Main Article Content
Abstract
Testosterone hormone (T) and inflammatory biomarkers are linked to the onset and progression of chronic diseases, but the interaction between them is poorly understood. We examined the association of testosterone, estradiol (E2) and prolactin (PRL) with biomarkers of inflammation, Tumor necrosis factor alpha (TNFα), Interleukin 6 (IL6) and C-reactive protein (CRP). The sample divided into three main groups (30/group) as following: 1st group (40-45) years, 2nd group (50-55) years, 3rd group (60-65) years, and each of these three main groups divided also, into two subgroups as the following: 1st subgroup (15 normotensive men), 2nd subgroup (15 hypertensive men). The results revealed that testosterone levels reduced significantly (P≤0.05) for all samples in different subgroups and groups. Both estradiol and prolactin increased significantly (P≤0.05) for all samples in different subgroups and groups during hypertension. TNFα, IL6 and CRP levels increase significantly (P≤0.05) for all samples in different subgroups and groups during both the progressive age and hypertension. The physiological impact of these findings be discussed according to the changes in the testosterone hormone and their anti-inflammatory effect during hypertension.
Keywords
Testosterone
Estradiol
Prolactin
TNFα
IL6
CRP.
Article Details
License
The authors transfer the copyrights of their papers to the Iranian Society of Ichthyology. However, the information could be used in accordance with the Creative Commons licence (Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
How to Cite
AL-NAJDI, A. sabeeh, & KHALIFA, A. A. (2021). The relationship between testosterone and pro-inflammatory cytokines in hypertensive men. Iranian Journal of Ichthyology, 8, 110–119. Retrieved from http://www.ijichthyol.org/index.php/iji/article/view/010015
References
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Bianchi, V.E. 2019. The anti-inflammatory effects of testosterone. Journal of the Endocrine Society 3(1): 91-107.
Blaya, R.; Thomaz, L.D.G.R.; Guilhermano, F.; Paludo, A.D.O.; Rhoden, L.; Halmenschlager, G. & Rhoden, E.L. 2016. Total testosterone levels are correlated to metabolic syndrome components. The Aging Male 19(2): 85-89.
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Colao, A.; Di Sarno, A.; Cappabianca, P.; Briganti, F.; Pivonello, R.; Di Somma, C. & Lombardi, G. 2003. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. European Journal of Endocrinology 148(3): 325-331.
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Fukai, S.; Akishita, M.; Miyao, M.; Ishida, K.; Toba, K. & Ouchi, Y. 2010. Age‐related changes in plasma androgen levels and their association with cardiovascular risk factors in male Japanese office workers. Geriatrics & Gerontology International 10(1): 32-39.
Grabowska-Markowska, J.; Pawłowska, I.; Ziółkowski, G. & Wójkowska-Mach, J. 2019. Bacteraemia caused by ochrobactrum anthropi-unusual behavior. Wiadomosci Lekarskie (Warsaw, Poland: 1960) 72(3): 489-492.
Hair, W.M.; Gubbay, O.; Jabbour, H.N. & Lincoln, G.A. 2002. Prolactin receptor expression in human testis and accessory tissues: localization and function. Molecular Human Reproduction 8(7): 606-611.
Hall, J.; Jones, R.D.; Jones, T.H.; Channer, K.S. & Peers, C. 2006. Selective inhibition of L-type Ca2+ channels in A7r5 cells by physiological levels of testosterone. Endocrinology 147(6): 2675-2680.
Halmenschlager, G.; Rhoden, E.L. & Riedner, C.E. 2011. The influence of age on bioavailable and free testosterone is independent of body mass index and glucose levels. World Journal of Urology 29(4): 541-546.
Harman, S.M.; Metter, E.J.; Tobin, J.D.; Pearson, J. & Blackman, M.R. 2001. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. The Journal of Clinical Endocrinology & Metabolism 86(2): 724-731.
Haug, E. & Gautvik, K.M. 1976. Effects of sex steroids on prolactin secreting rat pituitary cells in culture. Endocrinology 99(6): 1482-1489
Ho, K.Y.; Thorner, M.O.; Krieg Jr, R.J.; Lau, S.K.; Sinha, Y.N.; Johnson, M.L. & Evans, W.S. 1988. Effects of gonadal steroids on somatotroph function in the rat: analysis by the reverse hemolytic plaque assay. Endocrinology 123(3): 1405-1411.
