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AIM: To investigate the effects of exogenous testosterone treatment on the choroidal parameters in patients with androgen deficiency. METHODS: Right eyes of 24 patients with androgen deficiency and 31 healthy volunteers were included in the study. The eyes were scanned for subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), choroid-stromal area (C-SA), choroid-luminal area (C-LA), choroid-stromal to luminal area ratio (CSLR), and the choroidal parameters within central 1500 µm of the macula (CVI1500, C-LA1500, C-SA1500, and CSLR1500) by enhanced-depth imaging optical coherence tomography (EDI-OCT) at baseline, 6th and 18th weeks of the exogenous testosterone treatment. RESULTS: The mean SFCT values of the androgen deficient groups and healthy controls were 307.7±27.0 and 303.2±37.2 µm (P=0.8). However, CVI, C-SA, CSLR, CVI1500, C-LA1500, and CSLR1500 were significantly different between the groups (all P0.05). However, CVI1500 and LA1500 significantly increased at the end of the follow-up period (P

Aim. To study the frequency of hypogonadism (HG) in men with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to evaluate the impact of HG on the course of RA and and concomitant diseases. Materials and methods. A single-stage continuous study included 170 men with RA, 57 men with AS and 85 men with PsA, who were hospitalized at the Nasonova Research Institute of Rheumatology. Patients were assessed for total testosterone (ТS) levels and subsequently divided into subgroups with normal (12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of rheumatic disease, as well as on concomitant conditions. The second stage of the study involved a pairwise intergroup comparison among patients with HG with RA, AS and PsA. Results. The incidence of ТS deficiency among patients with RA was 24.1%, among patients with AS – 17.5%, and with PsA – 31.8%. In patients with RA, HG was associated with a significantly higher mean body mass index, higher fasting blood glucose and uric acid, higher erythrocyte sedimentation rate and anemia. Patients with AS with HG had significantly lower hemoglobin levels and more frequent anemia, as well as higher levels of C-reactive protein and erythrocyte sedimentation rate. In PsA, older age was observed in the androgen deficiency group, as well as higher body mass index and fasting glucose levels; obesity was more common. An intergroup comparison of quantitative and qualitative indicators between patients with androgen deficiency in all three rheumatic diseases (RDs) did not reveal significant differences in the average concentrations of ТS, luteinizing hormone, sex hormone binding globulin, experience of RD, laboratory markers of inflammatory activity, as well as glucose and uric acid. A similar incidence of diabetes mellitus, obesity and anemia was noted for all three nosologies. Conclusion. ТS levels and the presence of HG were not associated with the stage and activity of RD, but ТS deficiency was accompanied by higher laboratory indicators of inflammatory activity, lower hemoglobin values, and metabolic disorders. Patients with HG, regardless of nosology, had similar levels of sex hormones and indicators reflecting RD and concomitant conditions.

Testosterone therapy for men with hypogonadism due to identifiable hypothalamic-pituitary-testicular (HPT) pathology is uncontroversial. However, the risks and benefits of testosterone for men with clinical features of hypogonadism in the absence of identifiable HPT axis pathology have been uncertain. Recent landmark placebo-controlled trials assessed the benefits and risks of testosterone therapy (≤3 years) for middle-aged and older men with symptoms and possible signs of hypogonadism or end-organ androgen deficiency, low or low-normal serum testosterone concentrations, but no HPT pathology: Testosterone therapy (1) had modest—but clinically significant—benefits on average self-reported energy and mood, sexual function, and satisfaction; (2) in conjunction with a lifestyle programme, reversed or reduced incident type 2 diabetes mellitus (T2D) in men at high risk of or newly diagnosed with T2D; (3) modestly improved objectively assessed muscle strength and timed walking distance; (4) increased bone density and strength, but did not reduce falls or typical osteoporotic fractures and surprisingly increased the risk of fractures typically attributable to trauma; and (5) did not significantly increase the risk of myocardial infarction, stroke, or prostate cancer. These landmark trials help to inform clinical decision-making about testosterone therapy for men. [ABSTRACT FROM AUTHOR]

Women with hypopituitarism have various degrees of androgen deficiency, which is marked among those with combined hypogonadotrophic hypogonadism and secondary adrenal insufficiency. The consequences of androgen deficiency and the effects of androgen replacement therapy have not been fully elucidated. While an impact of androgen deficiency on outcomes such as bone mineral density, quality of life, and sexual function is plausible, the available evidence is limited. There is currently no consensus on the definition of androgen deficiency in women and it is still controversial whether androgen substitution should be used in women with hypopituitarism and coexisting androgen deficiency. Some studies suggest beneficial clinical effects of androgen replacement but data on long-term benefits and risk are not available. Transdermal testosterone replacement therapy in hypopituitary women has shown some positive effects on bone metabolism and body composition. Studies of treatment with oral dehydroepiandrosterone have yielded mixed results, with some studies suggesting improvements in quality of life and sexual function. Further research is required to elucidate the impact of androgen deficiency and its replacement treatment on long-term outcomes in women with hypopituitarism. The lack of transdermal androgens for replacement in this patient population and limited outcome data limit its use. A cautious and personalized treatment approach in the clinical management of androgen deficiency in women with hypopituitarism is recommended while awaiting more efficacy and safety data. [ABSTRACT FROM AUTHOR]

Testosterone is integral to men's sexual and overall health, but there is a gradual decline in the ageing male. The topical administration of testosterone is a valuable option as a supplement (replacement) therapy to alleviate hypogonadal symptoms. The clinical efficacy of a compounded testosterone 5% topical gel was assessed retrospectively in a male patient in his seventies by evaluating the laboratory testing of the serum total testosterone and the results of a validated androgen deficiency questionnaire. After treatment, the patient's hypogonadal symptoms improved and the serum total testosterone level achieved was considered clinically optimal. The skin permeation of the testosterone topical gel (biological testing) was evaluated in vitro using the Franz finite dose model and human cadaver skin, and it is shown that testosterone can penetrate into and through ex vivo human skin. Testosterone therapy is often prescribed for extended periods, and consequently, it is crucial to determine the beyond-use date of the compounded formulations. The analytical testing involved a valid, stability-indicating assay method for compounded testosterone 0.5% and 20% topical gels. This multidisciplinary study shows evidence supporting topically applied testosterone's clinical efficacy and the compounded formulations' extended stability. Personalized, topical testosterone therapy is a promising alternative in current therapeutics for hypogonadal patients. [ABSTRACT FROM AUTHOR]

