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Hypogonadism is highly prevalent in older men and men who have prostate cancer. The symptoms of hypogonadism, such as depression, decreased libido, erectile dysfunction, and decreased bone mineral density, can significantly impair a man's quality of life. Moreover, we know that testosterone plays an important role in erectile preservation and in the growth and function of cavernosal and penile nerves. There are compelling data to suggest that testosterone replacement therapy (TRT) in normal and high-risk men does not increase the risk for prostate cancer. In the few studies of men treated with TRT after a radical prostatectomy, there have been no biochemical recurrences. Based on these data, it is difficult to justify withholding TRT following a radical prostatectomy. If we do not lower the testosterone levels of eugonadal men after a radical prostatectomy, how can we justify not replacing testosterone levels in hypogonadal men to make them eugonadal following a radical prostatectomy?
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PMID:The role of testosterone replacement therapy following radical prostatectomy. 1798 94

In humans androgen decline is presented as a clinical picture which includes decreased sexual interest, diminished erectile capacity, delayed or absent orgasms and reduced sexual pleasure. Additionally, changes in mood, diminished well being, fatigue, depression and irritability are also associated with androgen insufficiency. The critical role of androgens on the development, growth, and maintenance of the penis has been widely accepted. Although, the exact effect of androgens on erectile physiology still remains undetermined, recent experimental studies have broaden our understanding about the relationship between androgens and erectile function. Preclinical studies showed that androgen deprivation leads to penile tissue atrophy and alterations in the nerve structures of the penis. Furthermore, androgen deprivation caused to accumulation of fat containing cells and decreased protein expression of endothelial and neuronal nitric oxide synthases (eNOS and nNOS), and phosphodiesterase type-5 (PDE-5), which play crucial role in normal erectile physiology. On the light of the recent literature, we aimed to present the direct effect of androgens on the structures, development and maintenance of penile tissue and erectile physiology as well. Furthermore, according to the clinical studies we conclude the aetiology, pathophysiology, prevalence, diagnosis and treatment options of hypogonadism in aging men.
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PMID:Hypogonadism and erectile dysfunction: an overview. 1808 42

In contrast to women, men do not experience a sudden cessation of gonadal function comparable to menopause. However, there is a progressive reduction in male hypothalamic-pituitary-gonadal (HPG) axis function: testosterone levels decline through both central (pituitary) and peripheral (testicular) mechanisms, and there is a loss of the circadian rhythm of testosterone secretion. The progressive decline in testosterone levels has been demonstrated in both cross-sectional and longitudinal studies, and overall at least 25% of men over age 70 meet laboratory criteria for hypogonadism (ie, testosterone deficiency). Such age-associated HPG hypofunctioning, which has been termed "andropause," is thought to be responsible for a variety of symptoms experienced by elderly men, including weakness, fatigue, reduced muscle and bone mass, impaired hematopoiesis, sexual dysfunction (including erectile dysfunction and loss of libido), and depression. Although, it has been difficult to establish correlations between these symptoms and plasma testosterone levels, there is some evidence that testosterone replacement leads to symptom relief, particularly with respect to muscle strength, bone mineral density, and erectile dysfunction. There is little evidence of a link between the HPG axis hypofunctioning and depressive illness, and exogenous androgens have not been consistently shown to have antidepressant activity. This article reviews the relationship between androgens, depression, and sexual function in aging men.
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PMID:Androgens and the aging male. 1822 89

The many similarities between the metabolic syndrome and Cushing's syndrome led to the hypothesis that excess glucocorticoids (GC) are part of the pathogenesis linking their features. We review recent work that confirms the initial similarities (obesity, glucose intolerance, hypertension, and hyperlipidemia) and extends them to associated features of both syndromes (osteopenia, hypogonadism, leukocytosis, depression, and muscle weakness). Recent studies report that these features also occur in subclinical Cushing's syndrome, hypercortisolemic depression, and the transgenic overexpression of 11beta-hydoxysteroid dehydrogenase type 1 (11beta-HSD1) in mouse models of excess GC in adipose tissue. Reducing excess GC--in the clinical syndromes and in the mouse model-reverses many of these features. Because local tissue excess GC may have a central role in the pathogenesis of the metabolic syndrome, selective 11beta-HSD1 inhibitors are under active development by several pharmaceutical companies.
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PMID:Adrenal steroids and the metabolic syndrome. 1836 16

Erectile dysfunction is a common problem affecting sexual function in men. Approximately one in 10 men over the age of 40 is affected by this condition and the incidence is age related. Erectile dysfunction is a sentinel marker for several reversible conditions including peripheral and coronary vascular disease, hypertension and diabetes mellitus. Endothelial dysfunction is a common factor between the disease states. Concurrent conditions such as depression, late-onset hypogonadism, Peyronie's disease and lower urinary tract symptoms may significantly worsen erectile function, other sexual and relationship issues and penis dysmorphophobia. A focused physical examination and baseline laboratory investigations are mandatory. Management consists of initiating modifiable lifestyle changes, psychological and psychosexual/couples interventions and pharmacological and other interventions. In combination and with treatment of concurrent comorbid states, these interventions will often bring about successful resolution of symptoms and avoid the need for surgical interventions.
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PMID:Erectile dysfunction. 1839 56

