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Rev. bras. ginecol. obstet ; 42(7): 427-435, July 2020. tab, graf
Article in English | LILACS | ID: biblio-1137856


Abstract Objective We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). Data sources We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO,WHO-ICTR, and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. Data collection Data extraction was performed by two reviewers with a preestablished data collection formulary. Data synthesis Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, whichmeans that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. Conclusion MoreRCTs are needed to supportor refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130

Resumo Objetivo Nós realizamos uma revisão sistemática para avaliar a efetividade e a segurança do Tribulus terrestris no tratamento da disfunção sexual feminina (DSF). Fontes de dados Nós realizados uma busca eletrônica irrestrita nas seguintes bases de dados: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR,, e OpenGrey. Seleção dos estudos Nós incluímos todos os ensaios clínico randomizados (ECR) que comparou T. terrestris com controles ativos/inativos. Após o processo de seleção, conduzido por 2 revisores, 5 ECRs (n = 279 participantes) foram incluídos. Extração de dados O processo de extração de dados foi realizado por dois revisores, utilizando-se um formulário de extração de dados pré-estabelecido. Síntese de dados Devido à falta de dados disponíveis e à heterogeneidade clínica entre os estudos incluídos, nós não realizamos meta-análises. O risco de viés foi avaliado pela tabela de risco de viés da Cochrane e, a certeza do corpo da evidência foi avaliada pelo Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Resultados Após 1 a três 3 meses de tratamento, mulheres na pré e pós-menopausa randomizadas ao T. terrestris tiveram um aumento significante nos escores de função sexual. O grupo com 3 meses de tratamento com T. terrestris exibiu um aumento significante dos níveis séricos de testosterona emmulheres pré-menopausa. Não houve relato de eventos adversos graves, e nenhum estudo avaliou qualidade de vida das participantes. A certeza da evidência foi considerada muito baixa, o que significa que existe pouca certeza na estimativa dos efeitos e que é provável que futuros estudos mudem estas estimativas. Conclusão Mais ECRs são importantes para apoiar ou refutar o uso do T. terrestris. A decisão de usar essa intervenção deve ser compartilhada com pacientes, e as incertezas sobre seus efeitos devem ser discutidas durante o processo de decisão clínica.

Humans , Female , Sexual Dysfunction, Physiological/drug therapy , Drugs, Chinese Herbal/therapeutic use , Plant Extracts/therapeutic use , Tribulus/chemistry , Saponins/adverse effects , Saponins/therapeutic use , Sexual Dysfunction, Physiological/blood , Testosterone/blood , Drugs, Chinese Herbal/adverse effects , Plant Extracts/adverse effects , Premenopause , Postmenopause , Diosgenin/analogs & derivatives , Diosgenin/adverse effects , Diosgenin/therapeutic use
Int. braz. j. urol ; 45(5): 1043-1054, Sept.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040070


ABSTRACT Objective Anacyclus Pyrethrum (AP) and Tribulus Terrestris (TT) have been reported as male infertility treatment in several studies; however, in Iranian traditional medicine these two plants are prescribed simultaneously. In this study, we aimed to determine the effects of AP and TT extracts both separately and simultaneously on the male Wistar rat fertility parameters. Materials and Methods 32 male Wistar rats were divided into 4 groups: Control, TT, AP, and AT treated groups. Treatment continued for 25 days and rats were weighed daily. Their testes were dissected for histological studies. Sperm analysis including sperm count, viability and motility were performed. Serum was obtained to evaluate testosterone, LH and FSH levels. Histological studies were conducted to study Leydig, and Sertoli cells, spermatogonia and spermatid cell numbers, and to measure seminiferous diameter and epithelium thickness. Results Sperm count increased in all the treatment groups. Sperm viability and motility in AT and AP groups were elevated. TT and AT groups showed significantly increased testosterone level compared to control group (P=004, P=0.000, respectively) and TT, AP and AT treatment groups showed increased LH level (P=0.002, P=0.03 and P=0.000, respectively) compared to control, while only AT group showed increased FSH (p=0.006) compared to control. Histological studies showed significant increase of spermatogonia, Leydig and Sertoli cell numbers and epithelial thickness in AT group compared to other groups. All the treatment groups had higher number of Leydig, spermatogonia and spermatid cells. Conclusion TT and AP improved sexual parameters; however, their simultaneous administration had higher improving effects on studied parameters.