Introduction: Previous work has demonstrated a deficiency in urology resident education when it comes to andrology and male infertility. We analyzed the top 100 most frequently cited and influential articles published on testosterone deficiency and its associated therapy, allowing trainees and clinicians to review and understand the characteristics of impactful literature for self-directed learning purposes. Methods: The ISI Web of Knowledge database was used to find articles on testosterone deficiency, hypogonadism, and replacement therapies. Relevant, peer-reviewed, English articles were included. Article details, including title, citation count, publication year, and more, were gathered. Articles were classified based on content (e.g. clinical outcomes, anatomy, and trends) using defined criteria. Results: The top 300 most cited were reviewed with 100 included. The most cited article had 774 citations, averaging 234 in the top 100. Publication years had peaks in 2003–2004 and 2006–2007. The US led in publications (56), followed by England (16), Germany (14), and Italy (13). Common affiliations included US Department of Veteran Affairs, Veterans Health Administration, RIC Research Education Clinical Center, and University of California System. Articles were categorized as LOE 2 (47), LOE 1 (22), and LOE 5 (21). Articles focused on clinical outcomes (71.7%), anatomy/biomechanics/physiology (14.1%), clinical guidelines (8.1%), and screening (4%). The " Journal of Clinical Endocrinology & Metabolism " published 26 of the top 100 cited articles. Conclusions: This analysis highlights influential articles regarding testosterone deficiency and management. The discussed articles have significant clinical and therapeutic implications for the practicing urologist which may bolster deficits in current resident education. [ABSTRACT FROM AUTHOR]

The objective: to study the state of androgen supply and erectile function in men with chronic distress. Materials and methods. We examined 30 internally replaced males (Average age, M±σ=50.50±3.83) with manifestations of chronic distress (Group I) and 20 practically healthy males (Group II), (Average age, M±σ=51.95±4.60). All men underwent general clinical examination, body mass index evaluation, assessment of depression according to Hospital Anxiety and Depression Scale (HADS), assessment of symptoms of androgen deficiency according to the Aging Males' Symptoms (AMS). Severity of erectile dysfunction was evaluated according to the International Index of Erectile Function scale (IIEF). The following parameters were determined in blood serum: luteinizing hormone (LH), folliclestimulating hormone (FSH), total testosterone (TT), free testosterone (TF), estradiol (E), cortisol (K). Results. According to the HADS scores in group I men, the average anxiety domain score was 12.03±1.50 points, the average depression domain score was 13.93±1.49, and the total score was 26.0±2.64 points. In patients of group II, the average anxiety domain score was 2.20±0.88 points, the average depression domain score was 2.60±1.00, and the overall score was 4.80±1.40 points. The comparison of the total score of group I and the total score of group II is statistically significant (p<0.05). According to the AMS, in men of group I, androgen deficiency was more expressed comparing to the control group (45.93±3.30 and 13.30±2.04 points, respectively, p<0.001). Analysis of the IIEF-15 questionnaire revealed a decrease in all indicators of erectile function in men of group I comparing to group II. A study of the hormonal state showed a decrease in the level of TT in men of group I compared to the indicators of group II: 9.30±2.84 and 15.27±0.96 ng/ml, respectively (p<0.001). The average TF levels in group I were reduced comparing to group II and reached 10.23±1.38 and 17.39±1.03 pg/ml, respectively (p<0.001). The levels of LH and FSH in men of group I were within normal age-related fluctuations and did not differ statistically significantly from similar levels of group II. The average E level in men with chronic distress was significantly increased comparing to the control group and reached up to 0.25±0.05 versus 0.11±0.03 nmol/l, respectively (p<0.001). The average C level in men with chronic distress was significantly increased comparing the control group and reached up to 13.33±2.19 versus 6.72±1.33 μg/dL, respectively (p<0.001). Conclusions. 1. The survey results indicate that chronic distress is a factor that worsens sexual function in men. In addition to erectile dysfunction, as evidenced by a decrease in the corresponding IIEF integrative indicator 15 «erectile function», the survey found a decrease in both the frequency of occurrence and the degree of sexual desire, a deterioration in orgasmic sensations in the form of a decrease in the frequency of ejaculation and orgasms. 2. Cortisol is an important hormone that forms protective reaction in stressful situations, but loses its positive properties during chronic distress. A prolonged increase in cortisol levels can lead to a pathological condition accompanied by an increase in BMI, depression, anxiety, decreased testosterone levels and ED. 3. A decrease in testosterone levels in chronic distress and visceral obesity in men is not accompanied by a compensatory increase in LH and FSH levels. This can be explained by increased aromatization of testosterone in visceral adipose tissue and a decrease in the pituitary gland's response to the development of androgen deficiency as a result of combined damage to the central and peripheral parts of the regulation of testosterone synthesis. [ABSTRACT FROM AUTHOR]

Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. In this review, we have highlighted factors, both biological and analytical, that introduce variation into the measurement of serum T concentrations in men; these need to be considered when requesting T levels and interpreting results. There is an ongoing need for analytical standardisation of T assays and harmonisation of pre- and post-analytical laboratory practices, particularly in relation to the laboratory reference intervals provided to clinicians. Further, there is a need to share with service users the most up-to-date and evidence-based action thresholds for serum T as recommended in the literature. Estimation of free testosterone may be helpful. Causes of secondary hypogonadism should be considered. A comprehensive approach is required in the management of male hypogonadism, including lifestyle modification as well as medication where appropriate. The goal of treatment is the resolution of symptoms as well as the optimisation of metabolic, cardiovascular, and bone health. The advice of an endocrinologist should be sought when there is doubt about the cause and appropriate management of the hypogonadism. [ABSTRACT FROM AUTHOR]

