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HIV acquisition risk with norethisterone (NET) enanthate (NET-EN) is reportedly less than for depo-medroxyprogesterone acetate intramuscular (DMPA-IM). We investigated the effects of these progestin-only injectable contraceptives on serum testosterone and sex hormone binding globulin (SHBG) levels, since these may play a role in sexual behavior and HIV acquisition. The open-label WHICH clinical trial, conducted at two sites in South Africa from 2018–2019, randomized HIV-negative women aged 18–40 years to 150 mg DMPA-IM 12-weekly (n = 262) or 200 mg NET-EN 8-weekly (n = 259). We measured testosterone by UHPLC-MS/MS and SHBG by immunoassay in matched pairs of serum samples collected at baseline (D0) and at peak serum progestin levels at 25 weeks post initiation (25W) (n = 214–218 pairs). Both contraceptives substantially decreased, from D0 to 25W, the total testosterone [DMPA-IM D0 0.560, 25W 0.423 nmol/L, -24.3% (p < 0.0001); NET-EN D0 0.551, 25W 0.253 nmol/L, -54.1%, (p < 0.0001)], SHBG [DMPA-IM D0 45.0, 25W 32.7 nmol/L, -29.8% (p < 0.0001); NET-EN D0 50.2, 25W 17.6 nmol/L, -65.1% (p < 0.0001)], and calculated free testosterone levels [DMPA-IM D0 6.87, 25W 5.38 pmol/L, -17.2% (p = 0.0371); NET-EN D0 6.00, 25W 3.70, -40.0% (p < 0.0001)]. After adjusting for change from D0, the total testosterone, SHBG and calculated free testosterone levels were significantly higher for DMPA-IM than NET-EN (64.9%, p < 0.0001; 101.2%, p < 0.0001; and 38.0%, p = 0.0120, respectively). The substantial and differential decrease in testosterone and SHBG levels does not explain our previous finding of no detected decrease in risky sexual behavior or sexual function for DMPA-IM or NET-EN users from D0 to 25W. Medroxyprogesterone (MPA) and NET are androgenic and are both present in molar excess over testosterone and SHBG concentrations at 25W. Any within or between contraceptive group androgenic effects on behavior in the brain are likely dominated by the androgenic activities of MPA and NET and not by the decreased endogenous testosterone levels. The clinical trial was registered with the Pan African Clinical Trials Registry (PACTR 202009758229976).

Purpose Breast cancer treatment is associated with weight gain, and obesity and its related cardiometabolic and hormonal risk factors have been associated with poorer outcomes. Dietary intervention may address these risk factors, but limited research has been done in the setting of metastatic breast cancer requiring systemic therapy. Methods Women with metastatic breast cancer on stable treatment were randomized 2:1 to an 8-week intervention ( n  = 21) or control ( n  = 11). The intervention included weekly assessment visits and an ad libitum whole-food, plant-based (WFPB) diet with provided meals. Cardiometabolic, hormonal, and cancer markers were assessed at baseline, 4 weeks, and 8 weeks. Results Within the intervention group, mean weight decreased by 6.6% ( p  < 0.01) after 8 weeks. Fasting insulin decreased from 16.8 uIU/L to 11.2 uIU/L ( p  < 0.01), concurrent with significantly reduced insulin resistance. Total cholesterol decreased from 193.6 mg/dL to 159 mg/dL ( p  < 0.01), and low-density lipoprotein (LDL) cholesterol decreased from 104.6 mg/dL to 82.2 mg/dL ( p  < 0.01). Total testosterone was unchanged, but free testosterone trended lower within the intervention group ( p  = 0.08) as sex hormone binding globulin increased from 74.3 nmol/L to 98.2 nmol/L ( p  < 0.01). There were no significant differences in cancer progression markers at week 8, although mean CA 15-3, CA 27.29, and CEA were lower in the intervention group ( p  = 0.53, p  = 0.23, and p  = 0.54, respectively) compared to control, when adjusted for baseline. Conclusion WFPB dietary changes during treatment for metastatic breast cancer are well tolerated and significantly improve weight, cardiometabolic and hormonal parameters. Longer studies are warranted to assess the durability of changes. Trial registration First registered at Clinicaltrials.gov (NCT03045289) on February 7, 2017.

