Resveratrol Modulates Bone Mineral Density and Bone Mineral Content in A Rat Model of Male Hypogonadism / 中国结合医学杂志

OBJECTIVE@#To determine whether resveratrol (Res) can correct osteoporosis induced in a rat model of male hypogonadism.@*METHODS@#Thirty-two rats were randomly divided into 4 groups, 8 in each group; 1) a control sham group: underwent a similar surgical procedure for induction of orchiectomy (ORCD) without ligation of any arteries or veins or removal of the testis and epididymis; 2) a control + Res-treated group (Con+Res): underwent sham surgery similar to the control, but was then treated with Res, as described below; 3) an ORCD-induced group: bilateral ORCD surgery as described above, and 4) a ORCD+Res-treated group: bilateral ORCD surgery followed by Res treatment. Res treatment began 4 weeks after ORCD and continued for 12 weeks. After 12 weeks, bone mineral density (BMD) and bone mineral content (BMC) were measured in the tibia and femur of each rat's right hind leg. Blood levels of bone turnover indicators such as deoxypyridinoline (Dpd), N-telopeptide of type I collagen (NTX I), alkaline phosphatase (ALP), and osteocalcin (OC), as well as receptor activator of nuclear factor kappa B (RANK) and osteoprotegerin (OPG) were assessed.@*RESULTS@#ORCD significantly decreased BMD (P<0.01) and significantly increased bone resorption, manifested by increased RANK. In addition, it inhibited serum levels of OPG and OC. Res treatment after ORCD effectively increased serum levels of bone formation markers such as OPG and OC, compared with testisectomized rats (P<0.05).@*CONCLUSION@#Res could ameliorate bone loss induced by male hypogonadism, possible via restoration of the normal balance between RANK and OPG.

Is serum PSA a predictor of male hypogonadism? Testing the hypothesis

ABSTRACT Objective: Male hypogonadism (MH) is common among infertile men. Besides testosterone, limited MH biomarkers are available, while researchers have suggested the use of prostate-specific antigen (PSA) to help diagnose MH. Hence, we sought to evaluate the potential use of PSA to predict MH among relatively young men with infertility in Nigeria. Materials and methods: The study included 707 male partners (35-44 years) in infertile couples seeking infertility evaluation at a third-level care center in Nigeria. MH was diagnosed using standard guidelines. Receiver operating characteristic (ROC) and regression analyses explored the potential of serum free PSA (fPSA) and total PSA (tPSA) in predicting MH and MH-related clinical features. Results: In all, 29.7% of the patients had MH (MH+ve). The MH+ve group had lower mean values of fPSA and tPSA than the group without MH (MH-ve). The best fPSA threshold of < 0.25 μg/L compared with the best tPSA threshold of < 0.74 μg/L had higher accuracy (area under the curve [AUC] 0.908 versus 0.866, respectively), sensitivity (87% versus 83%, respectively), and specificity (42% versus 37%, respectively) for MH diagnosis. After adjustment for confounders, fPSA level ≤ 0.25 μg/L was more likely to predict MH-related decreased libido (odds ratio [OR] 2.728, p<0.001) and erectile dysfunction (OR 3.925, p<0.001) compared with tPSA ≤ 0.74 μg/L in the MH+ve group. Conclusion: For MH diagnosis, fPSA and tPSA had good sensitivity but very poor specificity, although fPSA had better potential for MH diagnosis and association with MH-related clinical features than tPSA. Hence, fPSA could complement other biomarkers for MH diagnosis in men 35-44 years, although we recommend further studies to confirm these findings.

Testicular ultrasound inhomogeneity is an informative parameter for fertility evaluation / 亚洲男科学杂志(英文版)

