Tag: men

Use of testosterone replacement therapy to treat long-COVID-related hypogonadism

Abstract:

Summary: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can impair pituitary-gonadal axis and a higher prevalence of hypogonadism in post-coronavirus disease 2019 (COVID-19) patients compared with the general population has been highlighted. Here we report the first case of a patient affected with a long-COVID syndrome leading to hypogonadism and treated with testosterone replacement therapy (TRT) and its effects on clinical and quality of life (QoL) outcomes.

We encountered a 62-year-old man who had been diagnosed with hypogonadotropic hypogonadism about 2 months after recovery from COVID-19 underwent a complete physical examination, general and hormonal blood tests, and self-reported questionnaires administration before and after starting TRT. Following the TRT, both serum testosterone level and hypogonadism-related symptoms were improved, but poor effects occurred on general and neuropsychiatric symptoms and QoL.

Therefore, hypogonadism does not appear to be the cause of neurocognitive symptoms, but rather a part of the long-COVID syndrome; as a consequence, starting TRT can improve the hypogonadism-related symptoms without clear benefits on general clinical condition and QoL, which are probably related to the long-COVID itself. Longer follow-up might clarify whether post-COVID hypogonadism is a transient condition that can revert as the patient recovers from long-COVID syndrome.

Learning points: Hypogonadism is more prevalent in post-COVID-19 patients compared with the general population. In these patients, hypogonadism may be part of long-COVID syndrome, and it is still unclear whether it is a transient condition or a permanent impairment of gonadal function. Testosterone replacement therapy has positive effects on hypogonadism-related clinic without clear benefits on general symptomatology and quality of life, which are more likely related to the long-COVID itself.

Source: Amodeo A, Persani L, Bonomi M, Cangiano B. Use of testosterone replacement therapy to treat long-COVID-related hypogonadism. Endocrinol Diabetes Metab Case Rep. 2024 Mar 22;2024(1):23-0097. doi: 10.1530/EDM-23-0097. PMID: 38520748; PMCID: PMC10959025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959025/ (Full text)

Identifying the mental health burden in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients in Switzerland: A pilot study

Highlights:

  • First time study on mental health and well-being among ME/CFS patients in Switzerland.
  • High level (68.5%) of stigmatization reported due to ME/CFS.
  • Overall, ME/CFS led to a third of the patients and to half of the male patients to have suicidal thoughts.
  • ME/CFS led to secondary depression in 14.8% of the patients.
  • Lack of disease recognition and adequate patient support.

Abstract:

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating chronic disease of significant public health and clinical importance. It affects multiple systems in the body and has neuro-immunological characteristics. The disease is characterized by a prominent symptom called post-exertional malaise (PEM), as well as abnormalities in the immune-inflammatory pathways, mitochondrial dysfunctions and disturbances in neuroendocrine pathways. The purpose of this study was to evaluate the impact of ME/CFS on the mental health and secondary psychosocial manifestations of patients, as well as their coping mechanisms.

Method: In 2021, a descriptive cross-sectional study was conducted in Switzerland. A self-administered paper questionnaire survey was used to gather data from 169 individuals diagnosed with ME/CFS.

Results: The majority of the patients (90.5%) reported a lack of understanding of their disease, resulting in patients avoiding talking about the disease due to disbelief, trivialization and avoidance of negative reactions. They felt most supported by close family members (67.1%). Two thirds of the patients (68.5%) experienced stigmatization. ME/CFS had a negative impact on mental health in most patients (88.2%), leading to sadness (71%), hopelessness for relief (66.9%), suicidal thoughts (39.3%) and secondary depression (14.8%). Half of the male patients experienced at least one suicidal thought since clinical onset. Factors significantly associated with depression were the lack of cure, disabilities associated with ME/CFS, social isolation and the fact that life was not worth anymore with ME/CFS. The three main factors contributing to suicidal thoughts were (i) being told the disease was only psychosomatic (89.5%), (ii) being at the end of one’s strength (80.7%) and (iii) not feeling being understood by others (80.7%).