Humans , Animals , Male , Chrysanthemum cinerariifolium/chemistry , Plant Extracts/therapeutic use , Tribulus/chemistry , Infertility, Male/drug therapy , Organ Size , Reference Values , Sperm Count , Sperm Motility/drug effects , Spermatozoa/drug effects , Testis/drug effects , Testosterone/blood , Body Weight , Luteinizing Hormone/blood , Plant Extracts/pharmacology , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Fertility/drug effects , Follicle Stimulating Hormone/blood
Int. braz. j. urol ; 45(5): 1008-1012, Sept.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1040079


ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.

Humans , Male , Adult , Aged , Reproductive Control Agents/therapeutic use , Testosterone/blood , Chorionic Gonadotropin/therapeutic use , Hypogonadism/drug therapy , Reference Values , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Hormone Replacement Therapy/methods , Hypogonadism/blood , Middle Aged
Arch. endocrinol. metab. (Online) ; 63(4): 417-426, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019352


ABSTRACT Objective To investigate the associations among visceral adiposity index (VAI), lipid accumulation product (LAP), body fat percentage (%), and android/gynoid ratio (A/G ratio) in women with polycystic ovary syndrome (PCOS) and verify if the parameters representative of visceral obesity correlate with and exhibit the same frequency as body composition variables; anthropometric indices; and metabolic, hormonal, and inflammatory parameters. Subjects and methods This was a cross-sectional study that included 94 women with PCOS. Hormonal, metabolic, and inflammatory parameters were analyzed in all women. Free androgen index (FAI) and homeostasis model assessment (HOMA-IR), as well as LAP, VAI, and anthropometric indices, were calculated. The regions of interest (ROIs) in body composition and body composition indices were evaluated using a dual X-ray absorptiometry (DXA). Overall, 32 variables were selected as markers of body fat distribution. Results Among the 32 markers evaluated, 29 correlated with LAP, whereas 25 correlated with VAI, 19 with body fat (%), and 30 with A/G ratio. Additionally, some markers correlated with the four adiposity indices evaluated: ROIs, except for total mass and leg fat (%); body composition (body mass index, waist circumference, and hip circumference) indices; fasting insulin; and C-reactive protein. Conclusion LAP and VAI may be sensitive measures for screening and preventing metabolic syndrome and insulin resistance in PCOS, with LAP being more sensitive than VAI, and the A/G ratio may be more sensitive than body fat percentage.

Humans , Female , Adolescent , Adult , Young Adult , Polycystic Ovary Syndrome/blood , Intra-Abdominal Fat , Body Fat Distribution , Testosterone/blood , Blood Glucose/analysis , Body Composition , C-Reactive Protein/analysis , Sex Hormone-Binding Globulin/analysis , Biomarkers/blood , Cross-Sectional Studies , Sensitivity and Specificity , Inflammation Mediators/blood , Overweight/blood , Lipid Accumulation Product , Insulin/blood
Int. braz. j. urol ; 45(3): 621-628, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012317


Abstract Purpose: To investigate the relationship between 25-hydroxyvitamin D (25 (OH) D) levels and acquired premature ejaculation (PE). Materials and Methods: A total of 97 patients with acquired PE and 64 healthy men as a control group selected from volunteers without PE attending our Andrology Outpatient Clinic between November 2016 and April 2017 were included the study. All patients were considered to have acquired PE if they fulfilled the criteria of the second Ad Hoc International Society for Sexual Medicine Committee. Premature ejaculation diagnostic tool questionnaires were used to assessment of PE and all participants were instructed to record intravaginal ejaculatory latency time. Vitamin D levels were evaluated in all participants using high performance liquid chromatography method included in the study. Results: Compared to men without PE, the patients with acquired PE had significantly lower 25 (OH) D levels (12.0 ± 4.5 ng/mL vs. 18.2 ± 7.4 ng/mL, p < 0.001). In the logistic regression analysis, 25 (OH) D was found to be an independent risk factor for acquired PE, with estimated odds ratios (95% CI) of 0.639 (0.460-0.887, p = 0.007) and the area under curve of the ROC curve of 25 (OH) D diagnosing acquired PE was 0.770 (95% CI: 0.695 to 0.844, p < 0.001). The best cut-off value was 16 ng/mL with a sensitivity of 60.9%, specificity of 83.5%, PPV of 70.9%, and NPV of 76.4% to indicate acquired PE. Conclusions: This study demonstrates that lower vitamin D levels are associated with the acquired PE. The result of our study showed that the role of serum vitamin D levels should be investigate in the etiology of acquired PE. Perhaps supplementation of vitamin D in men with acquired PE will ameliorate the sexual health of these patients.

