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Anthropometric parameters in hypogonadal men with a history of cardiovascular disease receiving long-term testosterone therapy.
Source publication
Purpose
Erectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whet...
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Aims
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Materials and Methods
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Citations
... It has also been demonstrated that low testosterone levels are associated with major adverse cardiovascular events (MACEs) and a higher lethality of MACEs in patients with ED [12,13]. Moreover, it has been revealed that, in hypogonadal men with a history of CVD, testosterone replacement therapy improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors [14]. Thus, men with ED should be screened for comorbidities. ...
Background: Erectile dysfunction (ED) most often has vascular etiology and usually is the earliest symptom of vascular dysfunction. The aim of this study was to evaluate vascular dysfunction with the use of the Flow-Mediated Skin Fluorescence (FMSF) technique in men with and without ED. Methods: Included were 39 men (median age 53) with ED and 40 men (median age 41.5) without ED. Medical interview, physical examination, and anthropometrical measurements were performed for all participants. The serum total testosterone, LH, and SHBG determinations were performed in patients with ED, and the Free Testosterone Index (FTI) was calculated. The FMSF technique was used to measure the microcirculatory oscillations at the baseline and to determine the flowmotion (FM) and vasomotion (VM) parameters. The Normoxia Oscillatory Index (NOI) was calculated, which represents the contribution of the endothelial (ENDO) and neurogenic (NEURO) oscillations relative to all oscillations detected at low-frequency intervals (<0.15 Hz): NOI = (ENDO + NEURO)/(ENDO + NEURO + VM). Results: In men with ED were found significantly lower FM and VM parameters, but the NOI was significantly higher in comparison to men without ED. VM and FM correlated significantly positively with erectile function, orgasmic function, and general sexual satisfaction in the whole group and the FTI in the ED group. The thresholds of 53.5 FM (AUC = 0.7) and 8.4 VM (AUC = 0.7) were predictive values for discriminating men with ED. Conclusions: It was shown that the FMSF diagnostic technique may be helpful in the early diagnosis of microcirculation dysfunction due to impaired vasomotion caused by decreased testosterone activity.
... In a placebo-controlled study, patients with late-onset hypogonadism were treated with Tribulus terrestris vs. a placebo for erectile dysfunction and symptoms of the lower urinary tract. This study confirmed the results of other studies relating to the potent impact of this herbal remedy on boosting testosterone levels and enhancing sexual performance in patients with erectile dysfunction and partial androgen insufficiency [41]. ...
... For instance, research that appeared in the Journal of Rheumatology discovered that more than half of males with RA reported experiencing some sort of sexual dysfunction. Men with RA exhibited a higher prevalence of ED than men without RA (55% vs. 30%), according to a different study published in The Journal of Sexual Medicine [41]. ...
Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments.
... Все большее количество фактических научных данных показывает ключевую роль половых стероидных гормонов (прежде всего, андрогенов и эстрогенов) в обеспечении общего здоровья и профилактики различных возраст-ассоциированных патологических состояний и заболеваний у обоих полов. В частности, андрогены у мужчин благоприятно влияют на композиционный состав тела [1], костно-мышечную систему [2,3], когнитивные функции [4][5][6], показатели кардиометаболического здоровья [7,8], иммунитет [9] и целый ряд других показателей мужского здоровья. Помимо влияния на соматические расстройства и симптомы, проведенные исследования также показали, что половые стероиды (в частности, тестостерон) играют важную роль в психическом здоровье и патофизиологии психических и нейро-дегенеративных расстройств у мужчин [10][11][12]. ...
