Experimental pain thresholds and psychosocial features across menstrual cycle in myofascial orofacial pain compared to healthy individuals: cross-sectional study / Limiares de dor experimental e características psicossociais ao longo do ciclo menstrual na dor miofascial orofacial em comparação com indivíduos saudáveis: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: The hormonal impact on pain perception during the menstrual cycle is a major focus of study, and further elucidation in temporomandibular disorders (TMD) field is necessary. Thus, this cross-sectional study evaluated experimental pain thresholds, psychosocial features, and clinical pain report on TMD women across menstrual cycle versus healthy controls. METHODS: A total of 220 women's clinical files were screened, with 80 selected and divided into control group (healthy individuals, n=40) and TMD group (myofascial pain, n=40). Regarding the menstrual cycle phases, the files were divided into Pre-Luteal and Luteal. The Perceived Stress Scale (PSS), Pain Catastrophizing Scale (PCS), Mechanical Pain Threshold (MPT), Wind-up (WUR), Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Visual Analogue Scale (VAS) were analyzed at a 5% significance level, by Two-Way ANOVA test and post hoc Tukey test. RESULTS: PSS and PCS were significantly different between TMD and control group (p<0.001), regardless of menstrual cycle. Healthy individuals in the Luteal phase presented higher MPT values compared to the other phases (p<0.001). PPT showed significant difference across menstrual phases (p=0.022), but no differences in multiple comparisons. VAS values showed no difference between menstrual cycle phases (p=0.376). CONCLUSION: Finally, healthy individuals in the Luteal phase have higher MPT and PPT values on the orofacial region. Pain report in patients with TMD showed no difference throughout the menstrual cycle, showing that small alterations on experimental pain thresholds may not be clinically relevant. The presence of chronic pain seems to be more related to psychosocial features than hormonal fluctuations.

RESUMO JUSTIFICATIVA E OBJETIVOS: O impacto do ciclo menstrual na percepção da dor é um foco importante de estudo, sendo necessária uma maior elucidação na disfunção temporomandibular (DTM). Assim, este estudo transversal avaliou limiares de dor experimental, características psicossociais e relatos de dor em mulheres com DTM ao longo do ciclo menstrual, comparadas com controles saudáveis. MÉTODOS: 220 prontuários de mulheres foram analisados, sendo 80 selecionados para os grupos de controle (saudáveis, n=40) e DTM (dor miofascial, n=40). Nas fases do ciclo menstrual, as pacientes foram divididas nas categorias Pré-Luteal e Luteal. Os instrumentos Escala de Estresse Percebido (PSS), Escala de Pensamentos Catastróficos (PCS), Limiar de Dor Mecânica (MPT), Wind-up Ratio (WUR), Limiar de Dor à Pressão (PPT), Modulação Condicionada da Dor (CPM) e Escala analógica visual (EAV) foram analisados com nível de significância de 5%, pelos testes ANOVA de dois fatores e Tukey post hoc. RESULTADOS: As escalas PSS e PCS foram significativamente diferentes entre os grupos DTM e controle (p<0,001), independentemente do ciclo menstrual. Indivíduos saudáveis na fase luteal apresentaram MPT maior em comparação com outras fases (p,0,001). O PPT mostrou diferença significativa entre as fases menstruais (p=0,022), sem diferença nas comparações múltiplas. Os valores da EAV não apresentaram diferença entre as fases menstruais (p=376). CONCLUSÃO: Indivíduos saudáveis na fase luteal têm MPT e PPTl maior na região orofacial. Os relatos de dor em pacientes com DTM não mostraram diferença ao longo do ciclo menstrual, indicando que pequenas alterações nos limiares experimentais podem ser clinicamente relevantes. A presença de dor crônica parece estar mais relacionada com características psicossociais do que com flutuações hormonais.

Effects of medroxyprogesterone acetate combined with a levonorgestrel-releasing intrauterine contraceptive system on sex hormone and vascular endothelial growth factor levels after laparoscopic surgery for moderate and severe endometriosis / 中国基层医药

Objective:To investigate the effects of medroxyprogesterone acetate combined with a levonorgestrel-releasing intrauterine contraceptive system (Mirena) on the levels of sex hormone and vascular endothelial growth factor in patients with moderate and severe endometriosis after laparoscopic surgery.Methods:A total of 102 patients with endometriosis who received laparoscopic conservative surgery in Hangzhou Ninth People's Hospital from October 2015 to May 2018 were retrospectively analyzed. They were randomly assigned to undergo either medroxyprogesterone acetate treatment alone (control group, n = 51) or medroxyprogesterone acetate treatment + levonorgestrel-releasing intrauterine contraceptive system application (observation group, n = 51) for 6 successive months. Clinical efficacy, serum luteinizing hormone, follicle-stimulating hormone, estradiol and vascular endothelial growth factor levels, Visual Analogue Scale score, endometriosis recurrence rate, and adverse reactions were compared between the control and observation groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [94.12% (48/51) vs. 80.93% (41/51), χ2 = 4.320, P < 0.05]. At 6 months after surgery, serum luteinizing hormone, follicle-stimulating hormone, estradiol and vascular endothelial growth factor levels in the observation group were (5.72 ± 0.53) U/L, (5.05 ± 0.91) U/L, (156.02 ± 21.80) pmol/L and (155.39 ± 24.72) ng/L respectively, which were significantly lower than those in the control group [(6.51 ± 0.67) U/L, (5.73 ± 0.68) U/L, (177.20 ± 23.20) pmol/L and (186.22 ± 28.14) ng/L, t = 6.604, 4.275, 4.747 and 5.878, all P < 0.05). At 3 and 6 months after surgery, Visual Analogue Scale score in the observation group were (2.39 ± 0.33) points and (1.27 ± 0.20) points respectively, which were significantly lower than those in the control group [(2.72 ± 0.40) points, (1.52 ± 0.25) points, t = 4.545 and 5.577, both P < 0.05]. Two-year follow-up results revealed that endometriosis recurrence in the observation group was significantly lower than that in the control group [1.96% (1/51) vs. 13.73% (7/51), χ2 = 4.883, P < 0.05]. There was no significant difference in total incidence of adverse reactions between the two groups [15.69% (8/51) vs. 13.73% (7/51), χ2 = 0.078, P > 0.05]. Conclusion:Application of medroxyprogesterone acetate combined with a levonorgestrel-releasing intrauterine contraceptive system after laparoscopic surgery for moderate and severe endometriosis can effectively regulate serum levels of sex hormone and vascular endothelial growth factor, decrease endometriosis recurrence rate and is highly safe. This method is worthy of clinical promotion.