Humans , Male , Adult , Young Adult , Vitamin D/analogs & derivatives , Vitamin D Deficiency/complications , Vitamin D Deficiency/blood , Premature Ejaculation/etiology , Premature Ejaculation/blood , Testosterone/blood , Vitamin D/blood , Case-Control Studies , Logistic Models , Multivariate Analysis , Predictive Value of Tests , Prospective Studies , Surveys and Questionnaires , Risk Factors , ROC Curve , Middle Aged
Arch. endocrinol. metab. (Online) ; 63(3): 190-198, May-June 2019. tab
Article in English | LILACS | ID: biblio-1011166


ABSTRACT Objective To summarize current evidence regarding testosterone treatment for women with low sexual desire. Materials and methods The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. Results Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. Conclusion Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8

Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Sexual Dysfunction, Physiological/drug therapy , Testosterone/therapeutic use , Androgens/therapeutic use , Libido/drug effects , Societies, Medical , Testosterone/adverse effects , Testosterone/blood , Practice Guidelines as Topic , Androgens/adverse effects , Androgens/blood
Arch. endocrinol. metab. (Online) ; 63(3): 208-214, May-June 2019. tab
Article in English | LILACS | ID: biblio-1011163


ABSTRACT Objectives We aimed to measure the quality of life (QoL) of patients with Turner syndrome (PTS) and determine the extent to which their clinical or laboratory alterations influence QoL compared to reference women (RW) of the same age range. Subjects and methods From Dec-2013 to Dec-2014, 90 participants were recruited. They were 18 years and older: 48 with Turner syndrome (TS) (PTS) and 42 without (RW). Recruited subjects completed the Portuguese version of Short Form 36 (SF-36) questionnaire, and blood was drawn to measure LH, FSH, oestradiol (E2), progesterone (P4), SHBG, and SDHEA (by ECLIA) and testosterone (by LC MS/MS). Results Age and schooling were similar between groups. The most common occupations for PTS were health worker, administration and education, and health worker or cashier for RW. Most participants were Catholic or Evangelical. Eighty-one percent (39/48) of cases used Hormonal Replacement Therapy (HRT), mostly transdermal (23/39). RW and PTS scored similarly on the SF-36 questionnaire. RW had higher oestradiol (p = 0,01), lower FSH (p = 0,01) and higher testosterone (p = 0,01) than PTS. Concentrations of P4, LH, SHBG or SDHEA were similar. Significant associations were found among QoL and hormones (E2 with Vitality and LH with Physical Role) only in the PTS group. Conclusions PTS do not consider that TS affects their QoL as measured by domains on the SF-36. Oestradiol was related with QoL, emphasising the importance of HRT.

Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Quality of Life , Turner Syndrome/psychology , Hormone Replacement Therapy/psychology , Testosterone/blood , Turner Syndrome/blood , Brazil , Case-Control Studies , Surveys and Questionnaires , Estradiol/blood
Arch. endocrinol. metab. (Online) ; 63(2): 113-120, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001211


ABSTRACT Objective There is controversy regarding cognitive function in patients with congenital adrenal hyperplasia (CAH). This study is aimed at the assessment of cognitive functions in children with CAH, and their relation to hydrocortisone (HC) therapy and testosterone levels. Subjects and methods Thirty children with CAH due to 21 hydroxylase deficiency were compared with twenty age- and sex-matched healthy controls. HC daily and cumulative doses were calculated, the socioeconomic standard was assessed, and free testosterone was measured. Cognitive function assessment was performed using the Wechsler Intelligence Scale - Revised for Children and Adults (WISC), the Benton Visual Retention Test, and the Wisconsin Card Sorting Test (WCST). Results The mean age (SD) of patients was 10.22 (3.17) years [11 males (36.7%), 19 females (63.3%)]. Mean (SD) HC dose was 15.78 (4.36) mg/m 2 /day. Mean (SD) cumulative HC dose 44,689. 9 (26,892.02) mg. Patients had significantly lower scores in all domains of the WISC test, performed significantly worse in some components of the Benton Visual Retention Test, as well as in the Wisconsin Card Sorting Test. There was no significant difference in cognitive performance when patients were subdivided according to daily HC dose (< 10, 10 - 15, > 15 mg/m 2 /day). A positive correlation existed between cumulative HC dose and worse results of the Benton test. No correlation existed between free testosterone and any of the three tests. Conclusion Patients with CAH are at risk of some cognitive impairment. Hydrocortisone therapy may be implicated. This study highlights the need to assess cognitive functions in CAH.

