Studies have investigated the effects of androgen deprivation therapy (ADT) use on the incidence and clinical outcomes of coronavirus disease 2019 (COVID-19); however, the results have been inconsistent. We searched the PubMed, Medline, Cochrane, Scopus, and Web of Science databases from inception to March 2022; 13 studies covering 84 003 prostate cancer (PCa) patients with or without ADT met the eligibility criteria and were included in the meta-analysis. We calculated the pooled risk ratios (RRs) with 95% confidence intervals (CIs) to explore the association between ADT use and the infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and severity of COVID-19. After synthesizing the evidence, the pooled RR in the SARS-CoV-2 positive group was equal to 1.17, and the SARS-CoV-2 positive risk in PCa patients using ADT was not significantly different from that in those not using ADT (P = 0.544). Moreover, no significant results concerning the beneficial effect of ADT on the rate of intensive care unit admission (RR = 1.04, P = 0.872) or death risk (RR = 1.23, P = 0.53) were found. However, PCa patients with a history of ADT use had a markedly higher COVID-19 hospitalization rate (RR = 1.31, P = 0.015) than those with no history of ADT use. These findings indicate that ADT use by PCa patients is associated with a high risk of hospitalization during infection with SARS-CoV-2. A large number of high quality studies are needed to confirm these results.
Male ; Humans ; Prostatic Neoplasms/chemically induced* ; Androgen Antagonists/adverse effects* ; COVID-19 ; Androgens/therapeutic use* ; SARS-CoV-2

A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009-2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan-Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6-16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.
Adult ; Aged ; Androgens/adverse effects* ; Drug Implants ; Hematocrit ; Hormone Replacement Therapy/methods* ; Humans ; Hypogonadism/drug therapy* ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Polycythemia/epidemiology* ; Retrospective Studies ; Testosterone/adverse effects*

Local healthcare providers often question the possible steroidal activity of traditional Chinese medicine (TCM) herbs or herbal products and implicate them as a cause for adrenal insufficiency or Cushing's syndrome in patients with a history of TCM intake. We conducted a comprehensive database search for evidence of potential glucocorticoid, mineralocorticoid, androgenic or oestrogenic activity of herbs or herbal products. Overall, there are not many herbs whose steroidal activity is well established; among these, most cases were based on preclinical studies. Liquorice root may cause pseudoaldosteronism through interference with the steroidogenesis pathway. Although ginseng and cordyceps have some in vitro glucocorticoid activities, the corroborating clinical data is lacking. Deer musk and deer antler contain androgenic steroids, while epimedium has oestrogenic activity. On the other hand, adulteration of herbal products with exogenous glucocorticoids is a recurrent problem encountered locally in illegal products masquerading as TCM. Healthcare providers should stay vigilant and report any suspicion to the relevant authorities for further investigations.
Androgens ; analysis ; Animals ; Cordyceps ; Databases, Factual ; Deer ; Drugs, Chinese Herbal ; adverse effects ; analysis ; Epimedium ; Estrogens ; analysis ; Fatty Acids, Monounsaturated ; Glucocorticoids ; analysis ; Glycyrrhiza uralensis ; Humans ; Medicine, Chinese Traditional ; adverse effects ; Mineralocorticoids ; analysis ; Panax ; Plant Preparations ; analysis ; Risk ; Singapore ; Steroids ; adverse effects ; analysis ; Tissue Extracts

Objective: To investigate the clinical effects of oral Testosterone Undecanoate Capsules (TUC) combined with Qilin Pills (QLP) on late-onset hypogonadism (LOH) in men. METHODS: Sixty-three LOH patients meeting the inclusion criteria were randomly divided into a control group (aged ［48.4 ± 6.2］ yr, n = 32) and an experimental group (aged ［47.2 ± 5.6］ yr, n = 31) to be treated with oral TUC (80 mg, qd) and TUC + QLP (6g, tid), respectively, both for 3 months. Comparisons were made between the two groups of patients in the IIEF-5 scores, total testosterone (TT) levels, and scores in the Aging Males' Symptoms (AMS) scale before and after treatment. RESULTS: After treatment, the patients of the experimental group, as compared with the controls, showed a significantly increased IIEF-5 score (21.7 ± 5.8 vs 15.9 ± 4.7, P <0.05) and TT level (［16.7 ± 2.2］ vs ［13.1 ± 2.8］ nmol/L, P <0.05), but a decreased AMS score (20.7 ± 5.7 vs 31.3±6.5, P <0.05). CONCLUSIONS TUC combined with Qilin Pills has a better effect and a lower rate of adverse reactions than TUC used alone in the treatment of late-onset hypogonadism in males.
Androgens ; administration & dosage ; adverse effects ; Capsules ; Drug Therapy, Combination ; adverse effects ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Humans ; Hypogonadism ; blood ; drug therapy ; Male ; Middle Aged ; Testosterone ; administration & dosage ; adverse effects ; analogs & derivatives ; blood