Men with obesity demonstrate not only various metabolic disorders and insulin resistance, but also reduced testosterone levels and reproductive system dysfunctions. Although one of the ways for pharmacological correction of these abnormalities may be the use of luteinizing hormone receptor (LHR) agonists and antidiabetic drugs (specifically, metformin, MF), the mechanisms of their effects on the hypothalamic–pituitary–gonadal axis have not been sufficiently investigated. The aim of this work was to study the effects of long-term MF therapy (5 weeks, 120 mg/kg) and five-day treatment with LHR agonists, such as human chorionic gonadotropin (hCG, 20 IU/rat/day, s.c.) and allosteric agonist TP03 (15 mg/kg/day, i.p.), on blood testosterone levels and the expression of testicular and pituitary genes in male Wistar rats with long-term diet-induced obesity (DIO). TP03 moderately stimulated testosterone production in male rats with DIO without having an inhibitory effect on testicular LHR expression and only insignificantly reducing the pituitary expression of the LH β-subunit gene. After a single TP03 administration to DIO rats, its steroidogenic effect was comparable to that in the control group, but after a five-day administration, it was significantly inferior to it. In DIO rats, the steroidogenic effect of hCG after a single administration was lower than that in the control but comparable to that after a five-day administration, significantly exceeding the corresponding effects of TP03. Unlike TP03, hCG significantly reduced testicular LHR expression and more pronouncedly inhibited pituitary LH expression. MF treatment restored the androgenic status without significantly affecting the testicular expression of steroidogenic genes. In MF-treated groups, there was no increase in the steroidogenic effects of both LHR agonists. The results suggest the prospects for the use of TP03 and hCG to stimulate testicular steroidogenesis and increase the effectiveness of MF therapy in order to normalize testosterone production in DIO, which can be used to correct reproductive disorders in obesity. At the same time, a co-administration of MF and LHR agonists in DIO appears to be inappropriate. [ABSTRACT FROM AUTHOR]

Although testosterone replacement in men with classic hypogonadism due to an identified pathology of the hypothalamic-pituitary-testicular axis is uncontroversial, the role of testosterone treatment for men with age-related declines in circulating testosterone is unclear. This is due to the lack of large, long-term testosterone therapy trials assessing definitive clinical endpoints. However, men ≥50 years of age, particularly those who have a body mass index >25 kg/m² and multiple comorbidities, commonly present with clinical features of androgen deficiency and low serum testosterone concentrations. Clinicians are faced with the question whether to initiate testosterone therapy, a difficult dilemma that entails a benefit-risk analysis with limited evidence from clinical trials. Using a case scenario, we present a practical approach to the clinical assessment and management of such men. [ABSTRACT FROM AUTHOR]

Testosterone is integral to men’s sexual and overall health, but there is a gradual decline in the ageing male. The topical administration of testosterone is a valuable option as a supplement (replacement) therapy to alleviate hypogonadal symptoms. The clinical efficacy of a compounded testosterone 5% topical gel was assessed retrospectively in a male patient in his seventies by evaluating the laboratory testing of the serum total testosterone and the results of a validated androgen deficiency questionnaire. After treatment, the patient’s hypogonadal symptoms improved and the serum total testosterone level achieved was considered clinically optimal. The skin permeation of the testosterone topical gel (biological testing) was evaluated in vitro using the Franz finite dose model and human cadaver skin, and it is shown that testosterone can penetrate into and through ex vivo human skin. Testosterone therapy is often prescribed for extended periods, and consequently, it is crucial to determine the beyond-use date of the compounded formulations. The analytical testing involved a valid, stability-indicating assay method for compounded testosterone 0.5% and 20% topical gels. This multidisciplinary study shows evidence supporting topically applied testosterone’s clinical efficacy and the compounded formulations’ extended stability. Personalized, topical testosterone therapy is a promising alternative in current therapeutics for hypogonadal patients.

Background: Klinefelter Syndrome (KS) is a sex chromosomal syndrome usually with an extra X chromosome (47, XXY) in males, which has various phenotype (mosaicism 47, XXY/46, XY, or more chromosomes 48, XXXY, 49, XXXXY) and clinical features, including eunuchoid body proportions, abnormally long legs and arm span, gynecomastia, ynecomastia, absent or decreased facial and pubic hair, small hyalinized testes, small penis, below-normal verbal intelligence quotient, and learning difficulties. At present, there are no studies on the correlation between the clinical characteristics of patients with KS and the ultrastructural changes of intracellular organelles in testicular tissue in China. Case presentation: Here we report the ultrastructure manifestation of the testis tissues in a KS patient with hypogonadism and androgen deficiency, to find a relationship between ultrastructural changes of organelles and spermatogenic dysfunction, clinical features, timing of surgery and metabolic abnormalities. It has been shown that the spermatocytes are absent and the ultrastructure of Sertoli cells and Leydig cells is obviously abnormal, which may lead to spermatogenic dysfunction, androgen deficiency, impaired glucose tolerance (IGT), and abdominal fat accumulation. Conclusions: Based on the European Academy of Andrology (EAA) Gudilines on Klinefelter Syndrome, this study conducted a retrospective study on the diagnosis and treatment of one adult patient with KS, aiming to provide a standardized diagnosis and treatment for patients with KS. This study is also highly concerned with the correlation between the ultrastructural changes of target organs and clinical symptoms.

BACKGROUND: Obesity and androgen deficiency (AnD) are characterized by similar disturbances in metabolic parameters, the presence of signs of insulin resistance, metabolic syndrome, the risk of developing cardiovascular diseases (CVD) and vascular complications. These facts indicate the possibility of the presence of common mechanisms that determine the predisposition to the development of obesity and AnD, which may include genetic factors, in particular, the rs4646994 polymorphism of the ACE gene, which, according to recent data, is associated with the risk of developing CVD, hypertension, and obesity.AIM: To study the association of the carriage of polymorphic variants of the rs4646994 locus of the ACE gene with the features of anthropometric and androgenic status in men.MATERIALS AND METHODS: In the period from April 2020 to October 2021 there were observed male patients aged 18–75 years old, who were hospitalized in a therapeutic hospital because of comorbid somatic pathology (hypertension, coronary heart disease, dorsopathy, vegetative-vascular dystonia, gastroesophageal reflux disease, and others). Anthropometry, a study of the content of hormones of the reproductive system in the blood serum using enzyme-linked immunosorbent assay (ELISA), as well as a genetic study for the carriage of polymorphic variants of the rs4646994 locus of the ACE gene by the polymerase chain reaction (PCR) method, followed by electrophoresis of PCR products, were carried out. RESULTS: 82 patients took part in research. According to the results of genetic analysis, 17 people were assigned to the group of homozygotes for the wild type (I/I, G1), 41 people were assigned to the group of heterozygotes (I/D, G2), and 41 people were assigned to the group of homozygotes for the mutant allele (D/D, G3) 24 people. Body weight, chest circumference, waist and hips, body mass index in patients carrying the D allele of the rs4646994 polymorphism were statistically significantly higher than in I/I homozygotes. Differences in hormonal status also turned out to be statistically significant: patients from G1 compared with G2 and G3 had higher levels of total testosterone; from G1 compared to G3 — a higher level of free testosterone.CONCLUSION: An association of the carriage of the D allele of the rs4646994 polymorphic locus of the ACE gene with overweight and ADI was revealed.

Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. In this review, we have highlighted factors, both biological and analytical, that introduce variation into the measurement of serum T concentrations in men; these need to be considered when requesting T levels and interpreting results. There is an ongoing need for analytical standardisation of T assays and harmonisation of pre- and post-analytical laboratory practices, particularly in relation to the laboratory reference intervals provided to clinicians. Further, there is a need to share with service users the most up-to-date and evidence-based action thresholds for serum T as recommended in the literature. Estimation of free testosterone may be helpful. Causes of secondary hypogonadism should be considered. A comprehensive approach is required in the management of male hypogonadism, including lifestyle modification as well as medication where appropriate. The goal of treatment is the resolution of symptoms as well as the optimisation of metabolic, cardiovascular, and bone health. The advice of an endocrinologist should be sought when there is doubt about the cause and appropriate management of the hypogonadism.

Leptin, an adipokine hormone, is a critical regulator of energy homeostasis, appetite, and metabolism. Recent advances have elucidated its role in male fertility. This forum provides an overview of the interplay between leptin, its receptors, and signaling pathways in the context of male fertility, revealing its multifaceted impact on reproductive health. [ABSTRACT FROM AUTHOR]

Introduction. Androgenic deficiency is an important pathogenetic element in the development of metabolic syndrome and cardiovascular diseases in men. It has been proven that in male patients with type 2 diabetes, hypogonadism develops much more often. Objective – to study the metabolic and cardiovascular features of the course of type 2 diabetes mellitus (T2DM) in men with androgen deficiency.Materials and methods. The study included 124 men with type 2 diabetes. To diagnose hypogonadism, the levels of total testosterone (T), sex hormone binding globulin (SHBG), albumin and luteinizing hormone (LH) were measured. Free testosterone (free T) levels were calculated using a calculator from Ghent University Hospital, Belgium. A retrospective analysis of case histories was carried out (spectrum of late complications, the presence of heart attacks and strokes, laboratory data – total cholesterol (CS), triglycerides (TG), fasting blood plasma glucose, basal insulin level, glycated hemoglobin (HbA1c)). The HOMA-IR index was used to determine the degree of insulin resistance.Results. The average age of men was 57.39 ± 9.41 years. The incidence of laboratory-confirmed hypogonadism is 50.81%. An average positive correlation was found between androgen deficiency and the incidence of non-fatal cardiovascular events (r = 0.45, p < 0.05). There was no statistically significant relationship between the presence of hypogonadism and the incidence and degree of late complications of T2DM. Patients with low T levels tended to have higher HOMA-IR values compared to patients with normal T levels (p < 0.05). At the same time, the indicators of carbohydrate and lipid metabolism did not differ significantly in these groups (p > 0.05).Conclusions. The revealed incidence of hypogonadism in men with T2DM corresponds to the data of international studies. The presence of a significant correlation between low testosterone levels and cardiovascular events in patients with T2DM suggests that hypogonadism can be used as an additional criterion for cardiovascular risk. Testosterone deficiency exacerbates insulin resistance, which can lead to weight gain and impair carbohydrate metabolism.

At present, the issue of providing care to patients with cardiovascular disease (CVD), in particular coronary heart disease (CHD), which, despite advances in modern medicine, remains the leading cause of death in Ukraine and around the world. According to the Global Burden of Disease study for 2019, cardiovascular disease is the most common cause of death in Ukraine, accounting for 64.3% of total deaths in 2019. Well-known conditions that affect the cardiovascular prognosis include smoking, hypertension, lipid metabolism disorders, genetic predisposition, male gender, age, diabetes, insufficient physical activity, but at the same time the search for new factors that modify it continues. These include hypogonadism in men, which affects the course of cardiovascular disease (CVD), coronary heart disease (CHD) and cardiovascular prognosis in men, shown in studies. In view of this, the question arises of developing algorithms for the diagnosis of androgen deficiency in men with coronary heart disease. This prospective study included 37 men with chronic coronary heart disease (stable angina pectoris, postinfarction and atherosclerotic cardiosclerosis), aged 45 to 65 years, who were hospitalized. In addition to routine clinical and paraclinical examinations, patients were tested for total and bound plasma testosterone, prostate specific antigen (PSA); There was also a survey on the AMS questionnaire (The Aging Males’ Symptoms Scale), a questionnaire for men on the presence of age symptoms, where the patient is asked to answer a series of questions, assessing the severity of age symptoms from 1 (no symptoms) to 5 (very severe) after which the sum of points is calculated). As a result of the study, it was found that its sensitivity to detect androgen deficiency was 100%, while the specificity – 67.7%, respectively. Spearman’s rank correlation coefficient between total testosterone levels and the score obtained from the AMS questionnaire was -0.63 (p

Testosterone is frequently used for the optimization of mid-life health. This therapy is effective and safe if accompanied by adequate counseling, before prescription, and during administration. In this opinion piece, we discuss the style and substance of medication counseling for testosterone therapy. The role and scope of counseling are highlighted, with a focus on screening, diagnosis, medication counseling, sexual counseling, and monitoring. This article should prove useful for all health care professionals.

Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily overlooked, appropriate investigation and management often are missed. The workup of gynecomastia is highly individualized, based on the patient's presentation and related factors. It should be guided by thorough history taking and physical examination. Unless the patient has associated symptoms, or there is suspicion for an underlying clinical disorder causing the gynecomastia, the patient need not be investigated further. A breast ultrasound is not routinely recommended. Gynecomastia is a benign finding that will spontaneously regress in most patients; however, patients who are concerned with their physical appearance can be treated either medically or surgically. Patients who have had gynecomastia for more than 1 year tend to have fibrosis, which may be more difficult to treat. Management of gynecomastia is highly patient centered, following a detailed discussion about treatment goals and should be started early. Gynecomastia is not considered a premalignant condition; routine screening is not cost-effective, and imaging studies should be pursued only if physical examination findings suggest malignancy. [ABSTRACT FROM AUTHOR]

