Maturitas[JOURNAL]
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200 papers
Effects of a mutation in the transmembrane and coiled-coil domains 2 gene on ovarian function and reproductive aging.
Xu C, Ruan X, Li Y … +6 more , Yang Y, Wang Z, Liu A, Cheng J, Gu M, Mueck AO
Maturitas · 2026 Apr · PMID 41722335 · Publisher ↗
OBJECTIVES: A mutation in the transmembrane and coiled-coil domain 2 (TMCO2) gene was identified in a family with premature ovarian insufficiency (POI). To determine whether the TMCO2 mutation causes the decline in ovari...
OBJECTIVES: A mutation in the transmembrane and coiled-coil domain 2 (TMCO2) gene was identified in a family with premature ovarian insufficiency (POI). To determine whether the TMCO2 mutation causes the decline in ovarian function, Tmco2-deficient mice were bred and studied. DESIGN: The F2 generation of Tmco2-deficient mice was obtained, and the breeding outcomes were assessed. Physical characteristics of the female mice were observed. White fat, ovarian tissue, and serum from Tmco2 heterozygous female mice were collected at 8, 18, and 28 weeks of age. Follicle counts and hormone levels were measured and analyzed. RESULTS: (1) The birth rate of Tmco2 mice was only 4.26%. (2) At 28 weeks of age, the Lee index and the adiposity index of Tmco2 female mice were higher than those of Tmco2 (P = 0.0197 and 0.0180). (3) At 8 and 18 weeks of age, Tmco2 mice had more secondary follicles than Tmco2 (P = 0.0159 and 0.0238). At 18 weeks, Tmco2 had more small antral follicles than Tmco2 (P = 0.0317). However, at 28 weeks, Tmco2 had fewer resting follicles and secondary follicles than Tmco2 (P = 0.0397 and 0.0238). (4) The AMH levels of Tmco2 female mice peaked at 18 weeks. Their average FSH level at 28 weeks was significantly higher than that of Tmco2 (P = 0.0289). CONCLUSIONS: The inheritance pattern of Tmco2 mice was sublethal. The deficiency of Tmco2 adversely affected the growth and development of female mice. Tmco2 female mice experienced decreased ovarian reserve and advancing reproductive aging. The TMCO2 mutation in humans may lead to POI.
Age at natural menopause and cognitive aging in U.S. women: Educational attainment as a modifiable resilience factor.
Guo M, Mani SS, Gross AL … +4 more , Karvonen-Gutierrez CA, Reeves A, Langa KM, Kobayashi LC
Maturitas · 2026 Apr · PMID 41722334 · Full text
OBJECTIVES: While premature menopause is associated with adverse cognitive outcomes, less is known about the impact of late menopause and whether associations vary by socioeconomic status. This study examines the associa...
OBJECTIVES: While premature menopause is associated with adverse cognitive outcomes, less is known about the impact of late menopause and whether associations vary by socioeconomic status. This study examines the association between the timing of natural menopause and cognitive decline, focusing on the modifying role of education. STUDY DESIGN: The study included 5082 U.S. women from the Health and Retirement Study who had experienced natural menopause by 2008 and were followed through 2020. Age at menopause was self-reported and categorized as <40 (premature), 40-44 (early), 45-49, 50-55, and > 55 (late). Multivariable-adjusted mixed-effects linear regression models estimated associations with baseline cognition and rate of cognitive decline, including interaction terms to assess effect modification by education. MAIN OUTCOME MEASURE: Score on a 27-point cognitive scale that includes word recalls, serial 7 s, and backward counting. RESULTS: On average, participants were aged 69.9 years and had 12.6 years of education. Compared to those with menopause at 50-55, women with menopause before age 50 had significantly lower baseline cognitive scores. Late menopause was associated with faster cognitive decline (-0.01 standard deviations/year; 95% CI -0.017, -0.002), equivalent to 0.25 years of cognitive aging annually. Each additional year of education reduced this decline by 0.004 standard deviations/year (95% CI 0.001, 0.006), equivalent to 0.1 fewer years of cognitive aging annually. CONCLUSIONS: Earlier menopause was associated with a lower level of cognitive function, and late menopause with faster cognitive decline. Higher education may buffer adverse effects of late menopause. Dementia prevention strategies may need to consider menopause timing, especially for women with lower levels of education.
Twelve-month cost analysis of a geriatrician-led falls prevention clinic in Canada.
Davis JC, Wiley E, Khan KM … +7 more , Dian L, Madden K, Tai D, Hsu CL, Seo YS, Golbidi M, Liu-Ambrose T
Maturitas · 2026 Apr · PMID 41722333 · Publisher ↗
INTRODUCTION: A geriatrician-led falls prevention clinic service (that includes the option of a physiotherapist) to prescribe and deliver exercise is an evidence-based model of care. The economic data are unknown. Theref...
