The spermatogenesis and antioxidative activity of an ejaculate in young men with post pubertal visceral obesity and normal andrological anamnesis

Background: Taking into account a common development of a visceral obesity at men, research of its influence on a spermatogenesis and antioxidative activity of an ejaculate is actual. Aims: Assessments of spermatogenesis and antioxidative activity of ejaculate in young men with post pubertal visceral obesity and normal andrological anamnesis in comparing with healthy men. Materials and methods: 80 men with post pubertal and nutritional visceral obesity in the age of until 30 years and 30 healthy men have been included in cross-section research. The assessments of waist circumference, levels of gonadotropins and total testosteron, antioxidant activity of an ejaculate, its electronic-microscopic examination was carried spent. Statistically significant counted differences between groups at p <0.05. Results: In young men with post pubertal visceral obesity and normal andrological anamnesis the spermatogenesis was significantly worse in comparing with healthy men. These differences were were significant for waist circumference more more then 98 cm. Antioxidative activity of ejaculate in men with visceral obesity also was significantly lower in comparing with healthy men. The maximal expressiveness of sperm pathogenetic disorders was in men with waist circumference more then 102 cm. Conclusions: In young men with post pubertal visceral obesity and normal andrological anamnesis the spermatogenesis is worse compared to healthy men. If the waist circumference less than 102 cm, the spermatogenesis is normal in most cases, but antioxidant activity of an ejaculate is pathological and mediated through oxidative stress

Association between hypogonadism and reproductive tissue steroid-producing cells antibody in men with positive MAR test IgG and diabetes mellitus type 1

BACKGROUND: Autoimmune hypogonadism is frequently taped in men with positive direct mixed agglutination reaction antisperm antibodies IgG test (MAR test IgG). AIMS: Тo assess pathogenetic factor of autoimmune hypogonadism in men with positive MAR test IgG and diabetes mellitus type 1 (DM1). MATERIALS AND METHODS: A retrospective study included 97 patients with positive direct MAR test IgG: 30 men with DM1 and 67 – without DM. Assessment included testosterone level and titer of summary reproductive tissue steroid-producing cells antibody (LCA). Statistically significant differences were p<0,05. RESULTS: 43% of men with DM1 have abnormal LCA titer and it was significantly higher than in patients without DM – 21%. In both groups testosterone level was significantly lower in men with abnormal LCA titer than in patients with normal antibodies titer. Frequency of hypogonadism in men with abnormal LCA titer was significantly higher than in patients with normal antibodies titer also in both groups. There were no significantly differences of MAR test IgG in patients with normal and abnormal LCA titer. CONCLUSIONS: Autoimmune hypogonadism is a common complication in men with DM1 and positive MAR test IgG and it’s strongly associated with high titer of summary reproductive tissue steroid-producing cells antibody

The structure of pathozoospermia in young men with post-pubertal visceral obesity and a non-aggravated andrologic anamnesis

Introduction. Given the frequent development of visceral obesity in men, it is important to study its effect on spermatogenesis. Aim. Assessment of the structure of pathozoospermia in young men with post-pubertal visceral obesity and a non-aggravated andrologic anamnesis. Materials and Methods. In a single, one-stage study, 80 men with post-pubertal alimentary visceral obesity aged up to 30 years were included. The length of the circumference of the waist, the level of gonadotropins and total testosterone, the antioxidant activity of the ejaculate, its electron microscopic examination were estimated. Statistically significant differences were considered between groups at p <0.05. Results. 24% of men did not have pathosoospermia. The main pathogenetic phenomenon, revealed in patients with pathozoospermia, was astenozoospermia - 100%. There was also a high prevalence of teratozoospermia - 36%. The prevalence of oligozoospermia was 11% of cases. An increase in the content of spermatozoa with insufficiently condensed chromatin and a decrease in the antioxidant activity of the ejaculate were characteristic of all types of pathozoospermia in obese men. A decrease in testosterone levels was characteristic of oligozoospermia. At the same time, statistically significant negative correlations between waist circumference and testosterone level, quantitative indicators of ejaculate, its antioxidant activity, as well as a positive correlation between the waist circumference and the content of spermatozoa with insufficiently condensed chromatin were established. Conclusions. In young men with post-pubertal visceral obesity and a non-aggravated andrologic anamnesis, the prevalence of pathozoospermia in our study was 76%. The most common was oligozoospermia, which was characterized by the presence of the syndrome of normogonadotropic hypogonadism, which developed in patients with the most pronounced visceral obesity. An increase in the content of spermatozoa with insufficiently condensed chromatin and a decrease in the antioxidant activity of the ejaculate is characteristic of all types of pathozoospermia in obese men, which is due to oxidative stress

The clinical and epidemiological characteristics of hypogonadism in men with type 2 diabetes mellitus

