Shift Work Throws Urologic Health Off Schedule

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Nonstandard shifts and a circadian rhythm disturbance known as shift work sleep disorder contribute to a significant increase in urinary tract symptoms and reproductive problems, according to three studies conducted at the Baylor College of Medicine in Houston.

“A 45-year-old shift worker with shift work sleep disorder might look like a 75-year-old man in terms of his lower urinary tract symptoms,” John Sigalos, a medical student and investigator on one of the studies, said here at the American Urological Association 2017 Annual Meeting.

The other studies presented demonstrate that male shift workers with shift work sleep disorder have lower testosterone levels and more hypogonadal symptoms than daytime workers, and that infertile shift workers, especially those who work rotating shifts, have significantly worse semen parameters than infertile men who work the day shift.

In the United States, approximately 15% of the labor force works late-night or rotating shifts.

Lower Urinary Tract Symptoms Study

To determine the effect of poor sleep quality and shift work on lower urinary tract symptoms, Sigalos and his colleagues retrospectively reviewed the medical records of men treated at the Baylor andrology clinic from 2014 to 2016.

All the men had completed the International Prostate Symptom Score (IPSS) to evaluate lower urinary tract symptoms, completed questionnaires about work schedules and sleep disorders, and had blood samples taken.

Of the 2487 participants, 766 (30.8%) reported working nonstandard shifts in the previous month and, of these, 36.8% were considered to be at high risk for sleep disorders.

Mean IPSS score was higher in shift workers with sleep disorders than in shift workers without, and daytime workers (7.77 vs 5.37 vs 6.84; P < .0001 between all groups).

IPSS scores were 3.1 points lower in shift workers with sleep disorders than in shift workers without, after age, comorbidities, and testosterone levels were controlled for (= .0001).

These findings suggest that poor sleep quality — rather than shift work itself — contributes to the increase in lower urinary tract symptoms. Patients at risk for shift work sleep disorder should be screened for lower urinary tract symptoms and counseled about the risk, Sigalos told Medscape Medical News.

Hypogonadism Study

The potential for hypogonadal symptoms and sexual dysfunction was examined by another group of Baylor investigators who used the same cohort of men.

On multivariable analyses that controlled for age, Charlson comorbidity score, and testosterone levels, mean scores on the quantitative Androgen Deficiency in the Aging Male (qADAM) questionnaire were 0.8 points lower in nonstandard shift workers than in daytime workers (P < .01). And mean qADAM score was 3.9 points lower in shift workers at high risk for sleep disorders than in shift workers at low risk (P < .01).

In addition, there was an independent association between high risk for shift work sleep disorder and lower testosterone levels after age, comorbidities, and history of testosterone supplementation were controlled for (P < .01).

Semen Parameters Study

The effects of shift work and sleep quality on semen parameters and reproductive hormones in men were assessed in a prospective study by Taylor Kohn, MD, and his colleagues.

The study participants — 75 infertile shift workers, 96 infertile nonshift workers, and a control group of 26 fertile men — completed questionnaires about shift work and sleep quality, and underwent semen analysis and hormone testing.

Sperm density was significantly lower in infertile shift workers than in infertile nonshift workers (P = .012), as were total motile counts (P = .019) and testosterone levels (= .026).

However, the differences in sperm motility, forward progression measures, luteinizing hormone levels, and follicle-stimulating hormone levels were not significant.

All semen parameters were significantly lower in the infertile shift workers than in the fertile control group, and luteinizing hormone and follicle-stimulating hormone levels were significantly higher. Testosterone levels were about the same in the two groups.

On linear regression that controlled for age, Charlson comorbidity index, tobacco use, and average income, there was a significant negative association between total motile count and shift work (P = .039), and a significant positive association between total motile count and previous fertility (P = .041).

In addition, total motile counts were significantly lower in men who worked rotating shifts than in those who worked fixed shifts (P < .05).

