D. Santi

Low testosterone is associated with poor health status in men with human immunodeficiency virus infection: a retrospective study.

Men with human immunodeficiency virus (HIV) infection are often hypogonadal and develop several HIV‐associated non‐acquired immunodeficiency syndrome (AIDS) (HANA) conditions that impair overall health status. No studies explored the relationship between health status and serum testosterone (T) in HIV‐infected men. This study aims to investigate the association between total serum T and HANA, multimorbidity, and frailty in a large cohort of 1359 HIV‐infected men and to explore the relationship between patients’ overall health status and serum T. Among biochemical and hormonal measurement performed the main are serum total T, free triiodothyronine (fT3), and luteinizing hormone. Other outcome measurements include anthropometry, assessment of comorbidities and disabilities, overall health status defined as the number of HANA and by the 38‐item multimorbidity frailty index, anthropometry, and bone mineral density. The cumulative relative risk of comorbidities is increased in HIV‐infected men with hypogonadism (p < 0.001) and hypogonadism is associated with several comorbidities. The prevalence of hypogonadism increases progressively with the increase of the number of comorbidities. Frailty index is inversely related to serum total T (age‐adjusted r = 0.298, r2 = 0.089, p < 0.0001). Serum fT3 levels are significantly lower in hypogonadal than eugonadal men (p = 0.022). This suggests that low serum T could be considered a sensitive marker of frailty and poor health status and that the latter might induce hypogonadism. The more HIV‐infected men are frail the more they are hypogonadal. This suggests that hypogonadism might be a naturally occurring condition in unhealthy HIV‐infected men and raises concern about the safety of T treatment. In conclusion, low serum T is associated with multimorbidity, HANA, and frailty in HIV‐infected men and this association seems to be bidirectional. Given the wide attitude to offer T treatment to HIV‐infected men, caution is needed when prescribing T to HIV‐infected male patients, especially if the patient is unhealthy or frail.

Serum total estradiol, but not testosterone is associated with reduced bone mineral density (BMD) in HIV-infected men: a cross-sectional, observational study

SummaryBy investigating the relationship between serum testosterone, estradiol, and bone mineral density (BMD) in a large cohort of HIV-infected men, estradiol was associated with BMD, relative estrogen deficiency being involved in bone loss in men with hypogonadism, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss.IntroductionThe purpose of this study is to evaluate the relationship between serum testosterone, estradiol, and BMD in a large cohort of HIV-infected men.MethodsWe investigated biochemical, hormonal parameters, and BMD in 1204 HIV-infected men (age 45.64u2009±u20097.33xa0years) participating in a cross-sectional, observational study. Among other parameters, the main outcome measures were serum total testosterone and estradiol, gonadotropins, 25-hydroxyvitamin D [25(OH)D], parathormone (PTH), calcium, phosphorous, femoral, and lumbar BMD.ResultsIn men with HIV, the prevalence of osteoporosis and osteopenia is 15.1 and 63.2xa0% with 25(OH)D insufficiency being very common (60.1xa0%). After age adjustment, BMD is positively associated with estradiol, but not testosterone, at linear (pu2009<u20090.001) and stepwise (pu2009<u20090.05) multiple regression. Lumbar BMD significantly increases across the estradiol quartiles but not among testosterone quartiles. Femoral and lumbar BMD are significantly higher in men with estradiolu2009≥u200927xa0pg/mL than in those with estradiol <27xa0pg/mL. Apart from estradiol, only age, calcium, and BMI predict BMD at stepwise linear multiple regression, but the strength of this association is weak.ConclusionsEstradiol, but not testosterone, is associated with BMD in HIV-infected men and exerts a protective role on bone especially when it is above 27xa0pg/mL. Relative estrogen deficiency is a potential mechanism involved in bone loss in hypogonadal HIV-infected men, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss. Finally, reduced BMD in young-to-middle-aged HIV-infected men might be considered a peculiar hallmark of HIV infection due to its relevant prevalence, representing one of the several pieces composing the complicated puzzle of premature aging related to HIV infection.

‘Spare’ Luteinizing Hormone Receptors: Facts and Fiction

It is common opinion that maximal activation of luteinizing hormone (LH)-dependent steroidogenic signal occurs at <1% of human LH/choriogonadotropin (hCG) receptor (LHCGR) occupancy. This effect would be a consequence of an excess of receptors expressed on the surface of theca cells, resulting in a pool of LHCGRs remaining unbound (spare). This concept was borrowed from historical pharmacological studies, when discrepancies between ligand-receptor binding and dose-response curves of cAMP were evaluated by treating mouse or rat Leydig cells with hCG in vitro. Recent findings demonstrated the specificity of LH- and hCG-dependent effects, receptor heterodimerization, and differing behaviors of rodent versus human gonadotropin-responsive cells, which may help to revise the spare LHCGRs concept applied to human ovarian physiology and assisted reproduction.

Verso la personalizzazione del trattamento con FSH nell’infertilità maschile

SommarioL’infertilità maschile idiopatica rimane ad oggi una sfida terapeutica. I dati relativi al miglioramento della qualità spermatica dopo terapia con gonadotropine sono ancora controversi, nonostante il noto ruolo dell’ormone follicolo-stimolante (FSH) nella spermatogenesi. La ricerca scientifica si sta sempre più focalizzando su possibili fattori predittivi di risposta e schemi di trattamento efficaci, al fine di ottenere terapie personalizzate.