232 articles - 10.09.10
1: Int J Androl. 2010 Aug 19; [Epub ahead of print]
Eley A, Pacey AA.
Department of Infection and Immunity, The University of Sheffield Medical School, Sheffield, UK.
Summary Chlamydia trachomatis is an important bacterial cause of infertility. In men, the recommended specimen for diagnosing chlamydial infection is urine, with little or no emphasis placed on testing semen. A systematic review of the literature was conducted to search for studies in which men undergoing investigations for infertility produced both samples of urine and semen that were tested concurrently for C. trachomatis. An analysis of these studies was then performed. From 322 papers identified from the US National Library of Medicine PubMed database, 14 were selected for a detailed review and 11 were analysed further. Overall, the size of the study groups was only modest and differences between the studies included variation in geography and test methodology, especially whether commercial testing systems had been used. There was also a lack of consistency with regard to including men with azoospermia. Patients were typically 30-35 years old and the median duration of infertility was about 4 years. Of those patients positive for C. trachomatis in the 11 studies, 56% could be detected in both semen and urine, 20% only in urine and 23% only in semen. Deficiencies in existing studies would not allow for a meta-analysis, emphasizing the need for further research in this area for which a number of recommendations are made.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20731730&dopt=ExternalLink
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PMID: 20731730 [PubMed - as supplied by publisher]2: Int J Androl. 2010 Jun 23; [Epub ahead of print]
Nenonen HA, Giwercman A, Hallengren E, Giwercman YL.
Department of Clinical Sciences, Molecular Genetic Reproductive Medicine, Lund University.
Summary The CAG repeat in the androgen receptor (AR) has been widely studied in association with male infertility, but the results are conflicting. In a recent meta-analysis, infertile men had <1 repeat longer CAG stretch than fertile men when analysed in a linear regression model assuming that AR function diminishes with increasing CAG length. However, in vitro, a non-linear activity pattern was recently demonstrated so that ARs containing short and long stretches, respectively, displayed lower activity than the AR of median length. These results prompted us to explore the possible association between CAG number and male infertility risk in a stratified manner on the basis of data from the mentioned meta-analysis and subjects from our clinical unit. The study population included 3915 men, 1831 fertile and 2084 infertile. Data were divided into three categories: CAG < 22, CAG 22-23 (reference) and CAG > 23 and analysed in a binary logistic regression model. Men with CAG < 22 and CAG > 23 had 20% increased odds ratio of infertility compared with carriers of the median lengths [for CAG < 22: p = 0.03, 95% confidence interval (CI): 1.02-1.39; for CAG > 23: p = 0.02, 95% CI: 1.03-1.44]. These results show that an alternative model to a linear one for the genotype-phenotype association in relation to AR CAG repeats is likely, as lengths close to the median confine lowest risk of infertility.
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PMID: 20579136 [PubMed - as supplied by publisher]3: J Androl. 2010 May 13; [Epub ahead of print]
Snyder CN, Clark RV, Caricofe RB, Bush MA, Roth MY, Page ST, Bremner WJ, Amory JK.
Oral administration of testosterone might be useful for the treatment of testosterone deficiency. However, current "immediate-release" formulations of oral testosterone exhibit suboptimal pharmacokinetics, with supraphysiological peaks of testosterone and its metabolite, dihydrotestosterone (DHT), immediately after dosing. To dampen these peaks, we have developed two novel modified release formulations of oral testosterone designed to slow absorption from the gut and improve hormone delivery. We studied these testosterone formulations in sixteen normal young men enrolled in a two-arm, open-label clinical trial. Three hundred and six hundred milligram doses of immediate-release, and modified fast-release or slow-release formulations were administered sequentially to eight normal men rendered hypogonadal by the administration of the gonadotropin releasing hormone (GnRH) antagonist acyline. Blood for measurement of serum testosterone, DHT, and estradiol was obtained before and 0.5, 1, 2, 3, 4, 6, 8, 12, and 24 hours after each dose. A second group of eight men was studied with the co-administration of 1 mg of the 5alpha-reductase inhibitor, finasteride, daily throughout the treatment period. Serum testosterone was increased with all formulations of oral testosterone. The modified slow-release formulation significantly delayed the post-dose peaks of serum testosterone and reduced peak concentrations of serum DHT compared to the immediate-release formulation. The addition of finasteride further increased serum testosterone and decreased serum DHT. We conclude that the oral modified slow-release testosterone formulation exhibits superior pharmacokinetics compared to immediate-release oral testosterone both alone and in combination with finasteride. This formulation might have efficacy for the treatment of testosterone deficiency.
