Hypogonadism in Systemic Diseases

Rochira, Vincenzo

doi:10.1007/978-3-319-44441-3_28

Cited by 6 publications

(7 citation statements)

References 250 publications

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“…Several narrative reviews attempted to describe the prevalence of hypogonadism in this group of patients, highlighting the high heterogeneity of the studies and, overall, of the methodologies used to measure and define male hypogonadism [3]. Present data show that the prevalence of hypogonadism in HIV subjects is similar to that reported in other subjects with chronic diseases [44], such as those with diabetes mellitus [45], metabolic syndrome (MetS) [46], or erectile dysfunction [47], or who are using drugs that potentially interfere with T production [48,49]. Conversely, HIV patients show from 10 to 20 times higher prevalence of hypogonadism when compared to the general population [50].…”

Section: Discussionmentioning

confidence: 64%

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Santi

Spaggiari²,

Vena

et al. 2021

Cells

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Background: Hypogonadism is a common comorbidity in human immunodeficiency virus (HIV)-infected men, although the real prevalence is difficult to be estimated. Moreover, in HIV settings, the efficacy of exogenous testosterone (Te) administration at improving body composition remains unclear. Aim of the study: This review has a double aim. First, to estimate the prevalence of pituitary–testis axis abnormality in HIV-infected patients compared to uninfected subjects. Second, to evaluate the effect of androgen administration on body composition in HIV-infected men. Materials and Methods: A systematic review of the literature and meta-analysis was carried out. Two separated literature searches were performed, the first to evaluate the prevalence of Te deficiency in HIV-infected men and the second one to evaluate effects of androgen administration on body composition. Results: The overall prevalence of Te deficiency in HIV-infected men was calculated from 41 studies, showing a 26% prevalence, which was even higher when free T (fT) levels, more than total T, were considered. Indeed, TT serum levels were similar between HIV patients and controls, although higher SHBG and lower fT were detected in HIV populations. When HIV-infected men were treated with exogenous Te, a significant increase in body weight, lean body mass and fat free mass was detected. Conclusion: The systematic review confirms the high prevalence of Te deficiency in HIV-infected men, particularly when fT has been considered. Moreover, chronic androgen supplementation improves body composition, affecting the lean mass compartment. However, considering the general frailty of HIV patients, a tailored indication for Te therapy should be advocated.

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Section: Discussionmentioning

confidence: 64%

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Santi

Spaggiari²,

Vena

et al. 2021

Cells

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“…The association between diabetes mellitus (DM) and male hypogonadism has been largely claimed and proved [1,2] . Indeed, testosterone (T) deficiency and male hypogonadism are often found in patients with chronic metabolic diseases [3] .…”

Section: Introductionmentioning

confidence: 99%

Male hypogonadism and pre-diabetes interplay: association or causal interaction? A systematic review

Greco¹,

Corleto²,

Ebert³

et al. 2021

MTOD

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Aim:The association between type 2 diabetes mellitus (T2DM) and male hypogonadism has been largely demonstrated. Testosterone (T) serum levels are often lower in men with T2DM compared to the general population, and, conversely, men with higher T serum levels have shown lower risk of T2DM. On the contrary, the association between pre-diabetes and male hypogonadism has been less investigated thus far. Pre-diabetes is a common clinical condition preceding T2DM and has been recognized as a potential risk factor for other metabolic disorders and cardiovascular diseases. Therefore, the aims of this review are to investigate the association between pre-diabetes and male hypogonadism and to evaluate the potential effect of T treatment on glucose metabolism and anti-diabetic therapy on T serum levels. Methods:We conducted this systematic review developing different literature searches, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol.Results: In our analysis, male hypogonadism has a prevalence of around 24%-35% in pre-diabetic men. Moreover, we observed improvement of metabolic parameters in pre-diabetes with T treatment. On the contrary, antidiabetic therapy seems to have no particular effects on T serum levels. Conclusion:Overall, we demonstrated that, although T administration could be considered in pre-diabetic men, pre-diabetes-related treatments should be confined to the control glucose metabolism, since no evidence for a positive effect on total T serum levels is available. Future research should be oriented to study the role of new antidiabetic drugs in the sex hormonal status in hypogonadal men.

