Andrology最新文献

{"title":"The effect of topical and intraurethral alprostadil on erectile function: A systematic review and meta-analysis.","authors":"Iason Papadopoulos, Maksim Tishukov, Ioannis Sokolakis, Ioannis Katafigiotis, Ioannis Leotsakos, Markos Karavitakis, Julian Marcon, Christian G Stief, Nikolaos Pyrgidis","doi":"10.1111/andr.70025","DOIUrl":"https://doi.org/10.1111/andr.70025","url":null,"abstract":"<p><strong>Background: </strong>Erectile dysfunction (ED) affects up to 50% of men over 40. While phosphodiesterase-5 inhibitors (PDE5i) are the first line of medical treatment, they are not always effective. Alprostadil, available in injectable, topical, and intraurethral forms, offers an alternative treatment modality.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis aim to evaluate the efficacy and safety of topical and intraurethral forms of alprostadil.</p><p><strong>Materials and methods: </strong>The objectives and methods of this systematic review and meta-analysis were predefined in a protocol registered on PROSPERO (CRD42021260894). We systematically searched PubMed, EMBASE, and the Cochrane Library up to April 2024. Using a random-effects model, we compared the efficacy of topical and intraurethral forms of alprostadil against placebo. Additionally, we performed a qualitative assessment of the studies using RoB-2 and ROBINS-I tools.</p><p><strong>Results: </strong>The analysis included 11 randomized controlled trials and 4 non-randomized studies, encompassing 5869 patients with a mean age of 60 ± 9.4 years. The meta-analysis showed a statistically significant improvement in the IIEF score by 4.7 points (95% CI: 2.4-7.1, I² = 97%) in patients using the topical form of alprostadil compared to placebo. There was also a statistically significant improvement of ED in patients using intraurethral alprostadil compared to placebo, with a pooled odds ratio of 0.08 (95% CI: 0.04-0.16, I² = 54%). The most common adverse events reported were penile pain and erythema.</p><p><strong>Discussion: </strong>These results are limited by the variability in study designs and the relatively small number of included studies in the meta-analysis. Moreover, the low methodological quality of the included studies further limits the strength of the conclusions.</p><p><strong>Conclusions: </strong>Topical and intraurethral alprostadil significantly improve ED symptoms compared to placebo and are generally safe, with no serious adverse events. Further trials are necessary to confirm and expand on these findings.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is 'living apart together' a real advantage for patients consulting for sexual dysfunction? A cohort study.","authors":"Clotilde Sparano, Giovanni Corona, Giulia Rastrelli, Linda Vignozzi, Daniele Vignoli, Mario Maggi","doi":"10.1111/andr.70023","DOIUrl":"https://doi.org/10.1111/andr.70023","url":null,"abstract":"<p><strong>Background: </strong>Quantitative research on families has introduced a new category of relationship called living apart together, that is, when a couple in a committed relationship live in separate homes. This study aimed to confirm whether living apart together improves sexual relationships in those suffering from sexual dysfunction.</p><p><strong>Methods: </strong>This study comprised cross-sectional (N = 4852) and longitudinal (N = 1402) analyses. The former explored psychobiological, hormonal and relational correlates using the Structured Interview on Erectile Dysfunction scale. The latter assessed the occurrence of major adverse cardiovascular events in a subset of patients followed for 4.3 ± 2.59 years.</p><p><strong>Results: </strong>Compared to cohabiting couples, patients in living apart together relationships were younger and characterised by higher education levels, healthier lifestyles and lower comorbidity burdens (all p < 0.001). After adjusting for those confounders, the living apart together group reported better sexual functioning, more frequent sexual intercourse, and higher total testosterone levels (p < 0.001), and the relationship was often a source of conflicts within the familial context and of shorter duration (all p < 0.05). When total testosterone was included in a fully adjusted analysis of covariance, the difference in obtaining a full erection between cohabiting and living apart together relationships became non-significant (p = 0.086), suggesting a hormonal influence on erectile dysfunction. In the longitudinal analysis, Cox models adjusted for the aforementioned confounders showed that living apart together relationships are associated with a twofold greater risk of major adverse cardiovascular events than cohabiting relationships, independent of other risk factors, including total testosterone levels, waist circumference and pathological penile blood flow.