Conclusion: This study provided first time significant insights into the mental and psychological well-being of ME/CFS patients in Switzerland. The findings highlight the substantial experiences of stigmatization, secondary depression and suicidal thoughts compared to other chronic diseases, calling for an urgent need in Switzerland to improve ME/CFS patient’s medical, psychological and social support, in order to alleviate the severe mental health burden associated with this overlooked somatic disease.

Source: Rahel Susanne König, Daniel Henry Paris, Marc Sollberger, Rea Tschopp.  Identifying the mental health burden in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients in Switzerland: A pilot study, HELIYON (2024), doi: https:// doi.org/10.1016/j.heliyon.2024.e27031. https://www.sciencedirect.com/science/article/pii/S2405844024030627 (Full text)

Analysis and clinical determinants of post-COVID-19 syndrome in the Lombardy region: evidence from a longitudinal cohort study

Abstract:

Objective: To define macro symptoms of long COVID and to identify predictive factors, with the aim of preventing the development of the long COVID syndrome.

Design: A single-centre longitudinal prospective cohort study conducted from May 2020 to October 2022.

Setting: The study was conducted at Luigi Sacco University Hospital in Milan (Italy). In May 2020, we activated the ARCOVID (Ambulatorio Rivalutazione COVID) outpatient service for the follow-up of long COVID.

Participants: Hospitalised and non-hospitalised patients previously affected by COVID-19 were either referred by specialists or general practitioners or self-referred.

Intervention: During the first visit, a set of questions investigated the presence and the duration of 11 symptoms (palpitations, amnesia, headache, anxiety/panic, insomnia, loss of smell, loss of taste, dyspnoea, asthenia, myalgia and telogen effluvium). The follow-up has continued until the present time, by sending email questionnaires every 3 months to monitor symptoms and health-related quality of life.

Primary and secondary outcome measures: Measurement of synthetic scores (aggregation of symptoms based on occurrence and duration) that may reveal the presence of long COVID in different clinical macro symptoms. To this end, a mixed supervised and empirical strategy was adopted. Moreover, we aimed to identify predictive factors for post-COVID-19 macro symptoms.

Results: In the first and second waves of COVID-19, 575 and 793 patients (respectively) were enrolled. Three different post-COVID-19 macro symptoms (neurological, sensorial and physical) were identified. We found significant associations between post-COVID-19 symptoms and (1) the patients’ comorbidities, and (2) the medications used during the COVID-19 acute phase. ACE inhibitors (OR=2.039, 95% CI: 1.095 to 3.892), inhaled steroids (OR=4.08, 95% CI: 1.17 to 19.19) and COVID therapies were associated with increased incidence of the neurological macro symptoms. Age (OR=1.02, 95% CI: 1.01 to 1.04), COVID-19 severity (OR=0.42, 95% CI: 0.21 to 0.82), number of comorbidities (OR=1.22, 95% CI: 1.01 to 1.5), metabolic (OR=2.52, 95% CI: 1.25 to 5.27), pulmonary (OR=1.87, 95% CI: 1.10 to 3.32) and autoimmune diseases (OR=4.57, 95% CI: 1.57 to 19.41) increased the risk of the physical macro symptoms.

Conclusions: Being male was the unique protective factor in both waves. Other factors reflected different medical behaviours and the impact of comorbidities. Evidence of the effect of therapies adds valuable information that may drive future medical choices.

Source: Borgonovo F, Lovaglio PG, Mariani C, Berta P, Cossu MV, Rizzardini G, Vittadini G, Capetti AF. Analysis and clinical determinants of post-COVID-19 syndrome in the Lombardy region: evidence from a longitudinal cohort study. BMJ Open. 2024 Feb 6;14(2):e075185. doi: 10.1136/bmjopen-2023-075185. PMID: 38320835; PMCID: PMC10860093. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10860093/ (Full text)

A phenomenological study on the lived experience of men with Chronic Fatigue Syndrome

Abstract:

Whilst chronic fatigue syndrome (CFS) has been widely researched amongst women, studies investigating how men experience a CFS diagnosis is limited.