The type of job shift workers performed also made a difference. Men who performed physical labor in environments where chemical use was common (such as oil fields and refineries) had significantly lower total motile counts than physical laborers without chemical exposure, medical workers, white-collar workers, and first responders (P < .05).

Sleep satisfaction also seemed to play a role. “When assessing reported overall sleep amounts in the previous month, follicle-stimulating hormone and testosterone levels trended downward as men became more unsatisfied with the amount of sleep they were getting,” Dr Kohn reported.

Thinking Beyond the Prostate

It is important for urologists to think beyond the prostate when treating men with lower urinary tract symptoms or sexual dysfunction, said Howard Adler, MD, clinical associate professor of medicine at the Stony Brook University School of Medicine in New York.

When men present with symptoms like those reported in these studies, clinicians need to consider not only prostate-related symptoms, but also age-related changes in bladder function, renal function, and other medical conditions, such as diabetes, he told Medscape Medical News.

At Stony Brook, Dr Adler explained, he and his colleagues have begun “asking patients about sleep habits and snoring, and are sending them for sleep studies to see if they have apnea or something else, especially patients with a lot of night-time urination.”

The studies were supported by the Baylor College of Medicine. The authors and Dr Adler have disclosed no relevant financial relationships.

American Urological Association (AUA) 2017 Annual Meeting: Abstracts MP13-12 and PD13-08 presented May 12, 2017; Abstract MP91-06 presented May 16, 2017.

Written By: Neil Osterweil

Article Source: http://www.medscape.com/viewarticle/880096#vp_1

 

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Testosterone Does Not Appear to Increase The Risk For Cardiovascular Disease

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Testosterone replacement therapy does not appear to increase the risk for cardiovascular disease or thromboembolic events in middle-aged men.

In fact, the risk for a cardiovascular event was lower in men taking supplemental testosterone than in those who were not, said lead investigator Julian Hanske, MD, from Ruhr University Bochum in Herne, Germany, who collaborated on the study during a fellowship at Brigham & Women’s Hospital in Boston.

But physicians should know whether a patient suffers from obstructive sleep apnea before prescribing testosterone, Dr Hanske said here at the European Association of Urology 2017 Congress.

Cohort studies of the cardiovascular and thromboembolic consequences of supplemental testosterone have generally relied on sources such as the Surveillance, Epidemiology, and End Results Medicare database, which is limited to an older population, he told Medscape Medical News.

To get a better handle on the relative risks associated with testosterone replacement therapy in a younger population, Dr Hanske and his team searched the TRICARE American military insurance database, which covers all retired and active-duty military personnel and their dependents.

They looked for men 40 to 65 years of age treated for low levels of testosterone. Patients were excluded if they had a history of heart disease, thromboembolism, prostate cancer, or obstructive sleep apnea.

For the final cohort, 3422 men who took testosterone were matched with 3422 control subjects who did not by year of birth, then by date of first testosterone prescription, and then by race and baseline comorbidities.

The study outcomes were event-free survival and absolute risk for cardiovascular disease, thromboembolism or obstructive sleep apnea.

We have so many fears of testosterone replacement therapy.

Cardiovascular event-free survival was significantly better in the testosterone group than in the control group (P = .0085), and risk for coronary artery disease was lower in the testosterone group (P = .0082).

There was no difference in thromboembolic event-free survival between the testosterone and control groups (P = .0998).

These findings are reassuring, said session comoderator Raanan Tal, MD, head of the male infertility program at Rambam Medical Center in Haifa, Israel.

“We have so many fears of testosterone replacement therapy, and actually what they showed is that so many beliefs that we have cannot be supported,” he told Medscape Medical News.

“The fact that you don’t have an increase in cardiovascular events or thrombotic events is an important message — more important than the risk of increased obstructive sleep apnea,” he explained.

But the other comoderator said he thinks the findings would be more compelling if the investigators had used propensity-score matching or a similar statistical method to ensure a close case–control match.