</p><p><strong>Discussion: </strong>This study illustrates that partnership arrangements can shape sexual interest and complaints, as reported by the participants. While men involved in living apart together relationships show an ostensibly healthier phenotype, they experienced more often major adverse cardiovascular events. Therefore, co-residential relationship appears to provide more effective protection against future major adverse cardiovascular events for the male partner than a living apart together relationship.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract.","authors":"","doi":"10.1111/andr.70012","DOIUrl":"https://doi.org/10.1111/andr.70012","url":null,"abstract":"","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and impact of antisperm antibodies on semen quality and male reproductive health aspects: A 10-years retrospective study.","authors":"Andreia Filipa Neves Silva, Maria Schubert, Sabine Kliesch, Stefan Schlatt, Joao Ramalho-Santos, Sandra Catarina Gomes Amaral","doi":"10.1111/andr.70020","DOIUrl":"https://doi.org/10.1111/andr.70020","url":null,"abstract":"<p><strong>Background: </strong>The association between antisperm antibodies (ASA) and male (in)fertility is not fully understood, mainly due to contradictory reports. However, there is indication that ASA might affect several male reproductive health aspects warranting further investigation.</p><p><strong>Objective: </strong>To investigate the prevalence and impact of ASA on semen quality and its association with male reproductive function.</p><p><strong>Materials and methods: </strong>ASA presence was evaluated by the MAR test. Their prevalence, impact on semen quality and several aspects of male reproductive function were assessed, retrospectively, in a cohort of 2727 men, divided in 4 groups according to the percentage of ASA (without ASA, 10%-49% ASA, ≥50% ASA, and 10%-100% ASA).</p><p><strong>Results: </strong>The prevalence of ASA was 1.4%. When compared to the group without ASA, patients with ≥50% ASA, presented a higher percentage of semen agglutinates and leukocytes, and higher testicular volume. Subjects with 10%-49% and 10%-100% ASA, had lower levels of FSH and fructose, and higher levels of estradiol, α-glucosidase, and higher testicular volume. Furthermore, the 10%-49% ASA group presented a higher agglutination and percentage of round cells and leukocytes, when compared with the group without ASA. Similar results were observed in the 10%-100% ASA group. Interestingly, smoking habits were more frequent in the ≥50% ASA group, compared with the 10%-49% ASA group, with the chance of having ASA at a pathological level being 2-fold higher.</p><p><strong>Discussion and conclusion: </strong>In this study, data on ASA prevalence, impact in semen quality and on several aspects of male reproductive health were analyzed in one of the biggest and thoroughly characterized cohorts so far. Agglutination and impaired motility remain the most revealing parameters of ASA presence and should be considered in the clinical ASA management. Interestingly, we are the first to report an association between smoking and pathological ASA levels. The reported higher testicular volume and lower FSH in ASA patients may be of clinical relevance, suggesting that ASA might also have a role in the impaired fertility, highlighting the importance of ASA testing especially in men with lacking etiologic factors.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Folding, misfolding, and regulation of intracellular traffic of G protein-coupled receptors involved in the hypothalamic-pituitary-gonadal axis.","authors":"Alfredo Ulloa-Aguirre, Ross C Anderson, Teresa Zariñán, Rubén Gutiérrez-Sagal, Eduardo Jardón-Valadez, Claire L Newton","doi":"10.1111/andr.70018","DOIUrl":"https://doi.org/10.1111/andr.70018","url":null,"abstract":"<p><strong>Background: </strong>G protein-coupled receptors are a large and functionally diverse family of membrane receptors involved in a number of biological processes. Like other proteins, G protein-coupled receptors need to be properly folded in order to traffic to the plasma membrane and interact with agonist.</p><p><strong>Objective: </strong>Herein, we briefly review the process of folding and intracellular traffic of G protein-coupled receptors, with a focus on the gonadotropin-releasing hormone receptor and the gonadotropin receptors, whose variants can lead to misfolding, loss of plasma membrane trafficking and eventually to different forms of hypogonadism.