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PMID: 20378927 [PubMed - as supplied by publisher]4: J Androl. 2010 Feb 4; [Epub ahead of print]
Wang C, Harnett M, Dobs A, Swerdloff RS.
Currently available testosterone (T) injections in the United States are administered at 2 to 3 weekly intervals. Less frequent injections with favorable serum T pharmacokinetics would benefit hypogonadal men. The objective of this study is to assess the pharmacokinetics of long-acting testosterone undecanoate (TU) IM injection in hypogonadal men. An unblinded, multicenter, phase 3 clinical trial was conducted in 31 academic centers and contract research organizations. 130 males over 18 years of age with serum total T < 300 ng/dL were enrolled and received TU 750 mg injections at week 0, 4, and every 10 weeks thereafter for 9 injections over 84 weeks. The main outcome variables were serum total T, free T, dihydrotestosterone (DHT), estradiol (E2) levels and safety parameters. After the first injection patients maintained average trough T concentrations in the adult male range (300-1000 ng/dL or 10.4-34.7 nmol/L) before each injection and at multiple time points measured after the third and fourth injections. Serum free T, DHT and E2 levels and their ratios to serum T remained relatively consistent once steady-state was attained. TU injections were generally well tolerated with safety profiles similar to other T replacement. We conclude that hypogonadal patients treated for 84 weeks with TU 750 mg IM injection every 10 wk demonstrated average concentrations of T, its metabolites (DHT and E2), as well as ratios DHT:T and E2:T, within the adult male reference range at all time points measured. TU injections would be an acceptable alternative to the currently available 2-3 weekly injectables.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20133964&dopt=ExternalLink
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PMID: 20133964 [PubMed - as supplied by publisher]5: Andrologia. 2010 Feb;42(1):48-56.
Biswas TK, Pandit S, Mondal S, Biswas SK, Jana U, Ghosh T, Tripathi PC, Debnath PK, Auddy RG, Auddy B.
J. B. Roy State Ayurvedic Medical College and Hospital, Kolkata, India. biswastuhin@rediffmail.com
The safety and spermatogenic activity of processed Shilajit (PS) were evaluated in oligospermic patients. Initially, 60 infertile male patients were assessed and those having total sperm counts below 20 million ml(-1) semen were considered oligospermic and enrolled in the study (n = 35). PS capsule (100 mg) was administered twice daily after major meals for 90 days. Total semenogram and serum testosterone, luteinising hormone and follicle-stimulating hormone were estimated before and at the end of the treatment. Malondialdehyde (MDA), a marker for oxidative stress, content of semen and biochemical parameters for safety were also evaluated. Twenty-eight patients who completed the treatment showed significant (P < 0.001) improvement in spermia (+37.6%), total sperm count (+61.4%), motility (12.4-17.4% after different time intervals), normal sperm count (+18.9%) with concomitant decrease in pus and epithelial cell count compared with baseline value. Significant decrease of semen MDA content (-18.7%) was observed. Moreover, serum testosterone (+23.5%; P < 0.001) and FSH (+9.4%; P < 0.05) levels significantly increased. HPLC chromatogram revealed inclusion of PS constituents in semen. Unaltered hepatic and renal profiles of patients indicated that PS was safe at the given dose. The present findings provide further evidence of the spermatogenic nature of Shilajit, as attributed in Ayurvedic medicine, particularly when administered as PS.
Publication Types: Clinical Trial Research Support, Non-U.S. Gov't
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PMID: 20078516 [PubMed - indexed for MEDLINE]6: Andrologia. 2009 Dec;41(6):387-91.
Irkilata HC, Basal S, Taslipinar A, Gur A, Piskin MM, Kurt B, Tahmaz L, Bolu E, Dayanc M.
Departments of Urology and Endocrinology, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey.