Hotta, Y.; Kataoka, T. & Kimura, K. 2019. Testosterone deficiency and endothelial dysfunction: nitric oxide, asymmetric dimethylarginine, and endothelial progenitor cells. Sexual Medicine Reviews 7(4): 661-668.
Kalinchenko, S.Y.; Tishova, Y.A.; Mskhalaya, G.J.; Gooren, L.J.; Giltay, E. J. & Saad, F. 2010. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double‐blinded placebo‐controlled Moscow study. Clinical Endocrinology 73(5): 602-612.
Kalleinen, N.; Polo-Kantola, P.; Irjala, K.; Porkka-Heiskanen, T.; Vahlberg, T.; Virkki, A. & Polo, O. 2008. 24-hour serum levels of growth hormone, prolactin, and cortisol in pre-and postmenopausal women: the effect of combined estrogen and progestin treatment. The Journal of Clinical Endocrinology & Metabolism 93(5): 1655-1661.
Kapasi, A.A.; Kumar, R.; Pauly, J.R. & Pandey, K.N. 1996. Differential expression and autoradiographic localization of atrial natriuretic peptide receptor in spontaneously hypertensive and normotensive rat testes: diminution of testosterone in hypertension. Hypertension 28(5): 847-853.
Kelly, D.M. & Jones, T.H. 2013. Testosterone: a vascular hormone in health and disease. J Endocrinol 217(3): R47-71.
Khaw, K.T.; Dowsett, M.; Folkerd, E.; Bingham, S.; Wareham, N.; Luben, R. & Day, N. 2007. CLINICAL PERSPECTIVE. Circulation 116(23): 2694-2701.
Kienitz, T. & Quinkler, M. 2008. Testosterone and blood pressure regulation. Kidney and Blood Pressure Research 31(2), 71-79.
Krysiak, R.; Szkróbka, W. & Okopień, B. 2020. Endogenous testosterone determines metformin action on prolactin levels in hyperprolactinaemic men: A pilot study. Basic & clinical pharmacology & Toxicology 126(2): 110-115.
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Roselli, C. E.; Bocklandt, S.; Stadelman, H.L.; Wadsworth, T.; Vilain, E. & Stormshak, F. 2008. Prolactin expression in the sheep brain. Neuroendocrinology 87(4): 206-215.
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References
Agita, A. & Alsagaff, M.T. 2017. Inflammation, immunity, and hypertension. Acta Medica Indonesiana 49(2): 158-165.
Angelovich, T.A.; Hearps, A.C. & Jaworowski, A. 2015. Inflammation‐induced foam cell formation in chronic inflammatory disease. Immunology and Cell Biology 93(8): 683-693.
Barrado, M.J.G.; Blanco, E.J.; Hernández, M.C.; Osma, M.C.I.; Carretero, M.; Herrero, J.J. & Carretero, J. 2014. Local transformations of androgens into estradiol by aromatase P450 is involved in the regulation of prolactin and the proliferation of pituitary prolactin-positive cells. PloS one 9(6): e101403.
Bayer, S.R.; Alper, M.M. & Penzias, A.S. (Eds.) 2011. The Boston IVF Handbook of Infertility: A Practical Guide for Practitioners Who Care for Infertile Couples. CRC Press.
Bektas, A.; Schurman, S.H.; Sen, R. & Ferrucci, L. 2018. Aging, inflammation and the environment. Experimental gerontology105: 10-18.
Bianchi, V.E. 2019. The anti-inflammatory effects of testosterone. Journal of the Endocrine Society 3(1): 91-107.
Blaya, R.; Thomaz, L.D.G.R.; Guilhermano, F.; Paludo, A.D.O.; Rhoden, L.; Halmenschlager, G. & Rhoden, E.L. 2016. Total testosterone levels are correlated to metabolic syndrome components. The Aging Male 19(2): 85-89.
Buford, T.W. 2016. Hypertension and aging. Ageing Research Reviews 26: 96-111.
Clapp, C.; Torner, L.; Gutierrez-Ospina, G.; Alcantara, E.V.A.; Lopez-Gomez, F.J.; Nagano, M. & de la Escalera, G.M. 1994. The prolactin gene is expressed in the hypothalamic-neurohypophyseal system and the protein is processed into a 14-kDa fragment with activity like 16-kDa prolactin. Proceedings of the National Academy of Sciences 91(22): 10384-10388.