Early weaning (EW) leads to metabolic disorders in adulthood, being one of the causes of metabolic syndrome (MS). However, the range of hormonal disorders in EW has not been studied well enough, and approaches to its correction have not been developed. The aim of this work was to study metabolic and hormonal changes, including in the hormonal status of the gonadal and thyroid axes, in adult (10-month-old) male rats that were weaned in the early postnatal period, as well as to explore the restorative effect of 4-week treatment with different doses of metformin (MF), moderate (120 mg/kg/day) and relatively high (250 mg/kg/day), on these changes. Lactation in nursing female rats was interrupted with bromocriptine (10 mg/kg/day) on days 19–21 of lactation. After forced starvation during this period, rat pups were transitioned to a standard diet. At the age of 10 months, early weaned male rats showed characteristic signs of MS, such as obesity, impaired glucose tolerance, insulin resistance, hyperleptinemia and dyslipidemia. They also had reduced levels of testosterone, luteinizing hormone (LH), and thyroid hormones, and elevated levels of the thyroid-stimulating hormone (TSH). A 4-week treatment of adult rats with MF at a moderate dose reduced body and fat weight, partially restored metabolic parameters, and completely normalized testosterone, LH, thyroxine, triiodothyronine and TSH levels. The treatment with MF at a relatively high dose restored metabolic parameters more effectively, normalized leptin and insulin levels, but had a little effect on hormonal levels of the gonadal and thyroid axes. Thus, long-term treatment of early weaned male rats with a moderate dose of MF improves metabolic parameters and completely restores the hormonal status of the gonadal and thyroid axes, which indicates the promise of using such doses for the correction of MS and endocrine dysfunctions caused by interrupted or ineffective breastfeeding. [ABSTRACT FROM AUTHOR]

In recent years, the requirements for the level of the life quality have increased significantly; an integral part of it is the sexual harmony, which in men largely depends on sexual desire and erectile function. According to the results of modern scientific studies, there is no doubt that erectile dysfunction in men is closely connected with the cardiovascular diseases, obesity, diabetes mellitus and other comorbidities. This problem can also be caused by systematic psycho-emotional overload, deterioration of the environmental conditions, harmful factors of production, uncontrolled use of medicines, inflammatory processes in the genital organs, the growth of somatic diseases. The vast majority of works concerning “male menopause” is reduced to the effectiveness of hormone-replacement therapy in erectile dysfunction, while only few research works are devoted to the study of the connection between somatic pathology and androgen deficiency. There is a negative correlation between total testosterone level and systolic blood pressure. According to the research results of some scientists, it was found that 38% of patients with arterial hypertension had androgen deficiency, confirmed in the laboratory, which is significantly higher than in patients of the same age category with normal blood pressure. These dominant factors exert and increase the influence on each other, which must be taken into account in modern therapeutic practice. The study of the formation of comorbid conditions in men with low levels of androgens is of particular importance, as the knowledge of pathophysiological mechanisms can prevent their development and progression. The aim of this investigation was to study the state of penile vascular blood flow in men with arterial hypertension with erectile dysfunction, using color Doppler imaging with pharmacological induction of erection. The indicators of daily monitoring of arterial pressure and arterial stiffness in men with arterial hypertension of the II degree against the background of androgen deficiency or at normal testosterone levels and ways of correction of erectile dysfunction in these patients were also evaluated.

Abstract Background Many young adults with Duchenne Muscular Dystrophy (DMD) receive long-term glucocorticoids (GC). GC can cause hypogonadotrophic hypogonadism and adolescents may therefore be candidates for pubertal induction. It is unclear whether men with DMD on or off GC have age-appropriate endogenous testosterone production. Methods We undertook a quality improvement project to assess the feasibility of measuring salivary testosterone (SalT) levels in men with DMD at home. A Sal-T sampling kit was sent by post to all patients with DMD, aged 17 and older, registered at the John Walton Muscular Centre in Newcastle (n = 75). Submitted Sal-T samples were collected and submitted for analysis. Results Twenty-eight out of seventy-five patients returned samples (age range: 17–34 years). 6/28 samples were unsuitable for analysis. Overall Sal-T levels (n = 22) were significantly lower than in the healthy population (178 ± 107 v 287 ± 109 pmol/l, p = 0.0001). Sal-T was lower in those on GC compared to those off GC (144 ± 81 versus 218 ± 125 pmol/l, p = 0.05). Three patients were unable to collect a sample due to ventilator dependence. Conclusion Sal T can provide information about androgen status in DMD patients at home, overcoming barriers such as mobility difficulties and challenging venepuncture. However we only obtained samples in a minority of patients suggesting that Sal-T measurement may not be appropriate or acceptable to everyone. There needs to be a more detailed exploration of the barriers to sample submission.

The concentration of androgens in men has a tendency to decrease with age. Androgen deficiency, also known as low testosterone in men, is associated with an increased risk of morbidity. The current solution for treating androgen deficiency is testosterone replacement therapy, but this intervention is not ideal either. Testosterone replacement can exacerbate preexisting conditions such as prostate disease. An alternative solution may be the use of dietary supplements to increase testosterone synthesis in men with androgen deficiency. On the other hand, an increase in testosterone above the optimal level can have major disadvantages, from prostate cancer to cardiovascular disease. and abnormal aggression. A randomized, placebo- controlled clinical trial showed that Ashwagandha increased testosterone levels in men with ages between 18 and 50 who took 300 mg of Ashwagandha root extract twice a day for 8 weeks. Testosterone levels increased by 534.38% compared to the placebo group; this significant increase may be too intense for men who want a minimal increase to correct tesosterone levels. The current experiment aims to demonstrate through a comparative analysis between the study and the experiment whether the Ashwagandha root powder will increase testosterone levels in two volunteers, aged 20 and 30 years old, and whether this increase will be more moderate than in the previous study. Demonstrating that Ashwagandha can also be used for moderate increases in testosterone levels over longer periods of time, the hypothesis is that Ashwagandha root powder will be a more ideal option than Ashwagandha root extract for men who want a small and constant increase of testosterone levels for long periods, because the powder has a lower potency than the extract, with a lower possibility of overdose, being more advantageous in older men. [ABSTRACT FROM AUTHOR]

Testosterone is frequently used for the optimization of mid-life health. This therapy is effective and safe if accompanied by adequate counseling, before prescription, and during administration. In this opinion piece, we discuss the style and substance of medication counseling for testosterone therapy. The role and scope of counseling are highlighted, with a focus on screening, diagnosis, medication counseling, sexual counseling, and monitoring. This article should prove useful for all health care professionals. [ABSTRACT FROM AUTHOR]

