incontinence (EI). We also investigated whether statins, which are widely used for stroke prevention, affect sex hormone levels or the presence of poststroke AP/EI based on the hypothesis that intensive treatment with statins would inhibit the synthesis of cholesterol, the preferred substrate of testosterone. MethodsWe prospectively enrolled 40 patients who experienced ischemic stroke at least 3 months prior to study enrollment. We performed clinical and laboratory evaluations, including hormone-level measurements and neuropsychological tests. Poststroke AP and EI were assessed using interviews, then patients were divided into 2 groups: AP/EI-present or absent. ResultsOf the 40 patients (30 men, mean age 58.8 years), 16 (40.0%) were classified as AP/EI-present group. AP/EI were not related to stroke severity or location; however, the testosterone level was significantly lower in patients with AP/EI than in those without AP/EI (2.1 ± 1.7 vs. 3.9 ± 2.5 ng/mL, P = .023). After adjusting for potential confounding variables, low testosterone levels were a significant independent predictor of AP/EI (odds ratio .68, 95% confidence interval .49-.96, P = .027). In contrast, sex hormone levels and AP/EI prevalence did not differ between statin users and nonusers. Conclusions: AP/EI were associated with low testosterone levels in patients with previous ischemic stroke, but statin use did not affect AP/EI prevalence.

Association between Low Testosterone Levels and Sarcopenia in Cirrhosis: A Cross-sectional Study

Introduction and aim. Sarcopenia is an independent predictor of mortality in cirrhosis. Hypogonadism is common in cirrhosis and has been associated with sarcopenia in non-cirrhotic chronic liver disease populations. The aim of this study is to investigate if sarcopenia is associated with low testosterone levels in patients with cirrhosis.Material and methods. This is a retrospective analysis of prospectively collected data of 211 cirrhotic patients undergoing evaluation for liver transplantation. Sarcopenia was defined by computed tomography (CT) scan using specific cutoffs of the 3rd lumbar vertebra skeletal muscle index (L3 SMI). Morning testosterone levels were obtained in all patients.Results. Of the 211 patients, sarcopenia was noted in 94 (45%). Testosterone levels were lower in sarcopenic patients (10.7 ± 1.1 vs. 13.7 ± 1.4 nmol/L, p = 0.03) and hypotestosteronemia was more frequent in them too (34 vs. 16%, p = 0.004). In males, those with sarcopenia had lower testosterone levels (14.6 ± 1.4 vs. 21.9 ± 1.8, p = 0.002), and the corresponding frequency of hypotestosteronemia (42 vs. 19%, p = 0.006) was also higher. There were no significant differences in female patients. There was a weak correlation between L3 SMI and testosterone levels (r 0.37, p < 0.001). On multivariable regression analysis including sex, body mass index (BMI), hypotestosteronemia, MELD and etiology of cirrhosis, only hypotestosteronemia (RR 2.76, p = 0.005) and BMI (RR 0.88, p < 0.001) were independently associated with sarcopenia.Conclusion. Low testosterone levels are associated with sarcopenia in male cirrhotic patients. The potential therapeutic effect of testosterone to reverse sarcopenia in these patients warrants evaluation in future trials.

602 Clinical outcomes of androgen replacement therapy (ART) in Japanese patients with late-onset hypogonadism(LOH) syndrome -comparison of total and free testosterone value

The Japanese late-onset hypogonadism (LOH) guideline is using serum free testosterone (FT) level for diagnosis of LOH syndrome. On the other hand, the European and American guidelines are using total testosterone level (TT) for diagnosis of LOH syndrome. Serum total testosterone levels below 8 nmol/L (231 ng/dL) require substitution of testosterone in the E.A.U. recommendations. In this study, we compared serum free testosterone level and total testosterone level in patients who visited our LOH syndrome out-patient department. We also investigate clinical outcomes of androgen replacement therapy (ART) in patients with LOH syndrome. Two hundred thirty male patients who visited our LOH syndrome out-patient department from January, 2008 to September, 2013 were targeted at this study. The patient's average age was 55.1 years old. Average of AMS score in patients was 51.7 points. Only 20 patients (8.7%) were low value (less than 2.31ng/ml) and 86 (37.4%) patients were low and borderline value (less than 3.46ng/ml) in serum total testosterone (TT) level. On the other hand, 99 patients (43.1%) were low values (less than 8.5pg/ml), and also 175 examples (76.1%) were low and borderline value (less than 11.8pg/ml) in serum free testosterone (FT) level. Androgen replacement therapy (ART) was carried out for 3 months in 84 patients with patient with LOH syndrome. Sixty nine patients (82.1%) were effective for ART. Only four patients dropped out androgen replacement therapy because of dysuria and plethora. Fifty four patients (83%) with patients who were low value (l less than 8.5pg/ml) in serum free testosterone (FT) were effective for ART in 53 patients. Also 25 patients (80.6％) who was borderline value (less than 11.8pg/ml) in serum free testosterone (FT) level were effective for ART in 31 patients.

