Subclinical male hypogonadism

Giannetta, Elisa; Gianfrilli, Daniele; Barbagallo, Federica; Isidori, Andrea M.; Lenzi, Andrea

doi:10.1016/j.beem.2011.12.005

Cited by 68 publications

(58 citation statements)

References 51 publications

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“…This supports the hypothesis that Leydig cell dysfunction has a role in testicular dysgenesis syndrome (27) and is supported by the finding of subclinical hormonal failure (high luteinizing hormone level or reduced testosterone level) in 24% of our patients (19 of 80 patients) (28). As pointed out by Woodward et al (20), Leydig cell tumors and seminomas can be very similar at unenhanced US; however, we demonstrated that the pharmacodynamics of microbubbles differ.…”

Section: (38)supporting

confidence: 74%

Differential Diagnosis of Nonpalpable Testicular Lesions: Qualitative and Quantitative Contrast-enhanced US of Benign and Malignant Testicular Tumors

Isidori¹,

Pozza

Gianfrilli³

et al. 2014

Radiology

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).q RSNA, 2014 Purpose:To evaluate the diagnostic accuracy of unenhanced and quantitative contrast-enhanced ultrasonography (US) in the differential diagnosis of small nonpalpable testicular lesions. Materials andMethods:The local review board approved the protocol, and all patients provided written informed consent. One hundred fifteen patients (median age, 34 years; age range, 14-61 years) with nonpalpable testicular lesions were consecutively enrolled between 2006 and 2012 and underwent unenhanced scrotal US, contrast-enhanced US, surgical enucleation, and at least 18 months of follow-up. Clinical and histologic features were recorded, and qualitative and quantitative analysis of contrast-enhanced US time-intensity curves were performed. Logistic regression analysis was performed to explore features of malignancy. Receiver operating characteristic (ROC) curves were developed for cumulative unenhanced and contrast-enhanced US scores. Results:All lesions were 1.5 cm or smaller. Forty-four of the 115 patients (38%) had malignant tumors, 42 had benign tumors (37%), and 29 (25%) had nonneoplastic lesions. Conclusion:Benign testicular tumors are frequent incidental findings. Quantitative scrotal contrast-enhanced US is a noninvasive diagnostic tool that could improve the differential diagnosis and individualized management of small testicular lesions.q RSNA, 2014

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Section: (38)supporting

confidence: 74%

Differential Diagnosis of Nonpalpable Testicular Lesions: Qualitative and Quantitative Contrast-enhanced US of Benign and Malignant Testicular Tumors

Isidori¹,

Pozza

Gianfrilli³

et al. 2014

Radiology

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103

138

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“…Hormonal findings indicate a frequent condition of compensated hypogonadism in azoospermic men. It has been hypothesized that compensated male hypogonadism represents a milder form of hypogonadism potentially associated with neurological, psychological and cardiovascular disturbances, including alterations of bone metabolism and glycolipid profile (Giannetta et al, 2012;Bobjer et al, 2016). In subjects with sexual dysfunction and in the general population (Tajar et al, 2010), those with compensated hypogonadism more often report mood impairment, including higher somatized anxiety and depressive symptoms, when compared to eugonadal patients.…”

