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Re: Salivary Testosterone Measurement does Not Identify Biochemical Hypogonadism in Aging Men: A ROC Analysis
Urological Survey Male and Female Sexual Function and Dysfunction; Andrology Re: Salivary Testosterone Measurement does Not Identify Biochemical Hypogonadism in Aging Men: A ROC Analysis L. D. Hayes, N. Sculthorpe, P. Herbert, J. S. Baker, D. A. Hullin, L. P. Kilduff, D. Reed, R. Spagna and F. M. Grace School of Human Sciences, London Metropolitan University, London, United Kingdom Endocrine 2014; Epub ahead of print.
No Abstract Editorial Comment: A sample of 40 aging males approximately 60 years old, consisting of otherwise healthy hypogonadal (11 patients with a mean SD age of 61.2 3.4 years) or eugonadal (29, 62.5 5.5) participants, recruited from the Carmarthen district of South Wales, United Kingdom were stratified as hypogonadal and eugonadal following assessment of serum total testosterone (T). Salivary T did not significantly correlate with serum total T (r ¼ 0.040, p ¼ 0.813), sex hormonebinding globulin (r ¼ -0.106, p ¼ 0.531), calculated bioavailable T (r ¼ 0.133, p ¼ 0.432) or free T (r ¼ 0.134, p ¼ 0.431) when groups were pooled or considered individually. This is a small study but these data seem to suggest that serum and salivary testosterone levels do not correlate. Allen D. Seftel, MD
Re: Dyspareunia and its Comorbidities among Taiwanese Women: Analysis of the 2004-2010 Nationwide Health Insurance Database H. L. Liu, H. M. Lee and Y. C. Chung Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan J Sex Med 2015; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.064 available at http://jurology.com/ Editorial Comment: This study aimed to estimate the incidence of dyspareunia in Taiwan and investigate dyspareunia associated comorbidities using the National Health Insurance Research Database. The authors analyzed the 2004 to 2010 claims data on dyspareunia from the data set. Dyspareunia was identified by outpatient visits using the ICD-9-CM (diagnosis code 6250). A total of 978 females of different ages had experienced dyspareunia. The incidence of dyspareunia was greater among individuals 30 to 34 years. The findings of this study indicated that dyspareunia was comorbid with menopause, pelvic floor dysfunction and most gynecologic infections. In particular the more common physical causes of dyspareunia were introitus and vaginal infections (19.95%), menopause (16.80%), female genital organ and menstrual cycle disorders (15.22%), and female pelvic organ infections (13.65%). Thus, dyspareunia affects a small but significant number of women in Taiwan and has important associations. Allen D. Seftel, MD
0022-5347/15/1936-2052/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
2052
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.03.063 Vol. 193, 2052-2059, June 2015 Printed in U.S.A.
MALE INFERTILITY
2053
Re: Sexual Dysfunction among Reproductive-Aged Chinese Married Women in Hong Kong: Prevalence, Risk Factors, and Associated Consequences H. Zhang, S. Fan and P. S. Yip Department of Social Work, Renmin University of China, Beijing, China J Sex Med 2015; 12: 738e745.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.065 available at http://jurology.com/ Editorial Comment: This study aimed to estimate the prevalence, risk factors and associated consequences of female sexual dysfunction (FSD) among reproductive age Chinese married women in Hong Kong. Data were obtained from a community based survey across Hong Kong conducted by the Family Planning Association of Hong Kong in 2012, and included 1,518 married women 21 to 49 years old. The authors found that 25.6% of the married women surveyed reported at least 1 form of sexual dysfunction and that the prevalence of 6 domains of sexual dysfunction was as follows. Of the respondents 10.6% had lack of interest in sex, 10.5% did not find sex pleasurable, 9.3% had lubrication difficulties, 8.8% were unable to achieve orgasm, 8.8% had orgasm delay and 8.4% experienced physical pain during sex. Multivariate analyses showed that low education and income, average or poor health, lower frequency of sex, abortion history, traditional attitudes toward sex and marital dissatisfaction are all significant risk factors for different components of FSD. It was also found that 4 domains of FSD (the exceptions being orgasm delay and physical pain during sex) have severe consequences for life satisfaction and sexual satisfaction in married women. The prevalence of FSD in reproductive age Chinese married women in Hong Kong is about 26%, which is less than in similar women in the United States and some Asian countries. This is an interesting finding and deserves further exploration. Allen D. Seftel, MD
Male Infertility Re: Enclomiphene Citrate Stimulates Testosterone Production while Preventing Oligospermia: A Randomized Phase II Clinical Trial Comparing Topical Testosterone R. D. Wiehle, G. K. Fontenot, J. Wike, K. Hsu, J. Nydell and L. Lipshultz; ZA-203 Clinical Study Group Department of Urology, Repros Therapeutics, Inc. and Baylor College of Medicine, Houston, Texas Fertil Steril 2014; 102: 720e727.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.052 available at http://jurology.com/ Editorial Comment: Practitioners have used the selective estrogen receptor modulator (SERM) clomiphene citrate for decades to increase testosterone for hypoandrogenic males with infertility, since this SERM increases intratesticular testosterone rather than decreasing it, as exogenous androgen does. Unfortunately use of clomiphene citrate is off label for this indication in the United States, as it was not pursued as a Food and Drug Administration approved indication. The authors report results of a phase II clinical trial comparing the trans isomer of clomiphene, enclomiphene, to exogenous testosterone in men with hypoandrogenism and inappropriately low luteinizing hormone, so-called secondary hypogonadism. With enclomiphene administration testosterone increased to a level similar to exogenous testosterone levels, and luteinizing hormone increased with enclomiphene, as opposed to decreasing with exogenous testosterone. With a SERM under study for Food and Drug Administration approval for the treatment of hypoandrogenism