Influence of metformin on glycolipid metabolism in patients with polyeystic ovarian syndrome / 中国医师杂志

Objective To investigate the influence of metformin on glycolipid metabolism and sex hormone in patients with polycystic ovarian syndrome (PCOS).Methods 98 patients with PCOS were randomly divided into two groups,with 49 cases in each group.The control group were treated with clomifene,while the observation group were treated with clomifene combined metformin.The endometrial thickness and ovarian volume were observed in two groups before and after treatment.The changes of glycolipid metabolism and sex hormone indexes in two groups were analyzed before and after treatment.Results The endometrial thickness of observation group was significantly better than control group after treatment,while the sex hormone levels,ovarian volume and antral follicle count (AFC) were lower than control group (P ＜ 0.05).The glycolipid metabolism indexes of total cholesterol (TC),triacylglycerol (TG),fasting blood glucose (FBG),fasting insulin (FIN) and homeostasis model assessment-insulin resistance (HOMA-IR) in observation group were significantly better than control group after treatment (P ＜ 0.05).The rate of ovulation and pregnancy in observation group was significantly higher than control group after treatment (P ＜ 0.05).Conclusions Clomifene combined metformin can significantly improve glycolipid metabolism and sex hormone of patients with PCOS.It is helpful in promoting ovulation and improving clinical pregnancy rate.

Influence of metformin on glycolipid metabolism in patients with polycystic ovarian syndrome / 中国医师杂志

Objective@#To investigate the influence of metformin on glycolipid metabolism and sex hormone in patients with polycystic ovarian syndrome (PCOS).@*Methods@#98 patients with PCOS were randomly divided into two groups, with 49 cases in each group. The control group were treated with clomifene, while the observation group were treated with clomifene combined metformin. The endometrial thickness and ovarian volume were observed in two groups before and after treatment. The changes of glycolipid metabolism and sex hormone indexes in two groups were analyzed before and after treatment.@*Results@#The endometrial thickness of observation group was significantly better than control group after treatment, while the sex hormone levels, ovarian volume and antral follicle count (AFC) were lower than control group (P<0.05). The glycolipid metabolism indexes of total cholesterol (TC), triacylglycerol (TG), fasting blood glucose (FBG), fasting insulin (FIN) and homeostasis model assessment-insulin resistance (HOMA-IR) in observation group were significantly better than control group after treatment (P<0.05). The rate of ovulation and pregnancy in observation group was significantly higher than control group after treatment (P<0.05).@*Conclusions@#Clomifene combined metformin can significantly improve glycolipid metabolism and sex hormone of patients with PCOS. It is helpful in promoting ovulation and improving clinical pregnancy rate.

Rendimiento cognitivo en mujeres con síndrome de ovario poliquístico: un estudio piloto / Cognitive Performance in Women with Polycystic Ovarian Syndrome: A Pilot Study

Resumen El Síndrome de ovario poliquístico (SOP) es la enfermedad endocrina-metabólica más frecuente en las mujeres en edad reproductiva. A pesar de su alta prevalencia, hay pocas investigaciones que analizan los efectos de los cambios hormonales sobre la cognición de pacientes con SOP. Objetivo: comparar el rendimiento en habilidades cognitivas y los niveles de hormonas sexuales de un grupo de pacientes con SOP y con las de un grupo control. Método: Participaron 20 mujeres mayores de 21 años, sin tratamiento hormonal, dividas en dos grupos, el primero compuesto por 10 pacientes diagnosticadas con SOP según los criterios de Rotterdam (GSOP) y el otro, de control, compuesto por 10 mujeres sin diagnóstico de SOP (GCT). Se aplicaron las pruebas WAIS III y fluidez verbal semántica y fonológica de la batería NEUROPSI Atención y memoria, y se realizaron análisis sanguíneos de hormonas sexuales. Resultados: Las pacientes del GSOP obtuvieron puntajes inferiores a las del GCT en el CI Verbal (p=0.009), CI Total (p=0.029), índice de comprensión verbal (p=0.005), índice de memoria de trabajo (p=0.023) y en la prueba de fluidez verbal semántica (p=0.029). No se encontraron diferencias significativas en los niveles hormonales. Conclusión: el GSOP presentó menor rendimiento que el GCT en pruebas de tipo verbal, aunque no se presentó déficit en su ejecución. Se sugiere estudiar la relación de la insulinorresistencia con la cognición en pacientes con SOP.

Abstract Polycystic ovarian syndrome (PCOS) is the most common endocrine-metabolic disease in women of reproductive age. Despite its high prevalence, little research analyzes the effects of hormonal changes on cognition in patients with PCOS. Objective: To compare the performance in cognitive abilities and sexual hormone levels of a group of patients with PCOS and those of a control group. Method: Twenty women older than 21 years, without hormone treatment, divided in two groups, the first consisting by 10 patients diagnosed with PCOS according to the Rotterdam criteria (GSOP), and the other composed of 10 women without diagnosis of PCOS (GCT). WAIS III and semantic and phonological verbal fluency tests of the NEUROPSI attention and memory test battery were applied, and blood analyzes of sexual hormones were analyzed. Results: The GSOP patients obtained lower scores than the GCT in Verbal IQ (p=0.009), full scale IQ (p=0.029), verbal comprehension index (p=0.005), working memory index (p=0.023) and semantic verbal fluency test (p=0.029). No significant differences were found in sexual hormone levels. Conclusion: the GSOP showed lower performance than the GCT in verbal tests, although there was not deficit in its execution. It is suggested to study the relationship of insulin resistance with cognition in patients with GSOP.

