World Journal of Mens Health最新文献

Purpose: Varicocele is among the most common reversible causes of male infertility. Although varicocele is prevalent and there is a growing body of literature on the subject, there are still numerous debates surrounding the matter. This study presents Global Andrology Forum (GAF) clinical guidelines on the management of infertile men with varicocele.

Materials and methods: A team of clinicians and reproductive experts reviewed contemporary evidence on all aspects of varicocele, including systematic reviews, meta-analyses, and the results of the GAF global survey of practices. They then formulated expert statements and recommendations, subject to a modified Delphi process until a consensus was reached. The final statements and recommendations were rated using the GRADE system.

Results: A total of 31 statements and recommendations on the evaluation and management of varicocele were introduced and scored by 24 experts. All experts agreed with the final statements. Varicocele is a significant contributor to male infertility. Its diagnosis is based mainly on physical examination, although imaging can be used in certain cases. Clinical varicocele associated with abnormal sperm parameters is the primary unanimous indication of varicocele repair. However, other indications can still be considered, and recommendations for a tailored approach to controversial situations have been presented. There is inadequate evidence on the use of medical therapy for varicocele.

Conclusions: These clinical guidelines on the management of infertile men with varicocele, based on the GAF surveys, systematic reviews, and meta-analyses, point out the pivotal importance of varicocele in modern Andrology. Continued research is crucial to improving diagnostic accuracy and treatment outcomes, ultimately enhancing reproductive health for men with varicocele. Therefore, the current guidelines allow clinicians to develop effective management strategies for a common issue and address practical questions where evidence is lacking.

Purpose: This study used functional magnetic resonance imaging with time-course analysis to compare the temporal dynamics of brain activation patterns associated with visual sexual arousal among postoperative female-to-male (FtM) transgender individuals, men, and women.

Materials and methods: A total of 57 volunteers participated in this study, including 17 FtM transgender individuals undergoing cross-sex hormone therapy, 20 cisgender men, and 20 premenopausal cisgender women.

Results: The levels of free testosterone (free-T) and estradiol in FtM transgender individuals were more similar to those in cisgender men than in premenopausal women. The time-course analysis of brain activity while viewing a 9-minute erotic video revealed distinct patterns of blood-oxygenation-level-dependent (BOLD) signal changes across the three groups: FtM transgender individuals showed the greatest BOLD signal changes between 4 and 5 minutes; men's group between 2 and 3 minutes; and women's groups between 5 minutes 30 seconds and 6 minutes 30 seconds. The between-group analysis showed differential brain activity in the insula and caudate nucleus among the three groups. Compared to women, men showed significantly higher activities in both regions, whereas FtM transgender individuals exhibited significantly higher activity only in the insula, but not in the caudate nucleus (p<0.05). Free-T levels were positively correlated with BOLD signal changes in the insula and caudate nucleus.

Conclusions: These findings suggest that both the brain activation patterns during visual sexual arousal and the hormone levels in FtM transgender individuals more closely resemble those of cisgender men than cisgender women. Our findings would be helpful for further understanding of the interrelationship between gender identity and biological sex in FtM transgender individuals by examining time-resolved brain activation patterns in connection with sex hormone levels.

Purpose: While sperm recovery was demonstrated in males who failed prior testicular sperm extractions, the role and efficacy of autologous platelet-rich plasma (PRP) in males with non-obstructive azoospermia (NOA) undergoing salvage microdissection testicular sperm extraction (mTESE) still need to be determined.

Materials and methods: Patients with a history of NOA and at least one previous failed surgical sperm extraction were invited to participate in this study. We analyzed data from an inception cohort of 29 infertile males from January 2023 to February 2025. The primary endpoint was sperm retrieval (SR) rate at surgery. An Arteriocyte Magellan kit was used for the PRP preparation. After injecting local anesthesia as a spermatic cord block, up to 1.5 mL of the PRP mixture was injected into each testicle. After at least 90 days post-injection, microscopic-assisted testicular sperm extraction was performed. We assessed changes in serum hormone levels-specifically circulating total testosterone (TT), follicle-stimulating hormone, luteinizing hormone, and estradiol-following intratesticular PRP injection.

Results: In total, 4 out of 25 males (16.0%) had positive SR (3/20 [15.0%] with a single previous procedure, 1/3 [33.3%] with two prior procedures, and 0/2 [0%] with three prior procedures). No change in TT was noted after PRP treatment. Patients with successful SR had higher body mass index at baseline (30.1 [29.1 to 36.1] vs. 27.1 [24.8 to 27.8], p=0.011). Four patients (13.8%) withdrew from the study.

Conclusions: Autologous intratesticular PRP injection is a feasible, well tolerated procedure with a low complication rate and rapid recovery. However, the current scientific evidence is not yet sufficient to establish its efficacy in the context of mTESE.