Context: Injections with intramuscular (IM) testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive modality. However, they are difficult to self-administer and associated with some discomfort. Recently, subcutaneous (SC) administration of testosterone esters has gained popularity, as self-administration is easier with this route. Available data, though limited, support the feasibility of this route. Here we review the pharmacokinetics and safety of SC testosterone therapy with both long- and ultralongacting testosterone esters. In addition, we provide guidance for clinicians on how to counsel and manage their patients who opt for the SC route. Evidence Acquisition: Systematic review of available literature on SC testosterone administration including clinical trials, case series, and case reports. We also review the pharmacology of testosterone absorption after SC administration. Evidence Synthesis: Available evidence, though limited, suggests that SC testosterone therapy in doses similar to those given via IM route results in comparable pharmacokinetics and mean serum testosterone levels. With appropriate training, patients should be able to safely self-administer testosterone esters SC with relative ease and less discomfort compared with the IM route. Conclusion: Although studies directly comparing the safety of SC vs IM administration of testosterone esters are desirable, clinicians should consider discussing the SC route with their patients because it is easier to self-administer and has the potential to improve patient adherence. [ABSTRACT FROM AUTHOR]

Background: The common pathogenetic relations of type 2 diabetes mellitus (T2DM), testosterone (T) deficiency and non-alcoholic fatty liver disease (NAFLD) have indicated a new direction in the study of their mutual influence. It was found that NAFLD is more pronounced in men with T2DM and hypogonadism than in eugonadal patients and associated with hyperinsulinemia, insulin resistance, impaired lipid metabolism and adipose tissue dysfunction. However, the effects of testosterone replacement therapy (TRT) on the severity of NAFLD in men with hypogonadism have not been studied.Aims: To study the effect of TRT on the severity of NAFLD in men with T2DM and hypogonadism.MATERIALS AND METHODS: Anthropometric data, biochemical parameters (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltranspeptidase (GGTP), glucose, immunoreactive insulin, HOMA index, glycosylated hemoglobin, lipidogram), ELISA analysis (total T, LH, sex hormone binding globulin, resistin, adiponectin, leptin), as well as magnetic resonance imaging with determination of the liver fat fraction were examined.Results: The study included 60 men with T2DM and hypogonadism (mean age 54 [49; 57] years), who were randomized into 2 groups: 1 (n=30) - patients who received 1% transdermal T gel (50 mg/day) in addition to standard hypoglycemictherapy; 2 (n=30) - patients who received standard hypoglycemic therapy. The follow-up period was 6 months. T therapy was associated with a decrease in liver enzyme levels: AST by 31%, ALT by 21%, and GGTP by 15.9% (p

Abstract Background The present clinical trial was conducted to evaluate the efficacy and tolerability of a standardized saw palmetto oil containing 3% β-sitosterol in the treatment of benign prostate hyperplasia (BPH) and androgen deficiency. Methods Subjects aged 40–65 years with symptomatic BPH were randomized to 12-week double-blind treatment with 500 mg doses of β-sitosterol enriched saw palmetto oil, conventional saw palmetto oil and placebo orally in the form of capsules (n = 33 in each group). BPH severity was determined using the International Prostate Symptom Score (IPSS), uroflowmetry, serum measurement of prostate specific antigen (PSA), testosterone and 5α-reductase. During the trial, the androgen deficiency was evaluated using Aging Male Symptoms (AMS) scale, the Androgen Deficiency in the Aging Male (ADAM) questionnaire, serum levels of free testosterone. Results Subjects treated with β-sitosterol enriched saw palmetto oil showed significant decrease in IPSS, AMS and ADAM scores along with reduced postvoiding residual volume (p

BACKGROUND: Current studies investigated diseases associated with testosterone (T) deficiency; however, data on the combination of non-alcoholic fatty liver disease (NAFLD) with hypogonadism and diabetes mellitus (DM) in men are extremely limited. AIMS: To evaluate the effects of hypogonadism on the formation and progression of NAFLD in men with type 2 DM. METHODS: The study included 90 men with type 2 DM [age 54 (49–57) years]. Patients underwent clinical examinations, biochemical analysis (alanine aminotransferase (ALT), aspartate aminotransferase, gamma-glutamyl transpeptidase (GGTP), fasting glucose, immunoreactive insulin, HOMA index, HbA1c, lipid profile), immune enzyme analysis (luteinising hormone, total T, sex hormone binding globulin, resistin, adiponectin, leptin) and magnetic resonance imaging with liver fat fraction determination were performed. Patients were divided into two groups: 1–32 eugonadal patients and 2–58 men with newly diagnosed hypogonadism. RESULTS: Increased insulin resistance, hyperinsulinemia, hypertriglyceridemia were observed in men with hypogonadism compared to eugonadal patients. Along with biochemical signs of impaired liver function, such as an increase in liver enzyme concentrations of ALT by 24.5% (p = 0.02), GGTP by 60.5% (p = 0.001), de Rytis coefficient by 60.4% (p = 0.047), of men in the 2nd group, the liver fat fraction also increased, which together indicates NAFLD progression. The proton density of the liver fat fraction according to MRI was 4.12 [2.25–5.30] % in the 1st group and 10.30 [7.78; 14.44] % in the 2nd group (p=0.001). This was accompanied by an increase in fat production of resistin by 2 times and leptin by 12 times (p

Panax ginseng could promote testosterone production and ensure the normal function of androgens in some clinical cases as a medicine and nutritional supplement. The purpose of this work was to investigate the efficacy and way of action of Panax ginseng in the treatment of androgen deficiency rats. The male castrated rats were gavaged with Panax ginseng decoction for 10 weeks. Urine samples were analyzed for metabolites by UPLC-Q-TOF-MS, and feces were analyzed for changes in intestinal flora by 16sRNA high-throughput sequencing. The results showed that Panax ginseng could significantly antagonize the symptoms of weight gain, target tissue atrophy and serum hormone level decline caused by androgen deficiency. A total of 16 potential biomarkers were significantly altered after treatment in the metabolomics, which related to tryptophan metabolism, bile acid biosynthesis and steroid hormone biosynthesis. Based on the changes of intestinal flora, a total of 7 species with significant changes were found to be involved in the regulation of intestinal flora of androgen deficient rats by Panax ginseng. To conclude, our study verified the effect of Panax ginseng on androgen deficient rats, and explored its biological mechanism by metabolomics and gut microbiota metagenomics methods.

