Breed Differences in Serum Testosterone Levels of Male Pigs Are Highly Correlated with Differences in Testicular mRNA Levels of Enzymes and Proteins Involved in Testosterone Biosynthesis Process.

To clarify the causes of breed differences in serum testosterone levels of male pigs, which affect the mRNA expression of drug metabolizing enzymes and drug transporters in the liver and kidney, we focused on testicular enzymes and proteins involved in testosterone biosynthesis process and comparatively examined their mRNA levels by real time RT-PCR among low serum testosterone-type Landrace pigs and high serum testosterone-type Meishan and Landrace/Meishan-crossbreed (LM and ML) pigs. Testicular mRNA levels of the enzymes (3-hydroxy-3-methylglutaryl-CoA synthase 1 and 3-hydroxy-3-methylglutaryl-CoA reductase) and proteins (low density lipoprotein receptor and scavenger receptor class B member 1) affecting intracellular levels of cholesterol, a precursor of testosterone, were 2-5-fold higher in Meishan, LM and ML pigs than in Landrace pigs. Likewise, the mRNA levels of steroidogenic acute regulatory protein, which imports cholesterol to the inner mitochondrial membrane, and of testosterone biosynthesis enzymes (CYP11A1 and CYP17A1) were over 10-fold and approximately 3-fold higher, respectively, in Meishan, LM and ML pigs than in Landrace pigs. Furthermore, positive correlations between those mRNA levels and serum testosterone levels were observed. Despite large breed differences in testicular mRNA levels described above, no significant breed differences in intratesticular testosterone levels were observed. The present findings strongly suggest that breed differences in serum testosterone levels of male pigs are probably, at least in part, caused by differences in testicular mRNA levels of enzymes and proteins involved in testosterone biosynthesis process and by differences in the levels of testosterone released from testes.

Viabilidad de la varicocelectomía subinguinal con gafas de aumento en el tratamiento de la infertilidad masculina / Feasibility of loupe assisted subinguinal varicocelectomy in treatment of male infertility

Objetivos: Evaluar el impacto de la varicocelectomía subinguinal con gafas de aumento sobre la calidad del semen, el nivel de testosterona sérica y las tasas de embarazo espontáneo.MétodosSe recogieron datos de forma prospectiva de 102 hombres infértiles con varicocele clínico. Se compararon los valores preoperatorios de los parámetros de análisis de semen y el nivel de testosterona sérica con los valores postoperatorios a los 6 meses. Se evaluó la tasa de embarazo espontáneo a los 6 meses.ResultadosLa edad media de los pacientes era de 31,56±4,31 años. Se registró infertilidad primaria en 86 pacientes e infertilidad secundaria en 16. Se observó varicocele bilateral en 79 pacientes y varicocele unilateral en 23. La concentración total de espermatozoides (×106/ml) antes y después de la varicocelectomía fue de 12,82±3,91 y 20,06±2,13, respectivamente (p<0,0001). La motilidad espermática total (%) pre y posvaricocelectomía fue de 37,67±7,23 y 55,46±4,51 respectivamente (p<0,0001). La morfología espermática (criterios estrictos de morfología Kruger, %) antes y después de la varicocelectomía fue de 3,11±0,80 y 3,70±0,78, respectivamente (p<0,0001). El nivel de testosterona sérica (ng/dl) antes y después de la varicocelectomía fue de 323,90±67,81 y 396,74±40,88 respectivamente (p<0,0001). La tasa de embarazo espontáneo en las parejas con infertilidad primaria y secundaria fue de 18,60% y 31,25%, respectivamente. La diferencia de tasas no fue significativa (p=0,251). La tasa global de embarazo espontáneo fue del 20,5%.ConclusiónLa varicocelectomía subinguinal con gafas de aumento es una modalidad segura y eficaz para el tratamiento de varones infértiles, especialmente cuando no se dispone de medios para la cirugía microscópica. Sin embargo, solo los estudios comparativos de gran tamaño o los ensayos multicéntricos pueden confirmarlo. (AU)

Objectives: To study the impact of loupe assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate.MethodsThe data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months.ResultsThe mean age of patients was 31.56±4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (x106/ml) before and after varicocelectomy was 12.82±3.91 and 20.06±2.13 respectively (P<.0001). The total sperm motility (%) before and after varicocelectomy was 37.67±7.23 and 55.46±4.51 respectively (P<.0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11±0.80 and 3.70±0.78 respectively (P<.0001). The serum testosterone level (ng/dl) before and after varicocelectomy was 323.90±67.81 and 396.74±40.88 respectively (p<0.0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (P=.251). The overall spontaneous pregnancy rate was 20.5%.ConclusionLoupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large size comparative studies or multi-centric trials can confirm this. (AU)

Testosterone Replacement Therapy in Chronic Kidney Disease Patients.

