39. Testosterone Clinical Aspects

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39. Testosterone Clinical Aspects

 

 

 

CATEGORY: Anabolic Steroids 100 Courses

COURSE NUMBER: 39

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Syllabus

Content

1 The History of Testosterone and The Testes:

From Antiquity to Modern Times  1

Eberhard Nieschlag and Susan Nieschlag

2 Androgen Receptor in Health and Disease 21

Marco Marcelli

3 Physiology of Male Gonadotropic Axis and Disorders

of Sex Development  75

Berenice Bilharinho de Mendonca and Elaine Maria Frade Costa

4 Utility and Limitations in Measuring Testosterone 97

Mathis Grossmann

5 Male Puberty: What Is Normal and Abnormal? 109

David W. Hansen and John S. Fuqua

6 Hypogonadotropic and Hypergonadotropic Hypogonadism  133

Vijaya Surampudi and Ronald S. Swerdloff

7 Functional Hypogonadism: Diabetes Mellitus, Obesity,

Metabolic Syndrome, and Testosterone 147

Ricardo Martins da Rocha Meirelles

8 Male Hypogonadism and Aging 161

Pedro Iglesias, Florentino Prado, and Juan J. Díez

9 Hypogonadism After Traumatic Brain Injury  189

Alexandre Hohl and Roger Walz

10 Testosterone Therapy: Oral Androgens  203

Svetlana Kalinchenko, Igor Tyuzikov, George Mskhalaya,

and Yulia Tishova

11 Testosterone Therapy: Transdermal Androgens 225

Jonas Čeponis, Pavan Yadav, Ronald S. Swerdloff,

and Christina Wang

12 Testosterone Therapy: Injectable Androgens. . . . . . . . . . . . . . . . . . . . 237

Aksam A. Yassin

13 Benefits and Adverses Effects of Testosterone Therapy. . . . . . . . . . . . 253

Elaine Maria Frade Costa, Lorena Guimarães Lima Amato,

and Leticia Ferreira Gontijo Silveira

14 Testosterone and Sexual Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Giovanni Corona, Giulia Rastrelli, Simona Ferri, Alessandra Sforza,

and Mario Maggi

15 Testosterone Therapy and Prostate Cancer. . . . . . . . . . . . . . . . . . . . . . 285

Daniel de Freitas G. Soares, Ernani Luis Rhoden,

and Abraham Morgentaler

16 Testosterone and Cardiovascular Effects. . . . . . . . . . . . . . . . . . . . . . . . 299

Bu B. Yeap

17 Testosterone and Women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

Ruth Clapauch, Rita Vasconcellos Weiss,

and Ciciliana Maila Zilio Rech

18 Testosterone and Endocrine Disruptors: Influence of Endocrine

Disruptors on Male Reproductive Tract. . . . . . . . . . . . . . . . . . . . . . . . . 353

Eveline Fontenele, Rosana Quezado, and Tânia Sanchez Bachega

19 Testosterone Misuse and Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375

Rakesh Iyer and David J. Handelsman

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Testosterone Clinical Aspects


Research on testosterone is increasing in many senses; however there is still much controversy regarding its physiology and clinical use. This book addresses these topics, providing a broad overview about testosterone, from its basic features to the most recent evidence of clinical applicability. Also, specific conditions in which testosterone play a pivotal role are discussed in detail, such as hypogonadism, misuse and abuse, puberty, cardiovascular effects and testosterone therapy. Although not essential for survival, testosterone represents the essence of male biological function, being the important testicular androgen in men. Low serum testosterone levels are associated with cardiovascular morbidity, metabolic syndrome, type 2 diabetes mellitus, atherosclerosis, osteoporosis, sarcopenia, and mortality. Conversely, increased serum levels of testosterone may lead to deleterious events. In general, there is increasing evidence that serum testosterone is a major biomarker status of men’s health in general. Testosterone: From Basic to Clinical Aspects is an indispensable reference for all those who seek state-of-the-art knowledge regarding this hormone, from basic issues (including pharma-cology and physiology) through clinical aspects (related diseases and supplementation ther-apy).


