Diagnosing and treating testosterone deficiency in different parts of the world: changes between 2006 and 2010

Aim: An analysis of variations in diagnosing and treating testosterone (T) deficiency between different regions of the world in 2006 was repeated in 2010. Methods: Physicians were interviewed in Germany, Spain, the United Kingdom, Brazil and Saudi Arabia about (1) reasons to use/not to use T. (2) safety (prostate pathology) and other concerns in the decision not to provide T treatment. (3) the actual usage of T preparations for treatment of erectile dysfunction (ED). Results: More men were treated with T in 2010. ED and lack of libido (2006) but also depression and obesity (2010) were regarded as symptoms of T deficiency. For 70% of physicians, severity of complaints was more significant than the laboratory value of T to prescribe T, more so in Germany (96%) than in Spain and Saudi Arabia. Concerns about prostate disease remained strong and, therefore, 11% of eligible patients did not receive T. PDE-5 inhibitors are more often combined with T in 2010 for ED. Conclusion: More appropriate studies and more education of physicians are needed on diagnosing T deficiency, on the role of T in ED and on the evidence-based relative safety of T treatment.     

Unplanned Sexual Activity as a Consequence of Alcohol Use: A Prospective Study of Risk Perceptions and Alcohol Use Among College Freshmen

Objective: The authors' goal was to show how risk perceptions regarding unplanned sexual activity following alcohol use are prospectively related to subsequent alcohol consumption.

Participants: Undergraduate students (N = 380) completed questionnaires at 2 time points during their freshman year. Methods: In the middle of the academic year (T1), students estimated their risk of engaging in unplanned sex and reported their alcohol use during the previous term. Four months later (T2), they again reported alcohol use and indicated whether they had engaged in unplanned sex since T1. Results: Students who consumed more alcohol at T1 rated their risk of unplanned sex more highly, suggesting relative accuracy. Those with higher risk perceptions consumed more alcohol at T2 (controlling for T1 use), suggesting that they maintained the high-risk behavior. Last, those who were unrealistically optimistic (ie, estimated low risk at T1 yet had unplanned sex by T2) reported greater alcohol use at T2. Conclusions: These findings highlight the role that risk perceptions regarding sexual activity may play in college students' alcohol use.     

A pilot test of a self-guided,home-based intervention to improve condom-related sexual experiences,attitudes, and behaviors among young women

Objective: To conduct a pilot test of a brief, self-guided, home-based program designed to improve male condom use attitudes and behaviors among young women. Participants: Women aged 18–24 years from a large Midwestern University reporting having had penile–vaginal sex with two or more partners in the past 3 months. Sixty-seven enrolled; 91.0% completed the study. Methods: A repeated measures design was used, with assessments occurring at baseline, immediately post intervention (T2), and 30 days subsequent (T3). Results: Condom use errors and problems decreased, condom-related attitudes and self-efficacy improved, and experiences of condom-protected sex were rated more positively when comparing baseline with T2 and T3 scores. Further, the proportion of condom-protected episodes more than doubled between T1 and T3 for those in the lowest quartile for condom use at baseline. Conclusion: This low-resource, home-based program improved condom-related attitudes and promoted the correct and consistent use of condoms.     

Emotional Well-Being Factors Associated with Sexual Dysfunction in Adults with Type 1 or Type 2 Diabetes: Results from Diabetes MILES—Australia

Abstract

Objective: Diabetes is a chronic health condition that requires daily self-management activities to prevent or delay the onset of serious long-term complications. The two main types of diabetes are Type 1 (T1D) and Type 2 diabetes (T2D). Although both differ in their etiology, they share similar challenges of self-management of blood glucose levels, which, if are persistently high over time can lead to serious long-term complications. Sexual dysfunction (SD) is a common complication of both types of diabetes and affects both men and women. Although the physical aspects of SD are established, less is known about the emotional factors that may also impact SD in adults with diabetes. This study explored the emotional well-being factors associated with SD among 3,338 men and women with T1D and T2D. Methods: The relationships between self-reported SD and depressive and anxiety symptoms, and diabetes-specific distress, were examined using logistic regression modelling. Results: SD was associated with depressive symptoms (all sub-groups), anxiety (men/T2D; women/T1D/T2D), and diabetes-specific distress (women/T1D/T2D). Diabetes-specific distress was significantly higher in those with T2D who believed their SD was caused by their diabetes. Conclusions: SD impacts both men and women with T1D/T2D and is associated with emotional distress. Evaluation of SD and emotional problems should form part of routine clinical assessment.     

