Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile.

INTRODUCTION: Male obesity has a negative correlation with plasma testosterone (T) levels and sexual function (SF). AIM: To evaluate the effect of weight loss through bariatric surgery (BS) on SF, low T symptoms, and hormonal profiles in obese men. METHODS: Thirty-three men who underwent BS participated in this cohort study. Before surgery, all participants underwent clinical examinations, including anthropometric, lipid, glycemic, and hormonal evaluations. SF was evaluated using the International Index of Erectile Function (IIEF) questionnaire; low T symptoms were evaluated using the Aging Males' Symptoms (AMS) and Androgen Deficiency in the Aging Male (ADAM) questionnaires. The participants were reevaluated 6 months post-surgery. MAIN OUTCOME MEASURES: Sex hormone profile, SF, and low T symptoms RESULTS: After BS, a significant increase in mean total T (201 ± 111-548 ± 190 ng/dL, P < .001), free T (5.8 ± 2.8-9.3 ± 3.4 ng/dL, P < .001), bioavailable T (110.3 ± 57.8-198.6 ± 74.3 ng/dL, P < .001), and sexual hormone-binding globulin (19.8 ± 13.7-54.6 ± 23.2 nmol/L, P < .001) levels. There was a significant decrease in estradiol (64.6 ± 27.4-29.2 ± 20.0 [pg/mL], P < .001). SF significantly improved. The total IIEF score increased 5.2 points (62.3 ± 7.4-67.5 ± 7.4, P = .004), erectile function subdomain increased 2.4 points (25.7 ± 4.1-28.1 ± 3.9, P = .011), desire subdomain increased 1.0 points (8.3 ± 1.5-9.3 ± 1.6, P = .006), and intercourse satisfaction subdomain increased 1.2 points (11.4 ± 1.9-12.6 ± 1.8, P = .012). Post-surgery, a 44% reduction (P = .001) was observed in the positive ADAM questionnaire, and improvements in all domains of the AMS questionnaire were found (P < .001). CONCLUSION: Significant weight loss through BS improves erectile function, hormonal profile, and symptoms of T deficiency. Machado FP, Rhoden EL, Pioner SR, et al. Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile. Sex Med 2021;9:100400.

Hepatic and renal damage by alcohol and cigarette smoking in rats.

Chronic use of alcohol and tobacco cigarettes is associated to millions of deaths per year, either by direct or indirect causes. However, few studies have explored the additional risks of the combined use of these drugs. Here we assessed the effect of the combined use of alcohol and cigarette smoke on liver or kidney morphology, and on biochemical parameters in chronically treated rats. Male Wistar rats were allocated to receive 2 g/kg alcohol orally, which was followed by the inhalation of smoke from six cigarettes during 2 h (ALTB group) for 28 days. Other groups received alcohol alone (AL) or were exposed to cigarette smoke (TB) alone and were compared to control (CT) rats, which received water followed by ambient air. On day 29, rats were euthanized and blood samples were collected for aminotransferase enzymes (AST and ALT), creatinine, and urea analysis. Liver and kidney were weighted, dissected, fixed, and stained with hematoxylin and eosin for morphological analysis. Our results showed that necrosis was elevated in the AL, TB, and mainly the ALTB group in both liver and kidney of rats. Serum levels of AST and ALT were reduced by cigarette smoke exposure, independently of alcohol use. Serum creatinine levels increased after tobacco smoke exposure. On the other hand, TB and AL groups decreased serum urea levels, and their association restored that decrease. Absolute liver and kidney weights were lower in the cigarette smoke exposure rats. Lastly, body weight gain was lower in TB group and combined use restored it. Thus, we may infer that the use of alcohol, exposure to tobacco cigarette smoke or, mainly, their association promotes liver and kidney injuries, and this damage is related with biochemical changes in rats.

Testosterone replacement maintains smooth muscle content in the corpus cavernosum of orchiectomized rats.