CHANGE IN TESTOSTERONE LEVELS IN ENDOSCOPIC OPERATIONS ON THE PROSTATE GLAND

To date, there have been single studies showing a decrease in testosterone levels in patients as a result of urologic surgeries. It was found that a low level of testosterone has a negative impact on the physical and mental state of men. It was also found that a low level of testosterone increases the likelihood of postoperative complications.Purpose. Study the changes in testosterone levels in prostate plasma ablation.Patients and methods. 47 patients with benign prostatic hyperplasia who underwent plasma ablation of the prostate were examined. All patients were divided into 3 groups: Group I (14 patients) – patients with a normal preoperative level of testosterone (above 12 nmol/L), IIA group (17 patients) – patients with preoperative testosterone deficiency receiving HRT 2 weeks before surgery and during the entire period of postoperative follow-up and IIB group (16 patients) – patients with preoperative testosterone deficiency who did not receive therapy. In addition to standard general clinical examinations, all patients had a blood test for total testosterone, luteinizing hormone, sex hormone binding globulin. The level of free testosterone was calculated from the nomogram of Vermeulen, also testing was carried out using questionnaires AMS and IIEF-5.Results. The decrease in the level of testosterone as a result of the operation was noted in all patients. A month after the operation, none of the groups recorded a return of testosterone values to the original level. However, in the group of patients undergoing HRT, normalization of the testosterone level (12.1 nmol/L and more) was noted by 30 days. Also, early and late postoperative complications were assessed in all three groups. In the group of patients with testosterone deficiency who did not receive HRT, the number of complications was significantly higher. In the group of patients receiving HRT, there was an improvement in the general condition and erectile function, confirmed by the results of the AMS and IIEF-5 questionnaires.Conclusion. Performing plasma ablation of the prostate gland on a par with other methods of endoscopic surgery of the prostate gland leads to a significant decrease in the level of testosterone in the blood. Performing such operations against a background of testosterone deficiency adversely affects the clinical course of the early postoperative period, the development of complications and the general condition of the patient. Preoperative diagnosis and correction of testosterone deficiency is an important component that allows minimizing the number of risks and complications resulting from surgical interventions, as well as improving the quality of life and accelerating post-operative rehabilitation of patients.

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.

Оценка тестостеронемии у мужчин, подвергнутых оперативному лечению стриктур мочеиспускательного канала

Testosterone plays an important role in the functioning of various organs and systems of the male body. Its diagnostic and prognostic values are studied both in urological diseases and in the patients undergoing non-urologic surgery. To investigate changes in testosterone level in patients with urethral strictures (US) depending on its baseline level, the cause of US, the age of patients and the number of surgeries. The study comprised 30 patients aged 19-63 years with traumatic (76.7%) and inflammatory (23.3%) US. Primary and recurrent US were diagnosed in 25 (83.3%) and 5 (16.7%) patients, respectively. Nineteen (63.3%) patients underwent excision and primary anastomosis, while replacement urethroplasty was performed in 11 (36.7%) patients. In addition to the standard diagnostic work-up, all patients were tested for total serum testosterone 24 hours prior to surgery and at 1, 3, 7, 14 days after the operation. 33.3% of men with US had a testosterone deficiency in the absence of any testicular or endocrine injuries and diseases. Surgery was associated with a drop in testosteronemia in 83.3% of patients. The degree of postoperative testosterone level decline and its changes were significantly influenced by the age of patients and the number of operations. Men who had baseline testosterone deficiency and underwent repeat surgeries remained in a hypogonadal state throughout the postoperative period. Investigating the clinical value of testosterone in men with US and the risks of their surgical treatment associated with testosterone deficiency will provide insight into the role of testosterone in the treatment of this condition and the decision-making regarding pharmacological correction of testosterone deficiency in patients undergoing surgery for US.

Which Exercise Is Better for Increasing Serum Testosterone Levels in Patients with Erectile Dysfunction?

