Papers by Emmanuele A Jannini
BJUI, Oct 23, 2018
To validate a psychometric instrument, the Masturbation Erection Index (MEI) able to evaluate ere... more To validate a psychometric instrument, the Masturbation Erection Index (MEI) able to evaluate erectile function (EF) during masturbation. In fact, although the evaluation of EF during masturbation is pivotal in evaluating erectile dysfunction (ED), to date no specific psychometric tools have been developed to measure it both in the routine clinical practice and in the experimental setting. Subjects and Methods Of 560 male patients attending for the first time our andrological outpatient clinic, 99 (17.7%) were affected by ED. As a control group, we enrolled 102 sexually healthy men. All subjects were requested to fill out both the abridged International Index of Erectile Function (IIEF-6) and the MEI. The MEI was used together with a standardized tool, the Erection Hardness Score (EHS). The MEI was validated in terms of content validity. Test-retest reliability was assessed using the Intraclass Correlation Coefficient (ICC). Internal consistency was evaluated by the Cronbach's alpha. The comparability between MEI and IIEF-6 in measuring EF was tested by the Bland & Altman analysis. The Concordance Correlation Coefficient (CCC) between the two questionnaires was also determined.
The Journal of Sexual Medicine, Jul 1, 2010
Introduction. Worldwide many aging males practice sports. A high prevalence of late-onset male hy... more Introduction. Worldwide many aging males practice sports. A high prevalence of late-onset male hypogonadism has been observed in general population. Sport-participation influences the neuroendocrine system and may decrease serum testosterone. Aim. This preliminary study was designed to estimate the prevalence and the symptoms of undiagnosed testosterone deficiency in aging athletes. Methods. This observational survey was performed in 183 caucasian male athletes >50 years, in the setting of pre-participation screening. Pituitary-gonadal hormones and symptoms of hypogonadism were investigated. Serum total testosterone (TT), sex hormone binding globulin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), free-T4, and thyroid stimulation hormone (TSH) were assayed, and free T, bioactive T, and the LH/TT ratio were calculated. The International Index of Erectile Dysfunction (IIEF-15) and the Center for Epidemiological Studies Depression Scale (CES-D) were administered. Hypogonadal athletes were compared with eugonadal athletes as controls. Main Outcome Measures. Prevalence and clinical symptoms of severe (TT < 8 nmol/L) or mild (8 nmol/L Յ TT < 12 nmol/L) testosterone deficiency were investigated. Results. The mean sample age was 61.9 Ϯ 7.5 years (range 50-75). Severe or mild testosterone deficiency was observed in 12% and 18%, respectively, of overall athletes, with the highest prevalence in athletes >70 years (27.5% and 25.0%, respectively). TT did not correlate with age, training duration, or questionnaire scores. No differences were observed for nonspecific symptoms of hypogonadism, IIEF-15 and CES-D scores between eugonadal and severe hypogonadal athletes. Conclusions. Independently of its etiology, a significant percentage of aging athletes had undiagnosed testosterone deficiency. In a relevant number of these cases, testosterone deficiency was not overtly symptomatic. Our results suggest that sport-participation per se can influence the symptoms of hypogonadism. The history of clinical symptoms may be inaccurate to diagnose testosterone deficiency in aging athletes. Future research should address the clinical relevance and the specific risks of testosterone deficiency in aging athletes, and the need of a systematic pre-participation serum testosterone evaluation.
