Prevalence of late-onset hypogonadism among middle-aged and elderly males in China: results from a national survey / 亚洲男科学杂志(英文版)

This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l

Estudios de laboratorio de diversos parámetros orientados a tratar de dilucidar la fisiopatología del síndrome de ovarios poliquísticos. Parte 1 / Laboratory studies of various parameters aimed at trying to elucidate the pathophysiology of polycystic ovary syndrome. Part 1

Esta revisión fue realizada con el fin de evaluar nuestros resultados de laboratorio así como aquellos de la literatura que constituyen, a nuestro entender, aportes significativos en el síndrome de ovarios poliquísticos (SOP). Nuestro especial énfasis será presentar las limitaciones de las metodologías empleadas por nuestro grupo, comparativamente a las reportadas por otros investigadores. La determinación de andrógenos, en particular de Testosterona (TT), es quizá la de mayor complejidad dado que los resultados con los diferentes inmunoensayos empleados en nuestro medio producen resultados muy variables por los diferentes métodos y aún entre laboratorios que usan la misma metodología. La técnica de referencia es la cromatografía líquida en tándem con espectrometría de masa (LC-MSMS), de difícil aplicación en laboratorios de análisis clínicos debido a su alto costo y la imposibilidad de resolver numerosas muestras. En estudios previos demostramos que de los métodos habitualmente usados para evaluar la TT circulante, solo en 2 inmunoensayos los resultados obtenidos fueron satisfactoriamente validados indirectamente según el criterio del Consenso de los Centros para el Control y Prevención de Enfermedades (CDC, USA) contra LC-MSMS, los cuales fueron comparables a dicha metodología con niveles superiores a 0,5 ng/ml. El SOP puede presentar factores de riesgo aumentados para la enfermedad cardiovascular y la diabetes II. Estos factores no están debidamente categorizados en función de los distintos fenotipos del SOP. Se evaluarán los principales analitos empleados con este objetivo y los nuevos que aporten elementos de mayor especificidad en este sentido

This review was performed in order to evaluate our laboratory results as well as those of the literature that constitute, in our opinion, significant contributions in these pathophysiologies. Our special emphasis will be on presenting the limitations of the methodologies used by our group, compared to those reported by other researchers. The determination of androgens, in particular Testosterone (TT), is perhaps the most complex since the results with the different immunoassays used in our environment produce very variable results by the different methods and even between laboratories that use the same methodology. The reference technique is LC-MSMS, difficult to apply in clinical analysis laboratories because of its high cost and the inability to solve numerous samples. In previous studies, we demonstrated that, in comparison to LC-MSMS with the usual methods for evaluating circulating TT, the results obtained in only 2 immunoassays were satisfactorily validated indirectly according to the criteria of CDC against LC-MSMS, which were comparable to that methodology with levels higher than 0.5 ng/ml. PCOS may have increased risk factors for cardiovascular disease and diabetes II. These factors are not properly categorized according to the different phenotypes of PCOS. The main analytes used for this purpose will be evaluated and new ones that contribute elements of greater specificity in this sense

Value of the serum free testosterone level in detecting erectile dysfunction / 中华男科学杂志

Objective@#To investigate the values of serum calculated free testosterone (cFT), testosterone secretion index (TSI), and free testosterone index (FTI) in the diagnosis of ED with androgen deficiency by observing their changes in the patient.@*METHODS@#We conducted this study among 185 men complaining of ED and 35 20－40 years old healthy males presenting at the clinic for premarital medical checkup. We asked them about their medical history, to fill in the International Index of Erectile Function (IIEF-5) Questionnaire, and to complete the nocturnal penile tumescence (NPT) test. According to the data obtained, 150 of the complainants were diagnosed as ED patients and 25 of the healthy examinees were included in the control group. We determined the levels of total serum testosterone (TT), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), serum albumin (ALB), cFT, bio-available testosterone (bio-T), TSI, and FTI in the two groups of subjects. Using cFT ≤0.3 nmol/L, TSI ≤2.8, and FTI ≤0.4 as the critical values and TT ≤11.5 nmol/L as the gold standard for androgen deficiency, we calculated cFT-, TSI-, and FTI-related rates of missed diagnosis, misdiagnosis, and diagnostic coincidence.@*RESULTS@#With TT ≤11.5 nmol/L as the criterion, the cFT-, TSI-, and FTI-related rates of coincidence in the diagnosis of androgen deficiency in the ED patients were 90.8%, 85.8%, and 80.8%, those of missed diagnosis were 4.0%, 33.3%, and 44.0%, and those of misdiagnosis were 10.5%, 19.4%, and 12.6%, with the Kappa of values 0.755, 0.564, and 0.427, respectively (P <0.05). The levels of serum TT, cFT, Bio-T, TSI, and FTI were decreased with increased age of the 20－40 years old ED patients, with statistically significant differences among different age groups except the serum TT level. However, no statistically significant differences were found in the levels of TT, cFT, Bio-T, TSI, and FTI among the patients with different IIEF-5 scores.@*CONCLUSIONS@#The level of cFT has a higher value than those of TT, TSI, and TSI in the diagnosis of ED with androgen deficiency in 20－40 years old men.