Testicular volume (TV) is proposed to be a positive predictor of male fertility status, because of the relation known between the TV and the seminiferous tubule content. Independently of the measurement methodology, the role of TV and testicular ultrasound (US) assessments is still debated in andrological clinical practice. In this retrospective cohort study, we evaluated TV and testis US role in the diagnostic workup of andrological patients. All consecutive outpatients undergoing single-operator testis US (Modena, Italy) from March 2012 to March 2018 were enrolled, matching sonographic, hormonal, and seminal data. A total of 302 men were referred and evaluated for gynecomastia, suspected hypogonadism, couple infertility (CI), or sexual dysfunction. In the hypogonadal group, TV was lower compared to that in other groups (P < 0.001), and a significant, direct correlation between TV and testosterone level was observed in nonandrogen-treated patients (R = 0.911, P < 0.001), suggesting that testicular size could be related to the testosterone-secreting compartment. In the CI group, normozoospermic patients showed higher TV compared to men with impaired semen quality (P = 0.003) and azoospermia (P = 0.003). However, TV was not able to discriminate between patients presenting normal and altered semen quality. On the contrary, testis US inhomogeneity was more frequent in patients with impaired sperm quality (55.0%; P = 0.007) and azoospermia (40.0%; P = 0.012), compared to patients with normozoospermia (5%), identifying thereby the sonographic pattern as an informative parameter of the fertility status. Therefore, in the CI workup, US evaluation seems to be more informative than the TV assessment alone.

Histologically proven hepatic steatosis associates with lower testosterone levels in men with obesity / 亚洲男科学杂志(英文版)

Men with obesity often present with low testosterone (T) and sex hormone-binding globulin (SHBG) levels. Several mechanisms for this have been proposed, but as SHBG is secreted by hepatocytes and sex steroids undergo hepatic metabolization, this study investigates whether severity and histological components of nonalcoholic fatty liver disease (NAFLD) are associated with sex steroid levels in obese men. This cross-sectional study included 80 obese men (age: 46 ± 11 years; body mass index: 42.2 ± 5.5 kg m-2). Serum levels of total T and estradiol (E2) were measured using liquid chromatography coupled with tandem mass spectroscopy (LC/MS-MS) and SHBG and gonadotropins by immunoassay. Liver biopsies were evaluated using Steatosis, Activity, and Fibrosis scoring. Participants with steatohepatitis had similar median (1stquartile-3rd quartile) total T levels (7.6 [5.0-11.0] nmol l-1 vs 8.2 [7.2-10.9] nmol l-1; P = 0.147), lower calculated free T (cFT) levels (148.9 [122.9-188.8] pmol l-1 vs 199.5 [157.3-237.6] pmol l-1; P = 0.006), and higher free E2/T ratios (10.0 [6.4-13.9] x10-3 vs 7.1 [5.7-10.7] x10-3;.

Androgen receptor deficiency in monocytes/macrophages does not alter adiposity or glucose homeostasis in male mice / 亚洲男科学杂志(英文版)

Androgen deprivation in men leads to increased adiposity, but the mechanisms underlying androgen regulation of fat mass have not been fully defined. Androgen receptor (AR) is expressed in monocytes/macrophages, which are resident in key metabolic tissues and influence energy metabolism in surrounding cells. Male mice bearing a cell-specific knockout of the AR in monocytes/macrophages (M-ARKO) were generated to determine whether selective loss of androgen signaling in these cells would lead to altered body composition. Wild-type (WT) and M-ARKO mice (12-22 weeks of age, n = 12 per group) were maintained on a regular chow diet for 8 weeks and then switched to a high-fat diet for 8 additional weeks. At baseline and on both the regular chow and high-fat diets, no differences in lean mass or fat mass were observed between groups. Consistent with the absence of differential body weight or adiposity, no differences in food intake (3.0 ± 0.5 g per day for WT mice vs 2.8 ± 0.4 g per day for M-ARKO mice) or total energy expenditure (0.6 ± 0.1 Kcal h-1 for WT mice vs 0.5 ± 0.1 Kcal h-1 for M-ARKO mice) were evident between groups during high-fat feeding. Liver weight was greater in M-ARKO than that in WT mice (1.5 ± 0.1 g vs 1.3 ± 0.0 g, respectively, P = 0.02). Finally, M-ARKO mice did not exhibit impairments in glucose tolerance or insulin sensitivity relative to WT mice at any study time point. In aggregate, these findings suggest that AR signaling specifically in monocytes/macrophages does not contribute to the regulation of systemic energy balance, adiposity, or insulin sensitivity in male mice.