The Journal of Sexual Medicine, Mar 1, 2006
The Journal of Sexual Medicine, 2009
European journal of endocrinology, May 1, 2010
The treatment of transsexual subjects is a challenging task for the endocrinologist who, in colla... more The treatment of transsexual subjects is a challenging task for the endocrinologist who, in collaboration with the mental health professional and the surgeon, is called upon to confirm the diagnosis and adjust hormonal treatment aimed at suppressing endogenous sex hormones and to develop hormone characteristics of the desired gender. These guidelines are structured to provide evidence-based suggestions or, where evidence is lacking, expert recommendations on diagnostic procedures and hormonal treatment in adolescent and adult transsexuals, including long-term care and eligibility for surgery. The multidisciplinary approach to treatment, the additional diagnostic role of hormone administration and the need to maintain hormone levels within the physiological range are key suggestions stressed in the guidelines which are particularly important for an endocrinologist unfamiliar with this field. The need for psychological assessment before surgery is not common in many countries and should be stressed further in the guidelines. Some important issues such as time and method of hormone withdrawal before surgery together with when and which hormones should be administered after sex reassignment surgery has been completed also remain unclear. These guidelines represent a pivotal document for endocrinologists setting a standard for the care of transsexuals and providing directions for future research.
Proceedings of the National Academy of Sciences of the United States of America, Sep 15, 1998
Nuclear hormone receptors comprise a large family of zinc finger transcription factors, some with... more Nuclear hormone receptors comprise a large family of zinc finger transcription factors, some with hydrophobic ligands, such as thyroid hormone, vitamin D, steroids, etc., and others for which no ligand has been found. Thyroid hormone receptors (TRs) generally are considered to be confined to the vertebrata that possess a thyroid gland. Tunicates represent the most primitive of the chordates, and there are data supporting a role for thyroid hormone in their metamorphosis, but no data are available on TRs in this genus; hence, we have studied Ciona intestinalis. Screening of a Ciona library with the DNA binding domain of Xenopus laevis TR (xTR) resulted in the isolation of a nuclear hormone receptor, C. intestinalis nuclear receptor 1 (CiNR1). CiNR1 is similar to TRs of more evolved species with a conserved DNA binding domain whereas the ligand binding domain shows poor homology to vertebrate sequences. The C-terminal part of CiNR1 spans Ϸ200 amino acids more than other TRs, lacks the AF2 transactivation domain, and is not able to bind triiodothyronine. Phylogenetically, CiNR1 appears to be close to the common ancestral gene of TRs. Expression of CiNR1 was limited to the developing embryo and the larval stage, which suggests a role during development and metamorphosis. In transfection experiments, CiNR1 down-regulated basal transcription of a reporter gene driven by the TR palindrome responsive element. When CiNR1 was cotransfected with chicken TR␣, it attenuated the normal thyroid hormone response in a dominant negative fashion. This attenuation required the C-terminal portion of the molecule. Nuclear receptors are zinc finger transcription factors that regulate gene expression by binding to specific cis-acting sequences in the promoter region (1-3) and include receptors for several hydrophobic ligands, such as steroids, retinoic acid, thyroid hormone, vitamin D, ecdysone, as well as a variety of receptors, called orphans, without a known ligand (4). To date, Ͼ150 different members of this superfamily, spanning a large diversity of species from nematode to human, have been described (5). From the evolutionary point of view, all nuclear receptors can be grouped into six subfamilies: (i) a large one containing thyroid receptors (TRs), retinoic acid receptors (RARs), vitamin D receptors, ecdysone receptors, and numerous orphan receptors; (ii) one clustering retinoid X receptors, COUP, HNF4, and other orphan receptors; (iii) one containing steroid hormone receptors; (iv) one the NGFB group of orphan receptors; (v) one containing FTZ-F1 orphan receptors; and (vi) the last one containing only the GCNF1 orphan receptor (6). Although the TR͞RAR and steroid receptor subfamilies are well characterized in vertebrates, little is known
L'Endocrinologo, Mar 1, 2009
RiassuntoNel disturbo da desiderio sessuale ipoattivo nella donna in menopausa si utilizza tradiz... more RiassuntoNel disturbo da desiderio sessuale ipoattivo nella donna in menopausa si utilizza tradizionalmente — quando non controindicata e non rifiutata dalla paziente — la terapia sostitutiva con estrogeni o estroprogestinici, partendo dal presupposto che le condizioni di ipoestrinismo si associano a riduzione della motivazione e della risposta sessuale e a riduzione del benessere generale. Ma non sempre gli ormoni femminili sono sufficienti. Sono state quindi proposte terapie, perlopiù per somministrazione transdermica, con androgeni. Restano però ancora da determinare con sufficiente universalità i valori normali di testosterone nella donna onde stabilire i limiti dello stato carenziale.