INTRODUCTION: A geriatrician-led falls prevention clinic service (that includes the option of a physiotherapist) to prescribe and deliver exercise is an evidence-based model of care. The economic data are unknown. Therefore, for a 12-month period, we examined: 1) clinic demand, 2) clinic costs and 3) health resource use. METHODS: Clinic demand was quantified from a Falls Prevention Clinic Registry cohort for new and repeat visits and waitlist frequencies over 12 months. Costs of the Vancouver-based falls prevention clinic included operating and medical services plan costs. The number of falls experienced was self-reported. Health resource utilization from a healthcare system perspective was ascertained. Cost savings from falls averted over 12 months were estimated from literature and our randomized clinical trial data subset (n = 344) of falls prevention clinic users. We calculated the return on investment and benefit-cost ratio to reflect the incremental benefit of a structured home-based exercise program within the falls prevention clinic pathway. RESULTS: In 2024, annual demand for the falls prevention clinic totalled 543 visits (240 (44.2%) new baseline visits, 303 (55.8%) follow-up visits) with an average monthly waitlist of 30 individuals. Annual operating costs were ∼$317 thousand. Clinic demand costs were ∼$88 thousand (∼$51 thousand for new and ∼$37 thousand for follow-up visits). The cost of falls averted ranged from $1.5 million to $8.5 million based on a range of costs per fall of $4.2 thousand to $20 thousand. The return on investment ranged from ∼500% to 2.7 thousand %, while the benefit-cost ratio ranged from 6:1 to 28:1. DISCUSSION: The high return on investment yielded from the falls prevention clinic plus physiotherapist-delivered home-based exercise provides an economically attractive model of evidence-based care for falls prevention. TRIAL REGISTRATION: NCT01029171; NCT00323596 for the subsample.
Effect of a non-hormonal vaginal moisturizer on vaginal and vulvar health in postmenopausal women with breast cancer: A randomized clinical trial.
Martin BC, VItorino CN, Souza R … +5 more , Medolago N, Nahas GP, Carvalho-Pessoa E, Vespoli HL, Nahas EAP
Maturitas · 2026 Apr · PMID 41719902 · Publisher ↗
OBJECTIVE: To evaluate the effectiveness of non-hormonal vaginal moisturizer on vaginal and vulvar health in postmenopausal women with breast cancer. STUDY DESIGN: A randomized, open-label trial was conducted in women ag...
OBJECTIVE: To evaluate the effectiveness of non-hormonal vaginal moisturizer on vaginal and vulvar health in postmenopausal women with breast cancer. STUDY DESIGN: A randomized, open-label trial was conducted in women aged 45-65 years with breast cancer (stages I-III) who had completed oncological treatment (excluding endocrine therapy) and reported vaginal symptoms (vaginal dryness and/or dyspareunia). Participants were randomized into two groups: one group used a vaginal moisturizer (three times per week, at night, n = 50) and the other a vaginal lubricant (during sexual intercourse, n = 50). The 16-week intervention included assessments at baseline, 8, and 16 weeks. MAIN OUTCOME MEASURES: Vaginal and vulvar health were assessed using the Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), Vaginal Health Index (VHI), vaginal pH, and Vaginal Maturation Index (VMI). The primary outcome was improvement in vaginal health as measured by the VHI. RESULTS: Of the 100 randomized women, 12 discontinued the study (4 in the moisturizer group and 8 in the lubricant group). Adherence to the moisturizer was high (85.9%) and no serious adverse events were reported. At 8 and 16 weeks, the moisturizer group showed significant improvement in VAS (p = 0.014) and VuAS (p = 0.003) scores, as well as a significant increase in VHI scores, indicating improvements in elasticity, moisture, fluid volume, epithelial integrity, and pH (p < 0.0001) compared with the control group. Vaginal pH significantly decreased in the moisturizer group compared with the control group (p = 0.016). No significant between-group differences were observed in VMI scores after 16 weeks (p = 0.213). CONCLUSIONS: The non-hormonal vaginal moisturizer was effective in improving vaginal and vulvar health parameters in postmenopausal women with breast cancer compared with a vaginal lubricant. Brazilian Clinical Trials Registry (ReBEC,) number RBR-5cf7vzj.
Cardiovascular and musculoskeletal health in breast cancer survivors.
Moore HCF
Maturitas · 2026 Apr · PMID 41713085 · Publisher ↗
Most individuals diagnosed with breast cancer will experience long-term survival but often face lasting consequences of cancer and its treatment, including higher rates of heart disease and adverse musculoskeletal effect...