Sex steroid hormones (androgens, estrogens) play a critical role in the endocrine regulation of human body functions in normal and in various pathologies. Numerous complex mechanisms of their transportation from the site of synthesis to target cells are involved in the process of realization of their functions by sex steroid hormones, among which the most important role is played by sex steroids binding globulin (SSBG), synthesized in the liver and entering the systemic circulation. Until recently, SSBG was considered practically only as a specific transport system of sex steroids (androgens, estrogens) to target cells. Early studies have demonstrated an increase in the SSBG level in the blood as a person’s age increases, however, only relatively recently a polymorphism of the SSBG gene was established, which determines the genetically determined different degree of affinity of this transport protein to sex steroid hormones (androgens, estrogens) in different people, which allows us to consider SSBG not only as a unique individual transport protein of blood, but also as a unique serum regulator of the activity and tissue bioavailability of sex steroids. Modern studies have also shown close interrelations of the serum level of GSPS with some human diseases, which allows us to consider this transport protein not only as their potential serological marker, but as a direct independent mechanism of their pathogenesis.
... The beginning of cardiovascular and metabolic illnesses may be predicted by ED, sometimes by as much as 5 years [27]. ...
... On the other hand, studies have sustained negative relationship between low serum T levels and increased risk of cardiovascular disease, and both cardiovascular and all-cause mortality (40,41). Other studies have indeed suggested that both ED and testosterone status may independently predict subsequent CVD-related events and mortality, particularly in the presence of cardiometabolic risk factors (42,43), possibly due to systemic inflammation which participates in the activation of innate and adaptive immune cells and contributes to tissue damage, atherosclerosis, and insulin resistance, together with the other mechanisms. Furthermore, the role of testosterone as arterial vasodilator within the coronary circulation and other vascular beds is well known (44). ...
The history of diagnosing hypogonadism and hypotestosteronemia shows us the many steps that were necessary to achieve our current knowledge and the ability to improve these patients’ well-being. Moreover, so far, criteria for diagnosing hypotestosteronemia varies according to the underlying condition, and according to the consensus or guideline adopted. Furthermore, besides the many signs and symptoms, there are several complications associated with low testosterone levels such as osteoporosis, metabolic alterations, as well as cardiovascular disorders. However, data are often conflicting regarding the severity, timing or even the real clinical relevance of these complications, although these studies often lack essential information such as gonadotropin levels or the underlying cause of hypogonadism. The present review focus on the complications of male hypogonadism according to the cause of testosterone deficiency, highlighting the lack of information found in many studies investigating its effects. We thereby stress the necessity to always perform a complete evaluation of the type of hypogonadism (including at least gonadotropins and secondary causes) when investigating the effects of low testosterone levels.
... Erectile dysfunction (ED) is defined as the persistent inability to achieve and maintain an erection hard enough to permit satisfactory sexual intercourse [1]. According to the five-item International Index of Erectile Function questionnaire (IIEF-5) score, ED severity is classified on severe (score 1-7), moderate (8)(9)(10)(11), mild-moderate (12)(13)(14)(15)(16), mild (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25) [2]. ED has become a major health concern even in younger men, causing a significant impact on men's quality of life [3]. ...
... Six papers studied the effect of testosterone therapy (TT) to improve ED as a single therapy in hypogonadal men [19][20][21][22][23][24], with different formulations. All of them showed a benefit of the TT, according to the scores of the IIEF-EF or the IIEF-5. ...
... Hormone replacement therapy, both in monotherapy [19][20][21][22][23][24] and in combination with PDE5is [25], has shown significant benefits in the treatment of EF in patients with hypogonadism. This represents a reminder of the need of requesting testosterone levels in the study of patients with ED and offers hormonal treatment if needed. ...
Purpose of Review
This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Cochrane databases was done. Papers in English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports, clinical cases, or clinical trials protocols with no results were also excluded.
Recent Findings
We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal theraphy, psycho-sexual theraphy). However, others (some new molecules, stem cell theraphy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations.
Summary
Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as effective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.
... Testosterone deficiency is highly general in established CVD (Feldman et al. 2002). Previous research has also shown that testosterone can be a beneficial therapeutic agent for CVD (Alwani et al. 2021). Testosterone Undecanoate (TU) is an ester precursor of testosterone, when taken orally, it is absorbed through some intestinal lymphatic pathways and thus undergoes the first-pass metabolism circulating in the liver (Shackleford et al. 2003). ...