Ovotesticular disorder of sex development (OTDSD) is a rare condition and defined as the presence of ovarian and testicular tissue in the same individual. Most of patients with OTDSD have female internal genital organs. In this report, we present a case in which, we demonstrated prostate tissue using endoscopic and radiologic methods in a 46-XX, sex determining region of the Y chromosome negative male phenotypic patient, with no female internal genitalia. Existence of prostate in an XX male without SRY is rarely seen and reveals a complete male phenotype. This finding is critical to figure out what happens in embryonal period.
Publication Types: Case Reports Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19891638&dopt=ExternalLink
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PMID: 19891638 [PubMed - indexed for MEDLINE]7: J Androl. 2009 Nov-Dec;30(6):726-33. Epub 2009 Jul 3.
Heufelder AE, Saad F, Bunck MC, Gooren L.
Business Unit Primary Care, Men's Healthcare, Scientific Affairs, Bayer Schering Pharma AG, Berlin, Germany.
Men with the metabolic syndrome (MetS) and type 2 diabetes (T2D) often have low testosterone levels. Elevating low testosterone levels may improve features of the MetS and glycemic control. In a single blind, 52-week randomized clinical trial, the effects of supervised diet and exercise (D&E) with or without transdermal testosterone administration on components of the MetS in hypogonadal men with the MetS and newly diagnosed T2D were assessed. A total of 32 hypogonadal men (total testosterone <12.0 nmol/L) with newly diagnosed T2D and with the MetS as defined by the Adult Treatment Panel III and the International Diabetes Federation received supervised D&E, but 16 received it in combination with testosterone gel (50 mg) once daily (n = 16). No glucose-lowering agents were administered prior to or during the study period. Outcome measures were components of the MetS as defined by the Adult Treatment Panel III and the International Diabetes Federation. Serum testosterone, glycosylated hemoglobin (HbA(1c)), fasting plasma glucose, high-density lipoprotein cholesterol, triglyceride concentrations, and the waist circumference improved in both treatment groups after 52 weeks of treatment. Addition of testosterone significantly further improved these measures compared with D&E alone. All D&E plus testosterone patients reached the HbA(1c) goal of less than 7.0%; 87.5% of them reached an HbA(1c) of less than 6.5%. Based on Adult Treatment Panel III guidelines, 81.3% of the patients randomized to D&E plus testosterone no longer matched the criteria of the MetS, whereas 31.3% of the D&E alone participants did. Additionally, testosterone treatment improved insulin sensitivity, adiponectin, and high-sensitivity C-reactive protein. Addition of testosterone to supervised D&E results in greater therapeutic improvements of glycemic control and reverses the MetS after 52 weeks of treatment in hypogonadal patients with the MetS and newly diagnosed T2D.
Publication Types: Randomized Controlled Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19578132&dopt=ExternalLink
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PMID: 19578132 [PubMed - indexed for MEDLINE]8: J Androl. 2009 Nov-Dec;30(6):679-84. Epub 2009 May 28.
Efesoy O, Cayan S, Akbay E.
Department of Urology, University of Mersin School of Medicine, Mersin, Turkey.
The aim of the study was to prospectively investigate the efficacy of recombinant human follicle-stimulating hormone (rhFSH) in the treatment of various types of male-factor infertility at a single university hospital. The study included 61 infertile men receiving rhFSH because of various type of male infertility. Treatment included 100-150 IU of rhFSH 2-3 times/wk. All men were divided into 4 groups: hypogonadotropic hypogonadism (n = 21), isolated follicle-stimulating hormone (FSH) deficiency (n = 13), idiopathic oligoasthenospermia (n = 16) and maturation arrest on testicular biopsy (n = 11). Total motile sperm count (TMSC), serum FSH level, and testicular volume were compared before and after treatment in all groups. In the hypogonadotropic hypogonadism group, spermatozoa appeared in the ejaculate, with a mean TMSC of 6.67 +/- 1.57 million, in 15 of 21 patients (71.4%) who were totally azoospermic before the treatment. In the isolated FSH deficiency group, TMSC significantly increased from 6.64 +/- 3.27 to 32.4 +/- 9.09 million after the treatment (P = .003). TMSC did not significantly increase in the idiopathic oligoasthenospermia group. Two of the men with maturation arrest (18.1%) had spermatozoa in the ejaculate after the treatment. rhFSH therapy may be effectively used to improve sperm parameters in infertile men with hypogonadotropic hypogonadism and isolated FSH deficiency. In addition, rhFSH may effect some improvement by either providing sperm in ejaculate or increasing intracytoplasmic sperm injection success in infertile men with maturation arrest.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19478332&dopt=ExternalLink
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PMID: 19478332 [PubMed - indexed for MEDLINE]9: Andrologia. 2009 Apr;41(2):95-9.