No Abstract Editorial Comment: A sample of 40 aging males approximately 60 years old, consisting of otherwise healthy hypogonadal (11 patients with a mean SD age of 61.2 3.4 years) or eugonadal (29, 62.5 5.5) participants, recruited from the Carmarthen district of South Wales, United Kingdom were stratified as hypogonadal and eugonadal following assessment of serum total testosterone (T). Salivary T did not significantly correlate with serum total T (r ¼ 0.040, p ¼ 0.813), sex hormonebinding globulin (r ¼ -0.106, p ¼ 0.531), calculated bioavailable T (r ¼ 0.133, p ¼ 0.432) or free T (r ¼ 0.134, p ¼ 0.431) when groups were pooled or considered individually. This is a small study but these data seem to suggest that serum and salivary testosterone levels do not correlate. Allen D. Seftel, MD
Re: Dyspareunia and its Comorbidities among Taiwanese Women: Analysis of the 2004-2010 Nationwide Health Insurance Database H. L. Liu, H. M. Lee and Y. C. Chung Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan J Sex Med 2015; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.064 available at http://jurology.com/ Editorial Comment: This study aimed to estimate the incidence of dyspareunia in Taiwan and investigate dyspareunia associated comorbidities using the National Health Insurance Research Database. The authors analyzed the 2004 to 2010 claims data on dyspareunia from the data set. Dyspareunia was identified by outpatient visits using the ICD-9-CM (diagnosis code 6250). A total of 978 females of different ages had experienced dyspareunia. The incidence of dyspareunia was greater among individuals 30 to 34 years. The findings of this study indicated that dyspareunia was comorbid with menopause, pelvic floor dysfunction and most gynecologic infections. In particular the more common physical causes of dyspareunia were introitus and vaginal infections (19.95%), menopause (16.80%), female genital organ and menstrual cycle disorders (15.22%), and female pelvic organ infections (13.65%). Thus, dyspareunia affects a small but significant number of women in Taiwan and has important associations. Allen D. Seftel, MD
0022-5347/15/1936-2052/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
2052
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.03.063 Vol. 193, 2052-2059, June 2015 Printed in U.S.A.
MALE INFERTILITY
2053
Re: Sexual Dysfunction among Reproductive-Aged Chinese Married Women in Hong Kong: Prevalence, Risk Factors, and Associated Consequences H. Zhang, S. Fan and P. S. Yip Department of Social Work, Renmin University of China, Beijing, China J Sex Med 2015; 12: 738e745.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.065 available at http://jurology.com/ Editorial Comment: This study aimed to estimate the prevalence, risk factors and associated consequences of female sexual dysfunction (FSD) among reproductive age Chinese married women in Hong Kong. Data were obtained from a community based survey across Hong Kong conducted by the Family Planning Association of Hong Kong in 2012, and included 1,518 married women 21 to 49 years old. The authors found that 25.6% of the married women surveyed reported at least 1 form of sexual dysfunction and that the prevalence of 6 domains of sexual dysfunction was as follows. Of the respondents 10.6% had lack of interest in sex, 10.5% did not find sex pleasurable, 9.3% had lubrication difficulties, 8.8% were unable to achieve orgasm, 8.8% had orgasm delay and 8.4% experienced physical pain during sex. Multivariate analyses showed that low education and income, average or poor health, lower frequency of sex, abortion history, traditional attitudes toward sex and marital dissatisfaction are all significant risk factors for different components of FSD. It was also found that 4 domains of FSD (the exceptions being orgasm delay and physical pain during sex) have severe consequences for life satisfaction and sexual satisfaction in married women. The prevalence of FSD in reproductive age Chinese married women in Hong Kong is about 26%, which is less than in similar women in the United States and some Asian countries. This is an interesting finding and deserves further exploration. Allen D. Seftel, MD
Male Infertility Re: Enclomiphene Citrate Stimulates Testosterone Production while Preventing Oligospermia: A Randomized Phase II Clinical Trial Comparing Topical Testosterone R. D. Wiehle, G. K. Fontenot, J. Wike, K. Hsu, J. Nydell and L. Lipshultz; ZA-203 Clinical Study Group Department of Urology, Repros Therapeutics, Inc. and Baylor College of Medicine, Houston, Texas Fertil Steril 2014; 102: 720e727.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.052 available at http://jurology.com/ Editorial Comment: Practitioners have used the selective estrogen receptor modulator (SERM) clomiphene citrate for decades to increase testosterone for hypoandrogenic males with infertility, since this SERM increases intratesticular testosterone rather than decreasing it, as exogenous androgen does. Unfortunately use of clomiphene citrate is off label for this indication in the United States, as it was not pursued as a Food and Drug Administration approved indication. The authors report results of a phase II clinical trial comparing the trans isomer of clomiphene, enclomiphene, to exogenous testosterone in men with hypoandrogenism and inappropriately low luteinizing hormone, so-called secondary hypogonadism. With enclomiphene administration testosterone increased to a level similar to exogenous testosterone levels, and luteinizing hormone increased with enclomiphene, as opposed to decreasing with exogenous testosterone. With a SERM under study for Food and Drug Administration approval for the treatment of hypoandrogenism