Testosterone in men with hypogonadism and transgender males: a systematic review comparing three different preparations

Testosterone therapy is the cornerstone in the care of men with hypogonadism and transgender males. Gel and intramuscular injections are most frequently used and are registered and included in the international guidelines. The specific preparation should be selected according to the patient’s preference, cost, availability, and formulation-specific properties. As the majority of men with hypogonadism and transgender males require lifelong treatment with testosterone, it is important to utilize a regimen that is effective, safe, inexpensive, and convenient to use with optimal mimicking of the physiological situation. This systematic review reviews current literature on differences between the three most used testosterone preparations in adult men with hypogonadism and transgender males. Although it appeared hardly any comparative studies have been carried out, there are indications of differences between the preparations, for example, on the stability of testosterone levels, hematocrit, bone mineral density, and patient satisfaction. However, there are no studies on the effects of testosterone replacement on endpoints such as cardiovascular disease in relation to hematocrit or osteoporotic fractures in relation to bone mineral density. The effect of testosterone therapy on health-related quality of life is strongly underexposed in the reviewed studies, while this is a highly relevant outcome measure from a patient perspective. In conclusion, current recommendations on testosterone treatment appear to be based on data primarily from non-randomized clinical studies and observational studies. The availability of reliable comparative data between the different preparations will assist in the process of individual decision-making to choose the most suitable formula

Lipid droplet dynamics and insulin sensitivity upon a 5-day high-fat diet in Caucasians and South Asians

A 5-day High-Fat High-Calorie diet (HFHC-diet) reduces insulin-stimulated glucose disposal (Rd) in South Asian, but not Caucasian healthy lean males. We aimed to investigate if differences in myocellular lipid handling are underlying this differential response. A two-step hyperinsulinemic-euglycemic clamp and muscle biopsies were performed in 12 healthy lean Caucasian and South Asian males (BMI < 25 kg/m(2), 19–25 years) before and after a 5-day HFHC-diet (regular diet + 375 mL cream/day; 1275 kcal/day; 94% fat). Triglyceride extractions and Western Blots for lipid droplet and mitochondrial proteins were performed. Intramyocellular lipid content and HFHC-diet response were similar between ethnicities (group effect: P = 0.094; diet effect: +~30%, P = 0.044). PLIN5 protein content increased upon the HFHC-diet (P = 0.031) and tended to be higher in South Asians (0.87 ± 0.42 AU vs. 1.35 ± 0.58 AU, P = 0.07). 4-HNE tended to increase in South Asians upon the HFHC-diet (interaction effect: P = 0.057). In Caucasians ΔPLIN5 content correlated with ΔR(d) (Caucasians: r = 0.756, P = 0.011; South Asians: r = −0.085, P = 0.816), while in South Asians Δ4-HNE associated with ΔPLIN5 content (Caucasians: r = 0.312, P = 0.380; South Asians: r = 0.771, P = 0.003). These data indicate that in Caucasians, PLIN5 may be protective against HFHC-diet induced insulin resistance, which for reasons not yet understood is not observed in South Asians, who possess increased lipid peroxidation levels

Main characteristics of <i>Montastraea cavernosa</i> and <i>Xestospongia muta</i> population at the 11 Saba Bank sites.

<p>All values for densities and signs of stress are based on image analysis of 50 m² transect surveys at each site and do not correspond to the samples collected for genetic analyses. (n) number of <i>M</i>. <i>cavernosa</i> and <i>X</i>. <i>muta</i>; densities per square meter; percentage of <i>M</i>. <i>cavernosa</i> colonies with tissue loss and overgrowth; and percentage of <i>X</i>. <i>muta</i> with cyclic bleaching or Sponge Orange Band Disease (SOB [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0155969#pone.0155969.ref049" target="_blank">49</a>]). No disease was detected in any of the recorded <i>M</i>. <i>cavernosa</i> colonies.</p

Bleaching in Xestospongia muta.

<p>(A) Cyclic bleaching (blue arrows). (B) Close up of cyclic bleaching close up.</p

Sample locations on Saba Bank (SB01-SB11) and around Saba Island (SI01 and SI02).

<p>Included is a scheme of Saba Bank’s position with respect to nearby islands and in the wider Caribbean region (indicated by red square in overview).</p

Number of obtained sequences, number of haplotypes and genetic diversity indices for <i>Montastraea cavernosa</i> (ITS) and <i>Xestospongia muta</i> (I3-M11).

<p>Number of obtained sequences, number of haplotypes and genetic diversity indices for <i>Montastraea cavernosa</i> (ITS) and <i>Xestospongia muta</i> (I3-M11).</p

Frequency and distribution of haplotypes in populations of <i>Montastraea cavernosa</i> (A) and <i>Xestospongia muta</i> (B) in the wider Caribbean region.

<p>Haplotype frequencies provided as pie-chart per location, number of samples in brackets. Haplotype network of ITS (A) and I3-M11 (B), baes on all sequences collected throughout the wider Caribbean region. Size of circle reflects the number of individuals with a specific haplotype. Each line represents the genetic distance between haplotypes. Specific haplotype colors match those presented in the pie-charts. White circles (ITS) are haplotypes private to a certain location.</p

Matrix of pairwise population differentiation values (Φ_st) between populations of <i>Montastraea cavernosa</i> at Saba Bank and in the wider Caribbean and Gulf of Mexico.

<p>Significant values (p < 0.05) are provided in bold.</p