Warm needle moxibustion, mild moxibustion and electroacupuncture interventions have an anti-aging effect possibly by regulating hypothalamus-pituitary-testis axis in aged male rats / 针刺研究

OBJECTIVE: To observe the effect of warm needle moxibustion (WNM), mild moxibustion and electroacupuncture (EA) of "Shenshu" (BL23) and "Guanyuan" (CV4) on serum gonadal hormone levels and related gene expression in the hypothalamus and testis in aged rats, so as to explore their underlying mechanisms in anti-aging. METHODS: Forty male SD male rats were randomly divided into aged control, WNM, mild moxibustion, EA and medication groups (n ＝ 8 in each group), and other 8 male young adult SD rats were used as the youth control group. WNM (acupuncture plus moxibustion), mild moxibustion or EA (2 Hz /100 Hz, 1 mA) was separately applied to CV4 and bilateral BL23 for 15 min, once daily, 5 days a week for 8 weeks. Rats of the medication group received subcutaneous injection of testosterone propionate injection (7 mg/kg), once every 3 days, and those of the aged and youth groups received the same dose of 0.9% NaCl solution for 8 weeks. The levels of serum testoste-rone (T) and gonadotropin-releasing hormone (GnRH) were measured by ELISA. The expression of Kisspeptin (KISS-1), G protein-coupled receptors 54 (GPR54), RFamide-related peptide-3 (RFRP-3) and GPR147 mRNAs in the hypothalamus and GnRH-R, GPR54 and GPR147 mRNAs in the testis tissues were detected by quantitative real-time PCR. RESULTS: The levels of serum T and GnRH, and the expressions of KISS-1, GPR54, RFRP-3 and GPR147 mRNAs in the hypothalamus and GnRH-R and GPR54 mRNAs in the testis in the aged rats were significantly lower than those in the youth rats (P0.05)．. CONCLUSION: The WNM, mild moxibustion and EA therapies have an anti-aging effect by increasing serum T and GnRH levels in aged rats, which is possibly related to their effects in up-regulating the expression of hypothalamic KISS-1, GPR54, RFRP-3 and GPR147 mRNAs and testicle GnRH-R and GPR54 mRNAs, as well as down-regulating testicle GPR147 mRNA expression. The therapeutic effect of WNM, mild moxibustion and EA is evidently superior to that of medication.

Consideraciones clínicas y endocrinológicas en mujeres con trastorno bipolar / Clinical and endocrine considerations in bipolar women

El trastorno bipolar es una de las enfermedades mentales más discapacitantes. Existen diferencias en cuanto al tipo de episodios más frecuentes, la polaridad predominante y la frecuencia de comorbilidad según el sexo. En la mujer es importante considerar la etapa de vida reproductiva en que se encuentra, pues se sabe que puede influir en el curso de la enfermedad. Se ha informado una elevada comorbilidad del trastorno bipolar con trastorno disfórico premenstrual y una exacerbación de los síntomas en el período premenstrual en el 44% al 65%, que puede conducir a un peor curso de la enfermedad. El embarazo no parece incrementar la presencia de episodios de la enfermedad; sin embargo, el tratamiento se complica de forma importante, mientras que la suspensión de la medicación puede llevar a recaídas, el mantenerlo puede llevar a resultados obstétricos negativos, malformaciones congénitas e incluso alteraciones del neurodesarrollo. De tal manera que la evaluación de riesgo-beneficio en estas pacientes tiene que ser muy cautelosa. En el posparto, claramente se relaciona con un incremento en el riesgo de presentar algún episodio afectivo. Al llegar a la transición a la menopausia parecieran incrementarse los episodios de tipo depresivo. La relación entre el ciclo reproductivo y la presencia de episodios de enfermedad, así como los estudios en otras entidades psiquiátricas, han llevado a considerar que una relación entre las hormonas gonadales y los neurotransmisores podrían subyacer a esta entidad. En el presente artículo describimos algunas de las observaciones relacionadas con estrógenos, progesterona y sus metabolitos, testosterona y deshidroepiandrosterona

Bipolar disorder is one of the most disabling psychiatric illnesses. Some characteristics of the disorder vary with sex, such as predominant polarity, frequency and type of comorbidity, and type of episodes presented. In the case of bipolar women, it is important to consider reproductive events, due to their influence in the course of the disorder. High comorbidity of bipolar disorder and premenstrual dysphoric disorder with an exacerbation of symptoms in the premenstrual period has been reported in 44% to 65% which may lead to a worse disease course. In general, women with premenstrual symptom exacerbation show more affective - particularly depressive - episodes, more frequent relapses, and more severe symptomatology. Pregnancy does not appear to increase presence of bipolar episodes, but significantly complicates treatment. On the one hand, stopping the treatment, particularly abruptly, increases the risk of relapse; while on the other, the use of mood stabilizers represents a risk for the newborn. Poor neonatal outcomes, congenital malformations and neurodevelopment alterations in children of mothers exposed to mood stabilizers during pregnancy have been reported. So, a meticulous benefit-risk assessment should be carried out in pregnant bipolar women. In the postpartum period, a clearer relation with increased risk of affective episode has been observed; while the perimenopause increases depressive episodes. The inter-relation between reproductive cycle and bipolar episodes suggests that gonadal hormones are involved in their physio-pathology. Here we discuss some of the observations related to testosterone, dehydroepiandrosterone, estrogens, and progesterone

Effects of Taohechengqitang joint danazol on CA125 and gonadal hormone in endometriosis / 中国生化药物杂志

Objective To observe the effects of Taohechengqitang combined with danazol on CA125 and gonadal hormone in the treatment of patients with endometriosis.Methods 77 cases from July 2014 to January 2015 in department of obstetrics and gynecology of Daqing Longnan hospital were selected and divided into observation group of 40 cases and control group of 37 cases according to double-blind randomized.The observation group were treated with Taohechengqitang joint danazol treatment, and the control group were treated with danazol alone.The estradiol ( E2 ) , progestogen (P), cancer antigen 125 (CA125), thromboxane B2 (TXB2), endometrial cysts size and dysmenorrheal score pre-and post-treatment between two groups were compared.Results The contents of E2 and P post-treatment in observation group were lower than those in control group (P<0.05).The serum TXB2 and CA125 levels post-treatment in observation group were lower than those in control group (P<0.05).The endometrial cysts size and dysmenorrheal score post-treatment in observation group were lower than those in control group (P<0.05).The total efficacy in observation group was higher than that in control group (P<0.05).Conclusion Taohechengqitang combined with Danazol could reduce the CA125, E2 and P levels, relieve symptoms of dysmenorrhea and reduce the cyst volume, whose efficacy is exact.