A randomized,double-blind,placebo-controlled trial of testosterone gel on body composition and health-related quality-of-life in men with hypogonadal to low-normal levels of serum testosterone and symptoms of androgen deficiency over 6 months with 12 months open-label follow-up

Introduction: The clinical significance of low to low-normal testosterone (T) levels in men remains debated. Aim: To analyze the effects of raising serum T on lean body mass (LBM), fat mass (FM), total body mass, and health-related quality-of-life (HRQoL). Methods: Randomized, double-blind, placebo-controlled study. Men, aged 50–80 years, with serum total T<15 nmol/L and bioavailable T < 6.68 nmol/L, and a Aging Males’ Symptoms (AMS) total score >36, received 6 months treatment with transdermal 1% T gel (5–7.5?mg/day; n =183) or placebo gel (n =179), followed by 12 months open-label with T in all. Results: After 6 months, LBM increased in T- treated patients by 1.28?±?0.15?kg (mean ± SE) and FM decreased by 1.16?±?0.16?kg, with minor changes with placebo (LBM +0.02?±?0.10?kg and FM ?0.14?±?0.12?kg; all p < 0.001, T group vs. placebo). Changes were largely similar across subgroups of age, baseline total testosterone, and baseline BMI. Total HRQoL improved compared with placebo (p < 0.05, T group vs. placebo). Conclusions: Six months 1% T gel improved body composition and HRQoL in symptomatic men with low to low-normal T, with further improvements over the following 12 months.     

The Effect of Brief Functional Relaxation on College Students’ Needle Anxiety During Injected Vaccinations

Abstract

Objective: This study examined the effect of brief functional relaxation (FR) training on needle anxiety (NA) during vaccinations. Participants: From October 2010 through May 2012, 48 undergraduates were recruited through the psychology research participant pool. Methods: Students (N = 48) were randomly assigned to a 15-minute brief FR session delivered via MP3 player or a standard care condition (15 minutes of sitting quietly) prior to receiving injections at the immunization clinic. Measures were completed before (T1) and after (T2) the assigned condition, assessing expected NA, state anxiety, blood pressure, and heart rate; and after the injection (T3), self-reported NA during the injection. Results: Unexpectedly, the groups did not differ at T2. However, during the injection, brief FR participants indicated lower self-reported NA (T3) than standard care. Conclusions: Brief FR is a simple, inexpensive technique that may reduce NA in college health settings and help decrease delays in treatment seeking.     

The Political Sociology of Counter-Revolution: The Case of Brazil

Books reviewed in this articles:
Politics in Brazil 1930–1964: An Experiment in Democracy. By T homas E. S kidmore .
Brazilian Planning: Development Politics and Administration. By R obert T. D aland .
Le Brésil. Special issue of Les Temps Modernes.     

Elevated high sensitivity C-reactive protein levels in aging men with low testosterone

Objective.?We examined baseline data from a lipid treatment study to assess the relationship between testosterone (T) and the cardiovascular inflammatory marker, high sensitivity C-reactive protein (hsCRP).

Methods.?The baseline T, hsCRP, lipid, glycemic, and anthropometric data were obtained from 467 men (mean age: 52 years). Inclusion criteria included low-density lipoprotein cholesterol ≥?3.4 to 4.9?mmol/l and triglycerides?≤?4.0?mmol/l. The baseline hsCRP levels were examined across the following T subgroups: <6.9?nmol/l (moderate to severe hypogonadism), 6.9 to <10.4?nmol/l (mild to moderate hypogonadism), 10.4 to <15?nmol/l (low-normal T), and?≥?15?nmol/l (normal T).