Humans , Male , Female , Child , Adolescent , Hydrocortisone/administration & dosage , Cognition/drug effects , Adrenal Hyperplasia, Congenital/psychology , Anti-Inflammatory Agents/administration & dosage , Socioeconomic Factors , Testosterone/blood , Visual Perception/drug effects , Wechsler Scales , Hydrocortisone/pharmacology , Case-Control Studies , Cognition Disorders/diagnosis , Adrenal Hyperplasia, Congenital/metabolism , Adrenal Hyperplasia, Congenital/blood , Dose-Response Relationship, Drug , Intellectual Disability/diagnosis , Anti-Inflammatory Agents/pharmacology , Neuropsychological Tests
Int. braz. j. urol ; 45(1): 38-44, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-989971


ABSTRACT Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays. Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG-β subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after. Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951-1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients. Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.

Humans , Male , Adult , Aged , Aged, 80 and over , Prostatic Neoplasms/blood , Testosterone/blood , Luteinizing Hormone/blood , Follicle Stimulating Hormone/blood , Chorionic Gonadotropin/biosynthesis , Chorionic Gonadotropin/blood , Prostatic Neoplasms/drug therapy , ROC Curve , Sensitivity and Specificity , Chorionic Gonadotropin, beta Subunit, Human/urine , Chorionic Gonadotropin, beta Subunit, Human/blood , Androgen Antagonists/administration & dosage , Middle Aged
Medicina (B.Aires) ; 78(6): 399-402, Dec. 2018. tab
Article in Spanish | LILACS | ID: biblio-976137


Se denomina trans-varón (TV) a una persona de sexo biológico femenino con identidad de género masculino. Para adquirir caracteres sexuales y expresar un rol social semejante podría utilizarse: terapia hormonal cruzada (THC) y/o genitoplastia masculinizante. Se evaluó el perfil de seguridad a corto plazo (primer año) de la THC con las distintas formas farmacéuticas de testosterona disponibles en nuestro país. El estudio se realizó de manera retrospectiva, analizando las historias clínicas de 30 pacientes trans-varón que cumplían con los requisitos para ser incluidos. La edad media de la población fue de 27 años. La media basal de testosterona fue de 0.43 ng/ml, que luego aumentó a 6.36 ng/ml (valores normales para sexo masculino). El hematocrito incrementó de su valor basal 40.0 a 45.2% (p < 0.01) mientras la Hb de 13.6 a 15.2 g/dl (p < 0.01). El colesterol total se mantuvo estable con valores de 175 y 185 mg/dl (p = 0.81). No hubo cambios significativos en triglicéridos: 88.3 y 102 mg/dl (p = 0.08). El colesterol LDL incrementó en los primeros 6 a 12 meses de THC de 101.2 a 112.5 mg/dl (p = 0.17). A los 12 meses los niveles de colesterol HDL aumentaron de 50.1 a 52.0 mg/ dl (p < 0.01). Las enzimas hepáticas se mantuvieron estables. No existen datos en nuestro país sobre seguridad de la testosterona en TV. No tuvimos necesidad de suspender la medicación por efectos no deseados en los parámetros estudiados.

A trans-male (TM) is a biologically female person with male gender identity who wishes to acquire male sexual characteristics and fulfil a male social role. To achieve that purpose, both cross-hormonal therapy (CHT) and surgical phalloplasty can be used. We evaluated the short term (12 months) safety profile of CHT using different forms of testosterone available for prescription in Argentina. In this retrospective study, we analyzed the medical history of 30 trans-male patients fitting the inclusion criteria. The mean age of the population was 27 years. The mean basal serum level of testosterone was 0.43 ng/ml, which increased to 6.36 ng/ml (male hormonal levels). The hematocrit increased from a baseline of 40.0 to 45.2% (p < 0.01) and hemoglobin increased from 13.6 to 15.2 g/dl (p < 0.01). Total cholesterol remained stable with values of 175 and 185 mg/dl (p = 0.81). There were no significant changes in serum triglycerides: 88.3 and 102 mg/dl (p = 0.08). LDL increased in the first 6 to 12 months of CHT from 101.2 to 112.5 mg/dl (p = 0.17). At 12 months HDL levels increased from 50.1 to 52 mg/dl (p < 0.01). Hepatic enzymes remained stable. There is no available data regarding safety of testosterone use in TM in our country. In no case did we need to suspend the medication due to unwanted effects.