Influência da idade, sexo e dos hormônios gonadais na percepção dolorosa em modelo de dor neuropática em ratos / Influence of age, sex and gonadal hormones on pain perception in neuropathic pain model in rats

Os fatores idade e sexo modificam a experiência dolorosa em animais e seres humanos. Os efeitos dos hormônios gonadais têm sido estudados em diversos modelos experimentais de dor, no entanto, o efeito do envelhecimento na percepção à dor carece de mais investigação. O efeito do envelhecimento na dor neuropática ainda não está bem estabelecido. Neste estudo se procurou avaliar possíveis variações na percepção da dor da hiperalgesia mecânica, em função da idade, presença e ausência de hormônios gonadais e sexo em ratos Wistar machos e fêmeas, jovens e idosos no modelo de dor neuropática, ligadura da quinta raiz lombar. Os animais foram divididos nos seguintes grupos: ratos jovens orquiectomizados e não-orquiectomizados, ratos idosos orquiectomizados e não-orquiectomizados, ratas jovens ooforectomizadas com ou sem reposição de 17beta-estradiol e ratas idosas. Foi testado o limiar de retirada da pata após estímulo mecânico antes da ligadura e no 7º, 14º, 21º e 28o dias após a ligadura. Os resultados mostraram que todos os animais apresentaram comportamento hiperalgésico após ligadura da quinta raiz lombar durante os 28 dias de observação. A hiperalgesia ocorreu independentemente do sexo do animal, da presença ou ausência de hormônios gonadais ou idade. Não houve diferença entre ratos jovens e idosos não-orquiectomizados (p = 0,420), entre ratos jovens e idosos orquiectomizados (p = 0,560). Entre os ratos idosos com e sem orquiectomia houve diferença no 14º (p = 0,038) e 28º (p = 0,002) dias. Ratas jovens ooforectomizadas sem reposição de 17beta-estradiol apresentaram menor hiperalgesia que ratas ooforectomizadas com reposição durante todo o período (p = 0,001). Não houve diferença entre ratos idosos orquiectomizados e ratas idosas (p = 0,09). Ratos jovens não-orquiectomizados apresentaram menor hiperalgesia mecânica que ratas jovens ooforectomizadas com reposição de 17beta-estradiol (p = 0,001), o mesmo não ocorreu entre machos e fêmeas jovens gonadectomizados...

Age and sex modify the pain experience in animals and humans. The effects of gonadal hormones have been studied in various experimental pain models, however, the effect of aging on pain perception needs further investigation. The effect of aging on neuropathic pain is not well established. In this study, we sought to determine how aging and gonadal hormones affect mechanical hyperalgesia using spinal nerve ligation as a neuropathic pain model in aged and young male and female Wistar rats. Animals were divided into seven groups: aged female, ovariectomized young females with 17beta-estradiol replacement, ovariectomized young females without 17beta-estradiol replacement, orchiectomized and non-orchiectomized aged and young males. Rats were tested for mechanical hyperalgesia in the plantar surface of the left hindpaw before nerve ligation and on days 7, 14, 21 and 28 after nerve ligation. All animals of all groups showed mechanical hyperalgesic behavior after spinal nerve ligation during entire period of 28 days. Hyperalgesia was independent of the sex of the animal, the presence or absence of gonadal hormones or age. There was no difference between non-orchiectomized aged and young males (p = 0.420), and between orchiectomized aged and young males (p = 0.560). There was difference between aged male rats with and without orchiectomy in days 14 (p = 0.038) and 28 (p = 0.002). Young ovariectomized female rats without 17beta-estradiol replacement had less hyperalgesia than young ovariectomized female rats with replacement (p = 0.001). There was no difference between aged orchiectomized male rats and old female rats (p = 0.09). Young non-orchiectomized male rats showed less mechanical hyperalgesia than young ovariectomized female rats with 17beta-estradiol replacement (p = 0.001), that did not occur between young orchiectomized males rats and young ovariectomized females rats without 17beta-estradiol replacement (p = 0.51). Young ovariectomized...

The study of laparoscopic ovarian cystectomy in sequential hemostasis affect ovarian function / 中国基层医药

Objective To explore the laparoscopic ovarian cystectomy in sequential hemostasis for female patients with ovarian function .Methods 76 cases of patients with unilateral or bilateral ovarian cyst of our hospital from September 2011 to September 2012 were selected ,who were divided into the observation group and control group in accordance with the order of treatment .The observation group was 38 patients,intraoperative hemostasis were used sequential processing on bleeding wounds;The control group was 38 patients,intraoperative were used bipolar electro-coagulation treatment on bleeding wound to stop bleeding .Two groups were given the same preoperative nursing inter-vention,the two groups were observed and compared preoperative serum estradiol , luteinizing hormone and follicle-stimulating hormone and other hormone levels .Operative time were compared,respectively,1,4 months after surgery for hormone levels monitored.Results The mean operative time was (58.0 ±8.1) min in the observation group,(61.0 ±5.4)min in the control group,the two groups showed no significant difference (t =1.32,P>0.05);the observation group were preoperative serum estrogen diol (E2)values(131.4 ±9.6)poml/L,luteinizing hormone(LH) was (5.8 ±1.7)IU/L,follicle-stimulating hormone(FSH)(7.8 ±1.9)IU/L,were E2 preoperative value(128.3 ± 10.1)poml/L,LH value(5.8 ±2.2) IU/L,FSH(6.0 ±1.3) IU/L,the two groups showed no significant difference (t=1.34,0.82,1.02,all P>0.05);groups of patients after one month E2,FSH levels were decreased compared with the preoperative,with significant difference(the observation group,t=4.31,4.10,the control group t=4.18,4.15,all P<0.05);4 months after E2 levels were lower than that of the control group (t=5.22,P<0.05),LF,FSH levels were significantly higher than the observation group (t=4.20,5.09,all P<0.05).Conclusion Laparoscopic ovarian cystectomy in sequential method can effectively maintain hemostatic levels of sex hormones, the normal physiological function of ovarian protection for the effective way to stop bleeding ,which is worthy of further clinical practice .