BACKGROUND: Male hypogonadism is a frequent complication of diabetes mellitus (DM) type 2; therefore, a study of its clinical and epidemiological characteristics is of interest. AIMS: Assessment of clinical and epidemiological characteristics of hypogonadism in men with diabetes mellitus type 2. METHODS: A full-design, cross-sectional, screening, multicenter, non-interventional study included men with diabetes mellitus type 2. The study was conducted from November 2017 to January 2019.Medical history assessment, sexological testing, estimation of luteinizing hormone (LH), sex hormone-binding globulin; total testosterone and glycated hemoglobin were performed. Free testosterone was calculated by the Vermeullen method. Comparison of groups was carried out using Yates’s corrected version of chi-squared test, Mann-Whitney U-test, and Spearman’s rank correlation method was also used. Differences were considered statistically significant with p <0,05. RESULTS: The age of 554 men included in the study was 55 [50; 58] years, total testosterone level was 12,5 [9,1; 16,4] nmol/L; free testosterone was 0,266 [0,205; 0,333] nmol/L; HbA1c 7,2 [6,2; 8,9] %. Hypogonadism syndrome was detected in 181 men (32,7%). Total testosterone level in these patients was 7,8 [6,5; 9,4] nmol/L, and free testosterone level was 0,182 [0,152; 0,217] nmol/L. In patients without hypogonadism, these parameters were 14,7 [12,4; 18,0] nmol/L and 0,308 [0,265; 0,362] nmol/L, respectively. In most cases, patients with hypogonadism had normal, but lower LH levels of 3,3 [2,2; 4,9] U/L compared with patients without hypogonadism 3,8 [2,7; 4,9], p = 0,022. Most often, normogonadotropic hypogonadism was detected (89,5%). Statistically significant negative correlations were found between total testosterone levels and body mass index (r = -0,24; p <0,001), and waist circumference (r = -0,21; p<0,001). The prevalence of decreased libido in patients with hypogonadism (66,8%) is statistically significantly higher than that in men without hypogonadism (56,3%, p = 0,022). CONCLUSIONS: The prevalence of hypogonadism syndrome in men with diabetes mellitus type 2 is 32,7%. This type of hypogonadism is characterized by normal LH values

The prevalence of hypogonadism in men with type 2 diabetes mellitus in clinical practice

BACKGROUND: Hypogonadism is a common complication in men with type 2 diabetes mellitus (DM), but its prevalence remains unknown. AIMS: To estimate the prevalence of hypogonadism in men with type 2 DM. MATERIALS AND METHODS: Male patients with type 2 DM were enrolled into a single-cohort contemporaneous multicenter non-interventional screening study. The study period was from November 2017 through August 2018. Assessments included total testosterone, luteinizing hormone (LH), sex hormone-binding globulin, HbA1c levels. Levels of free testosterone were calculated by Vermeullen method. RESULTS: TheThe median of age of 400 included men was 56 years [51; 58], total testosterone was 12.3 [9.2; 16.5] nmol/l, free testosterone – 270 [217; 334] pmol/l, HbA1c – 7,1% [6.1; 8.6]. Hypogonadism was found in 135 men (33.7%). The total testosterone level in that group was 7.9 [6.8; 9.8] nmol/l, and free testosterone – 192 [164; 227] pmol/l. In hypogonadism-free men their levels were 15,1 [12,4; 18,6] nmol/l and 311 [270; 364] pmol/l, respectively. In most patients with hypogonadism LH level was low, but within normal ranges, and significantly lower than in men without hypogonadism – 3.2 [2.1; 4.7] IU/L vs 3.8 [2.7; 4.9] IU/L, respectively (p=0.007). Most commonly hypogonadism was with normal LH levels (92,6%, median LH level 3.2 [2.2; 4.3] IU/L, p<0,001). The frequency of hypogonadism with high LH level (10.2 [9.2; 14.7] IU/L) and low LH level (1.0 [0.6; 1.1] IU/L) was 4.4% and 3.0%, respectively. CONCLUSIONS: The prevalence of hypogonadism in men with type 2 DM was found to be 33.7%. Normal levels of LH are typical for this type of patients with hypogonadism

Pathogenetic factors of disorders in spermatogenesis and antioxidative activity of an ejaculate in young men with post pubertal visceral obesity and normal andrological anamnesis

BACKGROUND: Considering the negative influence of a visceral obesity on spermatogenesis, it is important to investigate its pathogenetic factors. AIMS: To reveal the pathogenetic factors of disorders in spermatogenesis and antioxidative activity of an ejaculate in young men with post pubertal visceral obesity and normal andrological anamnesis. MATERIALS AND METHODS: 47 men under 30 years with post pubertal and nutritional visceral obesity have been included into one-stage research. The length of circle of waist, lipid blood spectrum, blood levels of glucose and insulin, antioxidant activity and electronic-microscopic analysis of an ejaculate have been examined. Differences were considered statistically significant with p <0,05. RESULTS: The LDL and triglyceride levels in patients with disorders in spermatogenesis were significantly higher than considered in men with normozoospermia. Correlations between antioxidative activity of ejaculate and levels of LDL (n=47, r=-0,310; p=0,033), triglyceride (n=47, r=-0,366; p=0,011) and the number of normal spermatozoons in ejaculate (n=47, r=0,343;p=0,017) have been revealed. CONCLUSIONS: The dyslipidemia in young men with post pubertal visceral obesity and normal andrological anamnesis can be considered as pathogenetic factors of disorders in spermatogenesis. Nevertheless the dyslipidemia can influence spermatogenesis through oxidative stress