Purpose
Atherosclerosis is a lipid-driven chronic inflammatory disease that causes cardiovascular diseases (CVD). The association between radiation and atherosclerosis has already been demonstrated; however, the effects of low-dose radiation (LDR) exposure on atherosclerosis have not been reported. Our study aims to propose that LDR may cause atherosclerosis phenotypes by the upregulation of plasminogen activator inhibitor-1 (PAI-1) and downregulation of androgen receptor (AR), which are cytokines secreted from the liver.
Methods
Low-density lipoprotein (LDL) receptor deficient (Ldlr−/−) mice were irradiated at 50 mGy, 100 mGy, and 1000 mGy. LDR irradiated Ldlr−/− mice serum was analyzed by cytokine array and proteomics with silver staining. Oil Red O staining and BODIPY staining were performed to determine lipid accumulation in Human umbilical vein endothelial cells (HUVECs). Foam cell formation and monocyte recruitment were assessed through co-culture system with HUVECs and THP-1 cells.
Results
After irradiation with LDR (100 mGy) the mice showed atherosclerotic phenotypes and through analysis results, we selected regulated cytokines, PAI-1 and AR, and found that these were changed in the liver. LDR-regulated cytokines have the potential to be transported to endothelial cells and induce lipid accumulation, inflammation of monocytes, increased oxidized low-density lipoprotein (oxLDL) and foam cells formation, that were series of phenotypes lead to plaque formation in endothelial cells and induces atherosclerosis. As a further aspect of this study, testosterone undecanoate (TU) was found to pharmacologically inhibit a series of atherosclerotic phenotypes exhibited by LDR. This study suggests a role for PAI-1 and AR in regulating the development of atherosclerosis after LDR exposure. Targeting PAI-1 and AR could serve as an attractive strategy for the management of atherosclerosis following LDR exposure.
Erectile dysfunction (ED), which is defined as the inability to attain and maintain a satisfactory penile erection to sufficiently permit sexual intercourse, is a consequence and also a cause of cardiometabolic disorders like diabetes mellitus, systemic hypertension, central obesity, and dyslipidemia. Although there are mounting and convincing pieces of evidence in the literature linking ED and cardiometabolic disorders, impairment of nitric oxide-dependent vasodilatation seems to be the primary signaling pathway. Studies have also implicated the suppression of circulating testosterone, increased endothelin-1, and hyperactivation of Ang II/ATIr in the pathogenesis of ED and cardiometabolic disorders. This study provides comprehensive details of the association between cardiometabolic disorders and ED and highlights the mechanisms involved. This would open areas to be explored as therapeutic targets in the management of ED and cardiometabolic disorders. It also provides sufficient evidence establishing the need for the management of cardiometabolic disorders as an adjunct therapy in the management of ED.
Background
Previous research has shown that testosterone deficiency (TD) increases the risk of anemia, but it is unclear whether anemia affects testosterone levels. This study investigated the influence of anemia on testosterone levels.
Methods
Utilizing data from six NHANES cycles, including demographic, testosterone levels, and hemoglobin concentrations, we employed multivariable-adjusted logistic regression to investigate the relationship between anemia and testosterone levels. Moreover, a two-sample Mendelian randomization (MR) study employing genome-wide association study (GWAS) data examined the causal relationship. Kaplan–Meier survival estimation was used to compared the overall survival (OS) of anemic and nonanemic patients with low testosterone and normal testosterone levels.
Results
The inclusion of 21,786 participants (2318 with anemia and19,468 without anemia) revealed that nonanemic patients exhibited higher testosterone levels than did anemic patients (β = 22.616, 95% CI: 3.873–41.359, p = 0.01807). MR analysis confirmed anemia as a cause of TD (OR = 1.045, 95% CI: 1.020–1.071, p < 0.001). Anemic males with low testosterone had reduced OS compared to those with normal levels (p < 0.001).
Conclusions
Anemia emerged as a potential risk factor for TD, highlighting a bidirectional relationship between these conditions. Additional prospective investigations are essential for the validation and reinforcement of our findings.