Colao, A.; Di Sarno, A.; Cappabianca, P.; Briganti, F.; Pivonello, R.; Di Somma, C. & Lombardi, G. 2003. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. European Journal of Endocrinology 148(3): 325-331.
Colli, L.G.; Belardin, L.B.; Echem, C.; Akamine, E.H.; Antoniassi, M.P.; Andretta, R.R. & De Carvalho, M. H.C. 2019. Systemic arterial hypertension leads to decreased semen quality and alterations in the testicular microcirculation in rats. Scientific Reports 9(1): 1-12.
Cooke, P.S.; Nanjappa, M.K.; Ko, C.; Prins, G.S. & Hess, R.A. 2017. Estrogens in male physiology. Physiological Reviews 97(3): 995-1043
Corcoran, M.P.; Meydani, M.; Lichtenstein, A.H.; Schaefer, E.J.; Dillard, A. & Lamon-Fava, S. 2010. Sex hormone modulation of proinflammatory cytokine and CRP expression in macrophages from older men and postmenopausal women. The Journal of Endocrinology 206(2): 217
Cosma, M.; Bailey, J.; Miles, J.M.; Bowers, C.Y. & Veldhuis, J.D. 2008. Pituitary and/or peripheral estrogen-receptor α regulates follicle-stimulating hormone secretion, whereas central estrogenic pathways direct growth hormone and prolactin secretion in postmenopausal women. The Journal of Clinical Endocrinology & Metabolism 93(3): 951-958
Endre, T.; Mattiasson, I.; Berglund, G. & Hulthen, U.L. 1996. Low testosterone and insulin resistance in hypertension-prone men. Journal of human hypertension 10(11): 755-761.
Finkelstein, J.S.; Lee, H.; Burnett-Bowie, S.A.M.; Pallais, J.C.; Yu, E.W.; Borges, L.F. & Leder, B.Z. 2013. Gonadal steroids and body composition, strength, and sexual function in men. New England Journal of Medicine 369(11): 1011-1022.
Fogari, R.; Preti, P.; Zoppi, A.; Fogari, E.; Rinaldi, A.; Corradi, L. & Mugellini, A. 2005. Serum testosterone levels and arterial blood pressure in the elderly. Hypertension Research 28(8): 625-630.
Fukai, S.; Akishita, M.; Miyao, M.; Ishida, K.; Toba, K. & Ouchi, Y. 2010. Age‐related changes in plasma androgen levels and their association with cardiovascular risk factors in male Japanese office workers. Geriatrics & Gerontology International 10(1): 32-39.
Grabowska-Markowska, J.; Pawłowska, I.; Ziółkowski, G. & Wójkowska-Mach, J. 2019. Bacteraemia caused by ochrobactrum anthropi-unusual behavior. Wiadomosci Lekarskie (Warsaw, Poland: 1960) 72(3): 489-492.
Hair, W.M.; Gubbay, O.; Jabbour, H.N. & Lincoln, G.A. 2002. Prolactin receptor expression in human testis and accessory tissues: localization and function. Molecular Human Reproduction 8(7): 606-611.
Hall, J.; Jones, R.D.; Jones, T.H.; Channer, K.S. & Peers, C. 2006. Selective inhibition of L-type Ca2+ channels in A7r5 cells by physiological levels of testosterone. Endocrinology 147(6): 2675-2680.
Halmenschlager, G.; Rhoden, E.L. & Riedner, C.E. 2011. The influence of age on bioavailable and free testosterone is independent of body mass index and glucose levels. World Journal of Urology 29(4): 541-546.
Harman, S.M.; Metter, E.J.; Tobin, J.D.; Pearson, J. & Blackman, M.R. 2001. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. The Journal of Clinical Endocrinology & Metabolism 86(2): 724-731.
Haug, E. & Gautvik, K.M. 1976. Effects of sex steroids on prolactin secreting rat pituitary cells in culture. Endocrinology 99(6): 1482-1489
Ho, K.Y.; Thorner, M.O.; Krieg Jr, R.J.; Lau, S.K.; Sinha, Y.N.; Johnson, M.L. & Evans, W.S. 1988. Effects of gonadal steroids on somatotroph function in the rat: analysis by the reverse hemolytic plaque assay. Endocrinology 123(3): 1405-1411.