Guidelines for the diagnosis and treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus (Draft)

Hypogonadism in male patients is defined as a decrease in the serum testosterone level; it is associated with specific symptoms and/or signs (see the detailed description below). It is a common complication in diabetes mellitus. The guidelines do not review all disorders leading to the development of hypogonadism but focus on options for the treatment of hypogonadism, which is generally observed in male patients with diabetes. In the literature, data on the prevalence of hypogonadism in patients with diabetes are available. In the section on diagnostics, the medical history of patients with hypogonadism and diabetes, including the necessary methods for physical and laboratory inspection. Risk factors for and the clinical consequences of hypogonadism are separately considered. In the section on treatment options, variations in treatment using various androgenic therapeutic agents based on patients’ requirements, conservation of their reproductive function, and their risk factors are provided. Special attention is given to indications of, contraindications of and risk factors for androgenic therapy in male patients with diabetes, particularly those in their advanced age. The principles of the clinical monitoring are developed. The favourable effects of androgenic therapy for hypogonadism in male patients with diabetes are shown

Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition

Dear Colleagues! We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation. The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the “Standards” also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals. Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045. Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) – Type 2 DM, 6% (256 202) – Type 1 DM and 2% (89 870) – other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment ant have high risk of vascular complications. Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death. In сurrent edition of the “Standards”: New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given. Added a snippet that describes the continuous glucose monitoring. Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism. Proposes more stringent target levels of blood pressure. It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion. In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages. Recommendations for psychosocial support are added. The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated. Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added. For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation. This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM. On behalf of the Working Grou

Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 10th edition

Dear Colleagues!We are glad to present the 10th Edition (revised) of the Standards of Specialized Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), European Association for the Study of Diabetes (EASD 2018, 2019), American Diabetes Association (ADA, 2018, 2019, 2021), American Association of Clinical Endocrinologists (AACE, 2020, 2021), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2018) and Russian Association of Endocrinologists (RAE, 2019). Current edition of the “Standards” also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, CREDENCE, CAROLINA, DAPA-CKD, DAPA-HF, EMPEROR-Reduced trial, VERIFY, VERTIS CV, PIONEER, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 537 million patients by the end of 2021. According to the current estimation by the International Diabetes Federation, 643 million patients will be suffering from DM by 2030 and 784 million by 2045.Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 871 863 patients with DM in this country on 01.01.2021 (3,34% of population) with 92,3% (4 498 826)–Type 2 DM, 5,6% (271 468)–Type 1 DM and 2,1% (101 569)–other types of DM, including 9 729 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) confirmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 10 million patients (about 7% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment and have high risk of vascular complications.Severe consequences of the global pandemic of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.In сurrent edition of the “Standards”:New goals of glycemic control for continuous glucose monitoring (time in range, below range and above range, glucose variability) are given.It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes.In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.Indications for the use of antidiabetic agents in chronic kidney disease are expanded.Information about insulin pump therapy is added.Recommendations on vaccination are added.An algorithm for replacing some insulin preparations with others is given.This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discussions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians, pediatricians and other medical professionals involved in the treatment of DM.Compared with previous edition of the Standards of Specialized Diabetes Care edited by Dedov I.I., Shestakova M.V., ­Mayorov A.Yu., 10th edition, Moscow, 2021 (signed for printing on 10.09.2021) a number of changes have been made.On behalf of the Working Grou

[Androgens and Antiandrogens influence on COVID-19 disease in men].

The WHO has declared a SARS-CoV-2 pandemic. During a pandemic, the researches aimed at finding the new treatments for SARS-CoV-2 become relevant. The review focuses on studies of androgens and antiandrogens in this disease. Since the beginning of the COVID-19 epidemic, it has been noted that men have more severe forms of infection and higher mortality. The main cause of both the severity of the disease and the high mortality of men from COVID-19 are associated with androgens. It was found that patients receiving androgen deprivation are less likely to become infected and easily tolerate COVID-19. The researchers explain the effect of the therapy by the effect on the TMPRSS2 protein. It was found that both TMPRSS2 expression and a more severe course of coronavirus infection are observed in men with hyperandrogenism - androgenic alopecia, acne, excessive facial hair growth and increased skin oiliness. In this regard, some researchers suggest to use androgen deprivation for men at high risk of developing COVID-19. Steroid and non-steroidal antiandrogens are used for androgen deprivation. At the same time, obtaned scientific data on the relationship of severe forms and mortality of COVID-19 with low testosterone levels leads to a hypothesis about the possibility of a positive effect not of androgen devrivation therapy but of androgen replacement therapy in case of hypogonadism have diagnosed. These studies have not been completed recently, and data on the effectiveness and safety of antiandrogens and androgens in the treatment of a new coronavirus infection require clarification