Secondary male hypogonadism: A prevalent but overlooked comorbidity of obesity / 亚洲男科学杂志(英文版)

Male hypogonadism associated with obesity is a very prevalent condition and is increasing in parallel with the epidemic prevalence of obesity. Low testosterone levels promote higher fat mass with reduced lean mass. Male hypogonadism is related to an increase in associated cardiometabolic complications, such as hypertension, type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular disease. Its influence as a comorbidity of obesity is becoming more evident and should be evaluated and treated in at-risk patients. Mechanisms involved in this relationship include body composition changes, the presence of adipokines, insulin resistance, and other factors, some of which are still unknown. Weight loss and treatment to replace testosterone levels improve the metabolic profile and quality of life in patients with obesity and hypogonadism; these beneficial effects depend on treatment modality and duration of therapy. The use of testosterone replacement therapy may be indicated, as it has not been shown to increase cardiovascular risk, and retrospective studies suggest a reduction in events in men with metabolic syndrome and type 2 diabetes.

Study on the mechanisms of the variation of sexual hormone in young male obesity with acanthosis nigricans / 中华内分泌代谢杂志

Objective To assess the variation of sexual hormone and mechanisms of low testosterone in young male obesity with acanthosis nigricans. Methods Retrospective analysis was performed in 125 male obesity patients [ body mass index( BMI)≥28 kg/m2 ] . According to their clinical characteristics, they were divided into two groups including obesity without acanthosis nigricans(OB group, n=62) and obesity with acanthosis nigricans(AN group, n=63). 60 normal weight men were also recruited as a control group. Body fat and body weight were measured. Blood insulin, lipid profile, sex hormones levels, and inflammation factors were measured. Parameters of each group were compared and the correlations between total testosterone level and other index were analyzed. Results All the male obesities have the significant lower total testosterone levels than those of control group(P>0. 05), and those in AN group were lower than those in OB group(P>0. 05). The BMI and body fat in OB group and AN group were both significantly higher than those in control group(P>0. 05). The fasting insulin levels in all obese men were significantly higher than those in control group(P>0. 05), highest in AN group. Triglycerides(TG) in both OB and AN group were higher than those in controls, and not significant between later 2 groups. But high-density lipoprotein-cholesterol ( HDL-C) in the two groups were significantly lower than control, which in AN group were significantly lower than OB group. Total testosterone levels in AN group were negatively correlated with weight, waist circumference, hip circumference, fasting insulin, and homeostasis model assessment for insulin resistance ( HOMA-IR ) , and also negatively correlated with inflammation factors including C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR) , tumor necrosis factor-α( TNF-α) , and uric acid. However, total testosterone levels in AN group were not correlated with lipid metabolism index. Conclusion Young male obesity with acanthosis are associated with secondary hypogonadism. Hyperinsulinemia, insulin resistance, and inflammatory factors are risk factors for the occurrence of this secondary male hypogonadism.

Secondary male hypogonadism: A prevalent but overlooked comorbidity of obesity / 亚洲男科学杂志(英文版)

Male hypogonadism associated with obesity is a very prevalent condition and is increasing in parallel with the epidemic prevalence of obesity. Low testosterone levels promote higher fat mass with reduced lean mass. Male hypogonadism is related to an increase in associated cardiometabolic complications, such as hypertension, type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular disease. Its influence as a comorbidity of obesity is becoming more evident and should be evaluated and treated in at-risk patients. Mechanisms involved in this relationship include body composition changes, the presence of adipokines, insulin resistance, and other factors, some of which are still unknown. Weight loss and treatment to replace testosterone levels improve the metabolic profile and quality of life in patients with obesity and hypogonadism; these beneficial effects depend on treatment modality and duration of therapy. The use of testosterone replacement therapy may be indicated, as it has not been shown to increase cardiovascular risk, and retrospective studies suggest a reduction in events in men with metabolic syndrome and type 2 diabetes.

