title: Relationship of testis size and LH levels with incidence of major adverse cardiovascular events in older men with sexual dysfunction.
abstract: BACKGROUND
  Measurement of testis volume (TV) is a reliable clinical procedure that predicts reproductive fitness. However, the role of TV in overall and cardiovascular (CV) fitness has never been studied.
  
  
  OBJECTIVE
  The study aims to analyze the clinical correlates of TV in patients with sexual dysfunction (SD) and to verify the value of this parameter and its determinants (i.e., luteinizing hormone [LH] levels) in predicting major adverse CV events (MACE).
  
  
  METHODS
  A consecutive series of 2,809 subjects without testiculopathy (age 51.2 ± 13.1) consulting for SD was retrospectively studied. A subset of this sample (n=1,395) was enrolled in a longitudinal study.
  
  
  METHODS
  Several clinical and biochemical parameters were investigated.
  
  
  RESULTS
  After adjusting for confounders, TV was negatively associated with both LH (Adj. r=-0.234; P<0.0001) and follicle-stimulating hormone (Adj. r=-0.326; P<0.0001). In addition, overweight/obesity, smoking, and alcohol abuse increased as a function of TV (hazard ratio [HR]=1.041 [1.021-1.061], P<0.0001; 1.024 [1.005-1.044], P=0.012; 1.063 [1.015-1.112], P=0.009, respectively). Furthermore, mean blood pressure was positively related to increased TV (Adj. r=0.157; P<0.0001). The effect of these lifestyle factors on TV were only partially related to changes in gonadotropin levels. In the longitudinal analysis, after adjusting for confounders, TV was associated with a higher incidence of MACE (HR=1.066 [1.013-1.122]; P=0.014), and the stepwise introduction in the Cox model of lifestyle factors, mean blood pressure and body mass index progressively smoothed out the association, which was no longer statistically significant in the fully adjusted model. Conversely, the association of higher LH levels with increased incidence of MACE was not attenuated by the progressive introduction of the aforementioned confounders in the model.
  
  
  CONCLUSIONS
  Our data show that in SD subjects, TV and LH are associated with an adverse CV risk profile that mediate the higher TV-associated incidence of MACE. High LH levels are an independent marker of CV risk. Further studies are needed for clarifying determinants and mechanisms of testis enlargement that, beyond gonadotropins, could mediate the increased incidence of MACE.
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Francesco
authors.initials: F
authors.lastname: Lotti
authors.forename: Valentina
authors.initials: V
authors.lastname: Boddi
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D013737:Testis / Q000033:anatomy & histology* / Q000503:physiopathology
keywords: Cardiovascular Events; Hypertension; Luteinizing Hormone; Testis Volume; Testosterone