Zenico T, Cicero AF, Valmorri L, Mercuriali M, Bercovich E.
Department of Urology, Morgagni-Pierantoni Hospital, Forli, Italy. t.zenico@ausl.fo.it
Lepidium meyenii (Maca) is a cultivated root belonging to the brassica family used in the Andean region for its supposed aphrodisiac properties. We carried out a double-blind clinical trial on 50 Caucasian men affected by mild erectile dysfunction (ED), randomised to treatment with Maca dry extract, 2400 mg, or placebo. The treatment effect on ED and subjective well-being was tested administrating before and after 12 weeks the International Index of Erectile Function (IIEF-5) and the Satisfaction Profile (SAT-P). After 12 weeks of treatment, both Maca- and placebo-treated patients experienced a significant increase in IIEF-5 score (P < 0.05 for both). However, patients taking Maca experienced a more significant increase than those taking placebo (1.6 +/- 1.1 versus 0.5 +/- 0.6, P < 0.001). Both Maca- and placebo-treated subjects experienced a significant improvement in psychological performance-related SAT-P score, but the Maca group higher than that of placebo group (+9 +/- 6 versus +6 +/- 5, P < 0.05). However, only Maca-treated patients experienced a significant improvement in physical and social performance-related SAT-P score compared with the baseline (+7 +/- 6 and +7 +/- 6, both P < 0.05). In conclusion, our data support a small but significant effect of Maca supplementation on subjective perception of general and sexual well-being in adult patients with mild ED.
Publication Types: Randomized Controlled Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19260845&dopt=ExternalLink
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PMID: 19260845 [PubMed - indexed for MEDLINE]10: Int J Androl. 2009 Aug;32(4):279-87. Epub 2008 Dec 22.
van Casteren NJ, Looijenga LH, Dohle GR.
Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
Testicular microlithiasis (TM) has been associated with testicular germ cell tumours (TGCTs) in adolescents and adults and with its precursor carcinoma in situ (CIS). A clear definition of TM and the need for further diagnostics and follow-up is lacking. We reviewed the literature of TM and its association with TGCT/CIS and current follow-up advises and propose a management approach based on associated risk factors for TGCT. In the literature, a wide variance of TM incidence is reported in different patient populations. A consensus concerning the malignant potential of TM has not been reached. In addition, a clear definition on TM is lacking. Although a correlation between TM and TGCT or CIS is found, precise management and follow-up schedules are absent. We suggest that all hyperechogenic foci smaller than 3 mm without shadowing should be named TM irrespective of their number. In addition, we suggest a management scheme for physicians encountering TM in daily practice. Our algorithm suggests taking a testicular biopsy in a selected patient population with at least one additional risk factor for TGCT. A long-term active follow-up schedule, including ultrasonography and physical examinations, is not indicated in the remaining patients with TM.
Publication Types: Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19207616&dopt=ExternalLink
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PMID: 19207616 [PubMed - indexed for MEDLINE]11: J Androl. 2009 May-Jun;30(3):280-6. Epub 2009 Jan 8.
Pectasides D, Pectasides E, Papaxoinis G, Skondra M, Gerostathou M, Karageorgopoulou S, Kamposioras C, Tountas N, Koumarianou A, Psyrri A, Macheras A, Economopoulos T.