Study of the Biological Activities Preparation with Tribulus Terrestris l. on Free Serum Testosterone Changes in Male Rats / Монголын эм зүй, эм судлал

Wistar nonlinear rats weighing 170-220g. Rats were divided 5 groups, including control group, group-1, group-2, group -3 and reference group. Dried thistle extract and raw bovine testicle were contained by 1:1, 1:2 and 2:1 ratio. Each 0.1g ratio was dissolved in 20 ml distilled water and administered 2 times per day. Blood sampling was done for each rat after 3, 7, 14, 21, 28 and 35 days. Their testosterone level was measured by ELISA Kit. Results: The results indicated that free serum testosterone level in male rats increase and decrease in 7 days frequency. All tested groups showed gradual increase in the level of free serum testosterone when compared to that of corresponding control (p<0.05). Statistical comparison of all groups revealed that the maximum level was found in group 1. Moreover, group 3 was showed gradually increase in level of free serum testosterone, irrelative with period of decrease testosterone level. Conclusion: According to our results and previous study, it is suggested that preparation with Tribulus terrestris L. extract could be used in the androgen deficiency and erectile dysfunctions. Keywords: Tribulus Terrestris L, Free testosterone, Dihydrotestosterone, Protodioscin

Niveles de testosterona libre en pacientes del sexo masculino con diabetes mellitus tipo 2

Los niveles disminuidos de testosterona están asociados con esterilidad e impotencia sexual. El objetivo del presente estudio fue investigar la relación entre diabetes mellitus (DM) tipo 2 con los niveles de testosterona libre y si ésta se correlaciona con la HbA1c y IMC. Se analizó las concentraciones séricas de testosterona libre en 10 varones con un índice de masa corporal (IMC) medio de 27,4 kg/m², edad media 46,4 años, provenientes de zonas urbanas, que asisten a la Tercera Cátedra de Clínica Médica y el Programa Nacional de Diabetes. Las concentraciones promedio de testosterona libre fueron menores a los rangos considerados normales: 10,29 mg/dL vs 13-35 mg/dL. El valor promedio de HbA1c fue 6,43%. No se encontró correlación entre el IMC y la testosterona libre. Se deduce en esta serie de casos que los pacientes diabéticos tienen niveles reducidos testosterona libre y que la misma no se correlaciona con la HbA1c ni el IMC.

Decreased testosterone levels are associated with sterility and sexual impotence. The objective of this study was to study the relation between type 2 diabetes mellitus (DM) and levels of free testosterone and also whether this relation is correlated to HbA1c and body mass index (BMI). The free testosterone serum concentrations of 10 men with a medium BMI of 27.4 kg/m², mean age of 46.4 years from urban zones that attended the Third Chair of Medical Clinic and the National Program of Diabetes were analyzed. The mean concentrations of free testosterone were lower than the range considered normal: 10.29 mg/dL vs 13-35 mg/dL. The mean value of HbA1c was 6.43%. A correlation between BMI and free testosterone was not found. It is concluded that these diabetic patients have reduced free testosterone levels and these are not correlated to either HbA1c or BMI.

Diagnostic criteria for late-onset hypogonadism: A preliminary study / 中华男科学杂志

<p><b>Objective</b>To determine the stability of androgen indexes by analyzing the relationship of androgen indexes with the results of late-onset hypogonadism (LOH) questionnaire investigations, and offer some reference for the application of the diagnostic criteria for LOH released by The Chinese Society of Andrology in 2009.</p><p><b>METHODS</b>This study included 1 003 males aged 40 years or older who had accomplished the questionnaires of Androgen Deficiency in Aging Males (ADAM), Aging Males' Symptoms Scale (AMS), and International Index of Erectile Function-5 (IIEF-5). We evaluated the correlation of androgen indexes with the results of the questionnaire investigation, repeated the examination of androgen indexes for the subjects with total testosterone (TT) ≤11.5 nmol/L after an average of 1.5 years, and analyzed the factors inducing changes of androgen indexes.</p><p><b>RESULTS</b>Free testosterone index (FTI) ≤ 0.42 (OR, 1.369) and calculated free testosterone (cFT) ≤ 0.3 nmol/L (OR, 1.302) were considered as the risk factors of LOH in AMS, and so were testosterone secretion index (TSI) ≤ 2.8 nmol/IU (OR, 1.679) and cFT ≤ 0.3 nmol/L (OR, 1.371) in IIEF-5. Paired t-test on the results of the examination performed twice showed significant differences in the levels of TT, TSI, cFT, and FT (P<0.05).</p><p><b>CONCLUSIONS</b>Decreased testosterone may cause the diversity of LOH symptoms and hence the fluctuation of androgens. Therefore, the diagnosis of LOH depends on androgen indexes, varied symptoms in the questionnaires, and relief of the symptoms after testosterone therapy.</p>