Section: Discussionmentioning

confidence: 99%

037 Semen Quality Impairment is Associated with Sexual Dysfunction According to its Severity

Lotti¹,

Corona²,

Castellini³

et al. 2018

The Journal of Sexual Medicine

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STUDY QUESTION: Is sexual dysfunction associated with severity of semen quality impairment in men with couple infertility?SUMMARY ANSWER: In males of infertile couples the prevalence of erectile dysfunction (ED) increases as a function of semen quality impairment severity.WHAT IS KNOWN ALREADY: Infertile men are at a higher risk for sexual dysfunction, psychopathological and general health disorders. However, it has never been systematically investigated if these problems are associated with severity of semen quality impairment.STUDY DESIGN, SIZE, DURATION: Cross-sectional analysis of a first-time evaluation of 448 males of infertile couples attending an outpatient clinic from September 2010 to November 2015. In addition, 74 age-matched healthy, fertile men from an ultrasound study on male fertility were studied for comparison.PARTICIPANTS/MATERIALS, SETTING, METHODS: All subjects underwent a complete physical, biochemical, scrotal and flaccid penile colour-Doppler ultrasound evaluation and semen analysis. Patients had already undergone at least one semen analysis; therefore, the majority were aware of their sperm quality before taking part in the study. Validated tools, such as the International Index of Sexual Function-15 (IIEF-15), Premature Ejaculation Diagnostic Tool (PEDT), Middlesex Hospital Questionnaire (MHQ), National Institutes of HealthChronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score and Chronic Disease Score (CDS), were used to evaluate, respectively, sexual dysfunction, premature ejaculation (PE), psychopathological traits, prostatitis-like symptoms, lower urinary tract symptoms and general health status. MAIN RESULTS AND THE ROLE OF CHANCE:Among men with couple infertility, 96 showed azoospermia (Group #1), 245 at least one sperm abnormality (Group #2) and 107 normozoospermia (Group #3). Fertile men were considered as a control group (Group #4). After adjusting for age, we observed a higher prevalence of ED (IIEF-15-erectile function domain score <26) (18.3% versus 0%; P = 0.006) and PE (PEDT score >8) (12.9% versus 4.1%; P = 0.036) in males of infertile couples compared with fertile men. The ED prevalence increases as a function of semen quality impairment severity (P < 0.0001), even after adjusting for confounders (age, CDS, MHQ and NIH-CPSI total score), despite similar hormonal, glyco-metabolic and penile vascular status. Compared to fertile men, all three groups of males with couple infertility showed a poorer erectile function, associated with an overall psychopathological burden (MHQ total score), particularly with somatized anxiety (MHQ-S). Azoospermic men showed the worst erectile function and general health: in this group, erectile function was negatively associated not only with psychopathological disturbances (MHQ total and MHQ-S scores; P < 0.0001) but also with a less healthy phenotype (higher CDS; P = 0.015). In addition, azoospermic men reported higher PE prevalence and lower sexual desire and orgasmic function when compared to fertile men (all P <...

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“…Thus, the combination therapy (T plus PDE5i) must not be considered a routine approach to men unresponsive to monotherapy. However, the identification of men with subclinical hypogonadism [16] who may benefit from combined therapies to augment PDE5i responsiveness may be clinically useful in order to maximize benefits other than sexual performance itself, that is, cardiac performance. In man, the increasing evidence that T is a foe for the heart needs to be revisited [17]; in fact, an inverse relationship between T levels, the severity of atherosclerosis and carotid intima-media thickness exists.…”

Section: Expert Opinionmentioning

confidence: 99%

Does testosterone supplementation increase PDE5-inhibitor responses in difficult-to-treat erectile dysfunction patients?

Aversa

Francomano

Lenzi

2015

Expert Opinion on Pharmacotherapy

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Introduction: Men with erectile dysfunction (ED) considered challenging-totreat with PDE-5 inhibitors (PDE5i) include patients with severe neurological damage (e.g., due to radical prostatectomy), diabetes and severe vascular disease. Another factor that may limit PDE5i efficacy is the age-related decline of testosterone (T), occurring in 3 --35% of older men depending on different cut-offs chosen. T regulation of PDE5 expression has been accepted as one of the major mechanisms controlling vasodilator mechanisms in penile tissue. Areas covered: We reviewed data regarding the use of T as a salvage therapy in PDE5i nonresponders. Expert opinion: Guidelines recommend that hypogonadal men with ED should commence therapy with PDE5i due to time course effects of T on erection that needs 6 --12 weeks to occur. The possibility to 'salvage' some patients with low T not responding to PDE5i alone by adding T therapy should consider correct cut-off values, plasma T levels attained and androgen receptor (AR) polymorphism. Meta-analyses suggest that T treatment plus PDE5i yielded more effective results in noncontrolled versus controlled studies. We recommend T assay in all men with ED not responsive to PDE5i. Before commencing T treatment, side effects and consequent higher mortality in older frail men have to be avoided.

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Subclinical male hypogonadism

Cited by 68 publications

References 51 publications

Differential Diagnosis of Nonpalpable Testicular Lesions: Qualitative and Quantitative Contrast-enhanced US of Benign and Malignant Testicular Tumors

Differential Diagnosis of Nonpalpable Testicular Lesions: Qualitative and Quantitative Contrast-enhanced US of Benign and Malignant Testicular Tumors

037 Semen Quality Impairment is Associated with Sexual Dysfunction According to its Severity

Does testosterone supplementation increase PDE5-inhibitor responses in difficult-to-treat erectile dysfunction patients?

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