Humans , Male , Female , Adult , Young Adult , Testosterone/therapeutic use , Transsexualism/drug therapy , Transgender Persons , Reference Values , Testosterone/blood , Time Factors , Transsexualism/blood , Triglycerides/blood , Cholesterol/blood , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric
Acta fisiátrica ; 25(3)set. 2018.
Article in English, Portuguese | LILACS | ID: biblio-999736


Níveis de testosterona sérica já foram relacionados a piora de fatores hematológicos, função e envelhecimento vascular, contribuindo potencialmente para formação de trombos. Com o envelhecimento, dados epidemiológicos mostram declínio dos níveis de testosterona, prejuízo da função vascular e aumento das incidências de doenças vasculares, como o AVE. Objetivo: Descrever estudos que abordaram a potencial relação dos níveis de testosterona com a prevenção, apresentação clínica e prognóstico do AVE. Métodos: Uma pesquisa e seleção de artigos foi conduzida em três diferentes bases de dados (MEDLINE, SCIELO, LILACS) utilizando termos relacionados a testosterona e AVE (inglês e português), filtrada para estudos em humanos. Apenas estudos que abordaram algum aspecto da relação entre testosterona e AVE foram incluídos para discussão no presente estudo. Resultados: A busca resultou em 12 estudos relevantes para análise e discussão (7 observacionais, 3 transversais, 2 experimentais). Estudos observacionais verificaram um papel protetor da testosterona na incidência de AVE. Estudos transversais verificaram alterações endocrinológicas, como o hipogonadismo, na fase aguda do AVE, bem como melhor apresentação clínica (gravidade, tamanho da lesão). Estudos experimentais controlados verificaram benefícios clínicos e funcionais da suplementação de testosterona em pacientes em reabilitação. Conclusão: Apesar dos potenciais diversos benefícios destacados de níveis mais altos de testosterona no AVE, mais estudos que abordem de forma sistematizada o papel da testosterona em aspectos preventivos, de apresentação clínica, e de reabilitação e prognóstico serão bem vindos, para melhor manejo e otimização do tratamento do AVE.

Serum testosterone levels have already been related to endothelial function, vascular aging and hemathological factors, possibly contributing to thrombus formation. As aging progresses, epidemiological data shows declining testosterone levels, impaired vascular function and an increasing incidence of vascular diseases like stroke. Objective: The aim of present paper is to describe studies with a possible relation of testosterone levels with stroke prevention, clinical presentation, and prognosis. Methods: A research and selection of articles, filtering for humans studies only, was conducted in three different eletronic scientific databases, (MEDLINE, SCIELO, LILACS), using related and registered terms (english and portuguese) about "stroke" and "testosterone". Only studies that encompasses the role of testosterone in stroke and its different clinical aspects were included in the present review. Results: The search retrieved 12 relevant studies for analysis and discussion relating testosterone and stroke (7 observational, 3 cross sectional, 2 experimental). Observational studies verified a preventive role of testosterone levels on stroke incidence, cross-sectional studies verified endocrinologial alterations like hypogonadism on acute stroke phase and better clinical presentation (severity, brain lesion size). Experimental controled studies observed clinical benefits of testosterone supplementation in rehabilitation patients. Conclusion: Despite the potential benefits of higher levels of testosterne in stroke spectrum, more studies that systematically aproach the role of testosterone in stroke prevention, severity, clinical features, prognosis, rehabilitation and mortality will be welcome to better elaborate future medical management and otimization in stroke spectrum.

Humans , Testosterone/blood , Stroke/prevention & control , Rehabilitation , Androgens
Clinics ; 73: e86, 2018. tab
Article in English | LILACS | ID: biblio-890760


OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate in transgender women. METHODS: The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject. RESULTS: Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. CONCLUSION: In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.

Humans , Male , Female , Adult , Middle Aged , Young Adult , Testosterone/blood , Cyproterone Acetate/administration & dosage , Estradiol/blood , Estrogens/administration & dosage , Transgender Persons , Androgen Antagonists/administration & dosage , Prolactin/blood , Luteinizing Hormone/blood , Retrospective Studies , Dose-Response Relationship, Drug , Drug Interactions , Estrogens/blood , Follicle Stimulating Hormone/blood
Braz. j. med. biol. res ; 51(9): e7394, 2018. tab, graf
Article in English | LILACS | ID: biblio-951756