Research on testosterone is increasing in many senses; however there is still much controversy regarding its physiology and clinical use. This book addresses these topics, providing a broad over¬view about testosterone, from its basic fea¬tures to the most recent evidence of clin¬ical applicability. Also, specific conditions in which testosterone play a pivotal role are discussed in detail, such as hypogonadism, misuse and abuse, puberty, cardiovascular effects and testosterone therapy. Although not essential for survival, testosterone represents the essence of male biological function, being the important testicular androgen in men. Low serum testosterone levels are asso¬ciated with cardiovascular morbidity, meta¬bolic syndrome, type 2 diabetes mellitus, atherosclerosis, osteoporosis, sarcopenia, and mortality. Conversely, increased serum levels of testosterone may lead to deleteri¬ous events. In general, there is increasing evidence that serum testosterone is a major biomarker status of mens health in general. Testosterone: From Basic to Clinical Aspects is an indispensable reference for all those who seek state-of-the-art knowledge regarding this hormone, from basic issues (including pharma¬cology and physiology) through clinical aspects (related diseases and supplementation ther-apy).


Plasma testosterone levels were measured in the female partners of 146 consecutive infertile couples. The incidence of hyperandrogenism in the woman was correlated with ovarian function, incidence of pregnancy, male factor, and response of plasma testosterone levels to prednisone treatment. Over 70 per cent of the patients had pretreatment testosterone levels above 40 ng. per 100 ml. while after a minimum of two months of therapy approximately 80 per cent had levels below 40 ng. per 100 ml. High levels of plasma testosterone were associated with significant prolongation of the follicular phase of the cycle and increased incidence of amenorrhea or anovulation. An over-all pregnancy rate of 50.4 per cent resulted from the treatment. A direct relationship between pregnancy rates and sperm density as well as between pregnancy rates and degree of suppression of plasma testosterone after therapy was observed. These results demonstrate a high incidence of hyperandrogenism in female partners of infertile couples. The effectiveness of glucocorticoid treatment appears to be related to suppression of excessive androgen levels. The data also suggest that infertility is a relative state related to the fertility potential of each member of the couple. Improvement of the fertility potential of either member may result in conception.


Vaginal flora was studied quantitatively in 29 sexually active women, 16 to 33 years of age, to define the role ofC. vaginale in vaginitis. Seventeen were asymptomatic and 12 complained of symptoms of vaginitis. Seven asymptomatic women had scant secretions: four of these seven hadC. vaginale at log10 6 to 9 CFU per milliliter, none of whom had “clue” cells; none had trichomonas or candida; six had Lactobacilli at log10 7 to 9.7 per milliliter; only one had Bacteroidaceae at > log10 5 per milliliter. Ten asymptomatic women had easily collectable secretions; eight of 10 hadC. vaginale at log10 6.5 to 9.6 per milliliter, three of whom had “clue” cells; four had trichomonas and none candida; nine had Lactobacilli at log10 7 to 9.3 per milliliter; four had Bacteroidaceae at > log10 5 per milliliter. Twelve had vaginitis: five of 12 hadC. vaginale at log10 7.9 to 11 per milliliter, one of whom had “clue” cells; nine had either trichomonas or candida or both and three had no pathogen, includingC. vaginale; 10 had Lactobacilli at log10 7 to 10 per milliliter; six had Bacteriodaceae at >log10 5 per milliliter. Three had “clue” cells in absence ofC. vaginale.


Forty-five of 49 patients were aborted successfully with 15(S)-15-Me-PGF2α after previous techniques to induce abortion had met with failure in 39. Nine patients had spontaneous premature rupture of membranes without onset of labor. The majority of patients aborted within 7 hours following initiation of this method of treatment.


Cytogenetic and endocrine evaluation of a postpubertal 45,X female subject with Turner’s stigmas and spontaneous sexual development was performed. A 45,X chromosomal complement was found in the peripheral blood lymphocytes, bone marrow, and fibroblasts derived from skin and ovaries. Menarche, pubarche, and thelarche occurred at age 12; at age 16 she developed menstrual irregularities, with endometrial bleeding occurring every 60 to 90 days. The ovaries were normal in size, and histologic examination revelaed a marked paucity of primordial follicles, increased collagenization, and absence of corpora albicans. Anovulatory cycles with moderately elevated levels of luteinizing hormone (LH) and low follicle-stimulating hormone (FSH) levels were observed. LH-releasing hormone pituitary stimulation induced a normal LH release with a very slight FSH increase. Administration of clomiphene citrate successfully induced a normal-length ovulatory cycle. Similarities in the normonal situation of this patient and that seen in the Stein-Leventhal syndrome are pointed out.

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