OBJECTIVETo evaluate the efficacy and safety of testosterone undecanoate (TU) in the treatment of late-onset hypogonadism (LOH) by meta-analysis.

METHODSWe searched Pubmed (until April 1, 2014), Embase (until March 28, 2014), Cochrane Library (until April 17, 2014), CBM (from January 1, 2001 to February 2, 2014), CNKI (from January 1, 2001 to February 2, 2014), Wanfang Database (from January 1, 2000 to February 2, 2014), and VIP Database (from January 1, 2000 to Febru ary 2, 2014) for randomized controlled trials of TU for the treatment of LOH. We evaluated the quality of the identified literature and performed meta-analysis on the included studies using the Rveman5. 2 software.

RESULTSTotally, 14 studies were included after screening, which involved 1 686 cases. Compared with the placebo and blank control groups, TU treatment significantly increased the levels of serum total testosterone (SMD = 6.22, 95% CI 3.99 to 8.45, P < 0.05) and serum free testosterone (SMD = 4.35, 95% CI 1.86 to 6. 85, P < 0.05) but decreased the contents of luteinizing hormone (WMD = -2.23, 95% CI -4.03 to -0.42, P < 0.05), sex hormone binding globulin (WMD = 2.00, 95% CI 1.38 to 2.63, P < 0.05). TU also remarkably reduced the scores of Partial Androgen Deficiency of the Aging Males (WMD = -9.49, 95% CI -12.96 to -6.03, P < 0.05) and Aging Males Symptoms rating scale (WMD = -2.76, 95% CI -4.85 to -0.66, P <0.05) but increased the hemoglobin level (SMD = 2.35, 95% CI 0.29 to 4.41, P < 0.05) and packed-cell volume (SMD = 4.35, 95% CI 1.36 to 7.33, P < 0.05). However, no significant changes were shown in aspertate aminotransferase, alanine transaminase, prostate-specific antigen, or prostate volume after TU treatment (P > 0.05).

CONCLUSIONTU could significantly increase the serum testosterone level and improve the clinical symptoms of LOH patients without inducing serious adverse reactions. However, due to the limited number and relatively low quality of the included studies, the above conclusion could be cautiously applied to clinical practice.

Androgens ; therapeutic use ; Hemoglobin A ; metabolism ; Humans ; Hypogonadism ; blood ; drug therapy ; Luteinizing Hormone ; blood ; Male ; Prostate-Specific Antigen ; Randomized Controlled Trials as Topic ; Sex Hormone-Binding Globulin ; metabolism ; Testosterone ; adverse effects ; analogs & derivatives ; blood ; pharmacology

OBJECTIVETo observe the effect of Bushen Tiaojing Recipe (BTR) and Xiaoyao Pill (XYP) on the morphology and sex hormones secretion of adenohypophysis and ovaries in androgen-induced sterile rats (ASR).

METHODSFifty 9-day old SD female rats randomly recruited from total 60 rats were subcutaneously injected with testosterone propionate to establish the ASR model. And the rest 10 rats were recruited as the normal group. Thirty successfully modeled rats were recruited and randomly divided into the model group, the BTR group (administered with BTR suspension), and the XYP group (administered with XYP suspension), 10 in each group. Five weeks later, rats were decapitated in the proestrus. Serum levels of estradiol (E2), progesterone (P), testosterone (T), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were detected by radioimmunoassay. The morphologies of adenohypophysis and ovary were observed after HE staining.

RESULTSCompared with the normal group, serum E2 and T levels increased, while FSH and LH levels decreased in the model group (all P < 0.01). The morphology of adenohypophysis and ovary was abnormal in the model group. Compared with the model group, serum E2 and T levels decreased, while FSH and LH levels increased in the BTR group and the XYP group (P < 0.05, P < 0.01). Besides, E2 and T levels in the BTR group and FSH levels in the XYP group restored to normal (all P > 0.05). The damaged structure of adenohypophysis and ovary got restored to different degrees.