</p><p><strong>Results and discussion: </strong>Pathogenic variants of G protein-coupled receptors may provoke loss-of-function of the receptor protein, thereby leading to disease. The presence of a stringent cellular quality control system promotes proper protein folding compatible with endoplasmic reticulum export and concomitantly prevents unfolded proteins accumulating within the cell. Molecular chaperones and companion factors are key elements of the quality control system that maintain the integrity of the proteostasis network by regulating, at different levels folding and assembly of nascent proteins and by promoting degradation of defective conformers, preventing aggregation and toxic accumulation. Due to the importance of the concept of molecular chaperoning in protein folding, pharmacoperone drugs emulating the role of endogenous chaperones as stabilizers of protein conformation currently represent a novel therapeutic opportunity for rescuing misfolded receptors and treating different diseases due to protein misfolding.</p><p><strong>Conclusions: </strong>In vitro and in vivo studies in experimental animals and in humans have provided proof-of-principle of the beneficial effects of pharmacoperone drugs in modifying the course of human disease due to misfolding of G protein-coupled receptors.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fructose as a key biomarker for prognostication in idiopathic obstructive azoospermia associated with CFTR and ADGRG2 gene variants.","authors":"Zhongkun Liang, Tuerxunayi Yalikun, Xiaohui Ji, Jin Li, Ling Zhou, Jing Zhang, Jing Tian, Hui Chen, Ping Yuan","doi":"10.1111/andr.70014","DOIUrl":"https://doi.org/10.1111/andr.70014","url":null,"abstract":"<p><strong>Background: </strong>Isolated obstructive azoospermia (iOA) is classified as a type of obstructive azoospermia (OA) where cases remain \"unexplained\" even after excluding congenital absence of the vas deferens and external factors. This study aimed to determine if certain semen characteristics in iOA patients could indicate underlying genetic variants.</p><p><strong>Objectives: </strong>To investigate CFTR and ADGRG2 gene variants in patients with idiopathic obstructive azoospermia (iOA) and identify semen parameters associated with these variants to guide genetic testing.</p><p><strong>Materials and methods: </strong>Seventy-six iOA patients were divided into three groups based on variant status: Group I, patients with at least two CFTR variants or a hemizygous ADGRG2 variant; Group II, patients with one CFTR variant and no ADGRG2 variants; Group III, patients without any CFTR or ADGRG2 variants. Associations between genotypes and clinical parameters were analyzed using univariate and multivariate logistic regression to identify potential biomarkers.</p><p><strong>Result(s): </strong>Thirty-six of the 76 patients (47.37%) carried one or more CFTR or ADGRG2 variants. Twenty distinct variants, including three novel variants (c.1851A > T and c.2426C > T in CFTR, c.1105G > A in ADGRG2), were identified. The most common variant was c.1210-12T[5] (5T) (18.42%), followed by c.1666A > G (4.61%) and c.4056G > C (3.95%). Group I patients had significantly lower ejaculate volume, pH, and fructose levels compared with Groups II and III. The combined area under the curve (AUC) for fructose, age, pH, and volume was 0.979, with fructose alone achieving an AUC of 0.952. Diagnostic efficacy for variant detection was highest (88.1%) at a fructose cutoff of 0.591 µmol/ejaculate, with a sensitivity of 0.958, a specificity of 0.923, a positive predictive value (PPV) of 0.895 and a negative predictive value (NPV) of 0.877.</p><p><strong>Discussion and conclusion: </strong>Approximately 47% of iOA patients carry CFTR and ADGRG2 variants, characterized by significantly lower semen volume, fructose, and pH. Fructose was identified as an independent predictor of CFTR and ADGRG2 variants, highlighting its potential utility in guiding genetic testing and clinical decision-making in iOA patients.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial motility and vitality predict the semen quality after long-term cryostorage, even in patients with restricted ejaculate parameters.","authors":"Simone Bier, Daniela Hanke, Michael Zitzmann, Sabine Kliesch, Verena Nordhoff","doi":"10.1111/andr.70019","DOIUrl":"https://doi.org/10.1111/andr.70019","url":null,"abstract":"<p><strong>Background: </strong>Cryopreservation of human semen is the cornerstone for preserving male fertility before gonadotoxic therapy or in cases of high variability in semen parameters. This is particular crucial in cases of severe oligoasthenoteratozoospermia (OAT), where diminished sperm counts may compromise planned intracytoplasmic sperm injection (ICSI) procedures. Previous investigations in donor programs have shown long-term storage effects, such as decreased motility in cryopreserved semen samples. However, these studies were based on patients exhibiting normozoospermic semen samples. To date, there has been no comprehensive evaluation of the effect of long-term cryostorage on sperm samples from individuals with compromised semen parameters.