Hypogonadism and the quality of life in male patients with type-2 diabetes mellitus / 中华男科学杂志

<p><b>Objective</b>To compare the level of testosterone between type-2 diabetes mellitus (T2DM) patients and healthy controls and to investigate the status of hypogonadism and the influence of hypopgonadism on the quality of life.</p><p><b>METHODS</b>We collected serum total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), and other clinical data from 166 T2DM patients aged over 30 years and 186 age-matched healthy controls. We investigated the quality of life (QoL) of the two groups of subjects using the questionnaires of Androgen Deficiency in Aging Males (ADAM), Aging Male Symptoms (AMS), 36-Item Short-Form Health Survey (SF-36), and Special Quality of Life for Diabetes Mellitus (DSQL).</p><p><b>RESULTS</b>The level of calculated FT (cFT) was remarkably lower in the T2DM patients than in the healthy controls (P<0.05), but no statistically significant differences were observed between the two groups in the levels of TT, bio-available testosterone (Bio-T), and SHBG. The T2DM males with hypogonadism showed significant differences from those without in age, height, systolic blood pressure, and creatinine (P<0.05). Based on the criteria of cFT <0.3 nmol/L and AMS score ≥27, the incidence rate of hypogonadism was 51.81% in the T2DM patients, 31.58% in the 30－39 yr group, 32.50% in the 40－49 yr group, 50% in the 50－59 yr group, 69.23% in the 60－69 yr group, and 77.27% in the ≥70 yr group, elevated by 77.4% with the increase of 10 years of age (OR = 1.774, P<0.001). The AMS score was significantly correlated with the scores of DSQL (r = 0.557, P<0.001) and SF-36 (r = －0.739, P<0.001) in the T2DM patients.</p><p><b>CONCLUSIONS</b>T2DM patients have lower levels of cFT than healthy men, accompanied with a higher incidence of hypogonadism. Age is a main risk factor of hypogonadism. Severer testosterone deficiency symptoms are associated with lower scores of QoL in T2DM males.</p>

Study to evaluate serum free testosterone and hsCRP concentration to predict low hematocrit in type 2 diabetes mellitus.

Background: The primary objective of the study was to assess serum free testosterone and high sensitivity c-reactive protein concentrations and their correlation with hematocrit in patients of diabetes mellitus type 2. Hypogonadotropic hypogonadism is a common defect in type 2 diabetes, irrespective of the glycemic control, duration of disease, and the presence of complications of diabetes or obesity. It has been demonstrated that about one third of male patients with diabetes mellitus type 2 have low serum free Testosterone level. Methods: We have included 50 patients of diabetes mellitus type 2 presenting to the department of medicine SMS Hospital Jaipur. Both indoor and out door patients were selected who were free of microalbuminuria and diabetic nephropathy. Primary or secondary hypogonadism, other than diabetes mellitus and anemia of other causes were ruled out. Results: Diabetes mellitus type 2 patients with low serum free testosterone levels have significantly low hematocrit values ( n= 29) (p-value <0.001) and mild anemia compared to eugonadal men ( n= 21). Their correlation was highly significant. Patients with DM type 2 who have low serum free testosterone, also have high hs-CRP concentration. Though hematocrit values were low in patients with high hs-CRP concentration but it was not statistically significant. Conclusion: At the end of the study we concluded that both a low serum free testosterone level and high hs-CRP concentration may play an important role in the pathogenesis of mild anemia and low hematocrit values in DM type 2 patients.