The aim of this study was to compare muscle strength in male subjects with type 2 diabetes mellitus (DM2) with and without low plasma testosterone levels and assess the relationship between muscle strength, testosterone levels, and proinflammatory cytokines. Males (75) aged between 18 and 65 years were divided into 3 groups: control group that did not have diabetes and had a normal testosterone plasma level (>250 ng/dL), DnormalTT group that had DM2 with normal testosterone levels, and the DlowTT group that had DM2 and low plasma testosterone levels (<250 ng/dL). The age (means±SD) of the groups was 48.4±10, 52.6±7, and 54.6±7 years, respectively. Isokinetic concentric and isometric torque of knee flexors and extensors were analyzed by an isokinetic dynamometer. Plasma testosterone and proinflammatory cytokine levels were determined by chemiluminescence and ELISA, respectively. Glycemic control was analyzed by glycated hemoglobin (HbA1C). In general, concentric and isometric torques were lower and tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β plasma levels were higher in the groups with diabetes than in controls. There was no correlation between testosterone level and knee torques or proinflammatory cytokines. Concentric and isometric knee flexion and extension torque were negatively correlated with TNF-α, IL-6, and HbA1C. IL-6 and TNF-α were positively correlated with HbA1C. The results of this study demonstrated that muscle strength was not associated with testosterone levels in men with DM2. Low muscle strength was associated with inflammatory markers and poor glycemic control.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Testosterone/blood , Cytokines/blood , Diabetes Mellitus, Type 2/physiopathology , Diabetes Mellitus, Type 2/blood , Muscle Strength/physiology , Interleukin-6/blood , Tumor Necrosis Factor-alpha/blood , Inflammation Mediators/blood , Torque , Isometric Contraction/physiology , Knee
Int. j. morphol ; 35(4): 1342-1347, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-893139


SUMMARY: Morphine is one of the naturally occurring phenanthrene alkaloids of opium that induces adverse effects on male reproductive system. Resveratrol is a phytoestrogen and antioxidant of red grape. The main goal is to investigate whether resveratrol could inhibit adverse effects of morphine on sperm cell viability, count, motility as well as testis histology, testosterone hormone and nitric oxide levels in mice. In the present study, 48 male rats were randomly divided into 8 groups (n=6) and were treated intraperitoneally for 14 days with normal saline, resveratrol (2, 8, 20 mg/kg/day), morphine (20 mg/kg/day) and morphine (20 mg/kg/day) + resveratrol (2, 8, 20 mg/kg/day). At the end of experiments, sperm parameters (sperm cell viability, count, motility and morphology), testis weight, the diameter of seminiferous tubules, testosterone hormone level and nitric oxide were analyzed. The data were analyzed by SPSS software for windows (version 20) using one-way ANOVA test followed by Tukey's post hoc test, and P<0.05 was considered significant. The results indicated that morphine administration significantly decreased testosterone level, count, viability and motility of sperm cells and testis weight and increased nitric oxide compared to the saline group (P=0.000). Administration of resveratrol and resveratrol plus morphine significantly increased motility, count and viability of sperm cells, somniferous tubule diameter and testosterone, while it decreased nitric oxide level compared to morphine group (P=0.025). It seems that resveratrol administration could increase the quality of spermatozoa and prevented morphine-induced adverse effects on sperm parameters.

RESUMEN: La morfina es uno de los alcaloides fenantreno del opio que induce efectos adversos en el sistema reproductivo masculino. El resveratrol es un fitoestrógeno y antioxidante de la uva roja. El objetivo principal de este trabajo fue investigar si el resveratrol puede inhibir los efectos adversos de la morfina sobre la viabilidad celular de los espermatozoides, el recuento y la motilidad, así como la histología de los testículos, la hormona testosterona y los niveles de óxido nítrico en ratones. Se dividieron, aleatoriamente, 48 ratas machos en 8 grupos (n = 6) y se trataron de forma intraperitoneal durante 14 días con solución salina normal, resveratrol (2, 8, 20 mg / kg / día), morfina (20 mg / kg / día ) y morfina (20 mg / kg / día) + resveratrol (2, 8, 20 mg / kg / día). Al final de los experimentos, se analizaron los parámetros espermáticos (viabilidad celular, recuento, motilidad y morfología), el peso de los testículos, el diámetro de los túbulos seminíferos, el nivel de la hormona testosterona y el óxido nítrico. Los datos fueron analizados con el software de SPSS para Windows (versión 20) usando una prueba de ANOVA de una vía seguida de la prueba post hoc de Tukey, y P <0,05 se consideró significativo. Los resultados indicaron que la administración de morfina disminuyó significativamente el nivel de testosterona, el recuento, la viabilidad y la motilidad de los espermatozoides y el peso de los testículos, además del aumento de óxido nítrico en comparación con el grupo salino (p = 0,000). La administración de resveratrol y resveratrol más morfina aumentó significativamente la motilidad, el recuento y la viabilidad de los espermatozoides, el diámetro de los túbulos seminíferos y la testosterona, mientras que disminuyó el nivel de óxido nítrico comparado con el grupo morfina (p = 0,025). En conclusión, la administración de resveratrol podría aumentar la calidad de los espermatozoides y prevenir los efectos adversos inducidos por la morfina sobre los parámetros espermáticos.

