Search

Introduction: Sex hormone profile evaluation is commonly used in male infertility assessment to identify potential hormonal imbalances and underlying issues that can impact sperm production, sperm quality, or reproductive organ function. Objective: To evaluate the likelihood of having a child in subfertile and infertile men within five years based on their serum hormone levels on their initial encounter for infertility evaluation/treatment. Methods: We identified a retrospective cohort from the Subfertility, Health, and Assisted Reproduction (SHARE) study (compiled 1996-2017) linked with familial information from the Utah Population Database (UPDB) including all men with a measured value of albumin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), Free testosterone (T), total, and bioavailable T, sex hormone binding globulin (SHBG), and estradiol (E). We included men who had a semen analysis (SA) within 1 year of their hormone measurement. The primary outcome of the study was any evidence of childbirth, and the secondary outcome was the time from baseline hormone evaluation to childbirth. All men were followed for 60 months after their recorded hormone value for evidence of childbirth. Using Cox proportional hazards models, we modeled the likelihood of having a child and the time to childbirth (using linear regression) against the quintile of hormone distribution. Results: A total number of 1298 men who underwent hormone profile evaluation and SA were included in this study. The mean age for the total cohort was 33 (29-37) years old. Men who had a child at the end of the study period (31 (28-36)) were significantly younger than men without a child at the end of the study with a mean age of (35.5 (32-40.25)) (p < 0.001). The mean sperm concentration for the total cohort was 7.6 (1-27.4) (M/ml) and the mean total progressive motile count was 9 (0.9-47) (M). Overall, semen parameters showed no significant differences between men who had a child at the end of the study follow-up versus men who did not. Our models showed that prolactin serum levels in quantile 7 have the highest ratio (2.236 (0.919-5.44) p=0.076) for the likelihood of having a child. Total testosterone in quantiles 3 and 5 showed an increased likelihood of having a child (2.119 (1.176-3.821) (p=0.012), (2.518 (1.412-4.491)) (p=0.002), respectively. Albumin in quantiles 5-9 followed a similar pattern with the highest ratio in quantile 8 (3.551 (1.486-8.487)) (p=0.004). Our results did not show meaningful patterns between semen parameters, serum hormone levels, and time to having a child. Conclusions: The outcomes of this study indicate that prolactin, total testosterone, and albumin serum levels on the first visit in men with infertility concerns are associated with an increased likelihood of having a child. Abnormal semen analysis outcomes are not well associated with hypoandrogenism in infertile men. Our study shows that baseline serum prolactin, total testosterone, and albumin levels can be used to estimate the likelihood of having a child in subfertile and infertile men. These findings can provide the basis for further studies to determine an optimal screening method for male-factor infertility related to abnormal hormone levels. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Equity/salary/officer in company: Paterna bio, firmtech; Consulting: Turtle health, maximus, carrot; inherent bio. [ABSTRACT FROM AUTHOR]

Introduction: Biological males have had worse COVID-19 outcomes compared to females. Yet, the impact of hypogonadism (HG) on COVID complications remains unclear. Objective: We sought to compare COVID complications in males with various androgen status (eugonadal, treated HG, untreated HG) to females to evaluate the effect of testosterone levels on COVID outcomes. Methods: We used the IBM MarketScan database of commercial claims encounters to identify patients ages 18+ with a COVID diagnosis (n=756,855). We compared eugonadal males (no HG diagnosis), untreated HG males (HG diagnosis without therapy), treated HG males (HG diagnosis and testosterone prescription within 180 days before COVID diagnosis) to females. Rates of intensive care unit (ICU) admission co-occurring with initial COVID diagnosis were modeled using logistic regression. Acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF), and use of critical care services (CCS) were modeled using Cox proportional hazards models. Outcomes were regressed against group, age, rurality, and Charlson Comorbidity Index. Results: Eugonadal males (n=315,050) were at higher odds of ICU admission (OR: 1.611, 95% CI: 1.549-1.676), having ARDS (HR 1.766, CI: 1.670-1.868), having ARF (HR 1.609, CI: 1.575-1.644), and needing CCS (HR 1.696, CI: 1.652-1.742) compared to females. Treated HG males (n=2,343) and untreated HG males (n=22,614) were also more likely to experience all adverse outcomes compared to females. For untreated HG males the effect was less pronounced compared to eugonadal males and treated HG males for all outcomes (Figure 1). There were no differences in odds of all outcomes for castrate males (n=89) compared to females due to small sample size. Conclusions: Eugonadal males, treated HG males, and untreated HG males were more likely to have adverse COVID outcomes compared to females. This effect was most pronounced for eugonadal and treated HG males compared to untreated HG males, suggesting normal androgen status is detrimental to COVID-19 outcomes. This is one of the largest studies to show a complex relationship between testosterone and COVID outcomes. Disclosure: No. [ABSTRACT FROM AUTHOR]

Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI). The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant. Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b). There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene. Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome). [ABSTRACT FROM AUTHOR]

Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI). The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant. Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b). There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene. Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome [ABSTRACT FROM AUTHOR]

Hypogonadism is common in men with male factor infertility and hormone therapies may improve semen parameters and pregnancy rates in affected men. However, compared to paternal factors such as advanced age, male infertility or obesity, it is uncertain whether hypogonadism itself impacts perinatal birth outcomes and complications. This study evaluates the association between male hypogonadism and perinatal birth complications in the United States. We performed a retrospective analysis of the IBM MarketScan™ Commercial Claims and Encounters database between 2011-2017. We identified birth records using birth or pregnancy-related major diagnostic categories associated with persons age 0. Fathers were considered to be adult (> 18) male individuals with the same family identifier as the neonates listed as either the primary insurance beneficiary or spouse. Birth records were excluded if there was no family identifier or the father was unable to be linked. For each birth, we recorded whether they were preterm, diagnosed as low birth weight, or diagnosed with birth defects. For the fathers linked with each birth record, we determined paternal age, hypogonadism status, geographic region, and other associated comorbidities. Births were stratified based on whether the father had hypogonadism or not and we performed univariate tests for variation. Additionally, we conducted a multivariate logistic model of birth complication (preterm, low weight, or growth defect) against father's age, hypogonadism status, and paternal comorbidities. Between 2011 and 2017, paternal hypogonadism was found in 3.97% of fathers among 468,546 birth records. In contrast, no paternal hypogonadism was found in 96.03% of fathers among 468,546 birth records. Overall, our study reveals that paternal hypogonadism is positively associated with perinatal birth complications (odds ratio (OR) 1.10; 95% CI: 1.06, 1.13). Additionally, low birth weight was found in 46, 96% of birth among 196,607 birth records with paternal hypogonadism, follow by preterm birth with 7.64% of birth among 26,886 birth records with paternal hypogonadism. Male hypogonadism was associated with a statistically significant increase in perinatal birth complications. However, these results should be interpreted with caution because patients with male hypogonadism are also likely to have male infertility. For hypogonadism to be considered as a separate risk factor for perinatal birth complications further investigation will be needed. No [ABSTRACT FROM AUTHOR]

As the prevalence of male hypogonadism (HG) has increased, more patients are prescribed TRT. TRT may be associated with an increased risk of deep venous thrombosis (DVT). Although in recent years there have been more studies dedicated to adverse effects of TRT, the literature is mixed on whether TRT increases the risk of DVT. This study evaluates the risk of developing DVT in men with hypogonadism based on which types of treatments trends they receive using the MarketScan insurance claims database. We performed a retrospective analysis of the IBM MarketScan™ Commercial Claims and Encounters database between 2008-2017. We identified all men with an HG diagnosis using the International Classification of Disease 9th edition (ICD-9) or 10th edition (ICD-10). We recorded how often they received TRT (including formulations as oral, topical/transdermal gels/creams/patches, intranasal, injections, and pellet implants). We followed men to see how many were diagnosed with DVT or pulmonary embolism. We excluded men who had a record of thromboembolic events before their first HG diagnosis. We performed univariate tests of variation across different demographics in three separate stratifications: 1) In all patients stratified by whether they suffered DVT; 2) In patients with DVT stratified by whether they received any kind of treatment at any time; 3) In patients with DVT and any treatment stratified by the type of treatment. Hazard Ratios from Cox Models were calculated for the effects of TRT in the previous 6 months on DVT controlling for the following confounding variables: age and comorbidities such as smoking, drug abuse, obesity, heart disease, cardiovascular problems and surgery/immobilization. Age and TRT in the previous 6 months were included as time-varying covariates. We identified 1,853,889 total men with HG, of which 21,414 (1.16%) were diagnosed with DVT. Among men who suffered DVT, 7,487 (34.96%) received TRT at some point compared to 605,534 (33.04%) of the men who did not suffer DVT. Results from time-varying Cox models suggest that receipt of TRT in the previous 6 months does not significantly increase the risk of developing a DVT (hazard ratio (HR) 1.049; 95% CI: 0.85, 1.29) among men with HG. Our study suggests that TRT is not associated with a higher risk of developing DVT. DVT has evidence that the association was more pronounced among patients of later middle age and with chronic disease, whether with or without TRT. Further investigation is warranted to assess the risk effect of TRT on DVT development, which may allow for a more proactive approach in management. No [ABSTRACT FROM AUTHOR]