Niveles de testosterona total y libre en individuos con síndrome metabólico / Levels of total and free testosterone in individuals with metabolic sindrome

EL síndrome metabólico es un conjunto de factores de riesgo de origen metabólico que pueden aparecer de manera simultánea o secuencial en un mismo individuo, el SM es causado por la combinación de factores genéticos y factores asociados al estilo de vida, especialmente la sobrealimentación y la ausencia de actividad física, que promueven a su vez el desarrollo de enfermedades cardiovasculares (ECV) y otras patologías como la diabetes, enfermedad coronaria y cerebro vascular.. Entre los factores indirectos del síndrome metabólico, se ha establecido recientemente los niveles bajos de te stosterona como factor desencadenante en hombres. De allí que se desarrolló la presente investigación con el objeto de relacionar los niveles séricos de testosterona total y libre con el síndrome metabólico y sus criterios, en la población masculina. Para ello se determinaron los parámetros clínicos (presión arterial, circunferencia abdominal) y bioquímicos (glucemia basal, HDL-Colesterol, Triglicéridos ) que evalúan el síndrome metabólico asi como los niveles de Testosterona Total y Ligada . Resultados: los niveles de testosterona total y libre, son inferiores en el grupo de pacientes con síndrome metabólico, sin embargo al determinar la significancia estadística mediante la t de Student, no se aprecia diferencia en los valores promedio de testosterona total (sig 0,08) más si en los valores promedio de testosterona libre (sig 0,000). Ambas (testosterona total y libre) se correlacionan significativamente de manera inversa con la obesidad abdominal. Los niveles de testosterona libre se relacionan inversa y significativamente con la edad.

The Metabolic syndrome is a cluster of risk factors of metabolic origin that may occur simultaneously or sequentially in the same individual, the SM is caused by a combination of genetic factors and factors related to lifestyle, especially overeating and lack physical activity, which in turn promote the development of cardiovascular disease (CVD) and other diseases such as diabetes, heart disease and cerebrovascular .. Indirect factors of metabolic syndrome, was recently established low levels of testosterone as a factor trigger in men. Hence, this research was conducted in order to relate the serum total and free testosterone with metabolic syndrome and its criteria in the male population. For this clinical parameters (blood pressure, abdominal circumference) and biochemical (fasting glucose, HDL-cholesterol, triglycerides) evaluating the metabolic syndrome as well as Total Testosterone levels were determined and Bound. Results: The levels of total and free testosterone are lower in the group of patients with metabolic syndrome, however to determine statistical significance using Student's t, no difference was seen in the average values of total testosterone (sig 0.08 ) more if in the mean values of free testosterone (sig 0.000). Both (total and free testosterone) was significantly inversely correlated with abdominal obesity. Free testosterone levels are associated inversely and significantly with age.

THE LEVEL OF FREE AND BIOAVAILABLE TESTOSTERONE IN MEN AGED ABOVE 40 YEARS OLD / Монголын эм зүй, эм судлал

Introduction: With the average longevity in men and women, sexual health concerns have become more and more important and demands for help are far more common than in the past. The percentage of aging population is increasing also. A metabolic and hormonal change occurs in male during aging.The level of total, free and bioavailable testosterone decline with aging and it leads to decrease in sexual activities, metabolism and also the life quality.The aim of this initial study was the determination of free testosterone and bioavailable testosterone and it was the novelty of our study. Data obtained from our research can be used as basic information for hormone replacement therapy in late onset hypogonadism.Research goal: To study the free testosterone and bioavailable testosterone level in aging malesMaterials and Methods: This study is a part of study: “Androgen status of aging males” which was supported by Asian Research Center, Korean Foundation for Advanced Studies. The study was approved by IRB of MoH and written consent was obtained from all participants.Fasting blood samples were collected in the morning between 8.00-10.00 AM. We used commercial ELISA kits from Magiwel CoLtd (USA) for determining the total testosterone, sex hormone binding globulin levels. Bromcresol green method was used in determination of serum albumin level. Bioavailable and free testosterone were calculated by Alex Vermeulen, Lieve Verdonk and M. Kaufman’s formula, which was recommended by International Society for the Study of Aging Male.We studied 114 healthy males aged above 40 years old, all undergone the General and Urological examination.Result and discussion: The average age was 57.48±10.48 years in our study participants. In group of 40-49 years were 29% (n=33), in 50-59 age group 23% (n=26), in 60-69 age group 27% (n=38) and in age group over 70-s were 15% (n=17).Mean total testosterone was 6.04±1.83 ng/ml, in 40-49 age group it was 6.14±1.65 ng/ml, in 50-59 age group 6.04±2.36 ng/ml, in 60-69 age group 6.05±1.80 ng/ml, and over 70’s it was 5.85±1.43 ng/ml.Mean sex hormone binding globulin was 50.22±29.97 nmol/l, in 40-49 age group 37.60±23.03 nmol/l, in 50-59 age group 47.08±29.61 nmol/l, in 60-69 age group 57.24±33.91 nmol/l, and over 70’s it was 59.22±25.38 nmol/l.Mean albumin was 40.86±6.89 g/l, in 40-49 age group 44.55±5.93 g/l, in 50-59 age group 41.85±6.93 g/l, in 60-69 age group 38.92±6.85 g/l, and over 70’s was 36.55±4.77 g/l.Mean free testosterone was 0.112±0.064 ng/ml, in 40- 49 age group 0.124±0.058 ng/ml, in 50-59 age group0.114±0.077 ng/ml, in 60-69 age group 0.107±0.072 ng/ml, and over 70’s it was 0.097±0.044 ng/ml.Mean bioavailable testosterone was 2.53±1.48 ng/ ml, in 40-49 age group 2.76±1.37 ng/ml, in 50-59 age group 2.60±1.70 ng/ml, in 60-69 age group 2.51±1.56 ng/ml, and over 70’s it was 2.04±1.05 ng/ml.Conclusion:1. In our participants aged above 40 years old, the average mean of free testosterone was 0.112±0.066 ng/ml, free testosterone index was 16.95±11.82. Free testosterone had inverse correlation with aging (r=-0.168, p=0.03) and had peer decline among aging groups.2. The average mean of bioavailable testosterone was 2.53±1.48 ng/ml, and had age related inverse correlation (r=-0.169, p=0.037), which decline was deeper in men aged over 70 years.Key words:Aging, total, free, bioavailable testosterone,free testosterone index

