Management of male obesity-related secondary hypogonadism:A clinical update

The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism(MOSH)with emerging evidence on the role of testosterone therapy.We aim to provide an updated and practical approach towards its management.We did a comprehensive literature search across MEDLINE(via PubMed),Scopus,and Google Scholar databases using the keywords“MOSH”OR“Obesity-related hypogonadism”OR“Testosterone replacement therapy”OR“Selective estrogen receptor modulator”OR“SERM”OR“Guidelines on male hypogonadism”as well as a manual search of references within the articles.A narrative review based on available evidence,recommendations and their practical implications was done.Although weight loss is the ideal therapeutic strategy for patients with MOSH,achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice.Therefore,androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity.However,there is conflicting evidence for the appropriate use of testosterone replacement therapy(TRT),and it can also be associated with complications.This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH.Before starting testosterone replacement in functional hypogonadism of obesity,it would be desirable to initiate lifestyle modification to ensure weight reduction.TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients.Balancing the risks and benefits of TRT should be considered in every patient before and during longterm management.

Is Cancer Still the Villain, Even during COVID 19 Outbreak?

Background :Anxiety and depression are two common psychiatric conditions encountered in cancer treatment. Prevalence rate and risk factors show wide variations in different countries and the environment. COVID 19 outbreak has increased psychological disorders in general public and health workers. Whether this pandemic has increased the psychiatric morbidity in cancer patients needs to be addressed for planning strategies. Methods: This cross-sectional study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in the state of Kerala, India. The aim was to assess hospital prevalence and risk factors of anxiety and depression among cancer patients during COVID 19 pandemic. Patients on treatment for cancer and willing for the study were recruited. Hospital Anxiety and Depression Scale (HADS), a self-assessment valid tool for screening both anxiety (HADS-A) and depression (HADS-D) are used. HADS-A & D were calculated separately & categorized as normal, borderline and abnormal with a score of 0 - 7, 8 - 10 & 11 - 21 respectively. Separate structured questionnaire for COVID19 related questions and patient master file for patient & treatment characteristics were used in risk assessment. Data were entered in an Excel sheet and SPSS version 22 for statistical analysis. Findings: 208 patients were included in this study. The overall prevalence rate of anxiety was 7.2%, with borderline cases 4.3% and abnormal cases 2.9%. The overall prevalence of the rate of depression was 5.3% (3.4% borderline & 1.9% abnormal). Risk factors like age, sex, socioeconomic status, primary site, stage of the disease and default of disease had no statistical significance. Interpretation: The prevalence rate of anxiety and depression among cancer patients in this study is one among the lowest ever reported. COVID 19 outbreak has not brought any impact in the rate of psychological distress in our patients and the low rate may be due to the robust medical care including mental health interventions and reassurance by the Government.