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“…However, as for other systemic diseases ( 38 ) specificity of most of the symptoms and signs of hypogonadism is poor due to the overlap of clinical features with those of HIV infection, HAART undesired effects, and HIV-related comorbidities ( 16 ) ( Figure 1 ). Among signs and symptoms of hypogonadism that are less specific in MLWH those related to mood, behavior, psychological issues and physical performance need to be mentioned.…”

Section: Clinical Managementmentioning

confidence: 99%

“…Hence, a poor health status seems to be associated to low T in older, frail men even outside the context of HIV infection ( 34 – 37 ). In particular, low T levels are associated to several systemic diseases ( 38 ) such as obesity ( 39 ), diabetes mellitus ( 40 ), dyslipidemia, and metabolic syndrome ( 41 ). These forms of male hypogonadism are considered as strictly related to poor health, secondary to other morbidities and potentially reversible, and endocrinologists tend to classify them as a sort of functional hypogonadism ( 38 , 42 , 43 ).…”

Section: Introductionmentioning

confidence: 99%

“…In particular, low T levels are associated to several systemic diseases ( 38 ) such as obesity ( 39 ), diabetes mellitus ( 40 ), dyslipidemia, and metabolic syndrome ( 41 ). These forms of male hypogonadism are considered as strictly related to poor health, secondary to other morbidities and potentially reversible, and endocrinologists tend to classify them as a sort of functional hypogonadism ( 38 , 42 , 43 ). Actually, there is emerging evidence confirming the role of serum T as marker of frailty and the mutual relationship among comorbidities, health status, and sex steroids even in MLWH ( 31 , 33 , 44 ).…”

Section: Introductionmentioning

confidence: 99%

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Update on acquired hypogonadism in men living with HIV: pathogenesis, clinic, and treatment

Vincentis

Rochira

2023

Front. Endocrinol.

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Hypogonadism is a frequent finding among men living with HIV (MLWH) and it seems to occur earlier in comparison with the general male population. Although the prevalence of hypogonadism in MLWH has significantly lowered thanks to advancements in medical management, it remains high if compared with age-matched HIV-uninfected men, ranging from 13% to 40% in the age group of 20-60 years. Signs and symptoms of low serum testosterone (T) in MLWH are cause of concern since they are non-specific, of mild-to-moderate degree, and often overlapping with those of infection per se. For these reasons, hypogonadism can be underestimated in the absence of targeted laboratory blood examinations. With regard to the etiological factors involved in the T decrease, emerging evidence has suggested the functional nature of hypogonadism in MLWH, pointing out the mutual relationship between sex steroids, health status, comorbidities, and HIV-related factors. In agreement with this hypothesis, a therapeutic approach aiming at improving or reversing concomitant diseases through lifestyle changes (e.g. physical activity) rather than pharmacological T treatment should be theoretically considered. However, considering both patient’s barriers to lifestyle changes to be maintained overtime and the lack of evidence-based data on the efficacy of lifestyle changes in normalizing serum T in MLWH, T therapy remains an option when other non-pharmacological interventions are ineffective as well as for all other functional forms of hypogonadism. From this perspective, the traditional therapeutic management of male hypogonadism in MLWH, especially the role of T supplementation, should be revised in the light of the probable functional nature of hypogonadism by considering a good balance between benefits and harmful. This narrative review presents an overview of current knowledge on hypogonadism in MLWH, deepening the factors driving and taking part in T decrease, providing advice for the clinical approach, and underlining the importance of individualized treatment aiming at optimizing non-gonadal comorbidities and thus avoiding over-, or even unnecessary, treatment with T.

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Hypogonadism in Systemic Diseases

Cited by 6 publications

References 250 publications

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

The Prevalence of Hypogonadism and the Effectiveness of Androgen Administration on Body Composition in HIV-Infected Men: A Meta-Analysis

Male hypogonadism and pre-diabetes interplay: association or causal interaction? A systematic review

Update on acquired hypogonadism in men living with HIV: pathogenesis, clinic, and treatment

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