Second Department of Internal Medicine, Propaedeutic, Oncology Section, University of Athens, Attikon University Hospital, Rimini 1, Haidari, Athens, Greece. pectasid@otenet.gr
Our objective was to investigate the impact of methotrexate, paclitaxel, ifosfamide, and cisplatin (M-TIP) on long-term fertility in poor-risk nonseminomatous germ cell tumors (NSGCT). Thirty patients with poor-risk NSGCT (median age, 29 years; range, 17-62 years) were treated with methotrexate 250 mg/m(2) with folinic acid rescue (day 1) and paclitaxel 175 mg/m(2) (day 1), followed by ifosfamide 1.2 g/m(2) and cisplatin 20 mg/m(2) (days 2-6). Treatment consisted of 4 cycles of M-TIP administered every 3 weeks. Twenty-one patients were continuously disease-free at a median follow-up of 5.3 years (range, 0.9-8.4 years). Sperm count and hormonal analyses were examined prechemotherapy (30 patients) and postchemotherapy (21 patients). Counts were classified as follows: lower than 1 x 10(6)/mL, azoospermia; 1-20 x 10(6)/mL, oligospermia (OS); higher than 20 x 10(6)/mL, normospermia (NS). Patients were followed for a median of 2.3 years (range, 0.9-3.8 years) postchemotherapy. The prechemotherapy median luteinizing hormone (LH) serum levels were slightly above the upper normal limit, whereas the serum levels of follicle-stimulating hormone (FSH) and testosterone (T) were within the reference interval. Eleven (52.3%) patients had NS prechemotherapy. Among the patients with NS, 72.7% still had NS following chemotherapy. Overall, 17 of 21 (80.9%; 33.3% OS and 47.6% NS) patients had recovery of spermatogenesis after treatment. The median FSH serum levels were significantly elevated at least 1 year postchemotherapy when compared with the pretreatment levels. Eighteen months after the completion of chemotherapy the median FSH levels had returned to the reference limits. Serum LH and T levels were unaffected by chemotherapy. Prior to chemotherapy 4 of 30 patients had fathered 5 children. Since completion of chemotherapy, 5 patients have fathered 5 children. The majority of men with poor-risk germ cell tumors who were treated with the M-TIP regimen demonstrated recovery spermatogenesis after treatment, and Leydig cell function was unaffected.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19136393&dopt=ExternalLink
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PMID: 19136393 [PubMed - indexed for MEDLINE]12: J Androl. 2009 May-Jun;30(3):219-29. Epub 2008 Dec 4.
Zini A, Sigman M.
Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada. ziniarmand@yahoo.com
The advent of assisted reproductive technologies, particularly intracytoplasmic sperm injection (ICSI), has revolutionized the treatment of male-factor infertility. However, there are many unanswered questions regarding the safety of these techniques. These safety concerns are relevant because 1) these technologies often bypass the barriers to natural selection; 2) infertile men, particularly those with severe male-factor infertility, possess substantially more sperm DNA damage than do fertile men; and 3) experimentally, sperm DNA damage has been shown to adversely affect the developing embryo. This review discusses the etiology of sperm DNA damage, describes the individual tests of sperm DNA damage, and explores the relationship between sperm DNA damage and pregnancy outcomes. Based on a systematic review of the literature, sperm DNA damage is associated with lower natural, intrauterine insemination (IUI), and in vitro fertilization (IVF) pregnancy rates, but not with ICSI pregnancy rates. The literature also suggests that that sperm DNA damage is associated with an increased risk of pregnancy loss in those couples undergoing IVF or ICSI. Nonetheless, the true clinical utility of sperm DNA damage tests remains to be established, because the available studies are small and few in number and the study characteristics are heterogeneous. Although current data suggest that impaired sperm DNA integrity may have the greatest effect on IUI pregnancy rates and pregnancy loss by IVF and ICSI, further prospective studies are needed before testing should become a routine part of patient management.
Publication Types: Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19059901&dopt=ExternalLink
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PMID: 19059901 [PubMed - indexed for MEDLINE]13: Andrologia. 2008 Dec;40(6):398-400.
Giltay EJ, Haider A, Saad F, Gooren LJ.
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. giltay@dds.nl
C-reactive protein (CRP) is a marker of systemic low-grade inflammation, and may be associated with subjective symptoms of androgen deficiency. We studied the effects of normalisation of plasma testosterone levels in an open, nonrandomised study. Hypogonadal men (T levels: 5.9-12.1 nmol l(-1), aged 34-69 years) were treated for 15 months with parenteral testosterone undecanoate (1000 mg per 12 weeks). In 100 men, plasma CRP and Aging Male Symptom (AMS) self-report data were available at baseline, of 91 men at 6 months, of 59 men at 12 months and of 60 men at 15 months. Testosterone administration resulted in a profound decline in CRP levels and AMS scores (both P < 0.001). There was a positive association between CRP levels and AMS scores over time (r = 0.22; P < 0.001), while adjusting for smoking, alcohol use, age, and body mass index. Low-grade inflammation may be involved in the pathogenesis of subjective symptoms of androgen deficiency in ageing men.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=19032692&dopt=ExternalLink
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PMID: 19032692 [PubMed - indexed for MEDLINE]14: Andrologia. 2008 Oct;40(5):298-302.