Androgen receptor deficiency in monocytes/macrophages does not alter adiposity or glucose homeostasis in male mice / 亚洲男科学杂志(英文版)

Androgen deprivation in men leads to increased adiposity, but the mechanisms underlying androgen regulation of fat mass have not been fully defined. Androgen receptor (AR) is expressed in monocytes/macrophages, which are resident in key metabolic tissues and influence energy metabolism in surrounding cells. Male mice bearing a cell-specific knockout of the AR in monocytes/macrophages (M-ARKO) were generated to determine whether selective loss of androgen signaling in these cells would lead to altered body composition. Wild-type (WT) and M-ARKO mice (12-22 weeks of age, n = 12 per group) were maintained on a regular chow diet for 8 weeks and then switched to a high-fat diet for 8 additional weeks. At baseline and on both the regular chow and high-fat diets, no differences in lean mass or fat mass were observed between groups. Consistent with the absence of differential body weight or adiposity, no differences in food intake (3.0 ± 0.5 g per day for WT mice vs 2.8 ± 0.4 g per day for M-ARKO mice) or total energy expenditure (0.6 ± 0.1 Kcal h-1 for WT mice vs 0.5 ± 0.1 Kcal h-1 for M-ARKO mice) were evident between groups during high-fat feeding. Liver weight was greater in M-ARKO than that in WT mice (1.5 ± 0.1 g vs 1.3 ± 0.0 g, respectively, P = 0.02). Finally, M-ARKO mice did not exhibit impairments in glucose tolerance or insulin sensitivity relative to WT mice at any study time point. In aggregate, these findings suggest that AR signaling specifically in monocytes/macrophages does not contribute to the regulation of systemic energy balance, adiposity, or insulin sensitivity in male mice.

Effects of velvet antler polypeptide on sexual behavior and testosterone synthesis in aging male mice / 亚洲男科学杂志(英文版)

Twenty-four-month-old male C57BL/6 mice with low serum testosterone levels were used as a late-onset hypogonadism (LOH) animal model for examining the effects of velvet antler polypeptide (VAP) on sexual function and testosterone synthesis. These mice received VAP for 5 consecutive weeks by daily gavage at doses of 100, 200, or 300 mg kg-1 body weight per day (n = 10 mice per dose). Control animals (n = 10) received the same weight-based volume of vehicle. Sexual behavior and testosterone levels in serum and interstitial tissue of testis were measured after the last administration of VAP. Furthermore, to investigate the mechanisms of how VAP affects sexual behavior and testosterone synthesis in vivo, the expression of steroidogenic acute regulatory protein (StAR), cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc), and 3β-hydroxysteroid dehydrogenase (3β-HSD) in Leydig cells was also measured by immunofluorescence staining and quantitative real-time PCR. As a result, VAP produced a significant improvement in the sexual function of these aging male mice. Serum testosterone level and intratesticular testosterone (ITT) concentration also increased in the VAP-treated groups. The expression of StAR, P450scc, and 3β-HSD was also found to be enhanced in the VAP-treated groups compared with the control group. Our results suggested that VAP was effective in improving sexual function in aging male mice. The effect of velvet antler on sexual function was due to the increased expression of several rate-limiting enzymes of testosterone synthesis (StAR, P450scc, and 3β-HSD) and the following promotion of testosterone synthesis in vivo.

Secondary male hypogonadism induced by sellar space-occupying lesion: Clinical analysis of 22 cases / 中华男科学杂志