(Background) The aim of our study was to evaluate the efficacy and safety of testosterone replacement therapy (TRT) in men with chronic kidney disease and hypogonadism on conservative and hemodialysis treatment. (Methods) The studied population consisted of 38 men on hemodialysis (HD), 46 men with CKD stages II-IV (predialysis group, PreD) and 35 men without kidney disease who were similar in age to others (control group). Serum total testosterone level (TT) was measured, and free testosterone level (fT) was calculated. Hypogonadism criteria according to the EAU definition were fulfilled by 26 men on HD (68.4%) and by 24 men from the PreD group (52%). Testosterone replacement therapy (TRT) with testosterone enanthate in intramuscular injections every 3 weeks was applied in 15 men from HD and in 14 men from PreD. The safety of TRT was monitored by measuring PSA and overhydration. (Results) A significant rise of TT and fT was observed after 3 months of TRT, but no significant changes were observed after 6 and 12 months in the HD and PreD group. An intensity of clinical symptoms of hypogonadism measured by ADAM (androgen deficiency in the ageing male) questionnaire gradually decreased, and the intensity of erectile dysfunction measured by the IIEF-5 (international index of erectile functioning) questionnaire also decreased after 3, 6 and 12 months of TRT in the HD and PreD group. (Conclusions) The applied model of TRT is effective in the correction of clinical signs of hypogonadism without a significant risk of overhydration or PSA changes.

Feasibility of loupe assisted subinguinal varicocelectomy in treatment of male infertility.

OBJECTIVES: To study the impact of loupe assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate. METHODS: The data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months. RESULTS: The mean age of patients was 31.56 ±â€¯4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (×106/mL) before and after varicocelectomy was 12.82 ±â€¯3.91 and 20.06 ±â€¯2.13 respectively (P < .0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ±â€¯7.23 and 55.46 ±â€¯4.51 respectively (P < .0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11 ±â€¯0.80 and 3.70 ±â€¯0.78 respectively (P < .0001). The serum testosterone level (ng/dL) before and after varicocelectomy was 323.90 ±â€¯67.81 and 396.74 ±â€¯40.88 respectively (P < .0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (P = .251). The overall spontaneous pregnancy rate was 20.5%. CONCLUSION: Loupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large size comparative studies or multi-centric trials can confirm this.

SERUM HORMONE CONCENTRATIONS IN TRANSGENDER INDIVIDUALS RECEIVING GENDER-AFFIRMING HORMONE THERAPY: A LONGITUDINAL RETROSPECTIVE COHORT STUDY.

OBJECTIVE: To examine the association of various gender-affirming hormone therapy regimens with blood sex hormone concentrations in transgender individuals. METHODS: This retrospective study included transgender people receiving gender-affirming hormone therapy between January 2000 and September 2018. Data on patient demographics, laboratory values, and hormone dose and frequency were collected. Nonparametric tests and linear regression analyses were used to identify factors associated with serum hormone concentrations. RESULTS: Overall, 196 subjects (134 transgender women and 62 transgender men), with a total of 941 clinical visits, were included in this study. Transgender men receiving transdermal testosterone had a significantly lower median concentration of serum total testosterone when compared with those receiving injectable preparations (326.0 ng/dL vs 524.5 ng/dL, respectively, P = .018). Serum total estradiol concentrations in the transgender women were higher in those receiving intramuscular estrogen compared with those receiving oral and transdermal estrogen (366.0 pg/mL vs 102.0 pg/mL vs 70.8 pg/mL, respectively, P < .001). A dose-dependent increase in the hormone levels was observed for oral estradiol (P < .001) and injectable testosterone (P = .018) but not for intramuscular and transdermal estradiol. Older age and a history of gonadectomy in both the transgender men and women were associated with significantly higher concentrations of serum gender-affirming sex hormones. CONCLUSION: In the transgender men, all routes and formulations of testosterone appeared to be equally effective in achieving concentrations in the male range. The intramuscular injections of estradiol resulted in the highest serum concentrations of estradiol, whereas transdermal estradiol resulted in the lowest concentration. There was positive relationship between both oral estradiol and injectable testosterone dose and serum sex hormone concentrations in transgender people receiving GAHT.