Reduction of Serum Testosterone Levels During Chronic Glucocorticoid Therapy

Macadams, Michael R.; White, Richard; Chipps, Bradley E.

doi:10.7326/0003-4819-104-5-648

Cited by 334 publications

(124 citation statements)

References 13 publications

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“…Thus, hypogonadism in both sexes may well have contributed to bone loss. Although initiation of estrogen therapy has been recommended for women after organ transplantation, men may also need sex hormone replacement therapy; administration of both corticosteroids 22 and cyclosporin A 23 has been associated with decreases in serum testosterone levels.…”

Section: Discussionmentioning

confidence: 99%

A prospective study of bone loss and turnover after allogeneic bone marrow transplantation: effect of calcium supplementation with or without calcitonin

Välimäki

Kinnunen

Volin

et al. 1999

Bone Marrow Transplant

110

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Summary:Transplantation of solid organs including heart, kidney, and liver is associated with rapid bone loss and increased rate of fracture; data on bone marrow transplantation recipients (BMT) are scarce. The purpose of the present study was to examine the magnitude, timing, and mechanism of bone loss following allogeneic BMT, and to study whether bone loss can be prevented by calcium with or without calcitonin. Sixty-nine patients undergoing allogeneic BMT for malignant blood diseases were enrolled into the study. Forty-four (22 women, 22 men) completed 6 months, and 36 patients 1 year follow-up. They were randomized to receive either no additional treatment (n ‫؍‬ 22), or oral calcium 1 g twice daily for 12 months (n ‫؍‬ 12) or the same dose of calcium plus intranasal calcitonin 400 IU/day for the first month and then 200 IU/day for 11 months (n ‫؍‬ 10). Bone mineral density (BMD) at the lumbar spine and three femoral sites (femoral neck, trochanter, Ward's triangle) was measured by dual-energy X-ray absorptiometry (DXA). Bone turnover rate was followed with markers of bone formation and resorption (serum bone-specific alkaline phosphatase (B-ALP), type I procollagen carboxyterminal (PICP) and aminoterminal propeptide (PINP), serum type I collagen carboxyterminal telopeptide (ICTP)). Serum testosterone was assayed in men. Calcium with or without calcitonin had no effect on bone loss or bone markers; consequently the three study groups were combined. During the first 6 post-transplant months BMD decreased by 5.7% in the lumbar spine and by 6.9% to 8.7% in the three femoral sites (P Ͻ 0.0001 for all); no significant further decline occured between 6 and 12 months. Four out of 25 assessable patients experienced vertebral compression fractures. Markers of bone formation reduced: B-ALP by 20% at 3 weeks (P ‫؍‬ 0.027), PICP by 40% (P Ͻ 0.0001) and PINP by 63% at 6 weeks (P Ͻ 0.0001), with a return to baseline by 6 months. The marker of bone resorption, serum ICTP was above normal throughout the whole observation period, with a peak at 6 weeks (77% above baseline, P Ͻ 0.0001). In male patients serum testosterone decreased reaching a nadir (57% below baseline) at 6 weeks (P ‫؍‬ 0.0003). In conclusion, significant bone loss occurs after BMT. It results from imbalance between reduced bone formation and increased bone resorption; hypogonadism may be a contributing factor in men. Bone loss can not be prevented by calcium with or without calcitonin.

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Section: Discussionmentioning

confidence: 99%

A prospective study of bone loss and turnover after allogeneic bone marrow transplantation: effect of calcium supplementation with or without calcitonin

Välimäki

Kinnunen

Volin

et al. 1999

Bone Marrow Transplant

110

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“…Studies in rats suggest that the mechanism of this effect is a decrease in the number of gonadotrophin binding sites on the testicular interstitial cells (Saez et al, 1977). In men receiving chronic steroid therapy, serum total and free testosterone concentrations are reduced by almost one half (Reid er al., 1985;MacAdams et al, 1986) and it appears that this glucocorticoid effect may be mediated by both the pituitary and the testis, The reduction in testosterone is dose-dependent (Fig. 1).…”

Section: Calcironinmentioning

confidence: 99%

Pathogenesis and Treatment of Steroid Osteoporosis

Reid

1989

Clinical Endocrinology

173

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“…Among these drugs, glucocorticoids, stand out (24) inducing the reduction of cFT by combined actions both at the testicular and at the hypothalamic-pituitary level, being these adverse effects in the production of testosterone dose dependent (25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Laboratory diagnosis of late-onset male hypogonadism andropause

Clapauch¹,

Carmo²,

Marinheiro

et al. 2008

Arq Bras Endocrinol Metab

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OBJECTIVES: To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). METHODS: Total testosterone (TT), SHBG and albumin were measured in 216 men aged 52-84 years. The laboratorial definition of LOH was two values of calculated free testosterone (cFT) <6.5 ng/dl, according to Vermeulen's formula. RESULTS: At the first blood test, cFT was <6.5 ng/dl in 27% of the men. Laboratorial LOH (confirmed by two tests) was present in 19%, but TT levels were low in only 4.1%. Age influenced TT (p=0.0051) as well as BMI; 23.5% of patients > 70 years and 38.9% of the obese men who had TT within the reference range were, in fact, hypogonadal. CONCLUSION: Especially in obese men and in those > 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.

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Reduction of Serum Testosterone Levels During Chronic Glucocorticoid Therapy

Cited by 334 publications

References 13 publications

A prospective study of bone loss and turnover after allogeneic bone marrow transplantation: effect of calcium supplementation with or without calcitonin

A prospective study of bone loss and turnover after allogeneic bone marrow transplantation: effect of calcium supplementation with or without calcitonin

Pathogenesis and Treatment of Steroid Osteoporosis

Laboratory diagnosis of late-onset male hypogonadism andropause

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