“Age is a risk factor,” Andrea Salonia, MD, from the Vita-Salute San Raffaele University in Milan, pointed out. “The younger the patient, the lower the probability of having difficulties sleeping at night, and they did not adjust for that specific issue, or at least they did not find any kind of difference according to this specific variable.”

“At the same time, the number of patients they considered was amazing, and it is probably one of the most important studies in terms of the huge cohort they selected,” Dr Salonia told Medscape Medical News.

Dr Hanske, Dr Tal, and Dr Salonia have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2017 Congress: Abstract 256. Presented March 25, 2017.

Article Source: http://www.medscape.com/viewarticle/877786

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Testosterone therapy improves insulin sensitivity in diabetic men

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The January 2016 issue of the journal Diabetes Care reported the outcome of a randomized trial that revealed a beneficial role for testosterone treatment in men with diabetes.

“We hypothesized that testosterone may be an anti-inflammatory and insulin sensitizing agent since it has been known for some time that testosterone reduces adiposity and increases skeletal muscle,” remarked lead researcher Paresh Dandona, MD, PhD, who is a Distinguished Professor at the State University of New York and chief of endocrinology, diabetes and metabolism in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo. “Our previous work has shown that obesity is associated with oxidative stress and inflammation, and inflammatory mediators are known to interfere with insulin signaling.”

The trial included 94 type 2 diabetic men, among whom 44 had low testosterone levels and reduced insulin signaling genes indicative of decreased insulin sensitivity. Participants with low testosterone received a weekly testosterone injection or a placebo for 24 weeks. Body weight, body fat, markers of inflammation, insulin sensitivity and other factors were assessed before and after treatment.

At the end of the trial, men who received testosterone experienced a more than six pound average loss of body fat and an equal increase in muscle mass. They also had lower levels of the inflammatory markers C-reactive protein, interleukin-1b and tumor necrosis factor-a. “Most importantly, we saw a dramatic increase in insulin sensitivity, demonstrated by a 32 percent increase in the uptake of glucose by tissues in response to insulin,” Dr Dandona reported.

“Testosterone treatment for men, where indicated, will improve sexual function and increase skeletal muscle strength and bone density,” Dr Dandona noted. “This is the first definitive evidence that testosterone is an insulin sensitizer and hence a metabolic hormone.”

Article Source: http://www.lifeextension.com/WhatsHot/2015/11/November-Whats-Hot-Articles/Page-01#test

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Jane Fonda reveals testosterone is the secret behind her sex success at 73

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She has attributed her youthful looks to a healthy love life and given hope to millions by saying she had the best sex of her life at 71.

So it is something of a let down to find out that even sex symbol Jane Fonda needs artificial help.

The Barbarella star has revealed she took the male sex hormone testosterone from the age of 70 to boost her libido.

Miss Fonda said it made ‘a huge difference’.

Advising other women of a certain age how to pep up their love lives, three-times married actress, political activist and fitness guru said: ‘Here’s something I haven’t said publicly yet: I discovered testosterone about three years ago, which makes a huge difference if you want to remain sexual and your libido has dropped.

‘Use testosterone, it comes in a gel, pill or patch.’

Earlier this year, Robbie Williams shocked his legions of female fans by admitting he was injecting himself with testosterone to boost his sex drive.

Although testosterone is usually thought of as a male hormone, it is also made by women, but in much smaller amounts.

Levels drop off after the menopause, leading to some doctors prescribing testosterone alongside more traditional hormone replacement therapy.

It is relatively cheap, costing around £50 for six months’ supply and comes in patches, implants and gels.

But a reinvigorated love life can come at a cost.

Miss Fonda, now 73, and in a relationship with music producer Richard Perry, who is four years her junior, told the Sunday Telegraph: ‘I had to stop because it was giving me acne.

‘It’s one thing to have plastic surgery, but it is quite another to have adolescence acne. That is going too far.’