CONCLUSIONBTR and XYP both could improve ovulation failure.

Androgens ; adverse effects ; Animals ; Drugs, Chinese Herbal ; pharmacology ; Estradiol ; blood ; Female ; Follicle Stimulating Hormone ; blood ; Infertility, Female ; chemically induced ; drug therapy ; Luteinizing Hormone ; blood ; Ovary ; drug effects ; Ovulation ; Pituitary Gland, Anterior ; drug effects ; Progesterone ; blood ; Rats ; Rats, Sprague-Dawley ; Testosterone ; blood

PURPOSE: Androgen replacement therapy has been shown to be safe and effective for most patients with testosterone deficiency. Male partners of infertile couples often report significantly poorer sexual activity and complain androgen deficiency symptoms. We report herein an adverse effect on fertility caused by misusage of androgen replacement therapy in infertile men with hypogonadal symptoms. MATERIALS AND METHODS: The study population consisted of 8 male patients referred from a local clinic for azoospermia or severe oligozoospermia between January 2008 and July 2011. After detailed evaluation at our andrology clinic, all patients were diagnosed with iatrogenic hypogonadism associated with external androgen replacement. We evaluated changes in semen parameters and serum hormone level, and fertility status. RESULTS: All patients had received multiple testosterone undecanoate (NebidoR) injections at local clinic due to androgen deficiency symptoms combined with lower serum testosterone level. The median duration of androgen replacement therapy prior to the development of azoospermia was 8 months (range: 4-12 months). After withdrawal of androgen therapy, sperm concentration and serum follicle-stimulating hormone level returned to normal range at a median 8.5 months (range: 7-10 months). CONCLUSION: Misusage of external androgen replacement therapy in infertile men with poor sexual function can cause temporary spermatogenic dysfunction, thus aggravating infertility.
Adult ; Androgens/administration & dosage/adverse effects/*therapeutic use ; Azoospermia/*drug therapy ; Erectile Dysfunction/drug therapy ; Humans ; Hypogonadism/*drug therapy ; Infertility, Male/*chemically induced/drug therapy ; Male ; Oligospermia/*drug therapy ; Testosterone/administration & dosage/adverse effects/*analogs & derivatives/therapeutic use

OBJECTIVETo explore brain-protective effect of androgen, its dose-effect relationship and long-term adverse reaction.

METHODSeventy two 3-day-old SD rats were randomized into androgen group (n = 32), HIBD model group (n = 32) and sham operated group (n = 8). The androgen group and HIBD model group were further randomized into 30 mg/kg group, 60 mg/kg group, 120 mg/kg group and 240 mg/kg group, respectively. In androgen group and HIBD group, every rat was given testosterone or peanut oil, one time a day. Three days later, HIBD model was established by occlusion of the left common carotid artery and inhalation of 8% oxygen plus 92% nitrogen for 2.5 hours. Adult rats' ability of learning and memory was determined by water maze test. Escape latencies were recorded and analyzed by statistics. Vaginal cells of all female rats were examined everyday for identifying their estrous cycle. Female rats were allowed to live with normal adult male rats if the female rats were in estrous period. Vaginal cells were examined everyday until sperm was seen, which was the signal of gestation. Pregnancy rate and the number of embryos were recorded and analyzed by statistics. Acropetal coefficient was calculated. The testes and epididymis were taken from adult male rats, histopathological sections were made, and the structure of testis and epididymis were studied under light microscope.

RESULTIn Morris experiment, escape latencies (EL) of HIBD group were much longer than those of sham operation group (27.71 ± 3.19) s, time of first enter target (1(st) ET) was later than that of sham operation group (5.34 ± 0.83) s, times of target cross (TC) was less than that of sham operation group (18.88 ± 1.89) (P < 0.01, P = 0.0005). EL of androgen group (34.89 ± 3.68, 33.71 ± 3.38, 33.84 ± 3.45, 35.43 ± 2.43) were much shorter than that of HIBD group, 1(st) ET (5.39 ± 1.51, 6.28 ± 2.07, 5.09 ± 1.61, 5.85 ± 0.87) was earlier than that of HIBD group, TC (12.75 ± 2.05, 14.88 ± 3.36, 14.88 ± 2.36, 14.38 ± 1.60) was more than that of HIBD group (P < 0.01, P = 0.0001). Among the four doses groups of androgen group, EL, 1(st) ET and TC had no statistical significance (P > 0.05, P = 0.159). There were no statistical significance between male rats of androgen group [Testes acropetal coefficient (0.89 ± 0.07, 0.92 ± 0.08, 0.88 ± 0.11, 0.87 ± 0.09), epididymis acropetal coefficient (0.25 ± 0.02, 0.24 ± 0.05, 0.26 ± 0.04, 0.23 ± 0.05)], HIBD group and sham operation group (P > 0.05, P = 3.207). Among the four doses groups of androgen group had no statistical significance (P > 0.05, P = 6.663). There were no statistical significance between female rats of androgen group (pregnancy rate, 100%; times, 14.52 ± 3.34, 14.69 ± 2.28, 14.98 ± 2.67, 15.38 ± 3.07), HIBD group and sham operation group in pregnancy rate and times.

