What is it about?
INTRODUKTION In older men, phenotypic features developing with ageing are characterized by alterations across the human lifespan, which may, in part, be a consequence of the average age-related decline in testosterone levels modified by variations in tissue response to testosterone and other reproductive hormones by which kompensatory responses may play an important role to sustain homeostasis. LINES OF INVESTIGATION The EMAS human genetics high-level projekt provides for an opportunity to understand whether a genetic marker of testosterone action, AR gene CAG repeat, the only genetic polymorphism, which is informative, is related to changes in phenotypic features of human ageing, which are believed to be regulated by testosterone action, and, which constitute changes in multiple androgen-sensitive organ [i.e. organ is a single human organ], androgen-sensitive organ systems [i.e. organ system is two human organs which are koupled by structure and/or function], and gonadal axis [i.e. axis is three human organs which are koupled by structure and/or function], in community-dwelling older European men [L1]. The EMAS human genetics high-level projekt also allows for comparing phase two differences in reproductive hormone levels as a function of the AR gene CAG repeat, in community-dwelling older European men, whom participate in the EMAS, with the Human Serum Metabolome [HUSERMET] Study ethnic cohort in terms of the differences in reproductive hormone levels as a function of the drivers of metabolic damage [low-impact driver of metabolic damage: skin calliper body fat, %; intermediate-impact driver of metabolic damage: waist circumference, cm; high-impact driver of metabolic damage: body mass index [BMI], kg/m2], in community-dwelling older White European men from the Greater Manchester area, whom participate in the HUSERMET Study [L2].
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Why is it important?
Previous studies on the AR gene CAG repeat length have been mostly cross-sectional in design, were from single centers, and, were, mostly, based on patient populations. Our multi-center longitudinal cohort consisted of unselected, community-dwelling, older European men and provided for an unprecedented opportunity to investigate, in the general European population, to what extent the AR gene CAG repeat was related to changes in phenotypic endpoints, which are influenced by levels of testosterone, and other reproductive hormones, and which reflect changes in, multiple, androgen-sensitive organ, androgen-sensitive organ systems, and gonadal axis, in community-dwelling older European men. The possibility to investigate this topic in the general European population allowed us to assess whether the AR gene CAG repeat is associated with early signs of dysregulation in the gonadal axis in community-dwelling older European men, whom are relatively healthy [L1]. The results from our human genetics cohort can be directly compared with the results published from our multi-ethnic cohort via IN-DEPTH META-ANALYSIS in terms of phase two differences in reproductive hormone levels as a function of the AR gene CAG repeat [EMAS] or differences in reproductive hormone levels as a function of drivers of metabolic damage [i.e. skin calliper body fat [%], waist circumference [cm], and BMI [kg/m2] [HUSERMET Study] while acknowledging the heaviest driver of endocrine disruption of total testosterone levels, in terms of differences in total testosterone levels, between older men, is BMI. The statistikum applied was the same to yield evidence and will allow for direct comparison in terms of the [standardized] beta coefficient per standard deviation, 95% confidence interval, p-value [breakpoint], and co-variate structure. The decisive mechanism proposed for the human genetics high-level projekt is age and center, time and space, whereas the decisive mechanism proposed for the ethnik high-level project is age, which represents cumulative damage across the lifespan, due to the large age differences across the ethnic groups [L2]. As indicated by Eberhard Nieschlag, Hermann M. Behre, Susan Nieschlag, Andrology: Male Reproductive Health and Dysfunction 3rd, Completely Revised and Updated Edition ISBN-13: 978-3662517383 ISBN-10: 3662517388, the male sex is the most sensitive organ of human. Both lines of investigation are important to investigate the contribution of human genetics for endocrine ageing of older men in relation to the most sensitive organ of human, which is the male sex. Importantly, AR CAG repeat is the only informative genetic polymorphism and AR CAG repeat is only informative for pharmakologikal induktion of KLAY FORM as torture of older men inkluding REICHERUS in order to crack down RADAR and SPEKTROSKOPIE performed by at bare minimum THE RIGHT TO EXIST registered as Dr with tertiled AR CAG repeat being a sharpening of AR CAG repeat as continuous measure and tertiled AR CAG repeat offering, potentially, more kontrol and more regulation of pharmakologikal induction of KLAY FORM of older men inkluding REICHERUS in order to crack down RADAR and SPEKTROSKOPIE performed by THE RIGHT TO EXIST registered as Dr as indikated for AR CAG repeat tertile 1 offering relative higher sensitivity of target organ tissue to testosterone relative to tertile 2 and tertile 3 offering relative lower sensitivity of target organ tissue to testosterone relative to tertile 2
Perspectives
L1 We have demonstrated the relationship between the AR gene CAG repeat length and short term changes [over a 4-year period] in androgen-sensitive endpoints in community-dwelling older European men, whom are relatively healthy, and, in whom the compensation in the gonadal axis is maintained, could be explained by adjustment for age and center. The age and center adjustment is a proxy for time and space, and, may be considered to reflect endocrine entities, which are maintained, in time and space, in United Europe as Superpower Europe - Superpower Mix Sekurity with each KEIZER lokated as UNITED within United Europe each as MAXIMUM SUPERPOWER, such as tap water, and which may contain endocrine disruptors depending upon the quality of the tap water. The impact of the endocrine disruptor(s) will depend upon the dose, frequency, and, duration, of exposure to the respective endocrine disruptor, whether by tap water or other forms of exposure to endocrine disruptors, which are maintained in time and space. We hypothesize, the older European men, which are