Drug adulteration of sexual enhancement supplements: a worldwide insidious public health threat.

Worldwide, the consumption of dietary supplements for the enhancement of sexual performance is common. Consumers are generally fond of these products because they often want to avoid drugs, preferring "natural" than "chemical" solutions. This is challenging, as many of these supplements labelled "herbal" or "natural" are actually adulterated with drugs, mainly phosphodiesterase-5 inhibitors. This phenomenon is facilitated by fewer demanding regulations for marketing supplements. Thus, consumers may be widely exposed to serious adverse events, such as acute liver injury, kidney failure, pulmonary embolism, stroke or even death. We aim to warn physicians about this issue. This multidisciplinary review simultaneously deals with clinical consequences of this phenomenon, analytical toxicology and regulation. Indeed, after outlining this worldwide issue and highlighting that a drug-adulterated dietary supplement is actually a falsified drug, we discuss its main contributing factors. Then, we describe some examples of adverse events of which a case of sildenafil-tadalafil-induced ischaemic stroke that benefited medical care in our hospital. Furthermore, we present some means to avoid adulteration and discuss their limitations that may be explained by the heterogeneity of the regulation of dietary supplements between countries. Doing so, we point out the requirement of a global harmonization of this regulation for an efficient eradication of this public health threat. Meanwhile, dietary supplements should be considered adulterated until proven otherwise. Thus, we encourage physicians to investigate these products in the drug histories of their patients, especially when clinical conditions cannot be explained by classical aetiologies.

Sexual health in cancer: the results of a survey exploring practices, attitudes, knowledge, communication, and professional interactions in oncology healthcare providers.

PURPOSE: To assess, focusing on population of healthcare professionals providing oncosexology care to men with cancer, clinical practice, attitudes, knowledge, communication, and professional interaction. METHODS: We performed a descriptive cross-sectional study with an online self-administered e-questionnaire addressed to all medical, paramedical, or administrative professionals attending the 4th "Cancer, Sexuality and Fertility" Meeting in Toulouse, France. Their participation was voluntary and totally anonymous. RESULTS: The 165 respondents comprised 44% of physicians, 47% of paramedics, and 9% of other health professionals in oncology, from all French regions. Paramedics were significantly younger than physicians (p = .006). One third of respondents were degreed in sexology, but 75.8% were in demand of oncosexology-specific trainings, particularly paramedics (p = .029). Regarding the oncosexology network, respondents declared being linked to organ specialists (56.8%), psychologists (49.5%), oncologists (47.4%), nurses (31.5%), radiation therapists (27.4%), and general practitioners (25.3%). Compared to paramedics, physicians were more likely to be engaged in oncosexology care (p = .039) and couple counseling (p = .005), but the proportions of counseled patients or couple were identical (p = .430 and p = .252, respectively). Overall, 90% of respondents reported discussing sexuality issues with patients. Regarding the time for discussion, physicians reported communicating more at cancer announcement (p = .004) or after treatments (p = .015), while more paramedics reported discussing at another time (p = .005). Regarding the place for discussion, paramedics more frequently reported talking about sexuality in the hospital room (p = .001) or during a specific consult (p = .007). CONCLUSIONS: Results emphasize various levels for improving existing oncosexology care, such as developing oncosexology-specific educational and practical training programs, particularly for paramedics; consolidating information, counseling, and therapeutic education with formal procedures like implementing medical and paramedical "oncosexology moments," or strengthening the community-hospital networks, from diagnosis to survivorship.

Hypogonadotropic hypogonadism in men with hereditary hemochromatosis.

Hereditary hemochromatosis is a genetic disease that progresses silently. This disease is often diagnosed late when complications appear. Hypogonadotropic hypogonadism (HH) is one of the classical complications of hemochromatosis. Its frequency is declining probably because of earlier diagnosis and better informed physicians. Certain symptoms linked to HH can have an impact on a patient's sexuality, such as decreased libido, erectile dysfunction, and impairment of ejaculation, as well as on his reproductive capacities. This review is based on an online search in English, French and German language publications found in PubMed/Medline, up to 23 September 2016 using the following key word: Male infertility, Hypogonadotropic Hypogonadism, Hereditary Hemochromatosis. Thirty-four papers met these inclusion criteria. This review describes the impact of iron overload on male fertility, resulting in hypogonadotropic hypogonadism and proposes treatment modalities.

L'Hémochromatose Héréditaire est. une maladie génétique qui évolue en silence. Son diagnostic est. souvent fait tardivement, au stade des complications. Même si son incidence diminue, l'Hypogonadisme Hypogonadotrope (HH) est. l'une des complications classiques de l'Hémochromatose. Ceci est. probablement le résultat d'un diagnostic plus précoce, d'une meilleure information des médecins. Certains symptômes en lien avec l'HH, peuvent avoir un impact sur la sexualité (diminution de la libido, dysfonction érectile ou troubles de l'éjaculation…) ainsi que sur la reproduction.Cette revue repose sur une recherche online en langue anglaise, française et allemande de publications disponibles sur PubMed/Medline, jusqu'au 23 sept. 2016 à partir des mots clés suivants: infertilité masculine, hypogonadisme hypogonadotrope, Hémochromatose Héréditaire. Trente quatre publications ont satisfait aux critères de sélection. Cet article de revue décrit l'impact d'une surcharge en fer sur la fertilité masculine, notamment via l'Hypogonadisme Hypogonadotrope qu'elle induit et propose des modalités de traitement.

Anabolic steroids abuse and male infertility.

For several decades, testosterone and its synthetic derivatives have been used with anabolic and androgenic purposes. These substances were first restricted to professional bodybuilders, but become more and more popular among recreational athletes. Up to date, 3,000,000 anabolic-androgenic steroids (AAS) users have been reported in the United States with an increasing prevalence, making AAS consumption a major public health growing concern. Infertility is defined by the WHO as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse and a male factor is present in up to 50 % of all infertile couples. Several conditions may be related to male infertility. Substance abuse, including AAS, is commonly associated to transient or persistent impairment on male reproductive function, through different pathways. Herein, a brief overview on AAS is offered. Steroids biochemistry, patterns of use, physiological and clinical issues are enlightened. A further review about fertility outcomes among male AAS abusers is also presented, including the classic reports on transient anabolic steroid-induced hypogonadism (ASIH), and the more recent experimental reports on structural and genetic sperm damage.

Depuis plusieurs décennies, la testostérone et ses dérivés synthétiques ont été utilisés à des fins anaboliques et androgéniques. Initialement réservées aux culturistes professionnels, ces substances ont été progressivement utilisées par les athlètes et les pratiquants de la musculation.Actuellement, pas moins de 3 millions d'utilisateurs de stéroïdes anabolisants ont été signalés aux États-Unis, et la prévalence croissante de cette utilisation fait de ce phénomène un sujet de préoccupation majeur.L'infertilité est définie comme l'incapacité à obtenir une grossesse réussie après 12 mois ou plus de rapports sexuels réguliers non protégés, le facteur masculin étant impliqué dans 30 à 50 % des cas parmi tous les couples infertiles.L'abus de substances, y compris les anabolisants, est souvent associé à une altération transitoire ou persistante sur la fonction reproductive mâle par différentes voies.Un aperçu des produits anabolisants couramment utilisés ainsi que leurs modes d'utilisation et mécanismes d'action sont présentés. Les implications sur la fertilité sont détaillées. Outre l'inhibition axiale transitoire, les dommages structurels et génétiques des spermatozoïdes, connus à ce jour, sont décrits. Enfin, la spécificité et les modalités de la prise en charge thérapeutique de cette catégorie de patients infertiles sont évoquées.