L'Endocrinologo, Dec 1, 2015
SommarioSe l’ipotiroideo è a rischio di eiaculazione ritardata, l’ipertiroideo risulta particolar... more SommarioSe l’ipotiroideo è a rischio di eiaculazione ritardata, l’ipertiroideo risulta particolarmente prono all’eiaculazione precoce, che spesso si risolve col raggiungimento dell’eutiroidismo. Ma non c’è solo questo eclatante rapporto di causa-effetto per giustificare l’interesse dell’endocrinologo per questo sintomo. Sono stati dimostrati il coinvolgimento di altri ormoni e neurotrasmettitori che fanno dell’eiaculazione precoce una condizione patologica di assoluto interesse endocrinologico.
L'Endocrinologo, Oct 1, 2013
L'Endocrinologo, Oct 1, 2018
L'Endocrinologo, Aug 12, 2015
Nota della casa editrice Springer Nature rimane neutrale in riguardo alle rivendicazioni giurisdi... more Nota della casa editrice Springer Nature rimane neutrale in riguardo alle rivendicazioni giurisdizionali nelle mappe pubblicate e nelle affiliazioni istituzionali.
Journal of Endocrinological Investigation, May 8, 2020
PubMed, 2005
Androgens play a pivotal role in the development of the male reproductive tract. The spermatogene... more Androgens play a pivotal role in the development of the male reproductive tract. The spermatogenesis requires high levels of intratesticular testosterone secreted by the Leydig cells. Testosterone exerts its action through the androgen receptor (AR), which is located both in the cytoplasm and in the nucleus of cells in the target tissue. Severe defects of the AR may result in abnormal male sexual development, while more subtle modifications can be a potential cause of male infertility. Low circulating levels of testosterone can be found in 20-30% of infertile men, but administration of testosterone or gonadotropins does not result in improved sperm production. Abuse of anabolic steroids is a frequent cause of male infertility, and substances such as endocrine disruptors can alter male fertility through an anti androgenic action.
Journal of Endocrinological Investigation
Purpose Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has b... more Purpose Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized. Methods The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed. Conclusions These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.
Journal of Endocrinological Investigation
Background Klinefelter syndrome (KS) is frustratingly under-diagnosed. KS have a broad spectrum o... more Background Klinefelter syndrome (KS) is frustratingly under-diagnosed. KS have a broad spectrum of clinical features, making it difficult to identify. Objective We describe KS clinical presentation in a large Italian cohort. Design This is the first observational cohort study within a national network, the Klinefelter ItaliaN Group (KING). Primary outcomes were to describe the basic clinical features and the actual phenotype of KS in Italy. Secondary outcomes were to determine age at diagnosis and geographical distribution. Methods We performed a basic phenotyping and evaluation of the hormonal values of 609 adult KS patients. Results Mean age at diagnosis was 37.4 ± 13.4 years. The overall mean testicular size was 3 ml, and 2.5 ml in both testes in untreated KS group. BMI was 26.6 ± 5.8 kg/m2, and 25.5% of KS had metabolic syndrome (MetS). LH and FSH were increased, and mean total testosterone were 350 ± 9.1 ng/dl. A descriptive analysis showed that 329 KS patients were evaluated ...