Gooren LJ, Saad F, Haide A, Yassin A.
Vrije Universiteit Medical Center, Amsterdam, The Netherlands. ljgooren@truemail.co.th
The study was performed to measure the impact of testosterone (T) administration on circulating levels of 5alpha-dihydrotestosterone (DHT). Group 1 (32 men; mean age 61 years; mean T 6.9 +/- 1.9 nmol l(-1)) were treated for 15 months with long-acting T undecanoate. Group 2 (23 men, mean age 60 years, mean T 7.6 +/- 2.0 nmol l(-1)) were treated for 9 months with T gel. Plasma T and DHT were measured before and after 9 months T administration. In the men treated with T undecanoate plasma T and DHT were also measured after 12 and 15 months. Before T administration, plasma DHT ranged from 0.39 to 1.76 nmol l(-1) (0.30-1.90 nmol l(-1)). Mean DHT declined upon T administration from 0.95 +/- 0.50 to 0.55 +/- 0.30 nmol l(-1) (P < 0.05). With an arbitrary cut-off at 0.60 nmol l(-1), all 21 values of DHT > 0.60 nmol l(-1) had fallen from 1.29 +/- 0.50 to 0.70 +/- 0.60 nmol l(-1) (P < 0.01). Below this cut-off point 13 values rose and 21 fell upon T administration. Below this cut-off point values on average declined from 0.39 +/- 0.12 to 0.30 +/- 0.14 nmol l(-1) (P < 0.05). The study revealed that in a cohort of elderly men with subnormal plasma T levels plasma DHT levels declined upon T administration when they were in the higher range of normal (>0.6 nmol l(-1)), with a profound shift of DHT/T ratios presumed to be an indicator of a reduced 5alpha-reductase activity. Below plasma DHT levels of 0.6 nmol l(-1), responses of plasma DHT to T administration varied.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18811920&dopt=ExternalLink
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PMID: 18811920 [PubMed - indexed for MEDLINE]15: J Androl. 2009 Jul-Aug;30(4):363-9. Epub 2008 Sep 18.
Traish AM.
Department of Biochemistry, Institute for Sexual Medicine, Boston University School of Medicine, Center for Advanced Biomedical Research, 700 Albany St, W607, Boston, MA 02118, USA. atraish@bu.edu
Androgens are essential for development, growth, and maintenance of penile structure, and regulate erectile physiology by multiple mechanisms. Here we provide a concise overview of the basic research findings pertaining to androgen modulation of erectile tissue architecture and physiology. A significant body of evidence exists pointing to a critical role of androgens in erectile physiology. Studies in animal models have provided fundamental knowledge on the role of androgens in modulating tissue architecture and cellular, molecular, and physiological mechanisms. Based on data from our laboratory and those reported by others, we believe that androgens play a pivotal role in maintaining the structure and function of the peripheral penile nerve network, the structural integrity of the corpora cavernosa, the tunica albuginea, and the endothelium of the cavernous spaces. Further, androgens play an important role in regulating the differentiation of precursor cells into trabecular smooth muscle. In this review, we will focus our discussion on findings pertaining to the role of androgens in regulating penile tissue architectural elements in modulating penile function. This knowledge has a profound impact on the potential use of androgens in the clinical setting to treat patients with erectile dysfunction.
Publication Types: Research Support, Non-U.S. Gov't Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18802199&dopt=ExternalLink
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PMID: 18802199 [PubMed - indexed for MEDLINE]16: J Androl. 2009 Jan-Feb;30(1):33-40. Epub 2008 Sep 4.
Cayan S, Shavakhabov S, Kadioglu A.