Most individuals diagnosed with breast cancer will experience long-term survival but often face lasting consequences of cancer and its treatment, including higher rates of heart disease and adverse musculoskeletal effects. Certain chemotherapy agents and targeted therapies are associated with cardiotoxicity. For example, anthracycline chemotherapy drugs and trastuzumab, a monoclonal antibody targeting human epidermal growth factor receptor 2, increase the risk for cardiomyopathy. The induction of early menopause as a consequence of chemotherapy or as a part of breast cancer endocrine therapy can increase risk for both cardiovascular and musculoskeletal adverse events. Use of the selective estrogen receptor modulator tamoxifen increases risk for thromboembolic events. Estrogen-lowering therapies have been associated with worsening of blood pressure, cholesterol, blood sugar control, bone density loss and arthralgias. Strategies to monitor and mitigate these concerns include assessment through history and physical examination, selective testing, addressing co-existing risk factors, enabling healthy behaviors and appropriately treating emergent conditions. Management of the cardiovascular and skeletal consequences of breast cancer treatment often involves a multidisciplinary team that may include oncology, primary care, cardiology, rheumatology, and physical medicine and rehabilitation. A variety of resources are available to help patients and clinicians optimize cardiovascular and musculoskeletal health following a diagnosis of breast cancer.
Gender differences in quality of life and contributions of biopsychosocial factors.
Trakarnwijitr I, Zhou Z, Wolfe R … +4 more , Nelson M, Russell G, Zoungas S, Moran C
Maturitas · 2026 Apr · PMID 41707301 · Publisher ↗
BACKGROUND: Health-related quality of life is central to healthy ageing, yet gender differences among older adults and their underlying determinants are not well understood. We examined gender differences in quality of l...
BACKGROUND: Health-related quality of life is central to healthy ageing, yet gender differences among older adults and their underlying determinants are not well understood. We examined gender differences in quality of life in a large cohort of older Australians and the extent to which biopsychosocial factors mediate these differences. METHODS: We analysed baseline cross-sectional data from the Statins in Reducing Events in the Elderly trial, a randomised controlled trial of community-dwelling Australians aged ≥70 years without cardiovascular disease, major physical disability, or dementia. Quality of life was measured across eight domains of the 36-Item Short Form and summarised using the SF-6D index. Gender differences were examined using age-adjusted linear regression, with mediation assessed by the percentage reduction in the association between gender and quality of life after adjusting for individual biopsychosocial factors. RESULTS: Among 9971 participants (52% women; mean age 74.7 ± 4.5 years), women scored lower than men in Physical Functioning, Vitality, Mental Health, and Bodily Pain (all p < 0.001), but higher in General Health (p < 0.001). The SF-6D index was lower in women (mean difference - 0.03, p < 0.001). Pain severity, depressive symptoms, and histories of osteoarthritis and depression mediated the greatest amount of the gender difference in scores (between 42% and 92%). CONCLUSIONS: Older women reported better general health but poorer quality of life than men in most domains. These gender differences were largely attributable to pain and depressive symptoms, both of which are common and modifiable. Targeted management of these symptoms may improve quality of life and reduce gender disparities in later life.
Time since menopause and a circulating metabolomic signature for sarcopenia risk: Data from 68,064 women from the UK Biobank.
Zhang X, Xie B, Fu C … +3 more , Wang Q, Li J, Zhu D
Maturitas · 2026 Apr · PMID 41690209 · Publisher ↗
BACKGROUND: Menopause-related metabolic alterations may increase susceptibility to sarcopenia, yet the longitudinal dimension of reproductive ageing-namely time since menopause-has not been investigated using an innovati...
BACKGROUND: Menopause-related metabolic alterations may increase susceptibility to sarcopenia, yet the longitudinal dimension of reproductive ageing-namely time since menopause-has not been investigated using an innovative metabolomic strategy that captures dynamic, multi-pathway metabolic changes and constructs a validated metabolomic signature related to time since menopause. We aimed (1) to identify a plasma metabolomic profile related to time since menopause, (2) to evaluate the independent associations of time since menopause and the metabolomic signature with sarcopenia and its components, and (3) to quantify the mediation effect exerted by this profile. METHODS: We analyzed 68,064 naturally postmenopausal women (4406 with sarcopenia) from the UK Biobank and validated findings in 5971 women with repeat assessments. Time since menopause was defined as baseline age minus age at natural menopause. Nuclear magnetic resonance spectroscopy was used to quantify 251 plasma metabolites. Elastic net regression was applied to derive a metabolomic signature related to time since menopause, which was validated by correlation analysis. Multivariable logistic regression estimated odds ratios (ORs) for sarcopenia, low strength, mass, and performance; mediation was assessed via bootstrapping. RESULTS: Eighty-six metabolites spanning lipid, amino acid, and glycolytic pathways-closely linked to energy metabolism and protein homeostasis relevant to muscle physiology-comprised the signature related to time since menopause (baseline r = 0.27, P < 0.001). Each 5-year increase in time since menopause was associated with higher odds of sarcopenia (OR 1.13, 95% CI 1.09-1.16), and each 1-SD higher signature score was independently associated with sarcopenia (1.06, 1.02-1.10). The metabolomic signature mediated 13.3% of the association between time since menopause and sarcopenia. CONCLUSIONS: A distinctive, multi-pathway metabolomic signature tracks time since menopause and partly mediates its association with sarcopenia. Reflecting coordinated dysregulation in lipid and amino acid metabolism, this signature may provide a molecular link between reproductive ageing and postmenopausal muscle decline and has potential utility as a non-invasive biomarker for early risk stratification.