Influência da icterícia colestática na variação ponderal em modelo experimental / Influence of cholestatic jaundice on the weight variance in an experimental model

OBJETIVO: Avaliar a influência da icterícia colestática na variação ponderal. MÉTODOS: Foram utilizados 64 ratos adultos, distribuídos em seis grupos: F1 (n=6) - fêmeas normais, F2 (n=6) - fêmeas laparotomizadas, F3 (n=20) - fêmeas ictéricas, M1 (n=6) - machos normais, M2 (n=6) - machos laparotomizados, M3 (n=20) - machos ictéricos. A icterícia foi obtida com ligadura e secção do ducto biliopancreático. Os pesos dos animais foram registrados semanalmente, durante sete semanas. No 14º dia de experimento, dosaram-se as bilirrubinas séricas e os hormônios gonadais. Após a sétima semana, realizou-se estudo histológico do fígado. RESULTADOS: Os animais dos grupos F3 e M3 apresentaram bilirrubinas elevadas e diminuição da massa corpórea, quando comparados com os demais grupos. As diferenças ponderais foram significativas a partir da quarta semana entre as fêmeas e da quinta semana entre os machos. Nos animais ictéricos houve aumento do estradiol e diminuição da progesterona e da testosterona total. Septos de fibroses perivenular e periportal, colangite e hiperplasia de ductos biliares ocorreram no fígado dos animais ictéricos. Nenhum animal apresentou cirrose. CONCLUSÃO: Ocorreu redução do peso corpóreo murino em presença de icterícia colestática em ambos os sexos.

OBJECTIVE: To evaluate the influence of cholestatic jaundice in weight variation. METHODS: We used 64 adult rats divided into six groups: F1 (n = 6): normal females; F2 (n = 6): laparotomy females; F3 (n = 20): jaundiced females; M1 (n = 6): normal males; M2 (n = 6): laparotomy males; M3 (n = 20): jaundiced males. Jaundice was obtained by ligation and section of the biliopancreatic duct. The animal weights were recorded weekly for seven weeks. On the 14th day of the experiment, bilirubin and gonadal hormones were assessed. After the seventh week a histological study of the liver was performed. RESULTS: The animals in groups F3 and M3 showed elevated bilirubin and decreased body mass when compared to the other groups. The weight differences were significant from the fourth week on amongst females and from the fifth in males. In Jaundiced animals there was increased estradiol and decreased progesterone and testosterone. Perivenular septa and periportal fibrosis, cholangitis and bile duct hyperplasia occurred in the liver of jaundiced rats. No animal showed cirrhosis. CONCLUSION: There was decrease in murine body weight in the presence of cholestatic jaundice in both genders.

Influência das diferentes fases do ciclo menstrual na flexibilidade de mulheres jovens / Influence of different phases of menstrual cycle on flexibility of young women

INTRODUÇÃO: O ciclo menstrual é o principal responsável por modificações da fisiologia feminina, que pode afetar algumas respostas morfofuncionais. OBJETIVO: Verificar a influência das diferentes fases do ciclo menstrual na flexibilidade de mulheres jovens. MÉTODO: 44 voluntárias divididas em um grupo controle (n = 24), que fazia uso regular de contraceptivos hormonais, e um grupo experimental (n = 20), que não utilizava anticoncepcionais, foram submetidas a três dias de avaliações, uma em cada fase do ciclo menstrual (folicular, ovulatória e lútea). Foram avaliados dados antropométricos (massa corporal, índice de massa corporal, circunferência de cintura e abdômen) e de composição corporal (percentual de gordura e massa magra). A flexibilidade foi mensurada através do teste de sentar e alcançar no banco de Wells. Aplicou-se, então, o teste não paramétrico de Mann-Whitney para as comparações intergrupos e o teste de Friedman para a comparação entre as diferentes fases menstruais. Resultados: Não foram encontradas diferenças significativas intra e intergrupos entre as diferentes fases do ciclo (p > 0,05). Foi observada maior variabilidade no grupo controle em comparação ao experimental. CONCLUSÃO: As diferentes fases do ciclo menstrual não interferem na flexibilidade de mulheres jovens, independente do uso de anticoncepcionais hormonais.

INTRODUCTION: The menstrual cycle is the main responsible for changes in female physiology, which may affect some morphofunctional responses. OBJECTIVE: to investigate the influence of the different phases of the menstrual cycle on the physical flexibility of young women. METHODS: 44 volunteers were divided into a control group (n = 24), which made regular use of hormonal contraceptives, and an experimental group (n = 20), which did not use contraceptives. All volunteers underwent three days of evaluations, one for each phase of menstrual cycle (follicular, ovulatory and luteal). Anthropometric data (body mass, body mass index, waist and abdomen circumferences), and body composition data (body fat percentage and lean mass) were assessed. Flexibility was then analyzed through the sit and reach test on Wells bench. The non-parametric Mann-Whitney test was then applied for intragroup comparisons, and the Friedman test for comparison between the different menstrual phases. RESULTS: No significant differences between groups within and between different phases of the cycle were observed (p > 0.05). Greater variability within the control group was observed when compared to the experimental group. CONCLUSION: Regardless of the menstrual cycle phase and of the use of hormonal contraceptives, the physical flexibility is not altered in young women.

