The association between serum total testosterone and progression of hyperglycemia: a 15-year prospective cohort study.

BACKGROUND: The association between low testosterone concentration and increased risk of hyperglycemia in men has been demonstrated in observational and interventional studies. However, considering a variety of confounding factors, limited population-based studies have so far been conducted. Also, no information is available regarding the effect of testosterone on progressive development of dysglycemia. OBJECTIVE: To examine the effect of total testosterone on development of pre-diabetes/diabetes in normoglycemic middle-aged and older men. MATERIALS AND METHODS: Data were obtained from the Tehran Lipid and Glucose Study, a community-based prospective cohort of an Iranian population. Analyses were conducted on 903 normoglycemic eligible men aged 30-70 years. An illness-death model was applied to estimate the probabilities of three transitional phases of normoglycemia→diabetes, normoglycemia→pre-diabetes, and pre-diabetes→diabetes. RESULTS: Over a median follow-up of 12 years, 0.9% individuals developed diabetes. Per unit increase (ng/mL) in testosterone concentration, the transition rate from normoglycemia to pre-diabetes decreased by 6% [hazard ratios (HRs): 0.94 (95% confidence interval (CI): 0.90, 0.99)]. However, no effect for testosterone on the progression of diabetes from normoglycemia or pre-diabetes was observed [HRs: 0.79 (95% CI: 0.44, 1.41) and 0.98 (95% CI: 0.84, 1.16), respectively]. High body mass index was a strong predictor of hyperglycemia within all transitions. DISCUSSION: Independent of major confounding factors, low testosterone was associated with normoglycemia progression to pre-diabetes, but not with pre-diabetes to diabetes, which might indirectly highlight the stronger impact of other risk factors after occurrence of pre-diabetes. CONCLUSION: Low testosterone concentrations in men are associated with progression from normoglycemia to pre-diabetes, but not from pre-diabetes to diabetes.

Prediction of age at menopause in women with polycystic ovary syndrome.

OBJECTIVE: Considering the role of anti-Müllerian hormone (AMH) in female fertility and its high levels in women with polycystic ovary syndrome (PCOS), the longer reproductive span of these women is in doubt. In the present study, we aimed to improve earlier predictions using a non-linear model to substantiate the question as to whether PCOS women reach menopause later. METHODS: In total, 1162 women aged 20-50 years, comprising 378 PCOS cases and 784 eumenorrheic non-hirsute women, met the eligibility criteria. A scatterplot matrix was drawn to detect the association between age and AMH; this association was explored using a fractional polynomial regression model. Model assumptions were checked by examining the distribution of the residuals and plotting the standardized residuals against the functional form of AMH. RESULTS: The serum concentration of AMH among PCOS participants was significantly higher than in the controls (5.4 ng/ml (IQR 2.8-9.1 ng/ml) vs. 1.4 ng/ml (IQR 0.6-2.7 ng/ml), p < 0.001). The estimated mean age at menopause was 51.4 (95% CI 45-59) years and 49.7 (95% CI 45-55) years in PCOS cases and healthy controls, respectively. CONCLUSIONS: These findings provide the insight that, as reflected through significantly higher average levels of AMH in PCOS women, their predicted reproductive lifespan could be 2 years longer than their normo-ovulatory counterparts.

Women self-perception of excess hair growth, as a predictor of clinical hirsutism: a population-based study.

PURPOSE: Hirsutism is the most common indicator of hyperandrogenism. Both, the sensitivity of the patients to the serum androgen levels and the responsiveness of women to the perceived excess hair growth vary among different populations. This report elaborates the relationship between the woman's discerned abnormal hair growths with the clinical diagnosis of hirsutism. METHODS: The survey was conducted among 1160 women aged 18-45 and randomly selected from Tehran Lipid and Glucose Study for further detailed assessment of Hirsutism; using the m-FG scoring method. Data gathering was performed by interviews and physical examinations. The receiver operating characteristic curve was drawn and the new cutoff value, sensitivity, specificity and concordance percentage were calculated. RESULTS: The results demonstrated that among 12 androgen-dependent body areas, the chin skin had the highest area under curve of 0.81 (CI; 0.78-0.84). According to the patient's evaluation, a threshold point of 4 had the optimum concordance percentage of 0.77 with the modified Ferriman-Gallwey scoring system. CONCLUSIONS: Patient's self-identification of excess terminal hair based on the chin area has great sensitivity and reliability in predicting the clinical hirsutism.