Choice of method of diagnosis hypogonadism in obesity and metabolic syndrome in men

Nowadays, obesity and metabolic syndrome are considered as symptoms of male hypogonadism, which underlines the need for hormonal screening in these patients. However, remain unsolved some questions of laboratory diagnostics testosterone deficiency. In particular, there are contradictions in the choice of research method of free testosterone. The objectives of our work was to conduct a comparative evaluation of methods for studying androgen status of young and middle-aged men with obesity and metabolic syndrome, and determining the relationship between hormonal indicators and metabolic profile, blood pressure, anthropometric characteristics of obesity. The study included 51 patients with symptoms of obesity and metabolic syndrome, aged from 20 to 50 years, the control group consisted of 19 equal-age men with normal body weight. A significant decrease in total testosterone in men with metabolic syndrome was revealed. The dependence of the concentration of total testosterone with age and content sex-steroid-binding globulin was found. The role of free testosterone in the formation of the metabolic syndrome was shown. It was found that free saliva testosterone significantly correlated with the level of calculated serum free testosterone. In patients with obesity and metabolic syndrome there are a statistically significant increase in saliva testosterone indicators compared to calculated serum free testosterone, while at normal body weight differences are absent. It is concluded that saliva testosterone is more sensitive and appropriate marker for obesity and metabolic syndrome

Dehydroepiandrosterone biosynthesis, metabolism, biological effects, and clinical use (analytical review)

The review presents the fundamental information on the metabolism of dehydroepiandrosterone (DHEA), its biological role and possibilities of its use for replacement therapy. There were studied species differences in the synthesis of DHEA in the adrenal cortex. It was found that DHEA and DHEA-sulfate are produced only by the adrenal glands of humans and monkeys, including lower monkeys. Their biosynthesis involves the following steps: cholesterol → pregnenolone → 17-hydroxypregnenolone → DHEA. The adrenal glands of other species, including rats and mice do not synthesize DHEA. At the same time, in certain brain structures not only in man and monkey, but also in other animals DHEA and its precursors are synthesized de novo which are denoted as neurosteroids. It was demonstrated that Purkinje cells which play an important role in memory formation and learning are mainly place neurosteroid formation in mammals and other vertebrates. To establish the relationship of age and the level of DHEA and other steroids we studied the dynamics of their levels at different periods of postnatal development of people. Peak concentration DHEA observed in aged 25–30 years. In the interval from 20 to 90 years in humans the level falls approximately for 90 %. Cortisol levels in blood does not vary with age, leading to an imbalance in the ratio of cortisol/DHEA. Proved a major role of DHEA as a source (precursor) for the synthesis of biologically active sex steroids – testosterone, estradiol and estrone in peripheral tissues. This review presents the bioavailability of DHEA in various physiological and pathological processes in humans and animals. In animal experiments has shown a higher bioavailability of DHEA in transdermal administration as compared with oral administration as in this case there is no steroid rapid inactivation in the liver during its first passage. According to recent studies there is a pronounced dependence of bioavailability of DHEA during replacement therapy from the method of drug administration. </p

Diagnostic value of daily fluctuations in the free form of testosterone and cortisol in men with obesity and metabolic syndrome under the age of 50 years

The important pathogenetic link of obesity and metabolic syndrome (MS) in men are disorders of testosterone production in the testes and adrenal adrenal cortisol production. Тestosterone deficiency and functional hypercortisolism have a mutual influence on each other. Comprehensive assessment of testosterone and cortisol balance and identify their daily variability in the saliva may improve the diagnosis of hormonal disorders in men with obesity and MS. In the present study, by comparative and correlation analysis assessed the circadian rhythm of cortisol and testosterone production in young and middle age men, finding the relationship between the concentration of these hormones in the morning and evening portions of saliva with the changes of anthropometric, hemodynamic and metabolic parameters. The study involved 35 patients with MS, 16 – with overweight and obesity without the MS and 19 – with normal body weight. In men with obesity and MS found a violation of the circadian rhythm of testosterone production. Evening saliva testosterone showed a close correlation with the parameters of the MSome and clinical symptoms of androgen deficiency, as well as a more pronounced decrease with age. Circadian rhythm of cortisol production was not violated, but cortisol was significantly increased in the evening portion of saliva in patients with obesity and MS. MS was associated not only with an increase in the concentration of free salivary cortisol in the evening hours, but with lower cortisol levels in the batch of saliva collected in the morning, which is consistent with other studies