Perimenopausia y trastornos afectivos: aspectos básicos y clínicos / Perimenopause and affective disorders: basic and clinical topics

Depression is an affective disorder that is more frequent in women than men. The etiology of depression disorders is multi-factorial, since social and biological influences have been determined. Coincidence between periods with hormonal fluctuations and affective alterations has lead to a hypothesis that considers fluctuations in gonadal hormones as a possible cause of depression in women. In this respect, pre-clinical studies by using laboratory animals (rodents) point toward a stronger relationship between hormonal oscillations and depressive behavior in different models designed to evaluate the antidepressant effect of drugs. This evidence could be interesting since in pre-clinical studies social factors are not included. Specifically, several authors have reported that depressive behavior is more prevalent in stages of rats' life characterized by low concentrations of gonadal hormones, such as postpartum, diestrous phase, lactancy and after ovariectomy. In contrast, a major presence of depressive behavior is observed in phases with higher concentration of hormones, like proestrus (a phase coincident with ovulation), pregnancy and after hormonal restitution with estrogens and progestins. Interestingly, the development of depressive behavior after ovari-ectomy has been established in female mice, with a critical period 12 weeks after ovaries extirpation. The participation of specific hormones in female depression could be studied in lab animals, since rodent female progress from a reproductive to a non-reproductive phase with vaginal and endocrine changes. Young females have a 4-5 days cycle named estrous cycle, in which each vaginal phase is associated with different concentrations of gonadal hormones. Although rodents do not exhibit menses, a state similar to peri- and post-menopause could be identified. Aging females exhibit irregular cycles before progressing to an estrous constant phase with elevated levels of estrogens. Decline of estrogen levels produces a persistent diestrous phase considered as a post-menopausal state. Aging rats in persistent diestrous, as well as ovari-ectomized females (the most economic model of post-menopause in lab animals) show physiological and behavioral changes associated to hormonal deprivation. Thus, they are considered a good model to evaluate affective and cognitive alterations as well as potential hormonal substitutive treatments. Clinical and epidemiologic studies report that perimenopause is linked to an increased risk of developing depression in women, or with the presence of more intense symptoms of depression. In agreement with Stages of Reproductive Aging Workshop (STRAW), perimenopause includes the period named transition to menopause plus one year after the last menses. This period is characterized by irregular menstrual cycles and fluctuations in levels of estrogens. In this stage, the levels of follicle-stimulating hormone (FSH) are elevated in order to further stimulate the production of estrogens from ovaries. Finally, concentrations of estrogens are significantly reduced in late perimenopause, although the levels of FSH continue to be increased. Fluctuations of estrogens and FSH have been related to symptoms such as affective alterations, hot flushes and insomnia, while hormonal deprivation in post-menopause is linked to changes in body fat, fatigue, cognitive disorders and reduction in bone density. Variations in estrogens and FSH level have been consistently related to depression symptoms in perimenopausal women, while changes in progestins and testosterone are associated with dysphoric mood and aggression, respectively. Thus, in agreement with the main hormonal hypothesis, a substitutive therapy with estrogens as an antidepressant therapy in peri- and post-menopausal women has been implemented. The results of different clinical studies are contradictory possibly due to methodological differences as the type of hormone used as an antidepressant therapy, dosage, time of administration of treatments and the period of hormonal deprivation in women. In a consistent manner, basic studies support the idea that steroi-dal gonadal hormones have antidepressant properties, but these seem to depend on both specific features of hormonal treatments and endocrine conditions in females. It has been reported that 17β-estradiol (E2), ethinyl-estradiol (EE2) and estradiol benzoate produce antidepres-sant-like actions in ovariectomized young females. Pharmacological studies have demonstrated that the serotonergic system has a major participation in the antidepressant-like effect of E2, revealing its potential as a treatment for depressed women. In the same sense, estrogens that bind to estrogen receptors β (ERβ) are more effective to produce antidepressant- and anxiolytic-like effects than estrogens with higher affinity at ERa This evidence leads to consider ERβ as an important pharmacological target in depression. Studies evaluating estrogens in depression have determined that dosage is an important issue in the production of antidepressant-like effects. Dosage of estrogens that attain a physiological range have been reported to have more antidepressant efficacy in respect to lower or higher dose provoking infra- or supra-physiological levels of estradiol. In fact, a U-shape in the antidepressant effect of E2 has been detected. Finally, timing of hormonal therapy seems to be a more relevant factor at moment to attain an antidepressant effect with estrogen treatment. Old rats (14 months) that received a prolonged estrogen treatment immediately after ovariectomy showed an antidepressant-like response which was not observed when treatment was began five months after ovaries extirpation. ERs are dependent on endogenous estrogens levels which suggest that a reduction in the target site of E2 may be linked to its reduced antidepressant-like effect in females with a long-term hormonal deprivation. An apparently successful strategy to reduce depression in women has been to adjunct a hormonal treatment with antidepressant drugs in order to enhance antidepressant efficacy. Studies with a reduced number of patients have determined that combined therapy is able to reduce the scores in the Hamilton Depression Scale, and to allow the effect of antidepressant drugs in women with refractory depression. At this respect, basic studies have established that estrogens facilitate the antidepressant effects of several antidepressant drugs. It was reported that the anxiolytic effect of desipramine was more evident in the proestrus, a phase characterized by high levels of estrogens and progesterone in young females. Both estrogens and progesterone participate in the anxiolytic effect of desipramine, although the synergism with estradiol was more significant. By using specific animal models of antidepressant effects, it was found that E2 facilitated the antidepressant effect of fluoxetine, desipramine, venlafaxine and bupropion in young, ovariectomized female rodents. In contrast, a chronic study using old, ovariectomized female rats showed that estradiol valerate was unable to improve the antidepressant effect of citalopram, even though the antidepressant efficacy of both estrogen and citalopram was established previously. Differences in results could be due to variations in methodological aspects such as age of rats (young, three months, versus old, 15 month), type of estrogen used in each study (E2 versus estradiol valerate), animal model of depression (forced swimming test, acute model, versus chronic mild stress model), type of antidepressant used (citalopram in the last case), and dosage for both estrogens and antidepressant drugs. Interestingly, the strategy of a combined treatment could be a therapeutic advantage for those women that suffer depression associated to endocrine changes. Evidence from clinical and basic studies should be taken into account at moment to select the most advantageous therapy to treat depression in mature women.