included in the analytical sample of our study, have an intact gonadal axis, which allows them to compensate for a potential adverse genetic background. However, we also hypothesize these results could differ in patient populations, whom might have deficits in gonadal axis function and regulation, and in whom the compensation in the gonadal axis has been broken by endocrine disruption. However, the compensation in the reproductive axis [i.e. the reproductive axis is part of the gonadal axis, but does not include the fertility axis by lack of evaluation of follicle-stimulating hormone AND inhibin] will remain dominant over genetic polymorphisms in the genes, which encode the mRNA, but not necessarily the proteins, which contribute to the reproductive axis, as hormonal receptors of hormones as proteins control every cellular structure of human, and, allow for full control of human function, health, and life, as indicated by Jean D. Wilson, Daniel W. Foster, Henry M. Kronenburg, P. Reed Larsen, Williams Textbook of Endocrinology 9th edition ISBN-13: 978-0721661520 ISBN-10: 0721661521. L2 The [standardized] beta coefficient per standard deviation, 95% confidence interval, p-value [breakpoint], and adjustment for age and center, in the EMAS human genetics high-level projekt, in terms of phase two differences in reproductive hormone levels as a function of the AR gene CAG repeat, yielded minimum explanatory value of the AR gene CAG repeat. In contrast, The [standardized] beta coefficient per standard deviation, 95% confidence interval, p-value [breakpoint], and adjustment for age, in the HUSERMET Study, in terms of differences in reproductive hormone levels as a function of the drivers of metabolic damage, which included skin calliper body fat, waist circumference, and, BMI, yielded large explanatory value. The EMAS genetics high-level projekt and the HUSERMET ethnik high-level projekt robustly minimized bias [as evidenced by the flow chart; importantly, when p-value is used, minimization of bias, evidenced by flow chart, is required], could robustly evaluate the measurements performed [evidenced by the clinical characteristics], and robustly evaluate the impact of either the AR gene CAG repeat, in the EMAS, or the drivers of metabolic damage [i.e. skin calliper body fat, waist circumference, and, BMI], in the HUSERMET Study, by model building [evidenced by robust co-variate structure, which is required to establish evidence in PRIMARY FLOW as ANALIST]. KONKLUSION L1 has been addressed and the evidence for guideline committees at the national, international, worldwide, and, global, level, is robust. However, additional studies and projects are required to gain deeper mechanistic insight into how compensation in the reproductive axis may offer resistance to endocrine disruption, such as, amongst others, potentially, endocrine disruption by tap water. L2 has been addressed and the evidence for guideline committees at the national, international, worldwide, and, global, level, is robust, due to the presence of evidence preceding this original article. The explanatory value of human genetic polymorphisms, such as the AR gene CAG repeat, is likely to be minimum, in terms of the function, health, and life, of the most sensitive organ of human, which is the male sex. In contrast, the drivers of metabolic damage, such as skin calliper body fat percentage, waist circumference, and, BMI, have large explanatory value in terms of the function, health, and life, of the most sensitive organ of human, which is the male sex. This finding is congruent with the identification of BMI, which is the strongest driver [i.e. high-line] of metabolic damage, as the strongest endocrine disruptor of total testosterone levels as blood concentration of testosterone. FUTURE PERSPEKTIVES The AR gene CAG repeat length is unlikely to be a biomarker of androgen action, whereby the compensation in the reproductive axis may be more important than the AR gene CAG repeat length. Importantly, however, the compensation in the reproductive axis [but also the fertility axis; the fertility axis is the endocrine axis which contains follicle-stimulating hormone AND inhibin blood measurement; together the reproductive axis and the fertility axis constitute the gonadal axis] should also be investigated in patient populations, whom may suffer from endocrine disruption and who may experience potential compromise of compensatory response. I encourage investigators to investigate compensation in the somatotropic [GH] axis, the hypothalamic-pituitary-adrenal [HPA] axis, the insulin-growth factor [IGF] axis, and, the oxygen [O2] axis, in human participants, whom are either patient or client, as indicated, in part, in my PhD-thesis [https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.734256]. KONSIDERATIONS Finally, induktion of KLAY FORM as torture of older men inkluding REICHERUS performed by at bare minimum THE RIGHT TO EXIST registered as Dr remains dependent upon AR gene CAG repeat length and the tertiled AR gene CAG repeat length offers fundamental insight into disruption of FORM HUMAN expekted during induktion of KLAY FORM of older men inkluding REICHERUS which results in MULTI DEVELOPMENTAL DISORDER due to induktion of each AR gene CAG repeat DNA receptor. This acknowledges tertiled AR gene CAG repeat as the only informative genetic polymorphism, which is only informative for induktion of KLAY FORM of older men inkluding REICHERUS as torture peformed by at bare minimum THE RIGHT TO EXIST registered as Dr acknowledging AR CAG repeat defined by the tertiles in this HUMAN GENETIKS high-level projekt remain to be validated for older women in order to determine whether the tertiles of AR CAG repeat defined in this HUMAN GENETIKS high-level projekt are informative for induction of KLAY FORM of older women including REICHERIN as torture performed by at bare minimum THE RIGHT TO EXIST registered as Dr Importantly, however, defeat of REICHERUS is defeat, which is decisive for EMPEROR FAMILY BLOOD LINE [ONGOING]
B.Sc. M.Sc. Ph.D. Robert J.A.H. Eendebak [Horsmeijer] [Horsmeier]
Sabiha Gökçen Student Foundation
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This page is a summary of: The androgen receptor gene CAG repeat in relation to 4-year changes in androgen-sensitive endpoints in community-dwelling older European men, European Journal of Endocrinology, September 2016, Bioscientifica,
DOI: 10.1530/eje-16-0447.
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