Free testosterone and age correlation in mongolian aging males / Монголын Анагаах Ухаан

Materials and Methods: We studied 114 healthy males aged above 40 years old, who undergone urologists examination and General practitioner. All men answered the Aging Males’ Symptom Scale questionnaire. This is part of the ongoing study Mongolian males Andrological Status sponsored by Asian Research center, Korean Foundation for Advenced Studies. Formal concent permission was obtained from all participants, which approved by Ethical Committee of MoH. We took 4 ml blood from vien between 8-11am and determined testosterone, SHBG by ELISA and albumin by liquicolor reagent. Bioavailable testosterone was calculated, using previously described mathematical modeling, suggested by ISSAM.Result: The average free testosterone level was 0.112±0.06 ng/ml, in 40-49 age group 0.124±0.05 ng/ml, in 50-59 age group 0.114±0.07 ng/ml, in 60-69 age group 0.107±0.07 ng/ml, and over 70’s it was 0.097±0.04 ng/ml. If consider the free testosterone 100%, in 40-49 age than it is decreasing 91.6% in 50-59, 83.3% in 60-69 ages and 75% decreased in over 70s. Respectively, it decreases approximately by 0.8% every year after 40’s.Conclusion: The free testosterone level was 0.11±0.06 ng/ml in aging males and has reverse correlation with aging (r=-0.168, p= 0.03).

Bioavailable testosterone and age correlation in aging males / Монголын Анагаах Ухаан

Introduction: With the increasing longevity in men and women, sexual health concerns have become more and more important and demands for help are far more common than in the past. The percentage of aging population is increasing also. The of this study in aging men. Late onset hypogonadism will need the testosterone replacement therapy and we hope that our study result will help to get basic information of testosterone among over 40 yearsold Mongolian men.Goal: To determine the bioavailable testosterone (BT) of aging males and correlate with aging process.Materials and Methods: This study is a part of ongoing study: “Androgen status of aging males” which was supported by Asian Research Center, Korean Foundation for Advanced Studies. We studied 114 healthy males aged above 40 years old, all undergone the General and Urological examination. Bioavailable testosterone was determined by formula suggested by ISSAM.Result: The average bioavailable testosterone level was 2.53±1.48 ng/ml, in 40-49 age group 2.76±1.37 ng/ml, in 50-59 age group 2.60±1.70 ng/ml, in 60-69 age group 2.51±1.56 ng/ml, and over 70’s it was 2.04±1.05 ng/ml. If consider the bioavailable testosterone 100%, in 40-49 age than it is decreasing 94.2% in 50-59, 90.9% in 60-69 ages and 73.9% decreased in over 70s. Respectively, it decreases approximately by 0.9% every year after 40’s.Conclusion: The bioavailable testosterone level was 2.53±1.48ng/ml in aging males and has reverse correlation with aging (r=-0.169, p=0.037).