CONCLUSIONThe intellectual ability of rats decreased after HI. Androgen could reduce the effect of HI on intellectual ability. Androgen had no adverse reaction to the reproductive capacity of adult rats.

Androgens ; adverse effects ; pharmacology ; Animals ; Dose-Response Relationship, Drug ; Female ; Hypoxia-Ischemia, Brain ; psychology ; Male ; Maze Learning ; drug effects ; Rats ; Rats, Sprague-Dawley ; Reproduction ; drug effects

Androgen doping in power sports is undeniably rampant worldwide. There is strong evidence that androgen administration in men increases skeletal muscle mass, maximal voluntary strength and muscle power. However, we do not have good experimental evidence to support the presumption that androgen administration improves physical function or athletic performance. Androgens do not increase specific force or whole body endurance measures. The anabolic effects of testosterone on the skeletal muscle are mediated through androgen receptor signaling. Testosterone promotes myogenic differentiation of multipotent mesenchymal stem cells and inhibits their differentiation into the adipogenic lineage. Testosterone binding to androgen receptor induces a conformational change in androgen receptor protein, causing it to associate with beta-catenin and TCF-4 and activate downstream Wnt target genes thus promoting myogenic differentiation. The adverse effects of androgens among athletes and recreational bodybuilders are under reported and include acne, deleterious changes in the cardiovascular risk factors, including a marked decrease in plasma high-density lipoproteins (HDL) cholesterol level, suppression of spermatogenesis resulting in infertility, increase in liver enzymes, hepatic neoplasms, mood and behavioral disturbances, and long term suppression of the endogenous hypothalamic-pituitary-gonadal axis. Androgens are often used in combination with other drugs which may have serious adverse events of their own. In spite of effective methods for detecting androgen doping, the policies for screening of athletes are highly variable in different countries and organizations and even existing policies are not uniformly enforced.
Androgens ; adverse effects ; pharmacology ; physiology ; Doping in Sports ; Humans ; Sports ; Weight Lifting

OBJECTIVETo study the effects of cryptotanshinone on androgen synthesis for the prenatally androgenized male rats.

METHODSOn days 16-18 of pregnancy, rats were injected s. c. with testosterone propionas continuously for 3 days; male offspring were studied as subject. Serum concentrations of testosterone (T), 17a-hydroxy progesterone (17-OHP), blood glucose, and insulin were measured by radioimmunoassay. Then, the rats were treated with cryptotanshinone by gavage for 14 days, and the levels of serum T, 17-OHP and insulin were detected and the 17a-hydroxylase protein expression in interstitial cell was measured using the method of immunohistochemistry.

RESULTSThere was no difference between the male groups who were prenatally androgenized in serum levels of T, but the 17-OHP, fasting insulin levels and homeostatic model assessment for insulin resistance (HOMA-IR) elevated significantly (P < 0.05). Cryptotanshinone could lower the levels of 17-OHP (P < 0.05) but had no effect on 17a-hydroxylase.

CONCLUSIONPrenatally androgenized male rats exhibit elevated 17-OHP and diminished insulin sensitivity. Cryptotanshinone could decrease 17-OHP, but has no effect on insulin, indicating it may reduce androgen synthesis.

Androgens ; biosynthesis ; Animals ; Disease Models, Animal ; Female ; Humans ; Male ; Maternal Exposure ; adverse effects ; Phenanthrenes ; administration & dosage ; adverse effects ; Polycystic Ovary Syndrome ; drug therapy ; metabolism ; Pregnancy ; Prenatal Exposure Delayed Effects ; metabolism ; Random Allocation ; Rats ; Rats, Wistar