Hotta, Y.; Kataoka, T. & Kimura, K. 2019. Testosterone deficiency and endothelial dysfunction: nitric oxide, asymmetric dimethylarginine, and endothelial progenitor cells. Sexual Medicine Reviews 7(4): 661-668.
Kalinchenko, S.Y.; Tishova, Y.A.; Mskhalaya, G.J.; Gooren, L.J.; Giltay, E. J. & Saad, F. 2010. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double‐blinded placebo‐controlled Moscow study. Clinical Endocrinology 73(5): 602-612.
Kalleinen, N.; Polo-Kantola, P.; Irjala, K.; Porkka-Heiskanen, T.; Vahlberg, T.; Virkki, A. & Polo, O. 2008. 24-hour serum levels of growth hormone, prolactin, and cortisol in pre-and postmenopausal women: the effect of combined estrogen and progestin treatment. The Journal of Clinical Endocrinology & Metabolism 93(5): 1655-1661.
Kapasi, A.A.; Kumar, R.; Pauly, J.R. & Pandey, K.N. 1996. Differential expression and autoradiographic localization of atrial natriuretic peptide receptor in spontaneously hypertensive and normotensive rat testes: diminution of testosterone in hypertension. Hypertension 28(5): 847-853.
Kelly, D.M. & Jones, T.H. 2013. Testosterone: a vascular hormone in health and disease. J Endocrinol 217(3): R47-71.
Khaw, K.T.; Dowsett, M.; Folkerd, E.; Bingham, S.; Wareham, N.; Luben, R. & Day, N. 2007. CLINICAL PERSPECTIVE. Circulation 116(23): 2694-2701.
Kienitz, T. & Quinkler, M. 2008. Testosterone and blood pressure regulation. Kidney and Blood Pressure Research 31(2), 71-79.
Krysiak, R.; Szkróbka, W. & Okopień, B. 2020. Endogenous testosterone determines metformin action on prolactin levels in hyperprolactinaemic men: A pilot study. Basic & clinical pharmacology & Toxicology 126(2): 110-115.
Lakatta, E.G. & Levy, D. 2003. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a “set up” for vascular disease. Circulation 107(1): 139-146.
Levine, S. & Muneyyirci-Delale, O. 2018. Stress-induced hyperprolactinemia: pathophysiology and clinical approach. Obstetrics and Gynecology International 2018.
Malkin, C.J.; Pugh, P.J.; Jones, R.D.; Kapoor, D.; Channer, K.S. & Jones, T.H. 2004. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism 89(7): 3313-3318.
Maranon, R. & Reckelhoff, J.F. 2013. Sex and gender differences in control of blood pressure. Clinical Science, 125(7): 311-318.
Maria, M. 2016. The role of prolactin in men. Endocrinol Metab Syndr 5(222): 2161-1017.
Messini, C.I.; Dafopoulos, K.; Chalvatzas, N.; Georgoulias, P.; Anifandis, G. & Messinis, I.E. 2010. Effect of ghrelin and thyrotropin-releasing hormone on prolactin secretion in normal women. Hormone And Metabolic Research 42(03): 204-208.
Mohamad, N.V.; Wong, S.K.; Hasan, W.N.W.; Jolly, J.J.; Nur-Farhana, M.F.; Ima-Nirwana, S. & Chin, K. Y. 2018. The relationship between circulating testosterone and inflammatory cytokines in men. The Aging Male.
Moretti, C.; Lanzolla, G.; Moretti, M.; Gnessi, L. & Carmina, E. 2017. Androgens and hypertension in men and women: a unifying view. Current Hypertension Reports 19(5): 44.
Norata, G.D.; Tibolla, G.; Seccomandi, P.M.; Poletti, A. & Catapano, A.L. 2006. Dihydrotestosterone decreases tumor necrosis factor-α and lipopolysaccharide-induced inflammatory response in human endothelial cells. The Journal of Clinical Endocrinology & Metabolism 91(2): 546-554.
North, B.J. & Sinclair, D.A. 2012. The intersection between aging and cardiovascular disease. Circulation Research 110(8): 1097-1108.
Orshal, J.M. & Khalil, R.A. 2004. Gender, sex hormones, and vascular tone. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 286(2): R233-R249.
Pandey, K.N. 2014. Guanylyl cyclase/natriuretic peptide receptor-A signaling antagonizes phosphoinositide hydrolysis, Ca2+ release, and activation of protein kinase C. Frontiers in Molecular Neuroscience 7: 75.