University of Mersin School of Medicine, Department of Urology, 33079-Mersin, Turkey. selcayan@mersin.edu.tr
To date, there have been no randomized, controlled, prospective clinical studies that compare various techniques to describe the best method for the treatment of varicocele in infertile men. This meta-analysis aims to address the best treatment modality for palpable varicocele in infertile men. A MEDLINE search was performed for articles published between January 1980 and April 2008, and we analyzed 36 studies reporting postoperative spontaneous pregnancy rates and/or complication rates after varicocele repair using various techniques in infertile men with palpable unilateral or bilateral varicocele. Spontaneous pregnancy rates and postoperative complications such as hydrocele formation, recurrence, or persistence were compared among the techniques. In addition, interventional failure with radiologic embolization and reported complications with the laparoscopic approach were reviewed. Overall spontaneous pregnancy rates were 37.69% in the Palomo technique series, 41.97% in the microsurgical varicocelectomy techniques, 30.07% in the laparoscopic varicocelectomy techniques, 33.2% in the radiologic embolization, and 36% in the macroscopic inguinal (Ivanissevich) varicocelectomy series, revealing significant differences among the techniques (P = .001). Overall recurrence rates were 14.97% in the Palomo technique series, 1.05% in the microsurgical varicocelectomy techniques, 4.3% in the laparoscopic varicocelectomy techniques, 12.7% in the radiologic embolization, and 2.63% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P = .001). Overall hydrocele formation rates were 8.24% in the Palomo technique series, 0.44% in the microsurgical varicocelectomy techniques, 2.84% in the laparoscopic varicocelectomy, and 7.3% in the macroscopic inguinal (Ivanissevich) or subinguinal varicocelectomy series, revealing significant difference among the techniques (P = .001). We conclude that the microsurgical varicocelectomy technique has higher spontaneous pregnancy rates and lower postoperative recurrence and hydrocele formation than conventional varicocelectomy techniques in infertile men. However, prospective, randomized, and comparative studies with large number of patients are needed to compare the efficacy of microsurgical varicocelectomy with that of other treatment modalities in infertile men with varicocele.
Publication Types: Meta-Analysis Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18772487&dopt=ExternalLink
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PMID: 18772487 [PubMed - indexed for MEDLINE]17: J Androl. 2008 Sep-Oct;29(5):580-5. Epub 2008 Apr 17.
Resmini E, Andraghetti G, Rebora A, Cordera R, Vera L, Giusti M, Minuto F, Ferone D.
Department of Endocrinology and Medical Sciences, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy. resminieugenia@libero.it
Gender differences in leptin, ghrelin, and adiponectin levels have been described in a normal population. This is important for understanding differences between males and females in the regulation of food intake, weight gain, body fat distribution, and cardiovascular risk. It is unclear how endogenous and exogenous sex hormones may regulate circulating levels of these factors. Transsexuals during hormonal treatment may represent an ideal model to ascertain the role of exogenous sex hormones on these parameters. In this study, our objective was to evaluate adiponectin, ghrelin, and leptin levels in transsexual subjects during hormone therapy and to compare the results of males and females. Subjects were 26 nondiabetic transsexuals, which included 15 male-to-female (M-to-F, group 3) and 11 female-to-male (F-to-M, group 4) individuals, and 29 age- and BMI-matched controls, which included 15 males (group 1) and 14 females (group 2). Results showed that leptin levels were significantly lower in group 1 compared with group 2 (P = .04) and group 3 (P = .01); no differences were recorded between the other groups. Adiponectin levels were significantly higher in group 3 compared with group 4 (P = .03). No differences were found between the 4 groups for ghrelin levels. In conclusion, our data confirm the sexual dimorphism in serum leptin levels in normal subjects and demonstrate an increase in M-to-F transsexuals. While ghrelin does not show any sexual differences and seems not to be influenced by exogenous sex hormone administration, the lower adiponectin levels in F-to-M transsexuals during treatment confirm that androgens may decrease plasma adiponectin levels. This latter observation suggests that F-to-M transsexual patients could have a higher cardiovascular risk.
Publication Types: Controlled Clinical Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18421069&dopt=ExternalLink
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PMID: 18421069 [PubMed - indexed for MEDLINE]18: Int J Androl. 2008 Apr;31(2):201-8.
Newbold RR, Padilla-Banks E, Jefferson WN, Heindel JJ.