Trajectories of physical performance and associated factors in community-dwelling older adults.
Mucenecki LR, Machado KP, Barbosa-Silva TG … +6 more , Bertoldi AD, Tomasi E, Demarco FF, Gonzalez MC, Xavier MO, Bielemann RM
Maturitas · 2026 Apr · PMID 41690208 · Publisher ↗
OBJECTIVES: To investigate 10-year trajectories of physical performance and identify associated socioeconomic, demographic, health-related, and behavioral factors among community-dwelling older adults. STUDY DESIGN: Long...
OBJECTIVES: To investigate 10-year trajectories of physical performance and identify associated socioeconomic, demographic, health-related, and behavioral factors among community-dwelling older adults. STUDY DESIGN: Longitudinal cohort using data from three waves (2014, 2019, and 2024) of a population-based study of adults aged ≥60 in southern Brazil. MAIN OUTCOME MEASURES: Physical performance was assessed using gait speed (GS, m/s) and the Timed Up and Go test (TUG, seconds). Trajectories were modeled using a group-based semiparametric approach. Associations with socioeconomic, demographic, health-related, and behavioral factors were examined using multinomial and binomial logistic regression. RESULTS: 746 participants had their physical performance trajectories over 10 years modeled. Three GS trajectories (lower, 27.4%; intermediate, 60.8%; higher, 11.8%) and two TUG trajectories (gradual increase, 83.0%; rapid increase, 17.0%) were identified. Poorer physical performance trajectories were associated with sex, age, schooling, economic level, functional capacity, polypharmacy, low muscle strength, and self-rated health. The highest relative risk (RR) and odds ratio (OR) of being classified in the poorest GS and TUG trajectories were observed among women (RR 10.01, 95%CI 5.22-19.17; OR 2.26, 95%CI 1.40-3.63), individuals with <8 years of schooling/no schooling (RR 6.82, 95%CI 3.24-14.38; OR 2.80, 95%CI 1.69-4.64), and those with low muscle strength (RR 7.60, 95%CI 1.95-29.65; OR 2.70, 95%CI 1.46-4.97). Conversely, being physically active was associated with a lower risk of belonging to the poorest GS trajectory (RR 0.36, 95%CI 0.18-0.74). CONCLUSIONS: All trajectories demonstrated a decline in physical performance over time. The poorest trajectories were associated with socioeconomic, demographic, health-related, and behavioral factors, indicating that decline in physical performance is not solely attributable to chronological aging.
Effects of resistance training on postmenopausal women's muscle strength, muscle volume and muscle fat infiltration: A secondary analysis of a randomised controlled trial.
Thorell S, West J, Lindblom H … +3 more , Hammar M, Borga M, Spetz Holm AC
Maturitas · 2026 Apr · PMID 41687563 · Publisher ↗
OBJECTIVES: To investigate changes in muscle volume and muscular fat infiltration in postmenopausal women after 15 weeks of resistance training compared with a control group with an unchanged low level of physical activi...
OBJECTIVES: To investigate changes in muscle volume and muscular fat infiltration in postmenopausal women after 15 weeks of resistance training compared with a control group with an unchanged low level of physical activity. We also assessed whether the intervention group increased their muscle strength. STUDY DESIGN: This study was a secondary analysis of a randomised controlled trial on the effects of resistance training in postmenopausal women. Women with hot flushes (n = 65) were randomised to supervised resistance training three times per week for 15 weeks or to a control group. MAIN OUTCOME MEASURES: Muscle strength in the intervention group was measured with 8-repetition maximum tests. At baseline and after 15 weeks, 44 subjects were scanned with a 3.0 T magnetic resonance scanner using a whole-body Dixon protocol. A semi-automated method was used for calculation of muscle volume and muscle fat infiltration. RESULTS: Significant between-groups differences were seen in change of muscle volume (p < 0.001-0.015) between the intervention and control group from baseline to 15 weeks. Muscle volume increased by about 4 % (p < 0.001) for all muscles in the intervention group, whereas no change was seen in the control group. Muscle strength increased significantly in the intervention group for all tested muscles. Muscle fat infiltration did not change. CONCLUSION: Postmenopausal women with hot flushes and a low level of physical activity could, in just 15 weeks, increase their muscle volume and strength through resistance training. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01987778.