The Journal of Sexual Medicine, 2021
ABSTRACTBackgroundOnly few studies have assessed sexual dysfunction in men with Klinefelter syndr... more ABSTRACTBackgroundOnly few studies have assessed sexual dysfunction in men with Klinefelter syndrome (KS).AimTo define pooled prevalence estimates and correlates of erectile dysfunction (ED) and decreased libido (DL) in KS.MethodsA thorough search of Medline, Embase and Web of Science was performed to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effect models and the between-studies heterogeneity was assessed by the Cochrane’s Q and I2. The sources of heterogeneity were investigated by meta-regression and sub-group analyses. Funnel plot, Begg’s rank correlation and trim-and-fill test were used to assess publication bias.Main Outcome MeasureThe pooled prevalence of ED and DL in KS as well as 95% confidence intervals (CIs) were estimated from the proportion of cases of sexual dysfunction and the sample size. Variables that could affect the estimates were identified by linear meta-regress...
Journal of Endocrinological Investigation, 2020
Purpose Low testosterone (T) in Klinefelter's syndrome (KS) can contribute to typical features of... more Purpose Low testosterone (T) in Klinefelter's syndrome (KS) can contribute to typical features of the syndrome such as reduced bone mineral density, obesity, metabolic disturbances and increased cardiovascular risk. The aim of the present study is to review and meta-analyze all available information regarding possible differences in metabolic and bone homeostasis profile between T treated (TRT) or untreated KS and age-matched controls. Methods We conducted a random effect meta-analysis considering all the available data from observational or randomized controlled studies comparing TRT-treated and untreated KS and age-matched controls. Data were derived from an extensive MEDLINE, Embase, and Cochrane search. Results Out of 799 retrieved articles, 21 observational and 22 interventional studies were included in the study. Retrieved trials included 1144 KS subjects and 1284 healthy controls. Not-treated KS patients showed worse metabolic profiles (including higher fasting glycemia and HOMA index as well as reduced HDL-cholesterol and higher LDL-cholesterol) and body composition (higher body mass index and waist circumference) and reduced bone mineral density (BMD) when compared to age-matched controls. TRT in hypogonadal KS subjects was able to improve body composition and BMD at spinal levels but it was ineffective in ameliorating lipid and glycemic profile. Accordingly, TRT-treated KS subjects still present worse metabolic parameters when compared to age-matched controls. Conclusion TRT outcomes observed in KS regarding BMD, body composition and glyco-metabolic control, are similar to those observed in male with hypogonadism not related to KS. Moreover, body composition and BMD are better in treated than untreated hypogonadal KS. Larger and longer randomized placebo-controlled trials are advisable to better confirm the present data, mainly derived from observational studies.
The Journal of Sexual Medicine, 2018
Attitude towards homo-parenting is conditioned by several factors, as cultural, social, religious... more Attitude towards homo-parenting is conditioned by several factors, as cultural, social, religious and psychological aspects. In this study we aim to evaluate the role of socio-demographic charateristics, attachment style and masculinity or femininity related to positive and negative attitudes towards homparental couple.
Sexologies, 2008
ABSTRACT En Italia, el tratamiento hormonal de las personas transexuales únicamente puede ser pre... more ABSTRACT En Italia, el tratamiento hormonal de las personas transexuales únicamente puede ser prescrito por los endocrinólogos cuando el diagnóstico de transexualidad ha sido establecido por psicólogos/psiquiatras experimentados. Antes de que se efectúe la prescripción, hay que comprobar la presencia de graves afecciones, que podrían comprometer el cambio de sexo tanto física como moralmente. La experiencia de « vida real » tiene como objetivo reforzar el papel psicosocial según el sexo con el cual se identifica el transexual y permite confirmar el diagnóstico. La terapéutica es de tipo estrogénico y anti-androgénico en los hombres que desean convertirse en mujeres y de tipo androgénico, sobre todo ésteres de testosterona, en las mujeres que desean convertirse en hombres. La tromboflebitis profunda, que representaba la complicación más severa, es menos frecuente en la actualidad. El seguimiento endocriniano es indispensable ya que el hipogonadismo consecuente a la cirugía de transformación genital debe ser tratado con una terapia de substitución hormonal crónica adecuada.
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Papers by Emmanuele A Jannini