This study utilised an interpretative phenomenological approach to interview five men who have a medical diagnosis of CFS.

Six themes emerged to demonstrate the participants’ experiences prior to, during and after obtaining their CFS diagnosis.

Findings revealed that participants were initially reluctant to accept their condition, confounded by their perception that symptoms compromised their sense of masculinity. They also felt that healthcare professionals had limited recognition of CFS leading them to seek social support and legitimisation from other sources.

The struggle to come to terms with a different lifestyle and sense of masculinity prevailed. Such knowledge could be effectively utilised by researchers, practitioners and employers to facilitate an increased understanding of male accounts of the condition and more bespoke interventions where required.

Source: Snell GE, Seage CH, Mercer J. A phenomenological study on the lived experience of men with Chronic Fatigue Syndrome. J Health Psychol. 2023 Jul 17:13591053231186385. doi: 10.1177/13591053231186385. Epub ahead of print. PMID: 37455618. https://pubmed.ncbi.nlm.nih.gov/37455618/

 

Symptomatic Characteristics of Hypozincemia Detected in Long COVID Patients

Abstract:

Objectives: The aim of this study was to determine the characteristics of hypozincemia in long COVID patients.
Methods: This study was a single-center retrospective observational study for outpatients who visited the long COVID clinic established in a university hospital during the period from 15 February 2021 to 28 February 2022. Characteristics of patients with a serum zinc concentration lower than 70 μg/dL (10.7 μmol/L) were compared with characteristics of patients with normozincemia.
Results: In a total of 194 patients with long COVID after excluding 32 patients, hypozincemia was detected in 43 patients (22.2%) including 16 male patients (37.2%) and 27 female patients (62.8%). Among various parameters including the background characteristics of the patients and medical histories, the patients with hypozincemia were significantly older than the patients with normozincemia (median age: 50 vs. 39 years). A significant negative correlation was found between serum zinc concentrations and age in male patients (R = −0.39; p < 0.01) but not in female patients. In addition, there was no significant correlation between serum zinc levels and inflammatory markers. General fatigue was the most frequent symptom in both male patients with hypozincemia (9 out of 16: 56.3%) and female patients with hypozincemia (8 out of 27: 29.6%). Patients with severe hypozincemia (serum zinc level lower than 60 μg/dL) had major complaints of dysosmia and dysgeusia, which were more frequent complaints than general fatigue.
Conclusions: The most frequent symptom in long COVID patients with hypozincemia was general fatigue. Serum zinc levels should be measured in long COVID patients with general fatigue, particularly in male patients.
Source: Matsuda Y, Tokumasu K, Otsuka Y, Sunada N, Honda H, Sakurada Y, Nakano Y, Hasegawa T, Obika M, Ueda K, Otsuka F. Symptomatic Characteristics of Hypozincemia Detected in Long COVID Patients. Journal of Clinical Medicine. 2023; 12(5):2062. https://doi.org/10.3390/jcm12052062 https://www.mdpi.com/2077-0383/12/5/2062 (Full text)

Understanding the experiences of caring for a partner with myalgic encephalopathy: a qualitative study of men in Norway

Abstract:

Background: Informal caring is expanding in many countries as populations age. There is a lot of research on how to care responsibilities are experienced by next of kin, but there is little research on men, which is the focus of this study. This specific focus is Myalgic Encephalopathy (ME), which is a condition that often affects women. This means that it is men who often find themselves in a caring role.

Aim: This project aims to explore what it was like for Norwegian men to have a caring role toward a partner with ME and how it affects everyday life.

Method: A qualitative approach was used. Ten semi-structured interviews were conducted, and the participants were recruited from different places in Norway. All were between the ages of 30 to 60 years old and were caring for a partner for several years. To analyze the data, thematic analysis was used, to find different patterns in the data.