La depresión es un trastorno afectivo de origen multifactorial que se presenta con mayor frecuencia en la mujer que en el hombre. Las causas de esta diferencia se atribuyen tanto a factores sociales como biológicos. La coincidencia entre los periodos de fluctuaciones hormonales y la presencia de síntomas afectivos ha dado fuerza a la teoría de que los factores hormonales pueden ser una causa de la mayor prevalencia de depresión en la mujer. Los estudios básicos en los cuales no se presentan factores sociales sugieren que la depresión en la mujer podría tener un origen biológico. Uno de los periodos de mayor riesgo en la mujer es la perimenopausia. De acuerdo con el Grupo de Trabajo de los Estadios de la Edad Reproductiva (STRAW), la perimenopausia comprende el periodo denominado transición a la menopausia más un año después de la última menstruación. Este periodo se caracteriza por ciclos menstruales de duración variable y fluctuaciones en la concentración de estrógenos y progesterona. Conforme los ciclos se hacen impredecibles, ocurre una disminución de estrógenos, que genera alteraciones fisiológicas y afectivas. Diversos estudios epidemiológicos han logrado relacionar la perimenopausia con cambios en el estado afectivo de la mujer. Tomando en cuenta la hipótesis de que la privación de estrógenos se relaciona con los síntomas depresivos en la mujer, los tratamientos con estrógenos han sido considerados como una de las opciones terapéuticas. Los hallazgos clínicos son controvertidos, y la posible explicación son las diferencias en la metodología empleada en cada estudio, así como la falta de consistencia en la definición de perimenopausia y en los instrumentos de medición hormonal y del estado emocional de la mujer. De manera interesante, los estudios básicos apoyan la idea de que los estrógenos producen efectos antidepresivos importantes. Sin embargo, existen diferencias en la respuesta antidepresiva que dependen tanto del tipo de estrógeno como del estado hormonal de la hembra. Hasta el momento, los hallazgos más consistentes refieren al 17β-estradiol como la hormona más relevante para producir acciones antidepresivas en la hembra. El mismo estrógeno es efectivo en ratas viejas, con un periodo de privación hormonal moderado; sin embargo, deja de ser efectivo en la depresión experimental cuando ese periodo se extiende por varios meses. Otra alternativa terapéutica para tratar la depresión en la perimenopausia y posmenopausia es la terapia combinada de agentes hormonales y fármacos antidepresivos. En dos estudios con un reducido número de pacientes se determinó que la adición de estrógenos favorece el efecto de los fármacos antidepresivos en mujeres con depresión refractaria a dichos tratamientos. La investigación básica aporta resultados consistentes al respecto, ya que, por un lado, se ha determinado que diferentes estrógenos inducen un efecto tipo antidepresivo en ratas ovariectomizadas, y por otro, que la administración de dosis subefectivas de dichos estrógenos facilita el efecto antidepresivo, o incluso acorta la latencia de aparición del efecto antidepresivo de fármacos como la fluoxetina, la desipramina y la venlafaxina. Los resultados sugieren que los estrógenos pueden interactuar con diferentes sistemas de neurotransmisión para mejorar las acciones de los fármacos antidepresivos. Más aún, ha sido demostrado que el sistema serotonérgico participa en buena medida en las acciones antidepresivas de algunos estrógenos, lo cual aporta más evidencia sobre las fallas en la neurotransmisión serotonérgica en etapas de privación hormonal. La evidencia de los estudios básicos y clínicos apoya la idea de que la mujer tiene periodos de vulnerabilidad afectiva que se relacionan con cambios endocrinos importantes. Los tratamientos para la depresión en la mujer deben ser elegidos con base en las condiciones endocrinas de la paciente, así como en las características propias de los tratamientos.

Effects of Carthamus tinctorius on Semen Quality and Gonadal Hormone Levels in Partially Sterile Male Rats

PURPOSE: Traditional herbal medicine is just one of the many different approaches using plants in the remedy of diseases. Carthamus tinctorius (CT) or safflower is a popular plant that is used for coloring and flavoring in food industries. The effect of CT on spermatogenesis and sperm parameters has been reported in traditional medicine but has not yet been confirmed scientifically. Therefore, this study was designed to determine the effects of CT on spermatogenesis and the male reproductive system in an animal model. MATERIALS AND METHODS: Sixty male rats were divided into five groups. Four groups were injected with 5 mg/kg of busulfan as a model of partial infertility. Then, the experimental groups were treated with 10 mg/kg, 25 mg/kg, or 50 mg/kg of CT extract for 35 days. The control was treated with busulfan (infertile control) or distilled water only. After this period, the animals were sacrificed and blood samples were taken for hormonal assay. The semen was collected from the epididymis and the reproductive organs were assessed. Sperm count and motility were measured and smears were prepared for assessment of the other parameters. RESULTS: The results indicated that the percentage of sperm with good morphology, motility, and count increased significantly in the group treated with 10 mg/kg CT (p=0.002, p=0.03, and p=0.00001, respectively). The effects on hormonal changes and genital organ weights were also positive. CONCLUSIONS: It is probable that the CT extract affects spermatogenesis and as a result sperm quality. Further studies are needed.

Associação entre sexo e mortalidade em pacientes com sepse: os hormônios sexuais influenciam o desfecho? / Gender and mortality in sepsis: do sex hormones impact the outcome?

OBJETIVO: Análise comparativa da mortalidade em dois subgrupos de pacientes com sepse, diferenciados pela idade e sexo, admitidos na unidade de cuidados intensivos de um hospital de ensino. MÉTODOS: De dezembro de 2005 a abril de 2008, de um total de 628 pacientes admitidos na unidade de cuidados intensivos, 133 tinham o diagnóstico de sepse e foram separados em dois subgrupos com base na idade: subgrupo G1, com idades entre 14 - 40 anos e subgrupo G2, com idade acima de 50 anos. Os pacientes com idades entre 41 e 50 anos (n = 8) foram excluídos. Os subgrupos foram caracterizados quanto aos dados demográficos, indicadores prognósticos (escore APACHE II, disfunção orgânica e choque circulatório) e desfecho (mortalidade). RESULTADOS: O subgrupo G1 (n = 44) tinha 27 (61,4 por cento) pacientes do sexo feminino e o subgrupo G2 (n = 81) tinha 40 (49,4 por cento) pacientes do sexo feminino. A média do escore APACHE II, incidência de disfunção de múltiplos órgãos e progressão para choque circulatório não foram estatisticamente diferente entre pacientes femininos e masculinos em ambos os subgrupos. A taxa de mortalidade geral foi menor em mulheres do que em homens do subgrupo G1 (P = 0,04); no subgrupo G2 foi observada uma tendência inversa. CONCLUSÕES: Em pacientes com sepse, mulheres abaixo dos quarenta anos de idade, portanto em período fértil, tiveram menor mortalidade do que homens; houve uma tendência para menor mortalidade entre homens com mais de 50 anos.