Comment on "Endometriosis and menopausal health: An EMAS clinical guide".
Akcaoglu T
Maturitas · 2026 Apr · PMID 41687562 · Publisher ↗
Abstract loading — click title to view on PubMed.
Randomization to hormone therapy and changes in plasma biomarkers of Alzheimer's pathology: The women's health initiative memory study.
Shadyab AH, Zhang B, LaCroix AZ … +1 more , McEvoy LK
Maturitas · 2026 Apr · PMID 41678876 · Full text
The association of hormone therapy with Alzheimer's pathology among postmenopausal women is not well understood. We examined the association of randomized assignment to hormone therapy with changes in plasma biomarkers o...
The association of hormone therapy with Alzheimer's pathology among postmenopausal women is not well understood. We examined the association of randomized assignment to hormone therapy with changes in plasma biomarkers of Alzheimer's pathology in the Women's Health Initiative Memory Study. Rates of change in the biomarkers (p-tau217, p-tau181, Aβ42:Aβ40, GFAP, and NfL) over an average 15-year follow-up did not significantly differ for estrogen alone vs placebo or estrogen plus progestin vs placebo. These null associations do not support either a protective or a detrimental association of hormone therapy of the types tested in the Women's Health Initiative with long-term changes in plasma Alzheimer's biomarkers. CLINICALTRIALS.GOV: NCT00685009.
Exploring the influence of adenomyosis on endometrial cancer.
Matot R, Englander D, Sela Y … +6 more , Bor N, Geron Y, Zeevi G, Yeoshoua E, Raban O, Eitan R
Maturitas · 2026 Apr · PMID 41671920 · Publisher ↗
OBJECTIVES: To evaluate whether coexisting adenomyosis is associated with distinct clinicopathological features in women with endometrial cancer. STUDY DESIGN: This retrospective cohort included 399 women who had undergo...
OBJECTIVES: To evaluate whether coexisting adenomyosis is associated with distinct clinicopathological features in women with endometrial cancer. STUDY DESIGN: This retrospective cohort included 399 women who had undergone hysterectomy for histologically confirmed endometrial carcinoma at a tertiary center between 2016 and 2024. Patients were stratified according to the presence or absence of adenomyosis on final pathology. Clinical and pathological characteristics were compared, and multivariable logistic regression was used to adjust for potential confounders. MAIN OUTCOME MEASURES: Associations between adenomyosis and tumor invasiveness, stage at diagnosis, and other pathological features. RESULTS: The cohort consisted predominantly of postmenopausal women, with a median age of 67 years. Adenomyosis was identified in 94 patients (23.6%). Women with adenomyosis were more likely to have non-invasive tumors (1.1% vs. 6.8%; p = 0.037) and early-stage disease (Stage I-II: 91.3% vs. 80.8%; p = 0.029). After adjustment for age, adenomyosis was associated with lower odds of advanced-stage disease (adjusted odds ratio 0.40; 95% confidence interval 0.17-0.91). In a comprehensive model including age, histologic subtype, and peritoneal cytology, this association remained significant (adjusted odds ratio 0.20; 95% confidence interval 0.05-0.78). Endometrioid histology was independently protective (adjusted odds ratio 0.32; 95% confidence interval 0.13-0.75), while positive cytology was linked to advanced-stage disease (adjusted odds ratio 4.40; 95% confidence interval 1.86-10.40). CONCLUSIONS: Coexisting adenomyosis is associated with less invasive tumors and a lower likelihood of advanced-stage endometrial cancer. These findings suggest adenomyosis may influence tumor progression, potentially through structural or biological mechanisms. Prospective studies are needed to clarify the underlying biology and long-term prognostic impact. TRIAL REGISTRATION: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rabin Medical Center (Date 3 July 2025 /No RMC- 0037-25).
Association between intrinsic capacity and urinary incontinence in community-dwelling octogenarians: Results from the ilSIRENTE study.
Cacciatore S, Schlögl M, Calvani R … +5 more , Russo A, Tosato M, Wagg A, Marzetti E, Landi F
Maturitas · 2026 Apr · PMID 41671919 · Publisher ↗
BACKGROUND: Urinary incontinence (UI) is common in older adults. The construct of intrinsic capacity (IC) provides a multidimensional framework to assess functional reserves. This cross-sectional study examined the assoc...