Results: A data emerged two main themes and seven under the themes “experiencing the impact of caring for a partner with ME on everyday life “and providing different kinds of support. The experience around the role of caring was influenced by several factors, such as changes in finances and family dynamics as well as accessing formal support. Overall, the mean men felt that being in a caring role meant that life was being put on hold.

Conclusion: Findings from this study help to strengthen previous research. Having a caring role for a sick partner with ME was demanding and greatly affects everyday life. Men found the role of care challenging and it could negatively affect the person psychologically. For most people in a caring role, there was potential for better support both emotionally and financially.

Source: Elise Torp. Understanding the experiences of caring for a partner with myalgic encephalopathy: a qualitative study of men in Norway. M.Sc. Thesis. https://brage.inn.no/inn-xmlui/handle/11250/3019314?locale-attribute=en

Cardiovascular impairment in long covid one year post-sars-cov-2 infection

Background: Long Covid is associated with multi-organ inflammation, hypercoagulability, and several symptoms (fatigue, dyspnoea etc). Varying levels of cardiac involvement have been reported by cardiac magnetic resonance (CMR). We now describe longitudinal cardiovascular impairment in patients with Long Covid at 6 and 12 months post-SARS-CoV-2 infection.

Methods: 524 participants with Long Covid underwent a baseline scan at 6 months post infection (ClinicalTrials.gov: NCT04369807) and were rescanned 12 months post-infection if abnormal findings were reported at baseline. CMR (T1 and T2, cardiac mass, volumes, function, and strain), along with multi-organ MRI and blood samples were collected. Cardiovascular impairment was defined as one or more of: low left ventricular ejection fraction (LVEF), high left ventricular end diastolic volume (LVEDV), elevated native T1 in 3 or more cardiac segments. A significant longitudinal change was reported if greater than the repeatability coefficients derived from a population of 92 healthy controls.

Results: In 70 patients with cardiovascular impairment and Long Covid at baseline, 48 had complete paired data at 1 year, and of those 54% had not fully resolved. 19 (27%) patients with cardiovascular impairment had required hospitalization for acute COVID-19. Troponin or BNP were not predictive of CMR findings; however, hospitalization at the acute stage, male sex, kidney fibroinflammation and serum bicarbonate were. Individual symptoms were not specific to cardiovascular impairment or disease course.

Conclusion: CMR shows that cardiovascular impairment persists in Long Covid in some patients beyond 12 months post infection; however, this impairment may have pre-existing origin. Although there is an association with acute COVID-19 hospitalisation, male gender and high serum bicarbonate were predictive of cardiovascular impairment, subtypes of disease (based on symptoms, examination, and investigations) are yet to be established. Therefore, interventional trials with pre-specified subgroup analysis are required to inform therapeutic options.

Source: Roca-Fernandez A, Wamil M, Telford A, et al. CARDIOVASCULAR IMPAIRMENT IN LONG COVID ONE YEAR POST-SARS-COV-2 INFECTION. J Am Coll Cardiol. 2022 Mar, 79 (9_Supplement) 1312. https://doi.org/10.1016/S0735-1097(22)02303-8

Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol

Abstract:

(1) Introduction: Multiple studies have shown that peak oxygen consumption is reduced in the majority of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS )patients, using the gold standard for measuring exercise intolerance: cardiopulmonary exercise testing (CPET). A 2-day CPET protocol has shown different results on day 2 in ME/CFS patients compared to sedentary controls. No comparison is known between ME/CFS and idiopathic chronic fatigue (ICF) for 2-day CPET protocols. We compared ME/CFS patients with patients with chronic fatigue who did not fulfill the ME/CFS criteria in a male population and hypothesized a different pattern of response would be present during the 2nd day CPET.

(2) Methods: We compared 25 male patients with ICF who had completed a 2-day CPET protocol to an age-/gender-matched group of 26 male ME/CFS patients. Measures of oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure, workload (Work), and respiratory exchange ratio (RER) were collected at maximal (peak) and ventilatory threshold (VT) intensities.