Two years ago, she created envy in millions of bedrooms by telling how she was having the best sex of her life, despite having had spinal surgery and boasting an artificial knee and a titanium hip.

She said: ‘How do I still look good?  I owe 30 per cent to genes, 30 per cent to good sex, 30 per cent because of sports and healthy lifestyle with proper nutrition and for the remaining ten per cent, I have to thank my plastic surgeon.

But I’m happier, the sex is better and I understand life better. I don’t want to be young again.’

More recently, she has devoted 50 pages of her new autobiography to explaining how couples can keep the passion alive long after the vigour of their youth has failed.

However, her use of testosterone has remained secret until now.

British experts welcomed the revelation.

Professor John Studd, of the London PMS and Menopause Clinic has been prescribing testosterone for women for 30 years.

He said: ‘It is not just about libido.  The benefits include more energy, more self-confidence, better mood and all of those things.’

He added that carefully balancing the dose should remove the risk of side-effects such as acne and excessive bodily or facial hair.

Dr John Stevenson chairman of the charity Women’s Health Concern, said: ‘Jane Fonda clearly thinks there should be no time limit to being sexually active, which is fine. Good for her.’

However, the Royal College of Obstetricians and Gynaecologists warns that the long-term consequences of the treatment are unknown.

THE TRUTH BEHIND TESTOSTERONE

Testosterone can be part of the hormone replacement therapy given to menopausal women.

Gels that are rubbed into the skin are the most popular.  But patches, creams and implants are also available.

Topping up levels of the hormone can give a woman in her 50s or 60s the libido of someone half her age, as well as boost energy and mood.

But too high a dose carries the risk of acne and greasy skin and hair.

‘Masculine’ side-effects such as excessive bodily and facial hair and a deepened voice are also possible.

Testosterone pills aren’t given to women but can raise cholesterol, increasing the odds of heart attacks and strokes.

The Royal College of Obstetricians and Gynaecologists urges caution when prescribing the libido-boosting treatment to women other than those who have had their ovaries removed.

It advises: ‘Testosterone replacement may be associated with adverse clinical and metabolic side effects and long-term consequences are unknown.

Written By: Fiona Macrae

Read more: http://www.dailymail.co.uk/femail/article-2028544/Jane-Fonda-reveals-testosterone-secret-sex-success-73.html#ixzz4cj0r8L4x

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Effects of taking tadalafil 5 mg once daily on erectile function and total testosterone levels in patients with metabolic syndrome.

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We aimed to evaluate the efficacy of tadalafil 5 mg once-daily treatment on testosterone levels in patients with erectile dysfunction (ED) accompanied by the metabolic syndrome. A total of 40 men with metabolic syndrome were evaluated for ED in this study. All the patients received 5 mg tadalafil once a day for 3 months. Erectile function was assessed using the five-item version of the International Index of Erectile Function (IIEF) questionnaire. Serum testosterone, follicle-stimulating hormone and luteinising hormone levels were also evaluated, and blood samples were taken between 08.00 and 10.00 in the fasting state. All participants have three or more criteria of metabolic syndrome. At the end of 3 months, mean testosterone values and IIEF scores showed an improvement from baseline values (from 3.6 ± 0.5 to 5.2 ± 0.3, from 11.3 ± 1.9 to 19 ± 0.8 respectively). After the treatment, serum LH levels were decreased (from 5.6 ± 0.6 to 4.6 ± 0.5). There was significantly difference in terms of baseline testosterone and luteinising hormone values and IIEF scores (p < .05). Based on our findings, we recommend tadalafil 5 mg once daily in those men with erectile dysfunction especially low testosterone levels accompanied by metabolic syndrome.