Androgen deficiency in elderly men with systolic chronic heart failure / 老年心脏病学杂志（英文版）

Objective Several previous studies have shown androgens deficiency in men with CHF, and 2 studies on the prognostic significance of serum levels of androgens in CHF patients have yielded conflicting results. The aim of this study was to examine the relationship between serum concentration of testosterone and mortality in men with systolic CHF. Methods A total of 175 elderly (age≥60 years) men with CHF were recruited. Total testosterone (TT) and sex hormone binding globulin (SHBG) were measured, and free serum testosterone (eFT) was calculated. The median follow-up time was 1262 days. Results During follow-up 54 (30.9%) patients died. TT and eFT deficiency was found in 21.7% (38/175) and 27.4% (48/175) patients, respectively. Both TT and eFT were inversely associated with LVEF and NT-proBNP (all P<0.01). Kaplan-Meier curves for patients in low, medium and high tertiles according to TT and eFT level showed significantly different cumulative survival rate (both P<0.01 by log-rank test). However, after adjustment for clinical variables, there were no significant associations between either TT or eFT levels or survival time (OR=0.97, 95% CI, 0.84-1.12, P=0.28; and OR=0.92, 95% CI, 0.82-1.06, P=0.14, respectively). Conclusion Our study showed that although levels of TT and eFT are commonly decreased in elderly patients with systolic CHF and related to disease severity, they are not independent predictors for mortality.

Total estradiol, rather than testosterone levels, predicts osteoporosis in aging men / Estradiol prediz melhor osteoporose que testosterona total em homens idosos

OBJECTIVE: To study and establish sex hormone cutoff levels for osteoporosis risk in men over 50 years old. METHODS: Case-control study of 216 men > 50 years, 110 with osteoporosis (O) and 106 with normal bone density (C). We measured estradiol (E2), sex hormone binding globulin (SHBG), total testosterone (TT) and albumin. Free testosterone (FT) and bioavailable testosterone (BT) were calculated through Vermeulen's formula. RESULTS: There was no difference in TT between groups. Relative risks of osteoporosis were 1.89 for E2 < 37 pg/mL (p = 0.02); 1.91 for SHBG > 55 nmol/L (p = 0.019); 2.5 for FT < 7 ng/dL (p = 0.015); 2.7 for BT < 180 ng/dL (p = 0.0003). CONCLUSIONS: In men over 50 years old, TT was not indicative of osteoporosis risk while E2 < 37 ng/mL was. SHBG > 55 nmol/L, FT < 7 ng/dL and BT < 180 ng/dL can represent additional indications for osteoporosis screening in men over 50 years old.

OBJETIVO: Estudar e estabelecer pontos de corte dos hormônios sexuais para risco de osteoporose em homens após os 50 anos de idade. MÉTODOS: Estudo caso-controle de 216 homens > 50 anos, 110 com osteoporose e 106 com densidade óssea normal. Foram dosados: estradiol (E2), globulina ligadora de hormônios sexuais (SHBG), testosterona total (TT) e albumina. Foram calculadas: testosterona livre (TLC) e testosterona biodisponível (TB) pela fórmula de Vermeulen. RESULTADOS: Não houve diferença na TT entre os grupos. Os riscos relativos de osteoporose foram de 1,89 para E2 < 37 pg/mL (p = 0,02); 1,91 para SHBG > 55 nmol/L (p = 0,019); 2,5 para TLC < 7 ng/dL (p = 0,015) e 2,7 para TB < 180 ng/dL (p = 0,0003). CONCLUSÕES: Em homens acima de 50 anos, TT não indicou risco de osteoporose, mas E2 < 37 pg/mL sim. SHBG > 55 nmol/L, TLC < 7 ng/dL e TB < 180 ng/dL podem representar indicações adicionais para pesquisa de osteoporose em homens acima de 50 anos.

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.

Niveles elevados de andrógenos plasmáticos en mujeres con hipertensión asociada al embarazo / High androgen plasmatic levels in women affected with pregnancy-induced hypertension

Objective. To compare the plasmatic levels of free testosterone (FT), total testosterone (TT), and dehydroepiandrosterone sulphate (DHEAs) obtained from women with pregnancy-induced hypertension (PIH) and from uncomplicated pregnant women in the third trimester of pregnancy. Methods. FT, TT and DHEAs were measured by radioimmunoassay in plasma samples from 30 women with PIH (PIH group) defined as mean blood pressure > 105 mm Hg, and proteinuria > 100 mg/dL and < 300 mg/dL, and in 30 women with uncomplicated pregnancies (control group). Gestational age at the time of the study in the PIH group was 37 weeks +2 days (28+0 - 40+1), and in the control group, 37 weeks +1 day (28+0 - 41+6). The plasmatic androgen levels and the perinatal outcome were analysed in both groups. Results. There was no difference in the gestational age at birth. In the PIH group there were increased number of caesarean sections due to fetal distress (PIH group; n = 10, control group; n = 2; p = 0.05), lower birthweight (PIH group 2549 g [800-3400 g], control group 3242 g [2400-4200 g]; p = 0.02) and increased number of neonatal intensive unit care admissions (PIH group; n = 3, control group; n = 0). In the PIH group, FT and TT levels were significantly higher than controls (mean, SD) (FT PIH group, 5.94 (0.9) pg/mL; FT control group, 0.44 (0.2) pg/mL; p = 0.002. TT PIH group, 5.28 (2.4) nmol/L; TT control group, 3.6 (0.6) nmol/L; p = 0.02. There was no difference in DHEAs levels between the groups (mean, SD) (PIH group, 51.13 (23.7) µg/dL; control group, 70.0 (13.5) /igldL). Conclusions. In women complicated with PIH there is an increment in the plasmatic levels of FT and TT. This might contribute to the clinical findings and the adverse perinatal outcome observed in this patients.

