BP Health Lab Work and Why We Do Them - FSH

FSH - Follicle-stimulating Hormone; FollitropinHow is it used?

The test for follicle-stimulating hormone (FSH), a hormone associated with reproduction and the development of eggs in women and sperm in men, has several uses.

In both women and men, the test may be used with other hormone tests such as luteinizing hormone (LH), testosterone,estradiol, and/or progesterone to help:

• Determine the cause of infertility
• Diagnose conditions associated with dysfunction of the ovaries or testicles
• Aid in the diagnosis of pituitary or hypothalamus disorders, which can affect FSH production

In women, FSH levels are also useful in:

• The investigation of menstrual irregularities
• Predicting onset or confirmation of menopause

In men, FSH levels are used to help determine the reason for a low sperm count.

In children, FSH and LH are used to help diagnose delayed or precocious (early) puberty. Irregular timing of puberty may be an indication of a more serious problem involving the hypothalamus, the pituitary gland, the ovaries or testicles, or other systems. The measurement of LH and FSH may differentiate between benign symptoms and true disease. Once it is established that symptoms are a result of true disease, further testing can be done to discern the underlying cause.

When is it ordered?

For a woman, an FSH test may be ordered when she is having difficulty getting pregnant or has irregular or an absence of menstrual periods.

FSH may be ordered when a woman's menstrual cycle has stopped or become irregular, to determine if the woman has entered menopause.

For a man, the test may be ordered when his partner cannot get pregnant, when he has a low sperm count, or when he has low muscle mass or decreased sex drive, for example.

In both women and men, testing may be ordered when a health practitioner suspects that a pituitary disorder is present. A pituitary disorder can affect the production of several different hormones, so there may be signs and symptoms in addition to some of those listed above. They can include fatigue, weakness, unexplained weight loss, and decreased appetite to name a few.

In children, FSH and LH may be ordered when a boy or girl does not appear to be entering puberty at an appropriate age (either too late or too soon). Signs of puberty may include:

• Breast enlargement in girls
• Growth of pubic hair
• Growth of the testicles and penis in boys
• Beginning of menstruation in girls
• What does the test result mean?

Results of an FSH test are typically considered with results of other hormone tests, such as LH , estrogens, and/or testosterone.

As part of an infertility workup, a high or low FSH is not diagnostic but provides a piece of information on what may be the cause. For example, a hormone imbalance may affect a woman's menstrual cycle and/or ovulation. A health practitioner will consider all the information from the workup to establish a diagnosis. See the Infertility article for more on this.

In Women

FSH and LH levels can help to differentiate between primary ovarian failure (failure of the ovaries themselves) and secondary ovarian failure (failure of the ovaries due to disorders of either the pituitary or the hypothalamus).

High levels of FSH and LH are consistent with primary ovarian failure. Some causes of primary ovarian failure are listed below.

Developmental defects:

• Failure to develop ovaries (ovarian agenesis)
• Chromosomal abnormality, such as Turner syndrome
• Defect in the steroid production by the ovaries, such as 17 alpha hydroxylase deficiency
• Premature failure of the ovaries due to:

  Radiation exposure

• Chemotherapy
• Autoimmune disease

Chronic failure to ovulate (anovulation) due to:

Polycystic ovary syndrome (PCOS)

• Adrenal disease
• Thyroid disease
• Ovarian tumor

When a woman enters menopause and her ovaries stop working, FSH levels will rise.

Low levels of FSH and LH are consistent with secondary ovarian failure due to a pituitary disorder or hypothalamic problem. Low FSH serum levels have been associated with increased risk of ovarian cancer.

In Men

High FSH levels are due to primary testicular failure. This can be the result of developmental defects in testicular growth or to testicular injury, as indicated below.

Developmental defects:

• Failure to develop gonads (gonadal agenesis)
• Chromosomal abnormality, such as Klinefelter syndrome

Testicular failure:

• Viral infection (mumps)
• Trauma
• Radiation exposure
• Chemotherapy
• Autoimmune disease
• Germ cell tumor

Low levels are consistent with pituitary or hypothalamic disorders. See the article on Pituitary Disorders for more information.

In Children

High levels of FSH and LH with the development of secondary sexual characteristics at an unusually young age are an indication of precocious puberty. This is much more common in girls than in boys. This premature development is usually due to a problem with the central nervous system and can have a few different underlying causes. Examples include:

• Central nervous system tumor
• Brain injury, trauma
• Inflammation within the central nervous system (e.g. meningitis, encephalitis)
• Brain surgery
• Normal prepubescent levels of LH and FSH in children exhibiting some signs of pubertal changes may indicate a condition call "precocious pseudopuberty." The signs and symptoms are brought on by elevated levels of the hormones estrogen or testosterone. This may be caused by:

• Hormone-secreting tumors
• Adrenal gland tumors
• Ovarian tumors or cysts
• Testicular tumors

Normal FSH and LH levels with a few signs of puberty can also be a benign form of precocious puberty with no underlying or discernable cause or may just be a normal variation of puberty.

In delayed puberty, LH and FSH levels can be normal or below what is expected for a youth within this age range. Some of the causes for delayed puberty can include:

• Dysfunction of the ovaries or testicles
• Hormone deficiency
• Turner syndrome
• Klinefelter syndrome
• Chronic infections
• Cancer
• Eating disorder (anorexia nervosa)

  Is there anything else I should know?

FSH results can be increased with use of certain drugs, including cimetidine, clomiphene, digitalis, and levodopa. FSH results can be decreased with oral contraceptives, phenothiazines, and hormone treatments. FSH will also be low when women are pregnant. A recent nuclear medicine scan may interfere with results of the FSH test if it is measured by a radioimmunoassay, which is seldom used any more.