Purpose: There is a growing tendency of individuals resorting to Chat-Generative Pretrained Transformer (ChatGPT) as a source of medical information on specific ailments. Varicocele is a prevalent condition affecting the male reproductive system. The quality, readability, and consistency of the information related to varicocele that individuals obtain through interactive access to ChatGPT remains uncertain.

Materials and methods: This study employed Google Trends data to extract 25 trending questions since 2004. Two distinct inquiry methodologies were employed with ChatGPT 4.0: repetition mode (each question repeated three times) and cyclic mode (each question input once in three consecutive cycles). The generated texts were evaluated according to a number of criteria, including the Automated Readability Index (ARI), the Flesch Reading Ease Score (FRES), the Gunning Fog Index (GFI), the DISCERN score and the Ensuring Quality Information for Patients (EQIP). Kruskal-Wallis and Mann-Whitney U tests were employed to compare the text quality, readability, and consistency between the two modes.

Results: The results demonstrated that the texts generated in repetition and cyclic modes exhibited no statistically significant differences in ARI (12.06±1.29 vs. 12.27±1.74), FRES (36.08±8.70 vs. 36.87±7.73), GFI (13.14±1.81 vs. 13.25±1.50), DISCERN scores (38.08±6.55 vs. 38.35±6.50) and EQIP (47.92±6.84 vs. 48.35±5.56) (p>0.05). These findings indicate that ChatGPT 4.0 consistently produces information of comparable complexity and quality across different inquiry modes.

Conclusions: This study found that ChatGPT-generated medical information on "varicocele" demonstrates consistent quality and readability across different modes, highlighting its potential for stable healthcare information provision. However, the content's complexity poses challenges for general readers, and notable limitations in quality and reliability highlight the need for improved accuracy, credibility, and readability in AI-generated medical content.

Purpose: This study aimed to evaluate the efficacy and safety of ginseng berry extract (GBE) (SIRTBERRY™) in treating andropause symptoms in aging men.

Materials and methods: In this randomized, double-blind, placebo-controlled trial, 116 men with andropause symptoms were assigned to receive either 700 mg/day GBE or placebo for 8 weeks. The primary efficacy variables included changes in the aging male symptoms (AMS) scale and improvement rate as per the androgen deficiency in aging male (ADAM) questionnaire, from the baseline. Secondary efficacy measurements included changes in the total and free testosterone levels, serum lipid levels, International Index of Erectile Function (IIEF) scores, International Prostate Symptom Score (IPSS), and various hormonal and metabolic markers.

Results: The GBE group exhibited significant improvements in AMS scores, ADAM improvement rates, and IIEF scores compared to the placebo group. Specifically, the GBE group showed a 70% improvement in ADAM scores versus a 47.83% improvement in the placebo group (p=0.0376), and a greater reduction in AMS scores (p=0.0205). Significant enhancements were observed in erectile function, with the IIEF scores improved more in the GBE group (p=0.0334), particularly in the erectile function domain (p=0.0290). No serious adverse event was reported, and the safety profile of GBE was found to be comparable to that of placebo.

Conclusions: GBE significantly improved andropause symptoms, including sexual function, and demonstrated a favorable safety profile, suggesting its potential as a safe and effective alternative treatment for testosterone deficiency syndrome. Further research regarding its long-term benefits and applicability to broader populations is warranted.

Purpose: To evaluate the evidence on sperm DNA fragmentation (SDF) and its clinical applications in reproductive medicine, highlighting benefits, limitations, and guidelines for its use to assist clinicians in objective decision-making.

Materials and methods: A multidisciplinary team of clinicians and reproductive experts from the Global Andrology Forum (GAF) reviewed the latest evidence on SDF, covering indications, testing methods, recurrent pregnancy loss, varicocele and its repair, assisted reproductive technologies (ART), treatment of associated conditions, antioxidant therapy, and sperm selection for ART. Expert statements and recommendations were developed and graded with the GRADE system using a modified Delphi process.

Results: Based on the GAF surveys, systematic reviews, and meta-analyses related to SDF, 52 experts introduced and scored 24 statements and recommendations using the GRADE system. Of these, 87.5% (21/24) achieved strong ratings, reflecting broad consensus, while 12.5% (3/24) were rated weak. The guidelines provide evidence-based recommendations for clinical scenarios, including the role of SDF in infertility, recurrent pregnancy loss, and ART outcomes.

Conclusions: While there is growing interest and evidence regarding the clinical benefit of SDF testing and its utility in managing male infertility, significant gaps in the literature limit its routine use in clinical practice. The guidelines offer a structured framework for integrating SDF testing into male infertility management, emphasizing a tailored approach based on individual clinical scenarios. Clinicians must balance the benefits and limitations of SDF testing and antioxidant treatment to optimize care in reproductive medicine. These guidelines are critical for advancing evidence-based practices in male infertility management.