Objetivo. Comparar los valores plasmáticos de testosterona libre (TL), testosterona total (TT) y sulfato de dehidroepiandrosterona (DHEAs) entre mujeres con hipertensión asociada al embarazo (HAE) y mujeres con embarazos normales en el tercer trimestre de la gestación. Mátodos. Se midieron TL, TT y DHEAs en el plasma de 30 mujeres con diagnóstico de HAE (grupo HAE), definida como tensión arterial media > 105 mm Hg y proteínas en orina >100 mg/dL y < 300 mg/ dL, y en 30 mujeres embarazadas sin HAE (grupo control) y los valores obtenidos se compararon entre ambos grupos. La edad gestacional de las pacientes del grupo control fue lo más similar posible a las pacientes del grupo con HAE. Resultados. TL y TT resultaron significativamente más altas en el grupo con HAE (media, DS). TL grupo HAE 5.94 (0.9) pg/mL; TL grupo control 0.44 (0.2) pg/mL; p = 0.002. TT grupo HAE 5.28 (2.4) nmol/L; TT grupo control 3.6 (0.6) nmol/L; p = 0.02. No hubo diferencias significativas en los valores de DHEAs (media, DS) grupo HAE 51.13 (23.7) µg/dL; grupo control 70.0 (13.5) µg/dL. La edad gestacional al momento del estudio en el grupo HAE fue de 37 semanas + 2 días (28 + 0 -40+1) y en el grupo control de 37 semanas +1 día (28+0 - 41+6). No hubo diferencia en la edad gestacional al nacimiento. El grupo con HAE presentó un mayor número de cesáreas por indicación fetal (grupo HAE n = 10; grupo control n = 2; p = 0.05), menor peso al nacimiento (grupo HAE 2549 g [800-3400 g]; grupo control 3242 g [2400-4200 g]; p = 0.02) y mayor número de ingresos a la unidad de cuidados intensivos neonatales (grupo HAE n = 3; grupo control n = 0). Conclusiones. En embarazadas con HAE, TL y TT están elevadas, pudiendo contribuir en las manifestaciones clínicas y en el peor resultado perinatal que tienen estas pacientes.

The Relationship between Sex Hormones and Bone Turnover Markers in Adult Men

BACKGROUND: Bone mass changes in men is related to age, BMI, sex hormones and other factors. In prior studies, bone markers were negatively correlated with bone mineral density, free testosterone, and estrogen and was positively correlated with SHBG. In a study of sex hormones and bone markers in Korean men estradiol was negatively correlated with deoxypyridinoline. In this study, the relationship of testosterone, estradiol, calculated free testosterone, FEI and SHBG to bone turnover markers in adult men were investigated. METHODS: This was a cross-sectional study of 184 men who had undertaken a health screening program in one general hospital in Bundang from November, 2001 to February, 2003. We surveyed information concerning the past medical history, current medication, alcohol consumption amount per week and smoking amount by means of self questionnaire records. Serum total testosterone, estradiol, SHBG and osteocalcin, alkaline phosphatase were measured at a fasting state. Urine was tested for deoxypyridinoline. Free testosterone was calculated using albumin, SHBG, and total testosterone level. RESULTS: Deoxypyridinoline adjusted by age, BMI was negatively correlated with FEI (r=-0.17, P=0.020) and was positively correlated with smoking amount (r=0.20 P= 0.007). Osteocalcin was negatively correlated with calculated free testosterone and ethanol consumption amount (r=-0.186, P=.0.12, r=-0.186, P=0.012). Multiple regression analysis showed that the most powerful factor influencing deoxypyridinoline was smoking amount (R2= 0.046), followed by FEI, BMI, and the one influencing osteocalcin was BMI (R2=0.050), ethanol amount and calculated free testosterone. After adjusting for age, BMI, drinking amount and smoking amount FEI shown to be a predictor of deoxypyridinoline (beta=-0.08, p<0.01, R2=0.101). After adjusting for age, BMI, and drinking amount calculated free testosterone was shown to be a predictor of osteocalcin (beta=-0.570, P<0.01, R2=0.130) in multiple regression model. CONCLUSIONS: In adult men, FEI shown to be a predictor of deoxypyridinoline and calculated free testosterone to be a predictor of osteocalcin as an independent variable.