(3) Results: Baseline characteristics for both groups were similar for age, body mass index (BMI), body surface area, (BSA), and disease duration. A significant difference was present in the number of patients with fibromyalgia (seven ME/CFS patients vs. zero ICF patients). Heart rate at rest and the RER did not differ significantly between CPET 1 and CPET 2. All other CPET parameters at the ventilatory threshold and maximum exercise differed significantly (p-value between 0.002 and <0.0001). ME/CFS patients showed a deterioration of performance on CPET2 as reflected by VO2 and workload at peak exercise and ventilatory threshold, whereas ICF patients showed improved performance on CPET2 with no significant change in peak workload.

(4) Conclusion: This study confirms that male ME/CFS patients have a reduction in exercise capacity in response to a second-day CPET. These results are similar to published results in male ME/CFS populations. Patients diagnosed with ICF show a different response on day 2, more similar to sedentary and healthy controls.

Source: van Campen CLMC, Visser FC. Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol. Healthcare (Basel). 2021 Jun 5;9(6):683. doi: 10.3390/healthcare9060683. PMID: 34198946. https://pubmed.ncbi.nlm.nih.gov/34198946/

A comparison of patients with chronic fatigue syndrome attending separate fatigue clinics based in immunology and psychiatry

Abstract:

Hospital clinics for patients with chronic unexplained fatigue are held in departments of various disciplines. This causes difficulties for referrers in choosing the appropriate clinic and for researchers in generalizing findings from one type of clinic to others.

We randomly selected 37 outpatients attending an immunology fatigue clinic and 36 outpatients attending a psychiatry fatigue clinic, all of whom had chronic fatigue syndrome. We compared demographic factors, symptoms, disability, quality of life, psychological distress and illness attributions.

The patients from the two clinics were closely similar in their specific symptoms, disability, quality of life, psychological distress and previous attendance to mental health professionals. Psychological distress was high and equal in the two samples. The proportion of men was greater among patients attending the immunology clinic. In a post-hoc analysis, 64% of immunology attenders attributed their fatigue to physical factors, compared with 31% of psychiatry clinic attenders (chi(2)=6.35, 1 d.f., P=0.01).

These findings suggest that research data from one type of chronic fatigue clinic can be generalized to others. Clinically similar patients are referred to different clinics, and the choice of clinic may be influenced by the patients’ illness beliefs. The high levels of emotional distress suggest that psychosocial management is as important as physical management in hospital outpatients with chronic fatigue syndrome, irrespective of its aetiology.

 

Source: White PD, Pinching AJ, Rakib A, Castle M, Hedge B, Priebe S. A comparison of patients with chronic fatigue syndrome attending separate fatigue clinics based in immunology and psychiatry. J R Soc Med. 2002 Sep;95(9):440-4. http://www.ncbi.nlm.nih.gov/pubmed/12205207

 

Increased brain serotonin function in men with chronic fatigue syndrome

Recent neuroendocrine studies suggest that patients with chronic fatigue syndrome may have increased brain serotonin activity.1 2 This could be relevant to the pathophysiology of chronic fatigue syndrome because serotonin pathways have a role in mediating central fatigue.3 Currently, however, the existence of abnormal serotonin neuroendocrine function in patients with chronic fatigue syndrome is controversial because of contradictory findings from samples of heterogeneous patients 4 5 and the use of serotonin probes such as buspirone, which are of doubtful pharmacological specificity.1 We aimed to measure the increase in plasma prolactin after administration of the selective serotonin releasing agent d-fenfluramine in men rigorously diagnosed as having the chronic fatigue syndrome and carefully matched healthy controls.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127129/pdf/9251547.pdf

 

Source: Sharpe M, Hawton K, Clements A, Cowen PJ. Increased brain serotonin function in men with chronic fatigue syndrome. BMJ. 1997 Jul 19;315(7101):164-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127129/