Animals , Male , Rats , Stilbenes/administration & dosage , Genitalia, Male/drug effects , Morphine/toxicity , Sperm Motility , Spermatogenesis/drug effects , Testis/drug effects , Testosterone/blood , Nitric Oxide/blood
Int. j. morphol ; 35(4): 1607-1613, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-893175


SUMMARY: The purpose of this study was to compare different methods of maturity evaluation and their relation with performance-related physical and anthropometric variables in young soccer players, with different plasma zinc status. A total of 53 healthy male young soccer players (age: 13±1 years; body mass: 48±10 kg; stature: 160±10 cm) participated in this study. Variables from physical fitness (stature, ST; fat-free mass, FFM; handgrip strength in the dominant hand, DHS), testosterone and zinc plasma concentration were measured. Biological maturity was evaluated by sexual maturity (development of: pubic hair, PH; genitals, GD; axillary hair; AH), bone maturity (TW3 method; BA), and testosterone plasma concentration methods. We observed that: (i) the frequency of hypozincemics and normozincemics children stratified by BA-CA, PH and GD were similar in each category; (ii) the BA allowed the identification of differences between the three categories, in at least two performance-related variables (FFM and DHS, p<0.0001); (iii) the AH method was able to discriminate only for DHS (p<0.0001); and (iv) the testosterone method was not able to identify differences between the four maturation categories with regard to ST, FFM, and DHS. Results suggested that Zinc deficiency did not influence the results obtained for the maturation categories defined by the different assessment methods. The assessment of biological maturation by BA seems to be the most effective for the stratification of performance-related and anthropometric variables in young soccer players. Nevertheless, the AH method should also be considered as a fair option to be used in field studies and practice.

RESUMEN: El objetivo de este estudio fue comparar diferentes métodos de evaluación de madurez y su relación con variables físicas y antropométricas relacionadas con el desempeño en jóvenes jugadores de fútbol, con diferentes niveles plasmáticos de zinc. Participaron en este estudio 53 jugadores de fútbol jóvenes sanos (edad: 13 ± 1 años, masa corporal: 48 ± 10 kg, estatura: 160 ± 10 cm). Se midieron las variables de la aptitud física (estatura, ST, masa libre de grasa, FFM, fuerza de agarre en la mano dominante, DHS), testosterona y concentración plasmática de zinc. Se evaluaron la madurez sexual (desarrollo de vello púbico, PH, genitales, DG, cabello axilar, AH), madurez ósea (método TW3, BA) y concentración plasmática de testosterona. Se observó que: (i) la frecuencia de los niños hipoxincémicos y normozincémicos estratificados por BA-CA, PH y GD fueron similares en cada categoría; (ii) el BA permitió la identificación de diferencias entre las tres categorías, en al menos dos variables relacionadas con el desempeño (FFM y DHS, p <0,0001); (iii) el método AH fue capaz de discriminar sólo para DHS (p <0,0001); y (iv) el método de testosterona no fue capaz de identificar diferencias entre las cuatro categorías de maduración con respecto a ST, FFM y DHS. Los resultados sugirieron que la deficiencia de zinc no influyó en los resultados obtenidos para las categorías de maduración definidas por los diferentes métodos de evaluación. La evaluación de la maduración biológica por BA parece ser la más efectiva para la estratificación de variables de rendimiento y antropométricas en jóvenes jugadores de fútbol. Sin embargo, el método AH también debe ser considerado como una opción justa para ser utilizado en estudios de campo y práctica.

Humans , Male , Child , Adolescent , Adolescent Development , Anthropometry/methods , Child Development , Soccer , Brazil , Growth , Nutritional Status , Physical Fitness , Puberty , Testosterone/blood , Zinc/blood
Int. braz. j. urol ; 43(5): 957-965, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-892904


ABSTRACT Purpose: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation. Materials and Methods: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis. The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy. Results: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29μm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood. Conclusion: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.