<p><b>Objective</b>To analyze the clinical characteristics of secondary male hypogonadism induced by sellar space-occupying lesion, explore its pathogenesis, and improve its diagnosis and treatment.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 22 cases of secondary male hypogonadism induced by sellar space-occupying lesion, reviewed related literature, and investigated the clinical manifestation, etiological factors, and treatment methods of the disease. Hypogonadism developed in 10 of the patients before surgery and radiotherapy (group A) and in the other 12 after it (group B). The patients received endocrine therapy with Andriol (n=7) or hCG (n=15).</p><p><b>RESULTS</b>The average diameter of the sellar space-occupying lesions was significantly longer in group A than in B (［2.35±0.71］ vs ［1.83±0.36］ cm, P<0.05) and the incidence rate of prolactinomas was markedly higher in the former than in the latter group (60% vs 0, P<0.01). The levels of lutein hormone (LH), follicle stimulating hormone (FSH) and testosterone (T) were remarkably decreased in group B after surgery and radiotherapy (P<0.01). Compared with the parameters obtained before endocrine therapy, all the patients showed significant increases after intervention with Andriol or hCG in the T level (［0.78±0.40］ vs ［2.71±0.70］ ng/ml with Andriol; ［0.93±0.44］ vs ［3.07±0.67］ ng/ml with hCG) and IIEF-5 score (5.00±2.61 vs 14.50±3.62 with Andriol; 5.36±1.82 vs 15.07±3.27 with hCG) (all P<0.01). The testis volume increased and pubic hair began to grow in those with hypoevolutism. The patients treated with hCG showed a significantly increased testis volume (P<0.01) and sperm was detected in 7 of them, whose baseline testis volume was markedly larger than those that failed to produce sperm (［11.5±2.3］ vs ［7.5±2.3］ ml, P<0.01). Those treated with Andriol exhibited no significant difference in the testis volume before and after intervention and produced no sperm, either.</p><p><b>CONCLUSIONS</b>Hypothyroidism might be attributed to surgery- or radiotherapy-induced damage to the pituitary tissue, space-occupying effect of sellar lesion, and hyperprolactinemia. Both Andriol and hCG can improve the T level and erectile function, but the former does not help spermatogenesis.</p>

Diagnóstico y manejo del hipogonadismo masculino / Male hypogonadism management

El hipogonadismo masculino se caracteriza por disfunción testicular y/o del eje hipotálamo-hipofisario produciendo una reducción de las concentraciones de testosterona. Se clasifica en hipogonadismo hipogonadotrópico (Hh) e hipogonadismo hipergonadotrópico (HH), y a su vez en causas adquiridas y congénitas. Las gonadotropinas pueden estar elevadas (HH) o disminuidas (Hh) y en general cursan con niveles disminuidos de testosterona. Dentro de las pruebas que apoyan al diagnóstico y manejo se incluyen el ecosonograma testicular, evaluación genética, densitometría ósea, biopsia testicular, estudios imagenológicos, espermograma, anticuerpos antiespermáticos y las pruebas dinámicas. Por último, la terapia de reemplazo con testosterona es el principal tratamiento, y la meta es obtener valores de testosterona total entre 400 y 700 ng/dL. A continuación, se presenta el protocolo para el diagnóstico y manejo del hipogonadismo masculino, con la evidencia científica y la experiencia clínica de la Unidad de Endocrinología del IAHULA.

Male hypogonadism is characterized by testicular dysfunction secondary to testicular damage and/or hypothalamus-pituitary axis dysfunction resulting in a reduction in testosterone levels. It is classified as hypogonadotropic hypogonadism (Hh) or hypergonadotropic hypogonadism (HH), and these are also divided in acquired and congenital causes. Gonadotropins may be high (HH) or decreased (Hh) and generally occur with decreased testosterone levels. Among the tests supporting the diagnosis and management are included testicular ultrasonography, genetic screening, bone densitometry, testicular biopsy, imaging studies, spermogram, sperm antibodies and hormonal dynamic tests. Finally, testosterone replacement therapy is the main treatment, and the goal is to obtain total testosterone values between 400 and 700 ng/dL. Below, is presented the IAHULA Endocrinology Unit guidelines for male hypogonadism management, based on scientific evidence and clinical experience.

itamin D Levels in Men with Metabolic Syndrome with or Without Hypogonadism.