Aim: To investigate the effects of exogenous testosterone treatment on the choroidal parameters in patients with androgen deficiency., Methods: Right eyes of 24 patients with androgen deficiency and 31 healthy volunteers were included in the study. The eyes were scanned for subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), choroid-stromal area (C-SA), choroid-luminal area (C-LA), choroid-stromal to luminal area ratio (CSLR), and the choroidal parameters within central 1500 µm of the macula (CVI 1500 , C-LA 1500 , C-SA 1500 , and CSLR 1500 ) by enhanced-depth imaging optical coherence tomography (EDI-OCT) at baseline, 6 th and 18 th weeks of the exogenous testosterone treatment., Results: The mean SFCT values of the androgen deficient groups and healthy controls were 307.7±27.0 and 303.2±37.2 µm ( P =0.8). However, CVI, C-SA, CSLR, CVI 1500 , C-LA 1500, and CSLR 1500 were significantly different between the groups (all P <0.01). At the 6 th week visit after exogenous testosterone treatment, SFCT, CVI, C-LA, and C-SA were significantly decreased, and these parameters returned to baseline levels at the 18 th -week visit (all P >0.05). However, CVI 1500 and LA 1500 significantly increased at the end of the follow-up period ( P <0.001)., Conclusion: CVI is lower in androgen-deficient patients than in healthy subjects. The alterations in the choroid during the testosterone peak are transient in the treatment of patients with androgen deficiency. However, the increase in CVI within the central 1500 µm of the macula persists even after 4mo., Competing Interests: Conflicts of Interest: Yeter V, None; Koçak N, None; Kalyoncu M, None; Aşçı R, None; Arıtürk N, None., (International Journal of Ophthalmology Press.)

Aim: To study the frequency of hypogonadism (HG) in men with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to evaluate the impact of HG on the course of RA and and concomitant diseases., Materials and Methods: A single-stage continuous study included 170 men with RA, 57 men with AS and 85 men with PsA, who were hospitalized at the Nasonova Research Institute of Rheumatology. Patients were assessed for total testosterone (ТS) levels and subsequently divided into subgroups with normal (>12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of rheumatic disease, as well as on concomitant conditions. The second stage of the study involved a pairwise intergroup comparison among patients with HG with RA, AS and PsA., Results: The incidence of ТS deficiency among patients with RA was 24.1%, among patients with AS - 17.5%, and with PsA - 31.8%. In patients with RA, HG was associated with a significantly higher mean body mass index, higher fasting blood glucose and uric acid, higher erythrocyte sedimentation rate and anemia. Patients with AS with HG had significantly lower hemoglobin levels and more frequent anemia, as well as higher levels of C-reactive protein and erythrocyte sedimentation rate. In PsA, older age was observed in the androgen deficiency group, as well as higher body mass index and fasting glucose levels; obesity was more common. An intergroup comparison of quantitative and qualitative indicators between patients with androgen deficiency in all three rheumatic diseases (RDs) did not reveal significant differences in the average concentrations of ТS, luteinizing hormone, sex hormone binding globulin, experience of RD, laboratory markers of inflammatory activity, as well as glucose and uric acid. A similar incidence of diabetes mellitus, obesity and anemia was noted for all three nosologies., Conclusion: ТS levels and the presence of HG were not associated with the stage and activity of RD, but ТS deficiency was accompanied by higher laboratory indicators of inflammatory activity, lower hemoglobin values, and metabolic disorders. Patients with HG, regardless of nosology, had similar levels of sex hormones and indicators reflecting RD and concomitant conditions.

Androgen deficiency is known to cause both osteoporosis and sarcopenia. Myokines, humoral factors secreted from the skeletal muscles, have recently been getting attention as the key factors related to the interactions between muscle and bone. Dickkopf (Dkk) 2 is known as an inhibitor of canonical Wnt/β-catenin signaling, and Wnt/β-catenin signaling is crucial for the maintenance of muscle and bone. The present study was therefore performed to investigate the roles of Dkk2 in the alterations of muscle and bone of androgen-deficient mice with orchidectomy (ORX). ORX significantly enhanced Dkk2 mRNA levels, but not other Dkks and secreted frizzled related proteins, in the soleus muscles of mice. Moreover, ORX enhanced serum Dkk2 levels, but not Dkk2 mRNA levels in the tibial bone tissues, the white adipose tissues and liver of mice. In simple regression analyses, serum Dkk2 levels were negatively related to trabecular bone mineral density at the tibias in mice employed in the experiments. In vitro experiments, testosterone suppressed Dkk2 mRNA levels in mouse muscle C2C12 cells. In conclusion, we showed that androgen deficiency enhances Dkk2 expression and secretion in the muscles of mice. Dkk2 might be involved in androgen deficiency-induced muscle wasting and osteopenia as a myokine linking muscle to bone. [ABSTRACT FROM AUTHOR]

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The aim of the investigation was to study the relationship of blood testosterone levels with the severity of anxiety signs, depression and urological pathology symptoms in men of mature age with normal weight, overweight and obesity. Material and methods: 188 men of 36.7 average age participated in the study. Anthropometric examination was carried out, the HADS questionnaire (Hospital Anxiety and Depression Scale, 1983) was used to assess the level of anxiety and depression; the severity of urinary disorders symptoms was evaluated with the scale of IPSS (International Prostate Symptom Score). To study the sexual dysfunction the international index of erectile dysfunction (ICEF-5) was applied. AMS Men's Age Symptoms (Aging Males Symptoms) questionnaire was used to identify clinical signs of androgen deficiency. The content of testosterone and cortisol in blood serum was determined by EIA. Results and discussion: The growth of androgen deficiency along with the increase in the urinary disorders symptoms, extended anxiety, depression and enhanced signs of erectile dysfunction have been revealed in men with overweight and obesity relating to the men with normal body weight. The androgen deficiency growth influences the aging processes acceleration. In turn, the presence of urological pathology in men can plays an important role in the obesity pathogenesis through the increase in anxiety and depression.

Background. It is well known that the development of insulin resistance as the main factor of metabolic syndrome (MS) is accompanied by an imbalance in the cytokine system: an increase in the level of interleukin­6 (ІЛ­6), tumor necrosis factor­α (TNF­α) and a decrease in ІЛ­10, ІЛ­4. One of the causes of insulin resistance in men may be a decrease in testosterone production, since its sufficient amount increases the sensitivity to insulin. The purpose of the study: to evaluate the level of proinflammatory lymphokines and hormones in patients with type 2 diabetes mellitus (DM), MS and androgen deficiency. Materials and methods. We examined 76 men aged 35 to 68 years (29 — with MS and 47 — with type 2 DM). The level of proinflammatory lymphokines, estradiol, free and total testosterone was determined in the blood serum using radioimmune method, the content of TNF­α, ІЛ­6, leptin — by immune­enzyme methods. Insulin resistance was determined by the HOMA index. Diagnosis of MS was established based on the АТР III — NCEP criteria. The control group included 21 apparently healthy men. Results. Patients with type 2 DM and metabolic syndrome and those without MS had elevated levels of TNF­α and ІЛ­6, cortisol, aldosterone, adrenocorticotropic hormone (ACTH) and insulin. The conducted studies showed the presence of androgen deficiency in all groups of patients. More significant signs of androgen deficiency were observed in the examined men with MS and type 2 DM. The level of insulin and adrenocorticotropic hormone are directly proportional to the body mass index. In patients with MS and without MS, we observed only a tendency to increase in leptin level. There is a tendency to increase in the level of estradiol in men with type 2 DM and MS. Conclusions. Results of the study correspond to the hypothesis about the leading role of proinflammatory lymphokines of the immune system in the origin of type 2 DM. In this case, the cause of DM is dysfunction of not fatty tissue, bur heterospecific link of immunity.