The albumin-to-globulin ratio (AGR) has been associated with infectious diseases; however, its association with pneumonia in patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. This research aims to investigate the connection between AGR and hospital-acquired pneumonia (HAP). This retrospective analysis included 4,813 patients with aSAH from West China Hospital, Sichuan University. Serum samples were collected within seven days after admission. Logistic regression analysis was conducted to assess the association between AGR and HAP. Among the 4,813 patients, 1,249 (26.0%) developed HAP. The patients were classified into quartiles according to their AGR levels. Significant differences in odds ratios (ORs) were found in admission AGR: 0.76 (95% CI 0.63–0.93, p  = 0.007) for Q2, 0.78 (95% CI 0.64–0.94, p  = 0.016) for Q3, and 0.77 (95% CI 0.63–0.94, p  = 0.012) for Q4 versus Q1. ORs of minimum AGR were: 0.67 (95% CI 0.57–0.80, p  < 0.001) for Q2, 0.45(95% CI 0.37–0.54, p  < 0.001) for Q3, and 0.24 (95% CI 0.20–0.30, p  < 0.001) for Q4. ORs for AGR drift: 1.19 (95% CI 0.93–1.52, p  = 0.18) for Q2, 1.35 (95% CI 1.06–1.73, p  = 0.015) for Q3, and 2.00 (95% CI 1.57–2.55, p  < 0.001) for Q4. Furthermore, admission AGR (< 1.21) and minimum AGR (< 0.99) were linked to elevated CURB-65 scores 3 , 4 – 5 in HAP patients, yielding ORs of 0.46 (95% CI 0.27–0.77, p  = 0.003) and 0.44 (95% CI 0.27–0.69, p  < 0.001). AGR was associated with an increased risk of HAP. Furthermore, lower minimum AGR was associated with increased severity of HAP among aSAH patients. Further research is necessary to confirm this finding and investigate the underlying mechanisms.

Many aging men experience reduced energy and libido related to non-optimal testosterone levels. We conducted a randomized double-blind trial with Trigozim R fenugreek extract to assess impact on plasma and saliva testosterone, and some subjective effects. 95 men (40-80y) completed a 12-week intervention, taking 3 tablets daily with 0 mg (placebo; n = 22), 600 mg (n = 21), 1200 mg (n = 25) and1800 mg (n = 27) fenugreek extract and essential nutrients. Samples were collected at weeks 0, 2, 6, and 12. Participants answered a pre- and post-intervention questionnaire on lifestyle and libido. We measured total testosterone (HPLC-MS/MS) and sex hormone binding globulin (ELISA), calculated free testosterone index (FTI), and measured saliva testosterone. Plasma total testosterone and FTI increased after any dose of Trigozim R vs. baseline (13.0%, p = 1.0x10 -4 and 16.3%, p = 6.2x10 -6 ), but not vs. placebo (9.0%, p = 0.122 and 11.3% p = 0.059). 1800 mg Trigozim R resulted in 12.2% increased FTI (p = 0.025). Saliva testosterone concentration increased after any dose of Trigozim R vs. baseline (31.1%, p = 2.3x10 -4 ) and vs. placebo (37.2%, p = 0.042). 1800 mg Trigozim R for 12 weeks resulted in 19.6% (p = 0.006) increased saliva testosterone. Compliance was confirmed by enhanced plasma concentration of 25-hydroxy vitamin D 3 . We observed no subjective effects or side-effects of Trigozim R . Trigozim R increased saliva and plasma testosterone concentration during intervention but only for saliva vs. placebo. Saliva may be preferred for measuring free testosterone due to no protein-bound testosterone.

According to the free hormone hypothesis, biological activity of a certain hormone is best reflected by free rather than total hormone concentrations. A crucial element in this theory is the presence of binding proteins, which function as gatekeepers for steroid action. For testosterone, tissue exposure is governed by a delicate equilibrium between free and total testosterone which is determined through interaction with the binding proteins sex hormone-binding globulin and albumin. Ageing, genetics and various pathological conditions influence this equilibrium, hereby possibly modulating hormonal exposure to the target tissues. Despite ongoing controversy on the subject, strong evidence from recent in vitro, in vivo and human experiments emphasizes the relevance of free testosterone. Currently, however, clinical possibilities for free hormone diagnostics are limited. Direct immunoassays are inaccurate, while gold standard liquid chromatography with tandem mass spectrometry (LC–MS/MS) coupled equilibrium dialysis is not available for clinical routine. Calculation models for free testosterone, despite intrinsic limitations, provide a suitable alternative, of which the Vermeulen calculator is currently the preferred method. Calculated free testosterone is indeed associated with bone health, frailty and other clinical endpoints. Moreover, the added value of free testosterone in the clinical diagnosis of male hypogonadism is clearly evident. In suspected hypogonadal men in whom borderline low total testosterone and/or altered sex hormone-binding globulin levels are detected, the determination of free testosterone avoids under- and overdiagnosis, facilitating adequate prescription of hormonal replacement therapy. As such, free testosterone should be integrated as a standard biochemical parameter, on top of total testosterone, in the diagnostic workflow of male hypogonadism.