BACKGROUND: Urinary incontinence (UI) is common in older adults. The construct of intrinsic capacity (IC) provides a multidimensional framework to assess functional reserves. This cross-sectional study examined the association between IC and UI in community-dwelling octogenarians from the Ageing and Longevity in the Sirente (ilSIRENTE) study. METHODS: IC was computed as the mean of standardized (0-100) scores across five domains (locomotion, cognition, vitality, psychological well-being, and sensory function) derived from Minimum Data Set for Home Care (MDS-HC) instruments and supplementary tests. UI was defined as a score of 3 or more on MDS-HC item I1. Associations between IC and UI were examined using logistic regression models adjusted for sociodemographic and clinical covariates. Restricted cubic splines tested linearity. RESULTS: Among 320 participants (median age 83.9 years [81.7-88.5]; 67.2% women), 35 (10.9%) had UI. Incontinent individuals had a lower total IC score (60.2 [51.5-69.7] vs. 85.2 [76.1-92.7]; p < 0.001) and lower scores in the locomotion, cognition, vitality, psychological well-being, and sensory domains. In fully adjusted models, higher IC score was associated with lower odds of UI (per 10-point increase: OR 0.34, 95% CI 0.24-0.48). High IC score was associated with markedly lower odds of UI compared with low IC score (OR 0.07, 95% CI 0.02-0.20). Restricted cubic spline analyses supported linearity (p for non-linearity = 0.701). CONCLUSIONS: Lower IC scores were associated with higher odds of UI, particularly in locomotion, cognition, vitality, and sensory domains. These findings support UI as a marker of multidimensional vulnerability and highlight the value of IC-oriented assessment to guide multidomain interventions in geriatric care.
Functional testosterone deficiency in aging men: Clinical impact, diagnostic pathways, and treatment strategies.
Zitzmann M, Soave A, Bier S
Maturitas · 2026 Apr · PMID 41655564 · Publisher ↗
BACKGROUND: Testosterone constitutes an indispensable determinant of male corporeal integrity, psychological resilience, and overall vitality across the life course. Testosterone deficiency (male hypogonadism) represents...
BACKGROUND: Testosterone constitutes an indispensable determinant of male corporeal integrity, psychological resilience, and overall vitality across the life course. Testosterone deficiency (male hypogonadism) represents an endocrine disorder capable of engendering a broad spectrum of somatic derangements and psychosocial sequelae. Its origins may lie in testicular insufficiency, hypothalamic-pituitary dysfunction, or, more subtly, in functional hypogonadism arising from comorbid states such as obesity and type 2 diabetes mellitus. METHODS: This review distills contemporary evidence on the pathophysiology, clinical expression, diagnostic algorithms, and therapeutic armamentarium of male hypogonadism, with particular attention to functional hypogonadism and its repercussions for quality of life. Data from recent randomized trials and large-scale observational studies delineate both the efficacy and the safety of therapeutic strategies. RESULTS: Hypogonadism-whether primary, secondary, or functional - commonly manifests through disturbances of mood and cognition (including depression, fatigue, and mental decline), sexual dysfunction (diminished libido and impaired erectile capacity), disproportionate visceral adiposity, sarcopenia, osteopenia or osteoporosis, and anemia. These cumulative impairments markedly degrade quality of life. Crucially, aging per se does not precipitate hypogonadism; rather, age-associated comorbidities catalyze the emergence of functional hypogonadism. Epidemiological data corroborate a bidirectional nexus between functional hypogonadism and the metabolic syndrome, both being harbingers of increased cardiovascular mortality. Guideline-directed testosterone therapy, when judiciously prescribed, can reverse many of these perturbations-ameliorating sexual function, mood, vitality, muscle mass, bone density, and anemia-while simultaneously mitigating metabolic derangement. CONCLUSIONS: Converging evidence, including from recent large-scale randomized controlled trials, demonstrates that modern testosterone therapy does not augment cardiovascular risk or mortality. On the contrary, it confers tangible metabolic and quality-of-life advantages, even in advanced age, provided coexistent conditions are addressed concomitantly. Optimal outcomes hinge upon meticulous patient selection, exclusion of contraindications (e.g., active prostate carcinoma or current fertility intention), and vigilant monitoring of prostate health and hematocrit. When applied with discernment, testosterone therapy offers a safe and efficacious means of restoring androgen sufficiency, thereby enhancing male health and well-being in its fullest sense.
Dietary intake of live microbes is inversely associated with fatigue and modified by serum folate among adults aged 40 years or more.
Bigman G, Kleckner AS, Li Y … +3 more , Dennis EA, Ryan AS, Sorkin JD
Maturitas · 2026 Apr · PMID 41653707 · Full text
OBJECTIVES: To investigate the independent associations between dietary live-microbe intake, as well as circulating levels of folate metabolites, and fatigue, and to examine their interaction as a potential biological pa...