OBJECTIVE: Comparative assessment of the mortality rates of two septic patients' ages and/or gender subgroups, admitted to the intensive care unit of a university hospital. METHODS: From December 2005 to April 2008, from a total of 628 patients, 133 were admitted to the intensive care unit with sepsis and included into two age subgroups: (G1) 14 - 40 years old and (G2) more than 50 years old. Patients aged between 41 and 50 years old (n = 8) were excluded. Demographic data, prognostic indicators (APACHE II score, organ dysfunction and circulatory shock) and outcome (mortality) were analyzed. RESULTS: Of the G1 patients (n = 44), 27 were female (61.4 percent), and in G2 (n = 81), 40 were female (49.4 percent). For both groups, mean APACHE II scores, multi-organ dysfunction and progression to circulatory shock rates were not significantly different between female and male patients. For G1, overall mortality rate was lower in female than in male patients (P = 0.04), while for G2, the opposite trend was observed. CONCLUSIONS: In this sample, reproductive age female patients younger than 40 years old showed lower mortality rates compared with age-matched male patients; for patients older than 50 years old, male patients had lower mortality rates than female patients.

Notion to the significance of somatotropic axis, gonadal hormones with their post receptor signaling for growth modulating, and relevant treatment during adolescence with growth disorders / 中华内分泌代谢杂志

It is well known that a decline secular trend evaluated in the age of puberty onset.Sexual characteristics and linear growth spurt are two major events for puberty.The growth pattern of puberty characterized as acceleration-deceleration-cessation in growth velocity is specific for human being.It is modulated symphonically by both gonadal and somatotropic axes.This article reviews the advances in the modulming mechanisms of pubertal growth,particularly in the local sites of growth plate,and the concept of keeping positive balance between skeletal lineal growth and maturation.Finally,various therapeutic strategies for improving the final adult height in individuals with growth disorders during adolescence are discussed.

Posición oficial de la Sociedad Chilena de Climaterio para el manejo clínico de la mujer climatérica / Official position of the Chilean Society of Climacteric on the management of climacteric women

The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

Effect of mustard gas at LD50 dose on reproductive system of rats / 第二军医大学学报

Objective: To evaluate the effect of mustard gas on reproductive system in rats. Methods: Forty male SD rats and 40 female rats were equally divided into mustard gas-treated group and control group. Animals in mustard gas-treated group were injected with 5 mg · kg body weight (LD50) of mustard gas, and those in control group received propylene glycol injection. Serum hormonal determinations (estriol, testosterone, luteinizing hormone, follicle-stimulating hormone) were completed by collecting ocular vein blood at 1 day, 3 days, 5 days, 7 days and 28 days after injection. The rats were then killed were anatomized. Microscope was used to observe pathological changes in germ cells (ovary or testes). Two female rats and 3 male rats died during 4th and 5th day after injection. Results: The changes of serum hormone and pathology nearly restored to the normal levels in the female rats after injection of mustard gas for a short period. Most of the spermatogenic cells were still necrotic and seminiferous tubules still had hollow cross 1 month after injection in male rats. The FSH levels in the sera of male rats were significangtly increased from (1.210 0±0. 354 6) mmol/L in control group to 0.475 0±0. 045 1) mmol/L 28 days after injection(P<0.01). Conclusion: Mustard gas causes slight injury of ovary in female rats and the damage can recover in a short period, but it can cause long-time and unreversable injury to testes in male rats.

Changes of physiological pain threshold in gonadectomized rats / 第二军医大学学报

Objective: To investigate the modulatory effect of gonadal hormone on peripheral pain. Methods: Orchiectomized and ovariectomized rats models were established. Radio heater and Von-Frey hair were used to determine the peripheral mechanical and thermal pain threshold in gonadectomized rats and their corresponding sham-controls. Results: The body weight was increased and the uterus weight was decreased after ovariectomy in female rats(P<0.01). There was no significant change in the body weight of mate rats after orchiectomization. The 100% hind paw withdrawal threshold to Von-Frey hair stimulation was decreased significantly after ovariectomization in female rats, with no significant change in the thermal pain threshold. There was no significant changes in the 100% hind paw withdrawal threshold after Von-Frey hair stimulation or thermal pain threshold after orchidectomy in male rats. Conclusion: These results suggest that changes in androgen level of male rats have no influence on the peripheral basal pain threshold, and female gonadal hormone may inhibit the peripheral pain signaling and has no effect on thermal pain threshold.

Changes of sex hormone levels in male acne patients with normal serum testosterone and effect of antiandrogen therapy / 第二军医大学学报

Objective: To observe the sex hormone levels in adolescent male acne patients with normal serum testosterone, and to evaluate the curative effect of antiandrogen therapy. Methods: Totally 40 adolescent male acne patients with normal serum testosterone were evenly randomized into two groups, the treatment group received finasteride plus life-style intervention, and the control group received life-style intervention only. The curative effects were compared between the two groups, and the levels of serum testosterone, dihydrotestosterone (DHT), free testosterone (FT), sex hormone binding globulin (SHBG), and estradiol (E2), and the adverse effects were observed before and after treatment. The curative effects in the treatment group were also observed 3 months after drug withdrawal. Another 40 healthy adolescent males served as normal group for comparison of the baseline hormone levels with ance patients. Results: The patients in our group had significantly higher levels of body fat content, E2 (P<0.05), DHT, and FT (P<0.01), and lower level of SHBG (P<0.05) compared with those in the normal control group. The overall effective rate of the treatment group was 90%, which was significantly higher than that of the control group (25%, P<0.01); the effective rate of the treatment group was 85% 3 months after drug withdrawal. The levels of DHT (P<0.01) and FT (P<0.05) in the treatment group were significantly decreased and the levels of SHBG was significantly increased (P<0.05) after treatment. There were no severe adverse effects in both groups. Conclusion: The adolescent male acne patients with normal serum testosterone have higher body fat content, DHT, FT, E2 and lower SHBF levels. The therapy using finasteride plus life-style is effective) it can greatly improve the serum level of SHBF and reduce adverse effects, with low recurrent rate after drug withdrawal.