Breast Cancer (BC) prevention strategies range from lifestyle changes such as increasing physical activity and reducing body weight to preventive drugs like tamoxifen, known to reduce BC incidence in high-risk women. Sex Hormone Binding Globulin (SHBG) is related to BC risk due to its ability to bind circulating estradiol at high affinity and to regulate estradiol action. A study protocol is presented based on the assessment of the effect of different interventions such as tamoxifen at 10 mg every other day (LDT), intermittent caloric restriction (ICR) two days per week, lifestyle intervention (LI, step counter use) and their combination on the modulation of SHBG and several other biomarkers associated to BC. A randomized phase II biomarker study will be conducted in 4 Italian centers. Unaffected women aged between 18 and 70 years, carriers of a germline pathogenetic variant (BRCA1, BRCA2, PALB2, or other moderate penetrance genes), or with a >5% BC risk at 10 years (according to the Tyrer-Cuzick or the Breast Cancer Surveillance Consortium Risk models) or with a previous diagnosis of intraepithelial neoplasia will be eligible. A total of 200 participants will be randomized to one of the four arms: LDT; LDT + ICR; LI; LI + ICR. Interventions will span six months, with baseline and follow-up clinic visits and interim phone calls. The aim of the study is to verify whether LDT increases circulating SHBG more than LI with or without ICR after 6 months. Secondary objectives include assessing HOMA-index, inflammatory markers, adiponectin/leptin ratio, quality of life (QoL), safety, toxicity, mammographic density, and changes in microbiome composition across groups. The study's innovation lies in its inclusion of diverse BC risk categories and combination of pharmaceutical and behavioral interventions, potentially enhancing intervention efficacy while balancing tamoxifen's side effects on QoL, especially menopausal symptoms. EuCT number:2023-503994-39-00; Clinical trials.gov NCT06033092.

Background Alcohol intake is associated with a higher risk of estrogen receptor-positive (ER+) breast cancer (BC), presumably through its confirmed ability to increase sex hormone levels. Whether consuming alcohol within the recommended limit of one serving per day increases sex hormone levels among postmenopausal women taking aromatase inhibitors (AI) to inhibit estrogen production remains unknown. Therefore, we compared sex hormone levels following white wine to levels following white grape juice among ER + BC survivors taking AIs. Methods In this 10-week randomized controlled two-period crossover trial conducted from September 2022 to July 2023 among 20 postmenopausal women on AIs, we examined within-person changes in sex hormone levels following 3 weeks of 5 ounces of white wine daily versus 3 weeks of 6 ounces of white grape juice daily, with each drinking period preceded by two-week washouts and drinking period sequence allocated by randomization. Results All 20 participants completed the trial. Compared to daily grape juice, daily wine led to decreases in total estradiol (11.1%, 95%confidence interval[CI] -49.8%,57.2%), free estradiol index (0.7%, 95%CI -2%,0.7%), and free estradiol concentration (7.7%, 95%CI -48%, 63.9%) but increases in estrone (13.8%, 95%CI -9.5%,43.1%), dehydroepiandrosterone sulfate (DHEAS; 11.4%, 95%CI -3.3%,28.4%), and testosterone (12.6%, 95%CI -0.8%,27.7%) and decreased sex hormone-binding globulin (SHBG; -2.7%, 95%CI -21.9%,21.2%). Conclusions Five ounces of white wine daily did not lead to statistically significant increases in estradiol, but it led to changes in other sex hormones suggesting higher BC risk. Whether this level of alcohol intake diminishes AI effectiveness warrants further investigation. Trials Registration Clinicaltrials.gov NCT05423730 registered June 14, 2022.