Aims: To clarify the relation of metabolic syndrome (MS) with or without late-onset hypogonadism (LOH) and vitamin D deficiency in men. Study Design: Consecutive male patients with MS were additionally evaluated for LOH and vitamin D status. Place and Duration of Study: Department of Endocrinology, Alexandrovska University hospital, Sofia; between March 2010 and February 2011. Methodology: 99 men were included in the study. Of them 65 had MS and they were divided according to their morning total testosterone (TT) level (cutoff 10.4 nmol/l) into two groups: MS-LOH (N=21) and MS-noLOH (N=44). The control group consisted of 34 men without MS and LOH. Vitamin D levels were measured using electrochemiluminiscence immunoassay. Results: MS men were at mean age (±SD) = 50.4±9.6 years and had TT = 13.6±5.4 nmol/l. The control group was at age = 51.5±6.4 years (compared to MS: NS) and had TT = 17.9±5.6 nmol/l (compared to MS: P< .001). MS-LOH sub-group had age 47.9±10.5 years and TT = 8.1±1.5 nmol/l; MS-NoLOH sub-group – age 51.6±9.1 years, TT = 16.3±4.5 nmol/l. The levels of vitamin D were higher in the controls – 27.9±12.0 ng/ml compared to the MS – 16.2±9.1 ng/ml (P< .001). There was no difference in 25(OH)D between MS-LOH – 17.4±10.9 ng/ml and MS-NoLOH – 15.6±8.2 ng/ml sub-groups. They both differed from the control group (P< .001). There was a negative relationship between 25(OH)D and BMI in all patients (rho= -0,344, P< .001) and in the MS-LOH group (rho= -0,439, P< .05). Similar relationship was found between vitamin D and waist circumference (respectively: rho= -0,459, P< .001; rho= -0,553, P= .011). Much smaller in strength but significant correlation was the one between vitamin D levels and Aging Male Score in all patients (rho= -0,254, P< .05). Conclusion: There are no differences in vitamin-D levels when comparing metabolic syndrome patients with and without late onset hypogonadism.

Laboratory diagnosis of late-onset male hypogonadism andropause / Diagnóstico laboratorial do hipogonadismo masculino tardio (andropausa)

OBJECTIVES: To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). METHODS: Total testosterone (TT), SHBG and albumin were measured in 216 men aged 52-84 years. The laboratorial definition of LOH was two values of calculated free testosterone (cFT) <6.5 ng/dl, according to Vermeulen's formula. RESULTS: At the first blood test, cFT was <6.5 ng/dl in 27 percent of the men. Laboratorial LOH (confirmed by two tests) was present in 19 percent, but TT levels were low in only 4.1 percent. Age influenced TT (p=0.0051) as well as BMI; 23.5 percent of patients > 70 years and 38.9 percent of the obese men who had TT within the reference range were, in fact, hypogonadal. CONCLUSION: Especially in obese men and in those > 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.

OBJETIVOS: Avaliar os fatores que influenciam o diagnóstico laboratorial do hipogonadismo masculino tardio. MÉTODOS: Avaliamos 216 homens entre 52 e 84 anos. O diagnóstico laboratorial foi definido como dois valores de testosterona livre calculada (TLC) <6,5 ng/dl, segundo a fórmula de Vermeulen, a partir das dosagens de testosterona total (TT), SHBG e albumina. RESULTADOS: Na primeira dosagem, a TLC foi <6.5 ng/dl em 27 por cento da amostra. Hipogonadismo laboratorial (confirmado por duas dosagens) esteve presente em 19 por cento, no entanto a TT foi baixa em apenas 4.1 por cento dos homens. A idade influenciou a TT (p=0.0051) bem como o IMC; 23,5 por cento dos homens > 70 anos e 38,9 por cento dos obesos com TT dentro dos níveis de referência eram, na verdade, hipogonádicos. CONCLUSÃO: Especialmente em homens obesos e nos > 70 anos a dosagem de SHBG é importante para calcular TL e diagnosticar o hipogonadismo.

Diferentes respuestas somáticas y densitométricas sobre el hueso cortical y trabecular a la androgenoterapia en varones hipogonádicos / Different somatic and densitometric responses of cortical and trabecular bone to androgen therapy in hypogonadal men

Una consecuencia clínica de la deficiencia de testosterona en el varón es el descenso de la densidad mineral ósea (DMO), asociado a mayor riesgo de fractura (con la consiguiente morbi-mortalidad en el hombre añoso), y cambios de la composición y el contenido de calcio corporal total. Para cuantificar los efectos de la androgenoterapia sobre la composición corporal y el contenido de calcio corporal, correlacionar los cambios hormonales con los densitométricos y de la composición corporal, y constatar posibles diferencias densitométricas regionales, se incluyeron 15 varones hipogonádicos. Se determinaron variables antropométricas, bioquímicas, densitométricas y de la composición corporal en condiciones basales y bajo la terapia sustitutiva. Como resultado, se logró compensar el déficit androgénico y duplicar la concentración de estradiol. El eugonadismo inducido incrementó la DMO como el contenido del calcio corporal total. Además, redujo el porcentaje de masa grasa corporal total (principalmente abdominal) y aumentó la masa muscular corporal total, con incremento de la relación masa magra/masa grasa, sin cambios del índice de masa corporal. En conclusión, nuestros resultados afirman el papel preponderante de los esteroides sexuales sobre la composición corporal y su rol en el hueso. El hipogonadismo masculino constituye un factor de riesgo para osteoporosis y enfermedad cardiovascular.