Perusquía, M.; Herrera, N.; Ferrer, M. & Stallone, J.N. 2017. Antihypertensive effects of androgens in conscious, spontaneously hypertensive rats. The Journal of Steroid Biochemistry and Molecular Biology 167: 106-114.
Roelfsema, F.; Pijl, H.; Keenan, D.M. & Veldhuis, J.D. 2012. Prolactin secretion in healthy adults is determined by gender, age and body mass index. PloS one 7(2): e31305.
Roselli, C. E.; Bocklandt, S.; Stadelman, H.L.; Wadsworth, T.; Vilain, E. & Stormshak, F. 2008. Prolactin expression in the sheep brain. Neuroendocrinology 87(4): 206-215.
Sartorius, G.; Spasevska, S.; Idan, A.; Turner, L.; Forbes, E.; Zamojska, A. & Handelsman, D.J. 2012. Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self‐reporting very good health: The healthy man study. Clinical Endocrinology 77(5): 755-763.
Scragg, J.L.; Jones, R.D.; Channer, K.S.; Jones, T.H. & Peers, C. 2004. Testosterone is a potent inhibitor of L-type Ca2+ channels. Biochemical and Biophysical Research Communications 318(2): 503-506.
Seyrek, M.; Yildiz, O.; Ulusoy, H.B. & Yildirim, V. 2007. Testosterone relaxes isolated human radial artery by potassium channel opening action. Journal of Pharmacological Sciences 103(3):309-316.
Shimodaira, M.; Nakayama, T.; Sato, N.; Saito, K.; Morita, A.; Sato, I. & Izumi, Y. 2008. Association study of aromatase gene (CYP19A1) in essential hypertension. International Journal of Medical Sciences 5(1): 29.
Simpson, E.R.; Clyne, C.; Rubin, G.; Boon, W.C.; Robertson, K.; Britt, K. & Jones, M. 2002. Aromatase-a brief overview. Annual Review of Physiology 64(1): 93-127.
Spratt, D.I.; Morton, J.R.; Kramer, R.S.; Mayo, S.W.; Longcope, C. & Vary, C.P. 2006. Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization. American Journal of Physiology-Endocrinology and Metabolism 291(3): E631-E638.
Stamatelopoulos, K.S.; Georgiopoulos, G.A.; Sfikakis, P.P.; Kollias, G.; Manios, E.; Mantzou, E. & Alevizaki, M. 2011. Pilot study of circulating prolactin levels and endothelial function in men with hypertension. American Journal of Hypertension 24(5): 569-573.
Stanhewicz, A.E.; Wenner, M.M. & Stachenfeld, N.S. 2018. Sex differences in endothelial function important to vascular health and overall cardiovascular disease risk across the lifespan. American Journal of Physiology-Heart and Circulatory Physiology 315(6): H1569-H1588.
Sverdlov, A.L.; Ngo, D.T.; Chan, W.P.; Chirkov, Y.Y. & Horowitz, J.D. 2014. Aging of the nitric oxide system: are we as old as our NO?. Journal of the American Heart Association 3(4): e000973
Tanase, D.M.; Gosav, E.M.; Radu, S.; Ouatu, A.; Rezus, C.; Ciocoiu, M. & Floria, M. 2019. Arterial hypertension and interleukins: potential therapeutic target or future diagnostic marker?. International journal of hypertension 2019.
Torkler, S.; Wallaschofski, H.; Baumeister, S.E.; Völzke, H.; Dörr, M.; Felix, S. & Haring, R. 2011. Inverse association between total testosterone concentrations, incident hypertension and blood pressure. The Aging Male 14(3): 176-182.
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Tsilidis, K.K.; Rohrmann, S.; McGlynn, K.A.; Nyante, S.J.; Lopez, D.S.; Bradwin, G. & Platz, E.A. 2013. Association between endogenous sex steroid hormones and inflammatory biomarkers in US men. Andrology 1(6): 919-928.
Tsounis, D.; Bouras, G.; Giannopoulos, G.; Papadimitriou, C.; Alexopoulos, D. & Deftereos, S. 2014. Inflammation markers in essential hypertension. Medicinal Chemistry, 10(7), 672-681.
Vodo, S.; Bechi, N.; Petroni, A.; Muscoli, C. & Aloisi, A.M. 2013. Testosterone-induced effects on lipids and inflammation. Mediators of Inflammation 2013.