OBJECTIVE: To evaluate the effects of testosterone (T) on the maintenance of corpus cavernosum (CC) structure and apoptosis. METHODS: Animals were divided into three groups: sham operation group (n = 8) underwent sham operation; Orchiectomized (Orchiec)+ oily vehicle group (n = 8) underwent bilateral orchiectomy and received a single dose of oily vehicle by intramuscular injection (i.m.) 30 days after orchiectomy; and Orchiec + T group (n = 8) underwent bilateral orchiectomy and received a single dose of T undecanoate 100 mg/kg i.m. 30 days after the surgery. Animals were euthanized 60 days after the beginning of the experiment with an anesthetic overdose of ketamine and xylazine. Blood samples and penile tissue were collected on euthanasia. Azan's trichrome staining was used to evaluate smooth muscle, Weigert's Fucsin-Resorcin staining was used to evaluate elastic fibers and Picrosirius red staining was used to evaluate collagen. Apoptosis was evaluated using TUNEL technique. RESULTS: T levels decreased in Orchiec + oily vehicle when compared to sham operation and Orchiec + T groups (p < 0.001). T deprivation reduced trabecular smooth muscle content and penile diameter and T replacement maintained both parameters (p = 0.005 and p = 0.001, respectively). No difference was observed in the content of sinusoidal space (p = 0.207), elastic fibers (p = 0.849), collagen (p = 0.216) and in apoptosis (p = 0.095). CONCLUSION: Normal testosterone levels maintain CC smooth muscle content and do not influence elastic fibers, collagen content and apoptotic index. Further studies should be performed in order to investigate the mechanisms by which androgen mediates its effects on CC structure.

Total testosterone levels are correlated to metabolic syndrome components.

INTRODUCTION: Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin. Some studies suggest a possible link between low total testosterone (TT) levels and the presence of MetS. AIM: To analyze the strength and independence of associations between TT and MetS components in non-diabetic men. METHODS: In this cross-sectional study, 143 non-diabetic men older than 40 were analyzed. MAIN OUTCOMES MEASURE: Blood samples were collected to evaluate metabolic profile and TT levels. MetS was defined as the presence of three or more of the following characteristics: fasting blood glucose levels ≥ 100 mg/dL, triglyceride ≥ 150 mg/dL, HDL-c < 40 mg/dL, hypertension or blood pressure ≥ 130/85 mmHg, and waist girth > 102 cm. RESULTS: Mean age of the study population was 61.5 ± 8.61 years old. MetS was present in 47.9% of the individuals. Thirty-four men had low TT and MetS was observed in 23 (70%) against 50 (46%) in those with normal TT (≥ 300 ng/dL) (OR 4.94, p < 0.01), adjusted to confounder's factors. In multiple linear regression analysis, only waist circumference (Beta: -0.395; p = 0.03) and HDL-c (Beta: 0.19; p = 0.04) remained significantly correlated with TT levels. CONCLUSIONS: Low TT levels were associated with MetS diagnosis. Abdominal obesity was the MetS component independently correlated to low TT levels.

New therapy of skin repair combining adipose-derived mesenchymal stem cells with sodium carboxymethylcellulose scaffold in a pre-clinical rat model.

Lesions with great loss of skin and extensive burns are usually treated with heterologous skin grafts, which may lead rejection. Cell therapy with mesenchymal stem cells is arising as a new proposal to accelerate the healing process. We tested a new therapy consisting of sodium carboxymethylcellulose (CMC) as a biomaterial, in combination with adipose-derived stem cells (ADSCs), to treat skin lesions in an in vivo rat model. This biomaterial did not affect membrane viability and induced a small and transient genotoxicity, only at the highest concentration tested (40 mg/mL). In a rat wound model, CMC at 10 mg/mL associated with ADSCs increased the rate of cell proliferation of the granulation tissue and epithelium thickness when compared to untreated lesions (Sham), but did not increase collagen fibers nor alter the overall speed of wound closure. Taken together, the results show that the CMC is capable to allow the growth of ADSCs and is safe for this biological application up to the concentration of 20 mg/mL. These findings suggest that CMC is a promising biomaterial to be used in cell therapy.

Calculated free testosterone and radioimmunoassay free testosterone as a predictor of subnormal levels of total testosterone.