A clinical consequence of testosterone deficiency in males is the reduction of bone mineral density (BMD), associated with a higher risk of fracture (and a subsequent increase in morbi-mortality in elderly men) and with changes in body composition and total body calcium content. In order to quantify the effects of androgen therapy on body composition and body calcium content, and to correlate changes in hormone levels with densitometric changes and changes in body composition changes, as well as to determine potential regional densitometric differences, 15 hypogonadal men were included in the present study. Anthropometric, biochemical, densitometric and body composition variables were analyzed under basal conditions, and under replacement therapy. As a result, androgen deficiency was compensated, and estradiol level was twice as high. Induced eugonadism increased both BMD and total body calcium content. Also, replacement treatment reduced the percentage of total body fat, (primarily abdominal fat) and increased total muscle mass, with an increment of the lean mass/fat mass ratio, and no change in BMI. In conclusion, our results strengthen the preponderant role of sexual steroids on body composition, and its effect on bones. Male hypogonadism is a risk factor for osteoporosis and cardiovascular disease.

Testis transplantation with fetal testis as donor for treatment of male hypogonadism / 临床外科杂志

Objective To investigate the value of the clinical application of fetal testis for the treatment of male hypogonadism.Method We have performed the testicular transplantation to cure 6 patients suffered from hypogonadism with the fetal testis as donor.Results All patients had a significantly increased level of serum testosterone and the male secondary sexual characteristics and the sexual desire were improved.The size of testis was larger than before operation.Conclusion Testis transplantation with fetal testis as donor is an effective method to cure male hypogonadism and has great value of clinical application for its weak immunogenicity.

Study of Efficacy and Safety of Non-scrotoal Testosterone Transdermal Delivery Sustem(Androderm Patch) in Male Hypogonadism / 대한비뇨기과학회지

PURPOSE: Although various attempts have been made and employed to restore normal testosterone levels in hypogonadal patients, it is still to be improved to achieve efficient hormone delivery. Recently a non-scrotal transdermal delivery system, Androderm patch, has been developed and proven to be of high efficacy and safety. We performed this study to examine the efficacy and safety of Androderm patch in Korean subjects. MATERIALS AND METHODS: A total of 26 hypogonadal men who met the inclusion and exclusion criteria enrolled this study Subjects who had been treated with intramuscular administration of tetosterone had a 6-week washout period. After baseline evaluations, placebo patch was administered for 4 weeks and reexamined. Then patients received therapy over a 24-week period and were evaluated at 4-week intervals. The following efficacy parameters were evaluated at various time points during the study; serum concentrations of testosterone, bioavailable testosterone and estradiol, nocturnal penile tumescence test using Rigiscan, sexual function questionnaires, and hypogonadism symptoms. Also evaluated were safety parameters including skin tolerability, laboratory parameters, prostate evaluation and adverse events. RESULTS: Fifteen patients were completed the study and included for data analysis. Most cause of drop-out cases(7/8) was local skin irritability. Testosterone level was increased from the pretreatment level of 91.5+/-83.3ng/dl to 503.1+/-177.6ng/dl during treatment. Bioavailable testosterone level was also increased significantly during treatment. Compared to baseline evaluations, significant improvements were shown in Rigiscan parameters(RAU & TAU values), sexual function scores and hypogonadism symptoms. No changes were found in safety parameters. However, it was also shown that a majority of patients(79.2%) experienced skin irritability with varying degree of reaction. CONCLUSIONS: In conclusion, non-scrotal testosterone transdermal delivery system can produce physiologic serum androgen levels, improve objective and subjective sexual functions and reduce hypogonadal symptoms without any serious adverse reactions. However, it is suggested that the frequent skin irritability remains to be overcome for further improvement.