Developmental Endocrinology and Endocrine Disruptor Section, Laboratory of Molecular Toxicology, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA. newbold1@niehs.nih.gov
Environmental chemicals with hormone-like activity can disrupt the programming of endocrine signalling pathways that are established during perinatal life and result in adverse consequences that may not be apparent until much later in life. Increasing evidence implicates developmental exposure to environmental hormone mimics with a growing list of adverse health consequences in both males and females. Most recently, obesity has been proposed to be yet another adverse health effect of exposure to endocrine disrupting chemicals (EDCs) during critical stages of development. Obesity is quickly becoming a significant human health crisis because it is reaching epidemic proportions worldwide, and is associated with chronic illnesses such as diabetes and cardiovascular disease. In this review, we summarize the literature reporting an association of EDCs and the development of obesity, and further describe an animal model of exposure to diethylstilbestrol that has proven useful in studying mechanisms involved in abnormal programming of various oestrogen target tissues during differentiation. Together, these data suggest new targets (i.e. adipocyte differentiation and mechanisms involved in weight homeostasis) of abnormal programming by EDCs, and provide evidence that support the scientific term 'the developmental origins of adult disease'. The emerging idea of an association of EDCs and obesity expands the focus on obesity from intervention and treatment to include prevention and avoidance of these chemical modifiers.
Publication Types: Research Support, N.I.H., Intramural Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18315718&dopt=ExternalLink
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PMID: 18315718 [PubMed - indexed for MEDLINE]19: Int J Androl. 2008 Apr;31(2):93-102.
Paasch U, Salzbrunn A, Glander HJ, Plambeck K, Salzbrunn H, Grunewald S, Stucke J, Vierula M, Skakkebaek NE, Jorgensen N.
Department of Dermatology, University of Leipzig, Leipzig, Germany.
Population studies have shown that a high proportion of Nordic men may have so poor semen quality that they can be classified as sub-fertile according to international standards. A question is whether the Nordic data are specific for the Nordic countries or they should be seen as an expression of a general trend in Europe. We therefore carried out a prospective study of semen quality of young men raised in the former East Germany (Leipzig) and West Germany (Hamburg). To enable inter-regional comparisons, we utilized a common European research protocol previously used in studies in the Nordic-Baltic region. Three hundred and thirty-four young men representative of the general population from Hamburg, and 457 from Leipzig delivered semen samples, underwent physical examinations and provided information on life-style and reproductive health parameters. The study period in Hamburg was February 2003--July 2004, and in Leipzig July 2003--April 2005. No significant differences were observed in sperm concentration (median 46, 42, and 44 million/mL for men from Hamburg, Leipzig and the combined Hamburg-Leipzig group respectively) or total sperm count (154,141 and 149 million), whereas the differences for morphologically normal spermatozoa (9.4 and 8.4%) and motile spermatozoa (67 and 81%) were significantly different. Previously published studies have shown reduced fertility with decreasing sperm concentrations below 40-55 millions/mL and normal sperm morphology below 9-19%. Thus, a large fraction of young German men seem to have impaired semen quality that may reduce their natural fertility. However, it remains to be investigated to what extent poor semen quality contributes to the low German fertility rates.
Publication Types: Controlled Clinical Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18315714&dopt=ExternalLink
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PMID: 18315714 [PubMed - indexed for MEDLINE]20: Andrologia. 2008 Feb;40(1):44-8.
Saad F, Gooren L, Haider A, Yassin A.
Department of Men's Healthcare, Bayer-Schering, Berlin, Germany. farid.saad@bayerhealthcare.com
The effects of administration of testosterone (T) gel, resulting in plasma T levels in the low range of reference values, followed by testosterone undecanoate (TU), producing plasma T levels in the mid-normal range, were measured in 27 hypogonadal men aged 47-74 years. T gel had positive effects on the International Index of Erectile Function, the Aging Males' Symptoms Scale and International Prostate Symptoms Score and on the metabolic syndrome. The improvement was larger when TU was administered and plasma T levels were higher. The reduction in waist circumference and plasma cholesterol were larger with TU than with T gel, while the increases in plasma high-density lipoprotein and sex hormone binding globulin (an indicator of the severity of the metabolic syndrome) were larger with TU than with T gel. Both T gel and TU appeared safe on prostate parameters. Plasma haemoglobin and haematocrit were elevated but remained in the normal range. The assumption that treatment with T is adequate when achieved plasma levels of T are within the reference range is no longer tenable. Some androgen-dependent biological functions require higher plasma T levels than others, and, moreover, these thresholds differ among men.
Publication Types: Clinical Trial
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=18211301&dopt=ExternalLink
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PMID: 18211301 [PubMed - indexed for MEDLINE]