</p><p><strong>Objectives: </strong>The aim of this study was to identify the effect of long-term cryostorage on semen parameters such as motility and vitality. Additionally, we sought to identify variables, which could aid in predicting motility and vitality following the freeze-thaw process.</p><p><strong>Patients and methods: </strong>Within our center, we have archived sperm samples from 6022 patients cryopreserved between 2001 and 2019. Among these, 293 patients donated their samples for subsequent research following depot termination. We examined semen concentration, motility, morphology, and vitality of spermatozoa thawed after varying storage durations, alongside baseline metrics documented at the time of cryopreservation. Samples were stratified into three cohorts based on storage duration: 2.5 to ≤5 years, > 5 to ≤14 years, and > 14 years.</p><p><strong>Results: </strong>Our analysis revealed no changes in motility (p = 0.44), vitality (p = 0.08), or morphology (p = 0.44) across the cohorts. Regression analysis demonstrated that initial motility and sperm concentration were significantly associated with post-cryostorage motility, whereas storage duration was not (p = 0.72). Similarly, there was no association between storage duration and post-thaw value 2 vitality (p = 0.64).</p><p><strong>Discussion: </strong>The initial semen analysis as well as the evaluation of a short-term frozen sample immediately after cryopreservation, appeared to be the most important markers for predicting post-thaw motility and vitality.</p><p><strong>Conclusion: </strong>Our results demonstrate the reliability of long-term cryostorage of human spermatozoa for fertility preservation, even in individuals with constrained semen quality at the time of cryopreservation.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dupless: Toward a patient-friendly approach for erectile dysfunction nature differentiation - a study of 291 penile duplex Doppler ultrasound assessments.","authors":"Hille J Torenvlied, Kim E de Jager, Loes I Segerink, Rob C M Pelger, Jack J H Beck","doi":"10.1111/andr.70017","DOIUrl":"https://doi.org/10.1111/andr.70017","url":null,"abstract":"<p><strong>Background: </strong>Erectile dysfunction (ED) is a condition commonly classified as either psychogenic or organic. Traditional age-based categorizations are considered overly simplistic, yet many clinicians continue to rely on initial evaluation-patient symptoms and history, physical examination, blood tests, and questionnaires-for diagnosis due to limited modern tools.</p><p><strong>Objectives: </strong>This study aims to evaluate the predictive value of patient characteristics in individuals with \"ED of indeterminate origin\" following initial evaluation. Identifying these variables could enhance early diagnosis and reduce reliance on invasive procedures.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted on patients who underwent penile duplex Doppler ultrasound between January 2018 and January 2024 due to \"ED of indeterminate origin\". Patient data, including demographics, lifestyle factors, and medical history, were collected and analyzed using unpaired t-tests, chi-squared tests, Fisher's exact tests, and multivariate logistic regression to assess their predictive value.</p><p><strong>Results: </strong>Among the 291 patients in the cohort, 165 (56.7%) were diagnosed with organic ED and 113 (38.8%) with psychogenic ED. Significant differences in age, history of diabetes mellitus, and drug use were noted. Logistic regression revealed multicollinearity among the variables and explained only 5.8% of the variance in ED etiology. Subgroup analysis revealed that diabetes mellitus predicts organic ED in patients aged 40 years and older, while psychopathology is linked to psychogenic ED. No significant predictors were identified for patients under 40 years.</p><p><strong>Discussion and conclusion: </strong>The findings of this \"Dupless\" study highlight the limitations of relying solely on initial evaluation to differentiate ED etiology, stressing the need for additional diagnostic tools. While some predictive factors were identified, they proved insufficient for clinical use. Thus, an urgent need exists for the development of modern, noninvasive diagnostic tools to enhance ED classification. Future research could explore machine learning models to uncover complex patterns not evident in traditional statistical methods.