Wang, B.; Li, L.; He, Z.; Wang, L.; Zhang, S.; Qiao, H. & Tai, F. 2018. Effects of reproductive experience on paternal behavior, levels of testosterone, prolactin in serum and dendritic spines in medial prefrontal cortex of mandarin voles. Integrative Zoology 13(6): 711-722.
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Scragg, J.L.; Jones, R.D.; Channer, K.S.; Jones, T.H. & Peers, C. 2004. Testosterone is a potent inhibitor of L-type Ca2+ channels. Biochemical and Biophysical Research Communications 318(2): 503-506.
Seyrek, M.; Yildiz, O.; Ulusoy, H.B. & Yildirim, V. 2007. Testosterone relaxes isolated human radial artery by potassium channel opening action. Journal of Pharmacological Sciences 103(3):309-316.
Shimodaira, M.; Nakayama, T.; Sato, N.; Saito, K.; Morita, A.; Sato, I. & Izumi, Y. 2008. Association study of aromatase gene (CYP19A1) in essential hypertension. International Journal of Medical Sciences 5(1): 29.
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Spratt, D.I.; Morton, J.R.; Kramer, R.S.; Mayo, S.W.; Longcope, C. & Vary, C.P. 2006. Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization. American Journal of Physiology-Endocrinology and Metabolism 291(3): E631-E638.
Stamatelopoulos, K.S.; Georgiopoulos, G.A.; Sfikakis, P.P.; Kollias, G.; Manios, E.; Mantzou, E. & Alevizaki, M. 2011. Pilot study of circulating prolactin levels and endothelial function in men with hypertension. American Journal of Hypertension 24(5): 569-573.
Stanhewicz, A.E.; Wenner, M.M. & Stachenfeld, N.S. 2018. Sex differences in endothelial function important to vascular health and overall cardiovascular disease risk across the lifespan. American Journal of Physiology-Heart and Circulatory Physiology 315(6): H1569-H1588.
Sverdlov, A.L.; Ngo, D.T.; Chan, W.P.; Chirkov, Y.Y. & Horowitz, J.D. 2014. Aging of the nitric oxide system: are we as old as our NO?. Journal of the American Heart Association 3(4): e000973
Tanase, D.M.; Gosav, E.M.; Radu, S.; Ouatu, A.; Rezus, C.; Ciocoiu, M. & Floria, M. 2019. Arterial hypertension and interleukins: potential therapeutic target or future diagnostic marker?. International journal of hypertension 2019.
Torkler, S.; Wallaschofski, H.; Baumeister, S.E.; Völzke, H.; Dörr, M.; Felix, S. & Haring, R. 2011. Inverse association between total testosterone concentrations, incident hypertension and blood pressure. The Aging Male 14(3): 176-182.
Travison, T.G.; Araujo, A.B.; Kupelian, V.; O’Donnell, A.B. & McKinlay, J.B. 2007. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. The Journal of Clinical Endocrinology & Metabolism 92(2): 549-555.
Tsilidis, K.K.; Rohrmann, S.; McGlynn, K.A.; Nyante, S.J.; Lopez, D.S.; Bradwin, G. & Platz, E.A. 2013. Association between endogenous sex steroid hormones and inflammatory biomarkers in US men. Andrology 1(6): 919-928.
Tsounis, D.; Bouras, G.; Giannopoulos, G.; Papadimitriou, C.; Alexopoulos, D. & Deftereos, S. 2014. Inflammation markers in essential hypertension. Medicinal Chemistry, 10(7), 672-681.
Vodo, S.; Bechi, N.; Petroni, A.; Muscoli, C. & Aloisi, A.M. 2013. Testosterone-induced effects on lipids and inflammation. Mediators of Inflammation 2013.
Wang, B.; Li, L.; He, Z.; Wang, L.; Zhang, S.; Qiao, H. & Tai, F. 2018. Effects of reproductive experience on paternal behavior, levels of testosterone, prolactin in serum and dendritic spines in medial prefrontal cortex of mandarin voles. Integrative Zoology 13(6): 711-722.
Zeitlin, S.I. & Rajfer, J. 2000. Hyperprolactinemia and erectile dysfunction. Reviews in Urology 2(1): 39.
Zitzmann, M. & Nieschlag, E. 2007. Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism 92(10): 3844-3853.