PURPOSE: To evaluate the relationship among aFT, cFT, and total testosterone (TT) and the best method in diagnosing subnormal levels of TT. METHODS: A total of 213 men were analyzed. Fasting blood samples were drawn for the determination of the lipid profile as well as of plasmatic glucose and serum levels of albumin, TT, aFT, and sex hormone-binding globulin (SHBG). The values of cFT were determined by Vermeulen's formula. RESULTS: No correlation between aFT and cFT was observed (r = 0.062; P = 0.368), except after controlling for confounders (r = 0.188; P = 0.007). Only 44.8% of hypogonadal men (TT ≤ 300 ng/dL) were classified by aFT, whereas 72.4% of hypogonadal men were classified by both TT and cFT. Sensitivity, specificity, positive and negative predictive values, and positive likelihood ratio were greater in cFT when compared with aFT. CONCLUSIONS: Our results suggest that cFT is more accurate in diagnosing subnormal levels of TT. Furthermore, we do not recommend using aFT due to its lack of accuracy. Further studies should be performed in order to evaluate the correlation between aFT and cFT with clinical signs and symptoms of androgen deficiency.

The influence of age on bioavailable and free testosterone is independent of body mass index and glucose levels.

PURPOSE: To evaluate the influence of age on serum levels of total testosterone (TT), bioavailable testosterone (BT), free testosterone (FT), and sex-hormone binding globulin (SHBG), considering the presence of fasting blood glucose levels and body mass index (BMI) in a selected male population. METHODS: A total of 428 men were analyzed. Anthropometry was taken from all, considering BMI as general obesity indicative variable. Fasting blood samples were drawn for determination of plasma glucose levels and serum levels of albumin, TT, and SHBG. The values of BT and FT were calculated from TT, SHBG, and albumin, by Vermeulen's equation. Statistical significance was set at P ≤ 0.05. RESULTS: Age was negatively correlated to BT (r = -0.301; P < 0.001) and FT (r = -0.273; P < 0.001), but not to TT levels (r = 0.002, P = 0.974). Age was positively correlated to SHBG (r = 0.376; P < 0.001). Age was independently associated with the occurrence of high SHBG levels (OR = 1.07, 95%CI = 1.05-1.10, P < 0.001) and of low BT (OR = 1.04, 95%CI = 1.02-1.07, P < 0.001) and FT levels (OR = 1.05, 95%CI = 1.03-1.08, P < 0.001), but not with low levels of TT (P = 0.08). CONCLUSIONS: Age was significantly associated to high levels of SHBG and to low levels of BT and FT, without significant association to TT. This pattern was independent of BMI and glucose levels.

A cross-sectional study for the analysis of clinical, sexual and laboratory conditions associated to Peyronie's disease.

INTRODUCTION: Although Peyronie's Disease (PD) was first described over 250 years ago, its precise etiology remains obscure. AIM: Analyze a variety of potential associated factors with PD, including erectile dysfunction. MATERIALS AND METHODS: This cross-sectional study included 83 consecutive men with PD and 252 age-matched controls. All men completed the International Index of Erectile Function (IIEF) and were evaluated regarding their clinical and demographic characteristics, comorbidities, and used medications. Anthropometric measures included body mass index and waist circumference (WC). Fasting blood glucose, lipid profile, total testosterone, and dehydroepiandrosterone-sulfate were determined. MAIN OUTCOME MEASURES: Clinical and laboratory characteristics associated to PD. RESULTS: The mean age was 59.2 + or - 10 years in the cases and 59.7 + or - 12 years in the controls. Marital status, current smoking, and excessive consumption of alcoholic beverages were similar between groups (P > 0.05). PD was more common among white skin color males (P = 0.001). The mean score for each IIEF domain and the androgen levels were similar in the two groups. Thiazides were the only medication associated to PD (P = 0.03). Dupuytren's disease was more frequent among individuals with PD (P = 0.001). The distribution of all other comorbidities investigated was similar between groups (P > 0.05). The characteristics WC > 102 cm and levels of low-density lipoprotein (LDL) > 130 mg/dL were more prevalent in the controls (P < 0.05). After multivariate analysis, white skin color (OR: 8.47, 95%CI: 1.98-36.24) and thiazide use (OR: 2.29, 95%CI: 1.07-4.90) were associated to PD, and LDL > 130 mg/dL (OR: 0.55, 95%CI: 0.32-0.92) and WC > 102 cm (OR: 0.53, 95%CI: 0.29-0.96) were inversely associated to PD. CONCLUSIONS: In this study, PD was more common among white skin colored males. An inverse relationship with the presence of elevated serum levels of LDL and WC was observed. We found no association with medications other than thiazides and comorbidities other than Dupuytren's disease. Androgen serum levels and sexual dysfunction had also no association to PD.

