Dataset Information

The efficacy of anastrozole in subfertile men with and without abnormal testosterone to estradiol ratios.

ABSTRACT:

Background

Aromatase inhibitors (AIs), such as anastrozole, have shown effectiveness in treating oligoasthenozoospermia due to abnormal testosterone to estradiol (T/E₂) ratio (T/E₂ <10). However, its efficacy in subfertile men without abnormal T/E₂ ratio (T/E₂ >10) remained unevaluated. This retrospective study aimed to investigate whether patients with T/E₂ ratio >10 could also benefit from anastrozole treatment.

Methods

One hundred and five subfertile patients treated with 1 mg anastrozole daily were included, in which 62 patients had a T/E₂ ratio of <10, and 43 patients had this ratio >10. Semen parameters and sex hormone levels (including FSH, LH, PRL, E₂ and total T) were measured before and after a three-month treatment. T/E₂ ratio and total progressive motility sperm count were calculated from these results.

Results

Patients in both groups (T/E₂ ratio <10 and >10) showed significant increase in sex hormone levels (FSH, LH and total T), T/E₂ ratio and semen parameters (semen volume, sperm concentration, total sperm count, progressive motility and total progressive motility count). The changes of these parameters between two groups were comparable. A subgroup analysis comparing the effect of anastrozole on overweight and normal patients also showed no significant difference. Improvements in semen parameters were seen in some azoospermic and cryptozoospermic patients.

Conclusions

The majority of subfertile men with and without abnormal T/E₂ ratios responded to anastrozole treatment with significantly improved semen parameters and sex hormone levels. Anastrozole showed potential effectiveness in male subfertile patients with T/E₂ >10, to be confirmed by future prospective, randomized, controlled studies.

SUBMITTER: Yang Y

PROVIDER: S-EPMC9547167 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

The efficacy of anastrozole in subfertile men with and without abnormal testosterone to estradiol ratios.

Yang Yang Y Chen Shuyun S Chen Hong H Guo Yi Y Teng Xiaoming X

Translational andrology and urology 20220901 9

<h4>Background</h4>Aromatase inhibitors (AIs), such as anastrozole, have shown effectiveness in treating oligoasthenozoospermia due to abnormal testosterone to estradiol (T/E<sub>2</sub>) ratio (T/E<sub>2</sub> <10). However, its efficacy in subfertile men without abnormal T/E<sub>2</sub> ratio (T/E<sub>2</sub> >10) remained unevaluated. This retrospective study aimed to investigate whether patients with T/E<sub>2</sub> ratio >10 could also benefit from anastrozole treatment.<h4>Methods</h4>One ...[more]

PMID: 36217397

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Project description:IntroductionTestosterone therapy (TTH) for testosterone deficiency (TD) may lead to elevated estradiol (E2) levels requiring management to avoid unnecessary adverse effects.AimTo examine the impact of aromatase inhibitors, specifically anastrozole (AZ), in men with elevated E2 on TTH.MethodsAll patients on TTH at a high volume sexual medicine practice between 2005 and 2019 were reviewed. Men with E2 levels >60 pg/mL regardless of symptoms or 40-60 pg/mL with subjective symptoms were started on AZ 0.5 mg 3x/week. Routine hormone profile and symptom assessment were completed to ensure symptom resolution, reduction of E2 levels and maintenance of testosterone levels. Multivariable logistic regression was completed to determine predictors of men more likely to respond to therapy.Main outcome measureDemographic and hormonal profiles of men on AZ and predictors of response to therapy.Results1708 men with TD were placed on TTH. Of these, 51 (3%) were treated with AZ (AZ+). After exclusions, 44 (2.6%) had elevated estradiol levels >60 pg/mL or >40 pg/mL with symptoms. Demographics were similar between groups. TTH distribution between groups was different with greater rates of topical TTH in the AZ- groups (AZ+:34.1% vs AZ-:53.5%) and greater rates of intramuscular TTH in the AZ+ group (AZ+:38.6% vs AZ-:18.5%) (P = .017 overall). Of the 44 men treated with AZ, 68.0% had pre-AZ E2 levels ≥60 pg/mL and 32.0% had levels between 40 and 60 pg/mL. Median pre-AZ E2 levels were 65 (interquartile range [IQR], 55-94) pg/mL in comparison to 22 (IQR 15-38) pg/mL post-AZ E2 levels (P < .001). Total testosterone levels were similar before and after AZ use (616 (IQR 548-846) ng/dL and 596 (IQR 419-798) ng/dL, respectively, P = .926). No statistically significant predictive factors of E2 reduction using AZ were found.ConclusionWhile no statistically significant predictors for E2 recovery in men on AZ were found, AZ remains a reasonable option for E2 reduction in men with elevated levels on TTH. Punjani N, Bernie H, Salter C, et al. The Utilization and Impact of Aromatase Inhibitor Therapy in Men With Elevated Estradiol Levels on Testosterone Therapy. Sex Med 2021;9:100378.

Project description:Fracture risk is determined by bone strength and the risk of falls. The relationship between serum sex steroids and bone strength parameters in men is well known, whereas the predictive value of sex steroids for falls is less studied. The aim of this study was to assess the associations between serum testosterone (T) and estradiol (E2) and the likelihood of falls. Older men (aged ≥65 years) from the United States (n = 1919), Sweden (n = 2495), and Hong Kong (n = 1469) participating in the Osteoporotic Fractures in Men Study had baseline T and E2 analyzed by mass spectrometry. Bioavailable (Bio) levels were calculated using mass action equations. Incident falls were ascertained every 4 months during a mean follow-up of 5.7 years. Associations between sex steroids and falls were estimated by generalized estimating equations. Fall rate was highest in the US and lowest in Hong Kong (US 0.50, Sweden 0.31, Hong Kong 0.12 fall reports/person/year). In the combined cohort of 5883 men, total T (odds ratio [OR] per SD increase = 0.88, 95% confidence interval [CI] 0.86-0.91) and BioT (OR = 0.86, 95% CI 0.83-0.88) were associated with incident falls in models adjusted for age and prevalent falls. These associations were only slightly attenuated after simultaneous adjustment for physical performance variables (total T: OR = 0.94, 95% CI 0.91-0.96; BioT: OR = 0.91, 95% CI 0.89-0.94). E2, BioE2, and sex hormone-binding globulin (SHBG) were not significantly associated with falls. Analyses in the individual cohorts showed that both total T and BioT were associated with falls in MrOS US and Sweden. No association was found in MrOS Hong Kong, and this may be attributable to environmental factors rather than ethnic differences because total T and BioT predicted falls in MrOS US Asians. In conclusion, low total T and BioT levels, but not E2 or SHBG, are associated with increased falls in older men. © 2017 American Society for Bone and Mineral Research.

Dataset Information

The efficacy of anastrozole in subfertile men with and without abnormal testosterone to estradiol ratios.

Background

Methods

Results

Conclusions

Publications

The efficacy of anastrozole in subfertile men with and without abnormal testosterone to estradiol ratios.

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