Article Source: https://www.ncbi.nlm.nih.gov/pubmed/28295481

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Exploring the role of testosterone in the cerebellum link to neuroticism: From adolescence to early adulthood

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Highlights

  • Cerebellar volumes correlate inversely with neurotic personality traits in adolescents and young adults.
  • In males, higher endogenous testosterone levels is associated with lower scores on neurotic personality traits and larger cerebellar gray matter volumes.
  • Testosterone significantly mediates the relation between cerebellar gray matter and measures of neuroticism.

Abstract

Previous research has found an association between a smaller cerebellar volume and higher levels of neuroticism. The steroid hormone testosterone reduces stress responses and the susceptibility to negative mood. Together with in vitro studies showing a positive effect of testosterone on cerebellar gray matter volumes, we set out to explore the role of testosterone in the relation between cerebellar gray matter and neuroticism. Structural magnetic resonance imaging scans were acquired, and indices of neurotic personality traits were assessed by administering the depression and anxiety scale of the revised NEO personality inventory and Gray’s behavioural avoidance in one hundred and forty-nine healthy volunteers between 12 and 27 years of age. Results demonstrated an inverse relation between total brain corrected cerebellar volumes and neurotic personality traits in adolescents and young adults. In males, higher endogenous testosterone levels were associated with lower scores on neurotic personality traits and larger cerebellar gray matter volumes. No such relations were observed in the female participants. Analyses showed that testosterone significantly mediated the relation between male cerebellar gray matter and measures of neuroticism. Our findings on the interrelations between endogenous testosterone, neuroticism and cerebellar morphology provide a cerebellum-oriented framework for the susceptibility to experience negative emotions and mood in adolescence and early adulthood.

Article Source: http://www.psyneuen-journal.com/article/S0306-4530(16)30688-6/abstract?cc=y=

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Symptomatic response to testosterone treatment in dieting obese men with low testosterone levels in a randomized, placebo-controlled clinical trial

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Background:

Obese men commonly have reductions in circulating testosterone and report symptoms consistent with androgen deficiency. We hypothesized that testosterone treatment improves constitutional and sexual symptoms over and above the effects of weight loss alone.

Methods:

We conducted a pre-specified analysis of a randomized double-blind, placebo-controlled trial at a tertiary referral center. About 100 obese men (body mass index (BMI)greater than or equal to30kgm2) with a repeated total testosterone level less than or equal to12nmoll−1 and a median age of 53 years (interquartile range 47–60) receiving 10 weeks of a very-low-energy diet (VLED) followed by 46 weeks of weight maintenance were randomly assigned at baseline to 56 weeks of intramuscular testosterone undecanoate (n=49, cases) or matching placebo (n=51, controls). Pre-specified outcomes were the between-group differences in Aging Male Symptoms scale (AMS) and international index of erectile function (IIEF-5) questionnaires.

Results:

Eighty-two men completed the study. At study end, cases showed significant symptomatic improvement in AMS score, compared with controls, and improvement was more marked in men with more severe baseline symptoms (mean adjusted difference (MAD) per unit of change in AMS score −0.34 (95% confidence interval (CI) −0.65, −0.02), P=0.04). This corresponds to improvements of 11%and 20% from baseline scores of 40 and 60, respectively, with higher scores denoting more severe symptoms. Men with erectile dysfunction (IIEF-5less than or equal to20) had improved erectile function with testosterone treatment. Cases and controls lost the same weight after VLED (testosterone −12.0kg; placebo −13.5kg, P=0.40) and maintained this at study end (testosterone −11.4kg; placebo −10.9kg, P=0.80). The improvement in AMS following VLED was not different between the groups (−0.05 (95% CI −0.28, 0.17), P=0.65).

Conclusions:

In otherwise healthy obese men with mild to moderate symptoms and modest reductions in testosterone levels, testosterone treatment improved androgen deficiency symptoms over and above the improvement associated with weight loss alone, and more severely symptomatic men achieved a greater benefit.

 Article Source: http://www.nature.com/ijo/journal/v41/n3/full/ijo2016242a.html?WT.ec_id=IJO-201703

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