Testosterone deficiency syndrome (TDS) refers to the clinical signs and symptoms that result from an abnormally low testosterone level. Men with 'classic' hypogonadism can have unequivocally low testosterone levels and typical symptoms and signs. By contrast, the age-related decline of testosterone levels can be responsible for ambiguous clinical pictures, which can potentially be misinterpreted as part of the aging process or depression. Nevertheless, this decline can have detrimental effects on quality of life and on the function of multiple organ systems. TDS is underdiagnosed-its overall prevalence varies from 6% to 9.5% in community-dwelling men aged 40-70 years, and rises to 15-30% in diabetic or obese men-and undertreated; less than 10% of men with TDS receive treatment. This Review highlights potential pitfalls in the diagnosis of both clinical and biochemical components of TDS.
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PMID:Testosterone deficiency: a common, unrecognized syndrome. 1860 25

We present a case of isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) in a late onset hypogonadism (LOH) clinic, not diagnosed by examinations in internal medicine. A 54-year-old man showed body weight loss with severe appetite loss, general malaise and hypotension. He visited our clinic for a checkup for LOH after general examinations in internal medicine. His hormonal examination showed undetectable ACTH and cortisol levels. However, the values of other pituitary hormones and testosterone were normal. A load test for anterior pituitary hormone (CRH + TRH + LHRH + GRH test) revealed that the ACTH-cortisol system showed no response although the other pituitary hormones responded. These findings confirmed the diagnosis of isolated ACTH deficiency. Administration of hydrocortisone dramatically improved his symptoms. Symptoms of IAD are similar to those of LOH syndrome and depression. Thus, we should consider IAD as one of the differential diagnoses in LOH clinics.
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PMID:[Isolated ACTH deficiency in a late onset case of hypogonadism (LOH) not diagnosed by examination in an internal medicine clinic]. 1878 51

A 40-year-old unmarried male was referred to our hospital with anejaculation. His secondary sex characteristics, sexual function and ejaculation were previously normal but for the last 5 years he found it impossible to ejaculate even though he could achieve an erection. His genital stage was Tanner V, and pubic hair stage was Tanner III. There were no varicoceles or chromosomal aberrations. His testis volume was 10 ml on the right side and 12 ml on the left. His hormonal data were luleinizing hormone (LH) 0.3 mIU/ml (normal: 2.2-8.4 mIU/ml), fillicle stimulating hormone (FSH) 1.5 mIU/ ml (1.8-12 mIU/ml), testosterone 0.05 ng/ml (2.01-7.5 ng/ml). A gonadtropin releasing hormone (GnRH) test and human chorionic gonadotropin (hCG) stimulation test revealed low responses of LH, FSH and a normal response of testosterone. Magnetic resonance imaging of the head revealed slight depression of the diaphragma sellae, indicating an "empty sella". We diagnosed acquired hypogonadtropic-hypogonadism related empty sella. An hCG replacement therapy was introduced and after 3 months the patient's capacity to ejaculate was restored and testis volume was 14 ml on both sides. Six months after hormone replacement therapy, semen analysis revealed azoospermia. Then we added r-hFSH to his treatment and expect his sperm to reappear.
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PMID:[Acquired male hypogonadotropic hypogonadism (MHH) in a patient with empty sella: a case report]. 1917 4

HIV-associated hypogonadism is known to be a prevalent endocrine disorder, with a multifactorial etiology. Low testosterone levels are associated with decreased muscle mass, exercise capacity loss, erectile dysfunction, cognitive impairment, depression and decreased quality of life. In the same way, hypogonadism in HIV-infected men is associated with decreased muscle mass quantity and function, changes in corporal fat mass distribution and quantity, secretion of adipocytokines and endothelial dysfunction. This combined effect renders the entire body less sensitive to insulin, promoting development of atherosclerosis and glucose metabolism disorders. The clinical presentation is non-specific and hypogonadism screening scales are not useful in this population. Diagnostic procedures must include determination of free testosterone (FTc) in any HIV-infected men at the time of first HIV diagnosis and periodically, because of the clinical implications and the absence of specific predictive disease factors. Substitutive hormonal treatment must be offered only for HIV-infected men with FTc under reference levels and when reversible causes have been ruled out. Metabolic impact of hypogonadism suggests the incorporation of low testosterone levels to the list of cardiovascular risk factor in HIV-infected men.
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PMID:[Hypogonadism, erectile dysfunction and endothelial dysfunction among HIV-infected men]. 2193 92

Hypogonadism is highly prevalent in the elderly and in men with prostate cancer. Symptoms of hypogonadism, such as depression, lack of libido, and decreased bone mineral density, can significantly impair quality of life. In addition, testosterone plays an important role in erectile preservation and in growth and function of the cavernosal and penile nerves. There are compelling data showing that testosterone replacement therapy (TRT) does not increase the risk of prostate cancer. The literature (four published studies) concerning men treated with TRT after definitive therapy for prostate cancer reports only one biochemical recurrence. Based on these data, physicians cannot really justify withholding TRT from symptomatic patients after they have been successful treated for prostate cancer. This review gives the practising urologist an overview of the latest literature and useful advice on this controversial topic.
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PMID:[Testosterone replacement therapy and prostate cancer. The current position 67 years after the Huggins myth]. 1929 69


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