Evaluation of the effects of cigarette smoking on testosterone levels in adult men.

INTRODUCTION: Cigarette smoking is highly prevalent among men. Many studies have evaluated the effect of cigarette smoking on levels of male reproductive hormones; however, the findings still remain controversial. AIM: To evaluate the influence of cigarette smoking on serum levels of total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). METHODS: A total of 255 men (90 smokers and 165 nonsmokers), aged 30 to 70 years, were investigated. Weight and height were obtained and body mass index (BMI) was calculated. Also, waist circumference and hip circumference were measured and waist-to-hip ratio was obtained. Fasting blood samples were drawn for determination of plasmatic glucose levels and serum levels of total cholesterol, high-density lipoprotein cholesterol (HDL-c), triglycerides, albumin, prolactin, TT, SHBG, LH, and FSH. The values of low-density lipoprotein cholesterol (LDL-c) were determined by Friedwald equation and the values of FT and BT were calculated from TT, SHBG, and albumin. Statistical significance was set at P < or = 0.05. MAIN OUTCOME MEASURES: The influence of smoking on levels of TT, FT, and BT. RESULTS: No significant difference was observed in the mean values of TT (P = 0.580), FT (P = 0.869), BT (P = 0.933), SHBG (P = 0.279), LH (P = 0.573), and FSH (P = 0.693) in the different levels of pack-years when compared to nonsmokers. Moreover, after multivariate logistic regression, no association between increased pack-years of smoking and increased odds ratio for occurrence of low hormones and SHBG levels was observed. CONCLUSION: In this study, smokers and nonsmokers had similar mean values of androgens, gonadotropins and SHBG. However, it is necessary to standardize pack-years of smoking in order to elucidate the influence of cigarette smoking on sex hormone levels, as well as to minimize differences among studies and to confirm our results.

Evaluation of the pharmacotherapeutic efficacy of Garcinia cambogia plus Amorphophallus konjac for the treatment of obesity.

Hydroxycitric acid (HCA), the main compound of Garcinia cambogia extract, is a competitive blocker of ATP-citrate-lyase, presenting a potential inhibition of fatty acid biosynthesis. Glucomannan fibers, abundant in Amorphophallus konjac, seem to reduce the absorption kinetics of dietary fat. Therefore, the aim of this double-blind randomized study was to evaluate the pharmacotherapeutic efficacy of standardized extracts of G. cambogia (52.4% HCA) plus A. konjac (94.9% glucomannan) in the treatment of obesity. Fifty-eight obese subjects (BMI 30.0-39.9 kg/m(2)) were assigned to the placebo group (n = 26) or the treatment group (n = 32); no dietary restrictions were applied. Over a 12-week period, subjects were given daily doses of either Garcinia (2.4 g) plus Konjac (1.5 g) or placebo prior to their main meals (3 times/day). Before the start of treatment, and every 4 weeks thereafter, the following were recorded: height, weight, circumferences and body composition, resting energy expenditure (REE), lipid profile and glucose levels. The treatment had no significant effect on anthropometric parameters, REE, triglycerides or glucose levels. However, a significant reduction was observed in total cholesterol (-32.0 +/- 35.1 mg/dL) and LDL-c levels (-28.7 +/- 32.7 mg/dL) in the treated group, the final levels being significantly lower than those of the placebo group (p = 0.008 and p = 0.020, respectively). The results obtained suggest that the treatment had a significant hypocholesterolemic effect, without influencing the anthropometric or calorimetric parameters tested.