Prospective assessment of health‐related quality of life in men with late‐onset hypogonadism who received testosterone replacement therapy

The objective of this study was to characterise the status of health‐related quality of life (HRQOL) in Japanese men with late‐onset hypogonadism (LOH) treated with testosterone replacement therapy (TRT). HRQOL in 69 consecutive Japanese men with LOH undergoing TRT for at least 6 months was prospectively evaluated before and 6 months after the initiation of TRT using the Medical Outcomes Study 8‐Item Short‐Form Health Survey (SF‐8). All eight‐scale scores except for bodily pain (BP) in the 69 patients at 6 months after the introduction of TRT significantly improved compared with those before TRT; however, all scale scores except for BP in the 69 patients were significantly inferior to those in age‐matched Japanese controls irrespective of the timing of SF‐8. Multivariate analyses of several parameters revealed that both age and Aging Male Symptom (AMS) score had an independent impact on mental health (MH), despite the lack of an independent association between any score and the remaining factors examined. TRT appeared to significantly improve the status of HRQOL in men with LOH; however, even after the introduction of TRT, HRQOL associated with MH remained significantly impaired in elderly men and/or those with a high AMS score.     

Kisspeptin levels in idiopathic hypogonadotropic hypogonadism diagnosed male patients and its relation with glucose-insulin dynamic

Male hypogonadism is defined as the deficiency of testosterone or sperm production synthesized by testicles or the deficiency of both. The reasons for hypogonadism may be primary, meaning testicular or secondary, meaning hypothalamohypophyseal. In hypogonadotropic hypogonadism (HH), there is indeficiency in gonadotropic hormones due to hypothalamic or hypophyseal reasons. Gonadotropin-releasing hormone (GnRH) is an important stimulant in releasing follicular stimulant hormone (FSH), mainly luteinizing hormone (LH). GnRH omitted is under the effect of many hormonal or stimulating factors. Kisspeptin is present in many places of the body, mostly in hypothalamic anteroventral periventricular nucleus and arcuate nucleus. Kisspeptin has a suppressor effect on the metastasis of many tumors such as breast cancer and malign melanoma metastases, and is called “metastin” for this reason. Kisspeptin is a strong stimulant of GnRH. In idiopathic hypogonadotropic hypogonadism (IHH) etiology, there is gonadotropic hormone release indeficiency which cannot be clearly described.

A total of 30 male hypogonatropic hypogonadism diagnosed patients over 30 years of age who have applied to Haydarpasa Education Hospital Endocrinology and Metabolic Diseases Service were included in the study. Compared to the control group, the effect of kisspeptin on male patients with hypogonatropic hypogonadism and on insulin resistance developing in hypogonadism patients was investigated in our study.

A statistically significant difference was detected between average kisspeptin measurements of the groups (p?The reason for high kisspeptin levels in the patient group compared to the control group makes us consider that there may be a GPR54 resistance or GnRH neuronal transfer pathway defect. When patients and control groups were compared for HOMA-IR, the difference was not statistically significant. It is considered that kisspeptin is one of the reasons for hypogonatropic hypogonadism and has less effect on insulin resistance.     

When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction?

In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain. The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels. Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism. In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature. The key words used were “varicocele and hypogonadism” and “varicocele surgery and testosterone.” We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.     

肾虚肝郁证迟发性性腺功能减退症大鼠模型的建立与评价

目的 建立“肾虚肝郁证”迟发性性腺功能减退症(Late onset hypogonadism,LOH)动物模型,并对其进行评价.方法 以中医理论“房劳过度伤肾”、“郁久伤肝”为指导,采用“退役种鼠(40周龄)+复合情志刺激+孤养”方法,建立“肾虚肝郁证”LOH动物模型,与正常组(8周龄)比较,以血清总睾酮、悬尾实验、睾丸间质细胞超微结构、睾酮合成相关酶以及Caspase-3 mRNA和蛋白表达为指标.结果 模型组大鼠出现一系列典型的LOH精神、心理、体能改变,与正常组比较,模型组大鼠血清总睾酮水平明显降低,悬尾不动时间显著延长,睾丸组织Caspase-3 mRNA和蛋白表达增强,睾酮合成相关酶类固醇激素合成急性调节蛋白(Steroidogenic Acute Regulatory Protein,StAR)[13]、细胞色素胆固醇侧链裂解酶(Cytochrome P450side-chain cleavage,P450scc)[14]、3β-羟甾脱氢酶(3beta-hydroxysteroid dehydrogenase,3β-HSD) mRNA和蛋白表达下降,差异均有统计学意义(P＜0.01);模型组睾丸间质变少,睾丸间质细胞线粒体数量减少,出现水肿,线粒体嵴消失.结论 “退役种鼠+复合情志刺激+孤养”方法复制“肾虚肝郁证”LOH模型切实可行,有较高的实用价值.     

男童性腺功能低下的诊治进展

男童性腺功能低下在儿科内分泌临床较为常见,主要表现为青春期延迟,性发育不良和下丘脑-垂体-性腺轴功能低下。按病因分为两大类:原发性性腺功能低下和继发性性腺功能低下(低促性腺激素性性腺功能低下)。男性儿童及青少年常因性腺功能低下就诊于儿科内分泌临床,而新生儿期及婴幼儿期的性腺功能低下却往往被忽视。目前对男童性腺功能低下的诊断和处理存在不少争议和困难,本文就此问题进行讨论,期望对儿科临床医生有所帮助。