Animals , Male , Rats , Prostate/pathology , Prostate/ultrastructure , Testosterone/blood , Orchiectomy , Hormone Replacement Therapy , Androgens/deficiency , Prostate/drug effects , Rats, Sprague-Dawley
Rev. Assoc. Med. Bras. (1992) ; 63(8): 704-710, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-896386


Summary Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

Resumo Objetivo: Avaliar a relação entre testosterona sérica total (TT) e grau do câncer de próstata (CP) e o efeito da raça e de características demográficas sobre essa associação. Método: Foram analisados 695 pacientes submetidos a prostatectomia radical (PR), dos quais 423 tinham medidas dos níveis séricos de TT. Os pacientes foram classificados como portadores de hipogonadismo ou eugonadismo com base em dois limites de testosterona: limite 1 (300 ng/dL) e limite 2 (250 ng/dL). Avaliou-se a relação entre nível de TT e escore Gleason (GS) ≥ 7 em amostras de PR. Os resultados foram avaliados por análises univariada e multivariada, com ajuste para raça e outros fatores prognósticos demográficos. Resultados: Do total de 423 pacientes, 37,8% apresentavam hipogonadismo com base no limite 1, e 23,9% com base no limite 2. Os pacientes com hipogonadismo, independentemente do limite de referência, tiveram uma chance maior de GS ≥ 7 (OR 1,79, p=0,02 e OR 2,08, p=0,012, respectivamente). Na análise multivariada, após ajuste para idade, TT, índice de massa corporal (IMC) e raça, baixo TT (p=0,023) e idade (p=0,002) foram considerados fatores de risco independentes para GS ≥ 7. Entre os indivíduos negros, baixo TT sérico foi mais preditivo de doença de alto grau em comparação com os brancos (p=0,02). Conclusão: O hipogonadismo é independentemente associado a escores mais altos de GS no CP localizado. O efeito dessa associação é significativamente mais pronunciado entre homens negros, o que poderia explicar, em parte, as características agressivas do CP observadas nessa população.

Humans , Male , Prostatic Neoplasms/blood , Testosterone/deficiency , Testosterone/blood , Prostate-Specific Antigen/blood , Hypogonadism/blood , Prognosis , Prostatic Neoplasms/complications , Prostatic Neoplasms/ethnology , Prostatic Neoplasms/pathology , Retrospective Studies , Risk Factors , Neoplasm Grading , Hypogonadism/complications , Hypogonadism/ethnology
Ann. hepatol ; 16(3): 382-394, May.-Jun. 2017. tab, graf
Article in English | LILACS | ID: biblio-887250


ABSTRACT Introduction and aim. Endogenous sex hormones are associated with the risk of diabetes and metabolic syndrome. Recent studies suggested the role of these hormones in nonalcoholic fatty liver disease (NAFLD). We conducted a systematic review and meta-analysis of observational studies investigating the association between sex hormones and NAFLD. Material and methods. A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through April 2016. The inclusion criterion was the observational studies that assessed the association of serum total testosterone (TT) and sex-hormone binding globulin (SHBG) and NAFLD. We calculated pooled effect estimates of TT and SHBG with 95% confidence intervals (Cl) comparing between subjects with and without NAFLD by using random-effects model. Results. Sixteen trials comprising 13,721 men and 5,840 women met the inclusion criteria. TT levels were lower in men with NAFLD (MD = -2.78 nmol/l, 95%CI -3.40 to -2.15, I2 = 99%) than in those without. Men with higher TT levels had lower odds of NAFLD whereas higher TT levels increased the odds of NAFLD in women. In both sexes, SHBG levels were lower in patients with NAFLD than controls and this inverse association was stronger in women than men and higher SHBG levels were associated with reduced odds of NAFLD. Conclusion. Our meta-analysis demonstrated a sex-dependent association between TT and NAFLD. Lower TT levels are associated with men with NAFLD and inversely associated with women with NAFLD, whereas higher SHBG levels are associated with lower NAFLD odds in both men and women.

Humans , Testosterone/blood , Sex Hormone-Binding Globulin/analysis , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/etiology , Non-alcoholic Fatty Liver Disease/blood , Biomarkers/blood , Odds Ratio , Sex Factors , Risk Factors
Int. braz. j. urol ; 43(2): 317-324, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-840825


ABSTRACT Objective To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. Materials and Methods A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and total cholesterol were measured. The independent-samples t-test was used to compare the pre- and post-treatment scores of the patients. Results The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). Conclusion A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

Humans , Male , Adult , Aged , Penile Erection/drug effects , Ejaculation/drug effects , Phosphodiesterase 5 Inhibitors/administration & dosage , Lower Urinary Tract Symptoms/drug therapy , Premature Ejaculation/drug therapy , Tadalafil/administration & dosage , Erectile Dysfunction/drug therapy , Testosterone/blood , Time Factors , Blood Glucose/analysis , Penile Erection/physiology , Drug Administration Schedule , Cholesterol/blood , Surveys and Questionnaires , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Ejaculation/physiology , Lower Urinary Tract Symptoms/physiopathology , Premature Ejaculation/physiopathology , Erectile Dysfunction/physiopathology , Middle Aged