Results.?The median hsCRP levels were significantly (p?=?0.041) different across the four T subgroups; patients in the lower T subgroups had higher median hsCRP levels than patients in the higher T subgroups. The percentage of men with elevated hsCRP (>2?mg/l) was also significantly (p?=?0.038) different across the four T subgroups; 83% of men with T < 6.9?nmol/l had elevated hsCRP compared with 40% with T ≥ 15?nmol/l.

Conclusions.?This analysis demonstrated an inverse relationship between serum T and hsCRP in aging men. Urologists need to be aware that low T levels may not only adversely affect sexual function but also may worsen cardiovascular risk in aging, hypogonadal men.     

BOOK REVIEWS

Abstract

DISABILITY, SOCIETY, AND THE INDIVIDUAL Me Smart. Gaithers-burg, MD: Aspen Publication, 2001, 357 pp. Reviewed by John T. Pardeck.

THE LIGHTHOUSE HANDBOOK ON VISION IMPAIRMENT AND VISION REHABILITATION (VOLUMES ONE AND TWO). Barbara Silverstone, Mary Ann Lang, Bruce P. Rosenthal, and Eleanor E. Faye, Editors. New York: Oxford University Press, 2000, 1371 pp. Reviewed by John T. Pardeck.

NO PITY: PEOPLE WITH DISABILITIES FORGING A NEW CIVIL RIGHTS MOVEMENT. Joseph P. Shapiro. New York: Times Books, 1993, 372 pp. Reviewed by John T. Pardeck.     

REVIEWS

REVIEWS:Kasser, T., & Kanner, A. D. (Eds.). (2004). Psychology and Consumer culutre: The struggle for a good life in a materialistic world.
REVIEWS:Hargragve, D., & Pifitzer, F. (2003). The new contextual therapy: guiding the Power of give and take.
REVIEWS:Silverstiein, L. B., & Goodrich, T. J. (Eds.). (2003). Feminist family therapy: Empowerment in social context.
CLARIFICATION:The review of Kaethe Weingarten's book Common Shock-Witnessing Violence Every Day: How We are Harmed, How We Can Heal, by Charette Dersch (Journal of marital and Family Therapy,     

Problematic alcohol use and sexting as risk factors for sexual assault among college women

ABSTRACT

Sexual assault is a major public health concern and college women are four times more likely to experience sexual assault than any other group. We investigated whether sexting is a mechanism by which alcohol use increases risk for college women to be targeted for sexual assault. We hypothesized that sexting would mediate the relationship between problem drinking and sexual assault, such that drinking (T1 = beginning fall semester) would contribute to increased sexting (T2 = end fall semester), and in turn increase the risk of being targeted for sexual assault (T3 = end spring semester). Results: Among 332 undergraduate women (M(SD)age = 19.15(1.69), 76.9% Caucasian), sexting (T2) predicted sexual assault (T3; b = 3.98, p = .05), controlling for baseline sexual assault (b = 0.82, p < .01). Further, sexting (T2) mediated the relationship between problem drinking (T1) and sexual assault (T3) (b = 0.04, CI[.004,.12]). Conclusion: Findings suggest that sexting is one mechanism through which drinking increases the risk of college women being targeted for sexual assault.     

Interleukin-18 and testosterone levels in men with metabolic syndrome

Objective: Interleukin 18 (IL-18) is an adipokine associated with obesity. Data about the relationship of IL-18 to the metabolic syndrome (MS) are still scarce. Low testosterone (T) levels are common in men with MS, but we did not find data about the levels of IL-18 in men with low T. The aim of this study was to determine the levels of IL-18 in men with MS with or without low T.

Patients and methods: A total of 251 men were included in the study. Of them 218 had MS (IDF 2005) and they were divided according to their morning total testosterone (TT) level (cutoff 10.4?nmol/l) into two groups: MS-low T (N?=?84) and MS-normal T (N?=?134). The control group consisted of 33 men without MS and low T. IL-18 was determined in serum using enzyme-linked immunosorbent assay. A small group of eight men with MS and low T levels received testosterone therapy for three months and physical and laboratory parameters were monitored at the end of that period.