OBJECTIVES: To investigate the independent associations between dietary live-microbe intake, as well as circulating levels of folate metabolites, and fatigue, and to examine their interaction as a potential biological pathway underlying fatigue in aging adults. STUDY DESIGN: Cross-sectional analysis of adults aged ≥40 years participating in the National Health and Nutrition Examination Survey 2011-2023. MAIN OUTCOME MEASURES: Fatigue was assessed using the Patient Health Questionnaire fatigue item and categorized as none/low versus moderate/severe. Dietary intake of live-microbe foods was derived from two 24-h recalls and classified as low, medium, or high. Total serum concentrations folate and its metabolites, including 5-methyltetrahydrofolate, were quantified. Survey-weighted logistic regression, adjusted for sociodemographic, dietary, and clinical covariates, estimated main effects and interactions between the effects of 5-methyltetrahydrofolate and of live-microbe intake; sensitivity analyses additionally adjusted for depressive symptoms and sleep disturbance. RESULTS: Moderate/severe fatigue was reported by 16.3% of 14,376 participants and 15.0% reported no intake of live-microbe foods. High versus low live-microbe intake was associated with lower odds of moderate/severe fatigue (odds ratio [OR] 0.60; 95% confidence interval [CI] 0.46-0.79). Higher serum 5-methyltetrahydrofolate levels were also associated with lower odds of moderate/severe fatigue (OR 0.85; 95% CI 0.73-0.98). In stratified analyses, high live-microbe intake corresponded to 38-65% lower odds of moderate/severe fatigue only among adults with higher levels of 5-methyltetrahydrofolate, with no significant associations among those with lower levels. CONCLUSIONS: Intake of microbe-rich foods and higher levels of circulating 5-methyltetrahydrofolate are both associated with lower levels of fatigue in midlife and older adults, and folate sufficiency appears to potentiate the fatigue-reducing benefits of live-microbe foods, supporting a nutrient-microbe pathway relevant to healthy aging.
Authors' reply to Tugba Akcaoglu.
Erel T, Rees M, Lambrinoudaki I
Maturitas · 2026 Apr · PMID 41653706 · Publisher ↗
Abstract loading — click title to view on PubMed.
Breast cancer genetics and risk assessment 101: What women's health care providers need to know.
Ruddy BE, Persons PA, Dacek ER
Maturitas · 2026 Apr · PMID 41653705 · Publisher ↗
Breast cancer affects the lives of many women and their loved ones. Women's health practitioners have an important role in identifying women at increased risk for breast cancer and guiding them toward appropriate counsel...
Breast cancer affects the lives of many women and their loved ones. Women's health practitioners have an important role in identifying women at increased risk for breast cancer and guiding them toward appropriate counseling, imaging surveillance, and preventive care. Familial cancer syndromes account for a substantial proportion of breast cancer diagnoses. When family history or other clinical features suggest a hereditary predisposition, practitioners should consider recommending genetic testing and genetic counseling to help mitigate risk. The U.S. National Comprehensive Cancer Network offers evidence-based guidelines for identifying candidates for genetic testing and provides tools for surveillance and screening. Genetic counselors can help patients select appropriate tests and interpret results, facilitating informed decision-making. Additional risk factors for breast cancer include increasing age, lifestyle factors, prolonged exposure to endogenous or exogenous hormones, prior radiotherapy, high breast-tissue density, and a personal history of high-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ. Several validated risk-assessment tools for breast cancer are available for clinical use and incorporate patient-specific data to guide management. For individuals at increased risk of developing breast cancer, preventive and risk-reducing strategies include early-detection enhanced surveillance protocols, risk-reducing surgery, pharmacologic interventions, and lifestyle modifications.
Associations between BMI and menopausal symptoms among Danish nurses: A cross-sectional study.
Polano L, Thinggaard TW, Simonsen MK … +2 more , van Wijhe M, Vámosi M
Maturitas · 2026 Apr · PMID 41653704 · Publisher ↗
OBJECTIVE: To examine the association between body mass index and the severity of menopausal symptoms among Danish nurses. STUDY DESIGN: Cross-sectional analysis of the 2024 wave of the Danish Nurse Cohort. MAIN OUTCOME...
OBJECTIVE: To examine the association between body mass index and the severity of menopausal symptoms among Danish nurses. STUDY DESIGN: Cross-sectional analysis of the 2024 wave of the Danish Nurse Cohort. MAIN OUTCOME MEASURES: Total score on the Menopause Rating Scale dichotomized as no-to-mild (<9) versus moderate-to-severe (≥9), with domain cut-offs applied for somatic, psychological, and urogenital symptoms. Multiple logistic regression models were applied, adjusted for age, smoking, alcohol, physical activity, diet, cohabitation, and age at last menstrual period. RESULTS: Of 6078 women (mean age 63.5 (standard deviation 9.3) years), 55.8% reported moderate-to-severe symptoms. Each 5-unit increase in body mass index was associated with higher odds of moderate-to-severe symptoms (odds ratio 1.13, 95% confidence interval 1.06-1.20). Domain analyses showed associations for psychological (odds ratio 1.15, 95% confidence interval 1.08-1.23) and somato-vegetative (odds ratio 1.15, 95% confidence interval 1.08-1.22) domains, but not urogenital (odds ratio 0.96, 95% confidence interval 0.91-1.03). Participants with a body mass index of less than 18.5 kg/m had lower associated odds (odds ratio 0.53, 95% confidence interval 0.34-0.83) and participants with a body mass index of 30 kg/m or more had higher odds (odds ratio 1.24, 95% confidence interval 1.05-1.46) than women with an eutrophic body mass index. CONCLUSIONS: In a large national representative cohort of Danish nurses, higher body mass index was significantly associated with greater severity of menopausal symptoms, particularly psychological and somato-vegetative. These findings highlight the importance of considering weight-related factors when addressing midlife women's health and menopause care.