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling SMAD family member 6 as a novel biomarker for prognosis and immunotherapy response in testicular germ cell tumors.","authors":"Huawei Lin, Xiaowen Lin, Peisheng Huang, Xiaoxue Yu, Jianming Liu, Liangliang Huang, Yanni Wei, Jiahong Chen, Zhouda Cai, Le Zhang, Junhong Deng, Zhuoyuan Lin, Yu Zheng, Jianming Lu","doi":"10.1111/andr.70015","DOIUrl":"https://doi.org/10.1111/andr.70015","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite its rarity, testicular germ cell tumor (TGCT) is commonly diagnosed in young males aged 20-40. In recent years, the global prevalence of TGCT has gradually increased, with 12-30% of patients experiencing relapse and metastasis. However, there are currently no reliable biomarkers for accurately predicting the prognosis of TGCT patients. Therefore, identifying novel biomarkers for risk stratification in TGCT is an immediate priority.</p><p><strong>Materials and methods: </strong>Using TGCT samples from multiple centers, we identified a novel prognostic biomarker (SMAD family member 6 [SMAD6]) through differential expression analysis, Cox regression, and survival analysis. Immunohistochemistry (IHC) was then employed to evaluate SMAD6 expression levels in normal testicular tissues and TGCT samples. Finally, we examined the relationship between SMAD6 and its biological characteristics, mutation landscape, immune cell infiltration, and response to immunotherapy.</p><p><strong>Results: </strong>Our study identified SMAD6 as a risk factor for TGCT prognosis. IHC revealed significant expression of SMAD6 in TGCT tissues. Functional enrichment analysis indicated that SMAD6 may contribute to the activation of tumor progression-related pathways and suppression of immune-related pathways. Additionally, high SMAD6 expression was correlated with reduced CD8⁺ T cell infiltration, while patients with low SMAD6 expression benefited more from immunotherapy.</p><p><strong>Discussion and conclusions: </strong>This study highlights the potential of SMAD6 may be useful for TGCT prognosis and immunotherapy response prediction, offering a promising target for personalized medicine strategies.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-induced androgen deficiency in men: Prevalence, pathophysiology, and efficacy of testosterone therapy.","authors":"Hussein Kafel, Milena Braga-Basaria, Shehzad Basaria","doi":"10.1111/andr.70013","DOIUrl":"https://doi.org/10.1111/andr.70013","url":null,"abstract":"<p><strong>Background: </strong>Opioid analgesics are frequently prescribed for the treatment of chronic pain and are a common cause of male androgen deficiency. Despite its high prevalence, this adverse effect of chronic opioid use remains underappreciated by clinicians. As a result, androgen deficiency remains underdiagnosed and likely undertreated. This focused review discusses the expanding literature on opioid-induced androgen deficiency and the efficacy of testosterone therapy, with a particular focus on its anti-nociceptive effects.</p><p><strong>Methods: </strong>Original and review articles on opioid-induced male androgen deficiency published from 1950 through June 2024 were retrieved from PubMed using the key terms \"opioids,\" \"hypogonadism,\" \"low testosterone,\" and \"testosterone therapy.\" References within the retrieved publications were also researched.</p><p><strong>Results: </strong>Opioids suppress the gonadal axis mainly by inhibiting GnRH synthesis and secretion. The prevalence of opioid-induced androgen deficiency in men varies between 20% and 80% and is influenced by the type of opioid used, duration of exposure, age of the cohort, and how low testosterone was defined. Limited data from clinical trials suggest that testosterone therapy improves libido, body composition, and certain domains of quality of life. Early evidence also suggests that testosterone has anti-nociceptive properties, confirming findings from preclinical and population studies.</p><p><strong>Conclusion: </strong>Chronic opioid use is a common but underappreciated cause of androgen deficiency in men. There is a need to raise awareness among clinicians regarding this adverse effect of opioid use. Testosterone therapy could be considered in men with unequivocal androgen deficiency after a thorough clinical evaluation. Ongoing clinical trials will shed further light on the efficacy of testosterone therapy, particularly regarding its anti-nociceptive effects.</p>","PeriodicalId":7898,"journal":{"name":"Andrology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}