Every fourth patient at the age of 50 years, every third patient at the age of 60 years, every second man at the age of 70 years and almost everyone (90%) older than 80 years have Benign prostatic hyperplasia (BPH). Lower urinary tract symptoms developing against the background of BPH are often connected both with manifestations of the hyperplasia of a prostate, and with the age androgenic deficiency (AAD). Aim: To determine the frequency of emergence of age androgenic deficiency of patients with Benign prostatic hyperplasia (BPH). Materials and Methods: 180 patients with clinical signs of Benign prostatic hyperplasia have been examined. All patients were conducted with standard clinical examination: survey, measurement of International prostate symptom score (IPSS), assessment of quality of life (QOL). The research of the androgenic status of patients included clinical assessment of deficiency of androgens with the use of the standard international questionnaire: “The questionnaire of Aging Males’ Symptoms” (AMS) and hormonal blood test with determination of level of the general testosterone, follicle-stimulating and luteinizing hormones. Results: There were 118 patients with the low level of the general testosterone (Tgen) (67,7%) of all people. An average level of Tgen was 8,74 ± 0,9 nmol/l. In group of patients with low testosterone the GPA (grade point average) on a scale of AMS was 47,3 ± 9,1. Patients with BPH and AAD frequently have the accompanying pathology which is generally presented in such diseases as arterial hypertension, a metabolic syndrome, coronary heart disease, diabetes of the II type, anurolithic disease. Conclusions: Monitoring of the Tgen level is necessary for patients with BPH. Considering the high risk of a combination of BPH with the deficiency of testosterone it is necessary to include in the standard scheme of inspection the hormonal blood test with determination of the Tgen level.

Benign prostatic hyperplasia (BPH) — one of the most common urological diseases that lead to the development of symptoms of the lower urinary tract (SLUT). BPH-multifactorial disease, in which a significant role is given to increase the activity of the enzyme 5a-reductase and hormonal imbalance associated with the exchange of testosterone and dihydrotestosterone. However, to date, not all aspects of the etiology and pathogenesis of this condition have been studied. The results of numerous studies indicate a significant role of complex metabolic disorders included in the modern concept of "metabolic syndrome" (MS), the development and progression of BPH/SLUT. The main pathogenetic factors leading to the formation of BPH and concomitant urination disorders are considered to be a violation of the balance of sex hormones, the development of chronic ischemia of the pelvic organs, a violation of carbohydrate and lipid metabolism. The relationship between BPH and MS is one of the most urgent problems of modern medicine. Different components of MS independently from each other can influence more pronounced progression of BPH/SLUT in comparison with development of this disease in men without metabolic disorders that is the reason of lower efficiency of surgical and medical treatment of this group of patients.

Background: Many young adults with Duchenne Muscular Dystrophy (DMD) receive long-term glucocorticoids (GC). GC can cause hypogonadotrophic hypogonadism and adolescents may therefore be candidates for pubertal induction. It is unclear whether men with DMD on or off GC have age-appropriate endogenous testosterone production. Methods: We undertook a quality improvement project to assess the feasibility of measuring salivary testosterone (SalT) levels in men with DMD at home. A Sal-T sampling kit was sent by post to all patients with DMD, aged 17 and older, registered at the John Walton Muscular Centre in Newcastle (n = 75). Submitted Sal-T samples were collected and submitted for analysis. Results: Twenty-eight out of seventy-five patients returned samples (age range: 17–34 years). 6/28 samples were unsuitable for analysis. Overall Sal-T levels (n = 22) were significantly lower than in the healthy population (178 ± 107 v 287 ± 109 pmol/l, p = 0.0001). Sal-T was lower in those on GC compared to those off GC (144 ± 81 versus 218 ± 125 pmol/l, p = 0.05). Three patients were unable to collect a sample due to ventilator dependence. Conclusion: Sal T can provide information about androgen status in DMD patients at home, overcoming barriers such as mobility difficulties and challenging venepuncture. However we only obtained samples in a minority of patients suggesting that Sal-T measurement may not be appropriate or acceptable to everyone. There needs to be a more detailed exploration of the barriers to sample submission. [ABSTRACT FROM AUTHOR]

In recent years, the requirements for the level of the life quality have increased significantly; an integral part of it is the sexual harmony, which in men largely depends on sexual desire and erectile function. According to the results of modern scientific studies, there is no doubt that erectile dysfunction in men is closely connected with the cardiovascular diseases, obesity, diabetes mellitus and other comorbidities. This problem can also be caused by systematic psycho-emotional overload, deterioration of the environmental conditions, harmful factors of production, uncontrolled use of medicines, inflammatory processes in the genital organs, the growth of somatic diseases. The vast majority of works concerning “male menopause” is reduced to the effectiveness of hormone-replacement therapy in erectile dysfunction, while only few research works are devoted to the study of the connection between somatic pathology and androgen deficiency. There is a negative correlation between total testosterone level and systolic blood pressure. According to the research results of some scientists, it was found that 38% of patients with arterial hypertension had androgen deficiency, confirmed in the laboratory, which is significantly higher than in patients of the same age category with normal blood pressure. These dominant factors exert and increase the influence on each other, which must be taken into account in modern therapeutic practice. The study of the formation of comorbid conditions in men with low levels of androgens is of particular importance, as the knowledge of pathophysiological mechanisms can prevent their development and progression. The aim of this investigation was to study the state of penile vascular blood flow in men with arterial hypertension with erectile dysfunction, using color Doppler imaging with pharmacological induction of erection. The indicators of daily monitoring of arterial pressure and arterial stiffness in men with arterial hypertension of the II degree against the background of androgen deficiency or at normal testosterone levels and ways of correction of erectile dysfunction in these patients were also evaluated. [ABSTRACT FROM AUTHOR]