Evaluating the predictive validity of SARC-F cut-off scores for low muscle strength among older adults in a low-income community.
de Lima AB, Merchant RA, Faber MA … +1 more , Henriques-Neto D
Maturitas · 2026 Apr · PMID 41650663 · Publisher ↗
BACKGROUND: With an aging population, muscle health, encompassing locomotion and metabolic function, has become a public health priority. Handgrip strength is a validated surrogate measure of general muscle strength, but...
BACKGROUND: With an aging population, muscle health, encompassing locomotion and metabolic function, has become a public health priority. Handgrip strength is a validated surrogate measure of general muscle strength, but measurement may not be feasible in low-resource settings. The SARC-F questionnaire (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) provides a simple, low-cost, and practical tool for sarcopenia screening, though its optimal cut-off remains debated. OBJECTIVE: To evaluate the predictive validity of SARC-F cut-off scores in identifying low muscle strength among community-dwelling older adults in a low-income population. METHODS: We included 733 participants (221 men, 512 women; aged 60-95 years) from the Amazonas region of Brazil. All completed the SARC-F and underwent handgrip strength testing. Low handgrip strength was based on EWGSOP2 criteria (<27 kg men, <16 kg women). Agreement, sensitivity, specificity, predictive values, and ROC curves were calculated for cut-offs ≥4 and ≥ 2, stratified by sex. RESULTS: Low handgrip strength was highly prevalent (47.1% in men, 94.1% in women). Agreement between SARC-F and muscle weakness was generally poor (κ <0.4), except for men at the ≥4 threshold (κ = 0.41). Sensitivity was higher in men than in women (≥4: 48% vs 37%; ≥2: 70% vs 69%). Lowering the cut-off to ≥2 improved sensitivity but reduced specificity (65.8% men, 56.7% women). ROC analysis identified ≥2 as the optimal threshold, with AUC 0.68 in men and 0.63 in women. CONCLUSION: A SARC-F cut-off of ≥2 improves sensitivity for detecting probable sarcopenia and may be more suitable for screening in low-income settings. Longitudinal validation is warranted across diverse populations.
Advanced paternal age at birth and risk of cyanotic congenital heart defects in the United States.
Sang J, Ebong IA, Appiah D
Maturitas · 2026 Apr · PMID 41643280 · Publisher ↗
INTRODUCTION: Limited inconsistent evidence suggests a potential association between advanced paternal age (APA) and simple congenital heart defects, which often resolve without surgical interventions, in offspring. Ther...
INTRODUCTION: Limited inconsistent evidence suggests a potential association between advanced paternal age (APA) and simple congenital heart defects, which often resolve without surgical interventions, in offspring. There is no reported potential relationship between APA with major cardiac defects like cyanotic congenital heart defects (CCHD). This study evaluated the association between APA (age at birth ≥40 years) and the occurrence of CCHD among livebirths in the USA, accounting for maternal and other potential confounding factors. METHODS: Data were from the National Vital Statistics System, comprising 9.9 million singleton first-time livebirths among mothers and fathers aged ≥15 years from 2016 to 2023. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: From 2016 to 2023, the proportion of births to fathers with APA increased from 7.5% to 7.9%. A greater proportion of fathers with APA had offspring with CCHD (62.0 vs. 53.1 per 100,000), used infertility treatment (9.5% vs. 2.3%), and their partners were also older (34.6 vs. 27.0 years). In models adjusted for paternal factors (age, race and ethnicity, and education), APA was associated with a modest elevated odds for CCHD (OR = 1.22, 95% CI 1.11-1.34) which remained significant after further control for maternal pre-pregnancy sociodemographic and health factors (OR = 1.12, 95% CI 1.01-1.25). However, additional adjustments for infertility treatment attenuated the observed association (OR = 1.08, 95% CI 0.98-1.20). CONCLUSIONS: The findings of this large population-based study suggest no association between APA and CCHD after accounting for important confounders, including maternal factors and infertility treatment.
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