Results: MS men were at mean age (±SD)?=?53.77?±?9.59 years; body mass index (BMI)?=?34.0?±?6.3?kg/m²; and TT?=?12.59?±?5.66?nmol/l. The control group was at age?=?52.12?±?5.2 years (NS); BMI?=?25.6?±?2.4?kg/m² (p?p?p?p?p?p?Conclusions: In this study, higher IL-18 levels were found in the presence of MS compared to healthy men, but they did not differ between men having MS with or without LOH.     

Lead exposure is a risk for worsening bone mineral density in middle-aged male workers

Abstract

Objective: Lead exposure linked to osteoporosis in women. However, there is no direct evidence whether lead exposure has effects on bone metabolism in middle-aged male subjects. Therefore, the present study investigated the relationship between bone mineral densitometry measurements, bone markers, endocrine hormones and blood lead levels.

Material and methods: The present study included lead exposure patients (n: 30) and control subjects (n: 32). We recorded information on patient demographics and risk factors of osteoporosis. Blood lead levels were evaluated using Varian AA 240Z atomic absorption spectrophotometry. Bone mineral density measurements were measured using dual-energy X-ray absorptiometry.

Results: Each lumbar T and Z scores in the lead exposure group were lower than the control group. There were no significant differences in femur neck and femur total T and Z scores between two groups. Blood lead levels were also negatively correlated with lumbar 2-4 T score, total lumbar T score, lumbar 2-4 Z score and total lumbar Z score. Urinary hydroxyproline and urinary deoxypyridinoline levels in the lead exposure group were significantly higher compared to controls. Blood lead levels were strong, positively correlated with urinary deoxypyridinoline. Endocrine hormone levels and 1,25-dihydroxy-vitamin D3 levels were comparable between lead exposure and control group.

Conclusion: Lead exposure in male workers is an important factor for deterioration in bone mineral density. We should be screening blood lead levels and history of lead exposure in male osteoporosis.     

Longitudinal neural and behavioral trajectories of charity contributions across adolescence

This study examined the development of prosocial charity donations and neural activity in the ventral striatum when gaining rewards for self and for charity. Participants 10–22 years (95% European heritage) participated in three annual behavioral-fMRI waves (T1: n = 160, T2: n = 167, T3: n = 175). Behaviorally, donations to charity as measured with an economic Dictator Game increased with age. Perspective taking also increased with age. In contrast, self-gain and charity-gain enjoyment decreased with age. Ventral striatum activity was higher for rewards for self than for charity, but this difference decreased during adolescence. Latent growth curve models revealed that higher donations were associated with a smaller difference between ventral striatum activation for self and charity. These findings show longitudinal brain–donations associations in adolescence.     

Book Reviews

Book reviewed in this article: Foreign Investment in China under the Open Policy: The Experience of Hong Kong Companies. By John T. Thoburn, H. M. Leung, Esther Chau and S. H. Tang Investing in China: The Years of the Open Door Policy. By Richard Pomfret Cities and Development in the Third World. Edited by Robert B. Potter and Ademola T. Salau Economic and Political Incentives to Petroleum Exploration: Development in the Asia-Pacific Region. Edited by Jeremiah D. Lambert and Fereidun Fesharaki Extension Alternatives in Tropical Africa. By Jon Moris Economic Growth and Urbanization in Developing Areas. Edited by David Drakakis-Smith EC Trade Policy and the Third World: An Irish Perspective. By Alan Matthews     

Low-intermediate dose testosterone replacement therapy by different pharmaceutical preparations improves frailty score in elderly hypogonadal hyperglycaemic patients