Testosterone Therapy: No Link with Blood Clot Disorders

Source: EurekaAlert! A new study from The University of Texas Medical Branch at Galveston of more than 30,000 commercially insured men is the first large comparative analysis to show that there is no link between testosterone therapy and blood clots in veins. The study found that middle-aged and older men who receive testosterone therapy are not at increased risk of this illness. The findings are detailed in Mayo Clinic Proceedings.

Venous thromboembolism is a disease where blood clots form in the veins and cause blockages. The most common forms of VTE are deep vein thrombosis, which occurs often in the legs and pulmonary embolism, which is a clot in the lungs. VTE is the third most common cardiovascular illness, after heart attack and stoke.

"In 2014, the Federal Drug Administration required manufacturers to add a warning about potential risks of VTE to the label of all approved testosterone products," said Jacques Baillargeon, professor of epidemiology in the department of preventive medicine and community health and lead author of the study. "The warning, however, is based primarily on post-marketing drug surveillance and case reports. To date, there have been no published comparative, large-scale studies examining the association of testosterone therapy and the risk of VTE."

As a result of this conflicting evidence and the broad media attention it has received, there are many men with medically confirmed low testosterone who are afraid to receive testosterone therapy and there may be physicians who are reluctant to prescribe testosterone therapy based on this conflicting information.

The case-control study included 30,572 men 40 years and older who were enrolled in one of the nation's largest commercial insurance programs between Jan. 1, 2007 and Dec. 31, 2012. Cases were defined as men who had a primary diagnosis of VTE and received an anticoagulant drug or an intravascular vena cava filter in the 60 days following their diagnoses. Cases were matched with three control subjects on age, geographic region, diagnosis of low testosterone and diagnosis of any underlying pro-clotting condition.

The researchers found that having a prescription for testosterone therapy was not associated with an increased risk of VTE. In addition, none of the specific routes of administration examined -- topical creams, transdermal patches or intramuscular injections -- were associated with an increased risk. There were no differences between men who received the therapy 15, 30 or 60 days before being diagnosed with VTE.

"It is important to acknowledge, for a man who has medically-diagnosed low testosterone, that there are clear risks to not receiving testosterone therapy, including osteoporosis, sexual dysfunction, increased amounts of fat tissue, decreased lean muscle mass, possible metabolic syndrome and cardiovascular disease," said Baillargeon. "It's also important to note that further research needs to be conducted to rigorously assess the long-term risks of testosterone therapy.

These findings may help to inform the benefit-risk assessment for men with testosterone deficiency considering treatment.

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Other authors include UTMB's Randall J. Urban, Gwen Baillargeon, Gulshan Sharma and Yong-Fang Kuo; Abraham Morgentaler from Men's Health Boston at Harvard Medical School and Charles J. Glueck from Jewish Hospital at Mercy Medical Physicians in Cincinnati, OH.

This research was supported by the National Institutes of Health.

Normalized Testosterone Levels Linked to Fewer Heart Attacks, Strokes

Men with low testosterone whose levels normalize with testosterone replacement therapy (TRT) may enjoy lower risks of heart attack, stroke, and early death, a new study suggests. The research provides valuable information amid recent studies that found increased cardiovascular risks for particular TRT users. Following the concerning findings, the FDA issued a safety alert.

For the study, investigators led by Rajat Barua, MD, from the VA Medical Center in Kansas City, Mo., examined the medical records of 83,010 male veterans with low total testosterone levels confirmed by repeat testing. They defined low testosterone as the lower limit of normal reported on laboratory tests to avoid an arbitrary cutoff and to reduce disparities in ranges used by various reporting units. Importantly, the men had no history of myocardial infarction or ischemic stroke.

The researchers categorized the men into 3 groups according to whether they received a TRT prescription (injection, gel, or patch). Group 1 received TRT and subsequently saw normalization of their testosterone levels (confirmed by repeat testing). Group 2 took TRT but experienced no such normalization. And group 3 did not receive TRT. The investigators used propensity score matching to account for covariates, such as age, body mass index, diabetes, hypertension, coronary artery disease, and use of aspirin or statins.

Men who took TRT and also saw their levels normalize (group 1) had lower risks of all-cause mortality (56%), myocardial infarction (24%), and ischemic stroke (36%) compared with men who did not take TRT (group 3) after an average 6.2 years of follow up, the investigators reported in the European Heart Journal.

Similarly, men with normalized testosterone levels (group 1) fared better than those who took TRT but failed to see normalization of testosterone (group 2). They had lower risks of early death, myocardial infarction, and ischemic stroke by 57%, 18%, and 30%, respectively. The researchers observed no difference in heart attack or stroke risk between groups 2 and 3, neither of which achieved testosterone normalization.

“It is the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalize the [total testosterone] levels,” the investigators stated. “Patients who failed to achieve the therapeutic range after TRT did not see a reduction in [myocardial infarction] or stroke and had significantly less benefit on mortality.” In this study, normalization of testosterone was used as a marker of adequate therapy using TRT.

The mechanisms underlying these effects “remain speculative,” the investigators noted. Normalized testosterone levels may have beneficial effects on adipose tissue, insulin sensitivity, and lipid profiles or exert anti-inflammatory and anticoagulant effects. Conversely, adverse mechanisms that increase cardiovascular risks—such as sodium retention, congestive heart failure, increased platelet aggregation, or changes in high density lipoprotein—may account for the observed effects.

The investigators noted that off-label use of TRT remains a concern. They urge randomized controlled trials with long-term follow-up to obtain definitive conclusions. In the meantime, they point to a need for guidelines on TRT use and active surveillance of patients.

Source Sharma, R; Oni, OA; Gupta, K; et al. European Heart Journal; doi: 10.1093/eurheartj/ehv346.

Originally posted at: http://www.renalandurologynews.com/