PurposeWe investigated the correlations of serum total testosterone (TT) levels with body composition and physical fitness parameters in patients with erectile dysfunction (ED) to know the best exercise for testosterone deficiency.Materials and MethodsEighty-seven ED patients underwent serum TT assessment as well as body composition and basic exercise testing. The bioelectrical impedance analysis was used to assess body composition. Seven types of basic exercise tests were used to determine physical fitness. Correlations between serum TT levels and body composition/physical function parameters were evaluated using partial correlation analyses. A serum TT cut-off value was obtained for the parameters significantly correlated with serum TT levels.ResultsThe subjects had a mean serum TT level of 342.1 ng/dL. Among the body composition parameters, body and abdominal fat percentages showed statistically significant negative correlations with serum TT levels. Among the basic exercise test parameters, only the cycle ergometer test for cardiorespiratory fitness showed a statistically significant positive correlation with serum TT levels.ConclusionsSerum TT levels in patients with ED, may be increased by reducing fat percentage and improving cardiorespiratory fitness via aerobic exercise.

A Prospective Audit of Intermittent Anti-Androgen verses Pituitary Blockade Suggests a Bipolar Androgen Type Strategy May Be Safe in Untreated Prostate Cancer

Objective: A locally advanced Gleason 4 + 4 prostate cancer patient who was on self-medication with intermittent anti-androgen monotherapy (iAAm) over 14 years suggested that raised testosterone was not dangerous and this suggestion needed investigating. Patients: Others who were on AA continuously were recruited to ongoing audit of intermittent hormone therapy (IHT) and iAAm outcomes were compared with intermittent LHRH therapy (iLHRH or iMAB). Results: Between 1994 and 2007, 111 patients sought IHT because of side effects of treatment. Forty-two M0 patients received IHT with iLHRHm or iMAB and 33 received iAAm (31 of these were M0). PSA nadir below 4 was necessary for entry. Overall survival was 87, 72 and 67% with iAAm and 73, 56 and 43% with iLHRH/MAB at 5, 8 and 10 years respectively. Overall survival was 61, 55 and 33% continued on iAAm and 56, 41, and 32% on iLHRH/MAB at 5, 8, and 10 years respectively. Multivariable analysis and matched case control analysis confirm that the maintenance of advantage for iAAm Testosterone levels in patients on iAAm compared to iLHRH therapy was more intense throughout treatment. Conclusion: These results complement recent progress in using bipolar androgen therapy to reverse castration resistance and add to the increasing acceptance that controlled testosterone exposure might be relevant in hormone-naïve patients.

Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction.

IntroductionErectile dysfunction (ED) and cardiovascular (CV) diseases share common risk factors and ED has been accepted as an early manifestation of CV disease. Exercise stress testing (EST) is used to evaluate CV functions in men with ED. Low exercise workload, a slower heart rate recovery (HRR) after exercise, and inability to increase heart rate during EST (chronotropic incompetence) are independent negative predictors of adverse CV outcomes.AimTo assess the association among EST parameters, ED, and testosterone levels.MethodsThe study population consisted of 41 patients with ED and 40 controls. All participants underwent treadmill EST to assess cardiac autonomic functions. HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2), and 3rd (HRR3) minute heart rates during the recovery period from maximal heart rate. Total exercise duration, exercise capacity and chronotropic response, and plasma testosterone levels were evaluated. Erectile functions were evaluated with the Sexual Health Inventory for Men. Patients were divided into subgroups according to severity and duration of ED.Main Outcome MeasuresMean HRR1 (30.6 ± 11.9 vs 36.9 ± 9.9; P = .01), HRR2 (44.9 ± 12.4 vs 54.9 ± 7.8; P < .001), and HRR3 (50.1 ± 11.7 vs 63.0 ± 7.9; P < .001) were significantly lower in the ED than in the control group. Total exercise duration (9.4 ± 1.9 vs 10.9 ± 1.7 minutes; P < .001), exercise capacity (12.5 ± 1.9 vs 13.6 ± 1.4 metabolic equivalents; P = .004), and chronotropic response (0.88 ± 0.1 vs 1.0 ± 0.1; P < .001) were worse in the ED group. However, we found no association between severity and duration of ED and EST parameters. In addition, serum testosterone levels were significantly correlated with HRR1 (r = 0.36, P = .02) in men with ED.ConclusionOur data suggested that cardiac autonomic functions are impaired in patients with ED. A weak correlation between cardiac autonomic dysfunction and low testosterone levels in patients with ED was noted. However, further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions and testosterone replacement therapy in patients with ED.Kucukdurmaz F, Agar G, Resim S. Deterioration of Chronotropic Responses and Heart Rate Recovery Indices in Men With Erectile Dysfunction. Sex Med 2018;6:8–14.