In this nested case–control study of two cohorts, plasma levels of sex hormone–binding globulin were found to be associated with two polymorphisms of the sex hormone–binding globulin gene, SHBG . When these polymorphisms were used as predictive variables, low circulating levels of the globulin predicted an increased risk of type 2 diabetes, suggesting that genotypes and such plasma levels might help to stratify for the risk of type 2 diabetes. Plasma levels of sex hormone–binding globulin were found to be associated with two polymorphisms of the sex hormone–binding globulin gene SHBG . When these polymorphisms were used as predictive variables, low circulating levels of the globulin predicted an increased risk of type 2 diabetes. Studies since the mid-1990s have suggested that sex hormone–binding globulin may have biologic functions beyond simply regulation of the levels of free sex hormones. 1 – 3 Classically, the primary function of sex hormone–binding globulin was thought to be the binding of circulating hormones in order to affect the bioavailable fraction and sequester circulating androgens and estrogens, in particular, from biologic action. However, emerging experimental evidence indicates that even sex hormones bound to sex hormone–binding globulin may directly mediate cell-surface signaling, cellular delivery, and biologic action of sex hormones. 1 – 5 Moreover, clinical studies have associated low circulating levels of sex hormone–binding globulin . . .

Abstract Context Serum testosterone concentrations decline with age, while serum sex hormone-binding globulin (SHBG) concentrations increase. Objective To analyze associations of baseline serum testosterone and SHBG concentrations, and calculated free testosterone (cFT) values, with all-cause and cause-specific mortality in men. Design, Setting, and Participants The UK Biobank prospective cohort study of community-dwelling men aged 40–69 years old, followed for 11 years. Main Outcome Measures All-cause, atherosclerotic cardiovascular disease (CVD) and cancer-related mortality. Cox proportional hazards regression was performed, adjusting for age, waist circumference, medical conditions, and other covariates. Models for testosterone included SHBG and vice versa. Results In a complete case analysis of 149 436 men with 10 053 deaths (1925 CVD and 4927 cancer-related), men with lower testosterone had a higher mortality rate from any cause (lowest vs highest quintile, Q1 vs Q5, fully-adjusted hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.06–1.22, overall trend P < 0.001), and cancer (HR = 1.20, CI = 1.09–1.33, P < 0.001), with no association for CVD deaths. Similar results were seen for cFT. Men with lower SHBG had a lower mortality rate from any cause (Q1 vs Q5, HR = 0.68, CI = 0.63–0.73, P < 0.001), CVD (HR = 0.70, CI = 0.59–0.83, P < 0.001), and cancer (HR = 0.80, CI = 0.72–0.89, P < 0.001). A multiply imputed dataset (N = 208 425, 15 914 deaths, 3128 CVD-related and 7468 cancer-related) and analysis excluding deaths within the first 2 years (9261, 1734, and 4534 events) yielded similar results. Conclusions Lower serum testosterone is independently associated with higher all-cause and cancer-related, but not CVD-related, mortality in middle-aged to older men. Lower SHBG is independently associated with lower all-cause, CVD-related, and cancer-related mortality. Confirmation and determination of causality requires mechanistic studies and prospective trials.

The albumin to globulin ratio (AGR) has been associated with poor outcomes in various diseases, but the association with mortality in aneurysmal subarachnoid hemorrhage (aSAH) is still unclear. Our study aimed to explore the relationship between AGR and short-term case fatality in patients with aSAH. This retrospective study included 3,421 patients with aSAH at West China Hospital, Sichuan University. All Serum AGRs were obtained within 2 days of admission, and patients were categorized into four groups based on their AGR. Cox regression analyses were conducted to assess the relations between AGR and both 30-day and 90-day mortality. In 3,421 participants, 339 patients (9.9%) with 30-day mortality, and 407 patients (13.3%) with 90-day mortality. The patients were categorized into four quartiles based on their AGR levels: Q1 (AGR ≤ 1.33), Q2 (AGR: 1.33-1.50), Q3 (AGR: 1.50-1.70), and Q4 (AGR > 1.70). The HR after adjusted for confounders showed significant associations with 30-day mortality, Q2 group (HR 0.72, 95% CI 0.53-0.97), Q3 group (HR 0.72, 95% CI 0.54-0.96), Q4 group (0.53, 95% CI (0.39-0.72)) compared to Q1 group. The association was still significant for 90-day mortality, Q2 group (HR 0.77, 95% CI 0.59-1.01), Q3 group (HR 0.75, 95% CI 0.58-0.98), Q4 group (0.53, 95% CI (0.40-0.71) compared to Q1 group. A lower admission AGR was significantly associated with an increased risk for short-term case fatality and poor functional outcomes in patients with aSAH. Further prospective research is essential to confirm our findings and explore the mechanisms behind this association.