Hypogonadism in men with a history of prostate cancer presents a complex clinical challenge, with longstanding concerns that testosterone replacement therapy (TRT) could potentially stimulate cancer recurrence or progression. This paper provides an up-to-date review of the evidence on the safety and efficacy of TRT, focusing on its use in key clinical scenarios such as active surveillance, post-radical prostatectomy, and post-radiotherapy. We examine the latest data on oncological safety, including risks of disease progression and biochemical recurrence, alongside the benefits of TRT in addressing hypogonadal symptoms such as fatigue, mood disturbance, and sexual dysfunction. The discussion also considers how TRT safety aligns with advancements in prostate cancer biology, including the saturation model, and how these insights are reflected in guidelines from major organisations such as the British Society for Sexual Medicine (BSSM), American Urological Association (AUA), and European Association of Urology (EAU). Gaps in long-term data and areas for further research are identified, underscoring the need for careful application in clinical practice. This paper emphasises a multidisciplinary approach in patient selection, rigorous monitoring protocols, and fully informed decision-making. By presenting a comprehensive review of the evidence, we aim to clarify the role of TRT in improving quality of life for men in remission from prostate cancer, while ensuring that oncological safety remains the highest priority.

Purpose: Non-obstructive azoospermia (NOA), defined as the absence of sperm in the ejaculate due to testicular failure, is observed in 5% to 15% of infertile men and accounts for two-thirds of azoospermia cases. The management of NOA is marked by significant controversy and global variation in diagnostic and therapeutic approaches, highlighting the crucial need for well-designed and standardized clinical practice guidelines. We present comprehensive graded clinical practice recommendations and statements for diagnosing and treating NOA, aiming to establish standardized strategies that can globally help guide practitioners in their practice.

Materials and methods: A comprehensive literature review was conducted to gather evidence on the epidemiological, diagnostic, and therapeutic aspects of NOA. The Global Andrology Forum (GAF) recommendations were developed through the collaboration of a global panel of experts using the Delphi method and surveys to achieve consensus. Statements were graded according to the Oxford Centre for Evidence-Based Medicine "GRADE" classification as either "Strong" or "Weak." Statements receiving at least 80% expert consensus were graded as "Strong," while others were categorized as "Weak."

Results: The GAF has formulated a total of 49 recommendations and statements on the diagnosis and treatment of NOA, including 21 for diagnosis and 28 for treatment. The recommendations and statements were evaluated and graded by a panel of 48 GAF experts from 25 countries worldwide. The majority of experts (60.5%) had more than 10 years of clinical experience in managing NOA.

Conclusions: The GAF guidelines address discrepancies in NOA management across diverse clinical settings and provide comprehensive graded recommendations to guide clinicians in its diagnosis and treatment. Developed and graded by a large worldwide panel of experts, the current guidelines present simplified, high-standard strategies that can be seamlessly integrated into the daily global practice, offering practitioners a clear framework for managing NOA.

Purpose: Trials of testosterone therapy (TTh) focus on transdermal or intramuscular preparations. In clinical practice, a range of administrations are utilised, often with adjunct therapies, but evidence is limited. This study characterised the safety and effectiveness of TTh over 12 months in a real-world setting.

Materials and methods: A retrospective cohort study of adults treated by a men's health provider in the United Kingdom for testosterone deficiency between 2019 and 2024. Mixed effects models and Kaplan-Meier methodology were used. Changes in total testosterone, free testosterone, haematocrit, and quality of life (QoL; Likert scales of 1-5) domains over 12 months were evaluated overall and by baseline testosterone-defined groups.

Results: The cohort comprised 9,537 men (median age 42 years). Mean follow-up was 8.47 months. 8,517 were treated with sub-cutaneous testosterone injections (89.20%), 366 were prescribed transdermal testosterone (3.84%), 7,079 were prescribed human chorionic gonadotropin (75.23%), 675 (7.08%) were prescribed clomiphene citrate, and 1,308 (13.72%) were prescribed tadalafil (men may have received >1 treatment). Significant increases were observed in all 8 QoL domains, e.g., +1.26 points (95% confidence interval [CI]: 1.01 to 1.43) for libido. The mean increase in haematocrit by month 12 was 0.03 L/L (95% CI: 0.03 to 0.03). Trends and magnitude of increases in total and free testosterones and QoL did not differ between biochemical categories, with no difference in the rate of haematocrit exceeding 0.54 (p=0.18).

Conclusions: TTh in a 'real-world setting' had a favourable safety profile and was associated with significant increases in men's sexual function, energy levels, life enjoyment, and performance in both work and sport. Future studies should support development of nuanced algorithms considering age, symptom severity and testosterone profiles to identify men likely to benefit from TTh.