Site-specific effect of testosterone on bone mineral density in male hypogonadism

To assess the correlation between the remaining serum testosterone and bone mineral density(BMD), and to determine the effect of exogenous testosterone on BMD in subjects with male hypogonadism, we evaluated the serum testosterone levels and BMDs of the femur neck, Ward's triangle and the spine(L1-4) in 20 subjects with Klinefelter's syndrome and 7 with hypogonadotropic hypogonadism before and after testosterone replacement. BMDs of the femur neck, Ward's triangle and the spine were below the age-matched normal mean at 77.8%(21/20), 74.1%(20/27) and 88.9%(24/27), respectively. There were significant differences in serum testosterone levels and the spinal BMD between the two groups and the BMD of the spine closely correlated with the serum testosterone level (R = 0.63, p < 0.001). Following a mean 11.8 +/- 4.9 months of testosterone replacement, the BMD at all sites increased significantly and the pretreatment difference in spinal BMD between the two groups disappeared. We conclude that, although testosterone may increases the bone density, it has a site-specific effect of maintaining and increasing the bone mass especially at the spine in male hypogonadism.

Endocrinologic evaluation of male hypogonadism: Kallmann's syndrome / 대한비뇨기과학회지

A clinical investigation and hormonal study was on 36 patients of male hypogonadism who visited the Department of Urology, Dong San hospital, Keimyung university, School of Medicine from March, 1986 to August, 1990, retrospectively. The results were as follows; 1. The cause of primary hypogonadism was Klinefelter's syndrome in all 27 cases. In patients with secondary hypogonadism, there were 7 cases of Kallmann's syndrome, a case of delayed puberty and a case of pituitary tumor. 2. The major physical feature was delay in sexual maturation. In addition, anosmia was found in 4. cases, gynecomastia in 3 cases, family history in 2 cases, cryptorchidism in 2 cases, color blindness in 1 case, obesity in 1 case and associated renal agenesis in 1 case. 3. In hormonal study of primary hypogonadism patients, serum LH was 30.8 mIU/ml, serum FSH 40.3 mIU/ml and serum testosterone 3.9 ng/ml. The results of hormonal study in secondary hypogonadism were serum LH 1.4 mIU/ml, serum FSH 1.9 mIU/ml, serum testosterone 0.3ng/ ml and serum prolactin 4.2 mIU/ml. 4. LHRH stimulation test was performed in secondary hypogonadism to differentiate hypothalamic and pituitary lesion. In 4 cases of Kallmann's syndrome and a case of delayed puberty, 597.6+/-191.4% increase in circulating LH and 365.0+/-218.8% increase in circulating FSH were seen. In 3 cases of Kallmann's syndrome, 200% increase in circulating LH and 153% in crease in circulating FSH were found. A case of pituitary tumor shows 163% increase in circulating LH and 325% in circulating FSH. 5. The treatments of patients with secondary hypogonadism were composed of HCG and HMG administration. Dosage of HCG was 3000 IU, two times a week and HMG administration was combined to restore fertility. 6. To differentiate the hypothalamic from pituitary lesion, a single LHRH test was not always possible, because the limited or absent response to LHRH might indicate either pituitary lesion or pituitary hyporeponsiveness due to chronic deprivation of endogenous LHRH. In this respect, a prolonged LHRH stimulation test and triple stimulation test may help to differentiate hypothalamic from pituitary lesions.

GNRH test in Male Hypogonadism / 대한비뇨기과학회지

GnRH test was performed in male hypogonadism which included hypogonadotrophic hypogonadism, Kallmann's syndrome, oligospermia and azoospermia, total 24 cases. The results were as follows: 1. GnRH test is most useful in the evaluation of patients with suspected gonadotropins deficiency. 2. GnRH test is helpful in the differentiation of hypothalamic from pituitary disorder, but single GnRH test does not reliably differentiate. 3. GnRH test facilitate the differentiation between delayed puberty and isolated gonadotropins deficiency. 4. GnRH test is useful in the evaluation of patients with oligospermia or azoospermia, especially with normal basal hormone level, to diagnose the primary lesion. 5. GnRH test is valuable in the determination of treatment modality in hypogonadotrophic hypogonadism and infertile men.