Abstract

An open-label follow-up study of low-to-intermediate dose testosterone replacement therapy (TRT) was conducted in 64 overweight patients (aged 65–75 years) with late onset hypogonadism (LOH) and increased fasting plasma glucose (FPG). Patients were subdivided into four treatment groups: oral testosterone (T) (T undecanoate, 80?mg/d), transmucosal T (60?mg/d), transdermal T (30?mg/d) or no treatment (control), and evaluated at 0 and 6 months. FPG, hemoglobin (Hb), prostate-specific antigen (PSA) and total T were measured and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated. Body mass index (BMI), waist circumference, fitness level (6-min walking test), Aging Males’ Symptoms (AMS) scale, handgrip strength and energy expenditure with physical activity (Minnesota questionnaire for Leisure Time Physical Activity (LTPA)) were evaluated and a “frailty score” (based on: grip strength, gait speed and LTPA) was calculated. T levels increased in all treatment groups; the oral T group had values still in the hypogonadal range (5.9?±?1.1?nmol/L). PSA and Hb concentrations did not change in any group. BMI, waist circumference, FPG and HOMA-IR improved in all T-treated groups after 6 months, with a greater effect seen with transmucosal and transdermal T compared with oral T. This study indicates that low-to-intermediate dose TRT may be safely utilized in LOH patients to ameliorate somatic and psychological frailty symptoms in association with improved anthropometric and glycometabolic parameters in aging, overweight men with LOH and impaired fasting glucose.     

Diagnosing and treating testosterone deficiency in different parts of the world. Results from global market research

Aim. This study analysed variations between different regions of the world in diagnosing and treating testosterone (T) deficiency.

Methods. Physicians were interviewed in Germany, Spain and the United Kingdom, in Brazil, in Saudi Arabia and South Korea. Items in the survey: 1) reasons/motivation to use or not to use T; 2) what category of patients would not receive T on the basis of these concerns; 3) concerns about prostate pathology in the decision not to provide T treatment; 4) phosphodiesterase type 5 (PDE-5) inhibitors are efficacious, but T treatment makes a comeback.

Results. Between 5% and 10% of consulting patients suffered from T deficiency. The fear to induce prostate cancer appeared very powerful. About 68% of physicians associate the use of T more with risks than benefits, more so in Europe than elsewhere. As a result about 35% of hypogonadal men do not receive treatment. The PDE-5 inhibitors are very prominent in the treatment of erectile dysfunction. Of patients suffering from erectile dysfunction, 18% to 29% have T deficiency which is not always diagnosed and treated.

Conclusion. World-wide physicians require more education on diagnosing T deficiency, on the role of T in erectile dysfunction and the relative safety of testosterone treatment.     

Cross-sectional analysis between prostate volumes and serum sex hormones in Japanese men attending a urological clinic

Aim: To evaluate epidemiologically the association between measured prostate volume and sex hormones.

Methods: Between December 2012 and September 2014, 226 patients attending the urological clinic were assessed for the relationship between prostate volume (PV) and, serum sex hormones, physical size, personal habits, etc. Prostate volume was measured by using transabdominal ultrasonography. Statistically, the Pearson correlation coefficients test was used.

Results: Total cases, the cases of PV?≤?25?ml, and the cases of PV?>?25?ml were evaluated respectively. Total cases and the cases of PV?>?25?ml showed a positive significant correlation with testosterone (T), but the cases of PV?≤?25?ml showed no such correlation. The cases of PV?>?25?ml had a positive significant correlation with estradiol (E2), but total cases and cases of PV?≤?25?ml did not. Dehydroepiandrosterone sulfate (DHEAS) showed no correlation with any case of PV, however it decreased significantly with age and had a correlation with alopecia. The E2/T ratio had no correlation with any case of PV, but on the other hand, the T/DHEAS and E2/DHEAS ratios had significant positive correlation with PV?>?25?ml.

Conclusions: Serum T and E2 had significant positive correlation with measured PV especially in larger prostates. This result seems to correspond with the conventional theory that T and E2 have an etiological effect on benign prostatic hyperplasia. DHEAS did not show direct correlation with PV, however it appeared to suppress the role of T and E2 on benign prostatic hyperplasia growth. DHEAS might be a key to understanding the etiology of benign prostatic hyperplasia with aging.