Correlation between Calculated Bioavailable Testosterone and Free Testosterone by Direct Immunoassay / 대한남성과학회지

PURPOSE: We investigated whether free testosterone measured by direct immunoassay(aFT) reflects aging as well as bioavailable testosterone(free testosterone index; cBT) calculated from serum testosterone(T) and sex hormone-binding globulin(SHBG). MATERIALS AND METHODS: Serum T, SHBG, and aFT were measured in sera of 414 patients who presented with erectile dysfunction and partial androgen deficiency symptoms but no serious medical comorbidities. Their mean age was 52.5 years(or=50: 262). The cBT was obtained by calculation from T and SHBG. The mean values of T, aFT, SHBG, and cBT were compared according to the age range. We analyzed the correlation between cBT and aFT and calculated the correlation coefficient. RESULTS: The mean values of T(ng/mL), aFT(pg/mL), SHBG(nmol/L), and cBT(nmol/L) were 3.39, 13.08, 24.3, and 6.04, respectively, in the 3rd and 4th decades; 4.34, 14.72, 23.36, and 7.74 in the 5th and 6th decades; and 4.05, 13.83, 27.32, and 5.96 in the 7th and 8th decades. The SHBG increased and T/aFT/cBT declined as age increased from the 5th and 6th to the 7th and 8th decades. The change was statistically insignificant only for aFT. The correlation between cBT and aFT was weak, with a correlation coefficient of 0.391. CONCLUSIONS: Because free testosterone measured by direct immunoassay did not reflect the age-related changes of SHBG, a single measurement is not a reliable index of bioavailable testosterone.

The study of serum testosterone concentration in different aged men / 中华老年医学杂志

Objective To study the relationship of total serum testosterone and free testosterone with the age of men. Methods A total of 136 heathy men were classified into six groups. Enzyme immunoassay was applied to measure the serum level of testosterone and free testosterone, and then the relationship between the androgen change and the age was analyzed. Results The level of testosterone of 20-, 30-, 40-, 50-, 60- and 70-78 age group were (6.208?2.275),(4.960?1.719),(5.910?3.054),(4.964?1.531) ,(3.967?2.514) and (4.146?2.497) mg/L respectively.Free testosterone concertrations were:(23.300?9.530),(22.060?12.627),(16.290?6.858),(14.782?6.851) ,(14.005?8.724) and (12.256?7.462) ng/L respectively. The level of blood testosterone decreased in 60-year age groups and the difference between 20-, 30-year old group and 60-year old group was significant (P

The Relationship among Testosterone, IGF- 1 and Fat Mass

BACGROUND: The age-related increase in fat mass seems related to decrease in hormone level. Few studies have been done in Korea concerning the association between testosterone, GH (growth hormone) and fat mass. This study was undertaken to evaluate the relationship among testosterone, IGF-1 and fat mass. METHODS: The study was performed from February to October 2001 in the Health Screening Center of Pundang CHA Hospital with 243 men as subjects. Fat intake was measured through interview with diet therapist and other data were obtained by self-questionnaire. Fat mass was measured using Inbody 3.0 and the level of total testosterone, SHBG and IGF-1 in serum were measured. RESULTS: Smoking was negatively correlated with fat mass and WHR (waist to hip ratio) (P <0.05) and fat intake was positively correlated with fat mass (P <0.05). Fat mass was negatively correlated with total testosterone, calculated free testosterone, and SHBG (gamma = 0.26; P <0.01, gamma = 0.15; P <0.05, gamma = 0.31; P <0.01). WHR was positively correlated with age (gamma =0.26; P <0.01) and negatively correlated with total testosterone, calculated free testosterone, and IGF-1 (gamma = 0.24; P <0.01, gamma = 0.20; P <0.01, gamma = 0.16; P <0.05). After adjustment for age, body mass index, smoking, and fat intake, the calculated free testosterone and IGF-1 were independently negatively correlated with fat mass (beta = 0.072; P <0.01, beta = 0.0035; P <0.05) and WHR (beta = 6.9E-04; P <0.05, beta = 4.0E-05; P <0.05) but, total testosterone and SHBG were not independently correlated with fat mass and WHR. CONCLUSION: The results indicate that the calculated free testosterone and IGF-1 can be independent determinants of fat mass and WHR in middle-aged men.