Antonio Aversa | Università degli Studi "La Sapienza" di Roma (original) (raw)
Papers by Antonio Aversa
Background: Cross-sex hormone treatment in male-to-female (M2F) transsexuals appears reasonably s... more Background: Cross-sex hormone treatment in male-to-female (M2F) transsexuals appears reasonably safe. Little is known about its long-term use. The aim of our study was to evaluate the effect of long-term high dose estrogens, plus the antiandrogen cyproterone acetate, on bone composition and on biochemical/hormonal parameters in M2F transsexuals.
Methods: A retrospective analysis was performed on 45 young M2Fs (mean age 39.5 years; body mass index (BMI) = 22) receiving estrogens (previously 100 mg ethinyl estradiol, now 2–4 mg oral estradiol valerate/day or 100 mg transdermal estradiol/day) plus the antiandrogen cyproterone acetate 100 mg/day. Data were retrieved from 20 subjects after reassignment surgery (mean hormonal treatment duration
15.6 years). A complete hormonal and biochemical assessment, as well as bone biochemical markers (parathyroid hormone (PTH), calcium, phosphorus, alkaline phosphatase and plasma pyridinoline crosslinks), were evaluated. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry
(DEXA).
Results: All subjects had suppressed serum testosterone levels (mean = 0.57 nmol/l), whereas serum estradiol levels were within the supraphysiological range (mean = 880 pmol/l). A mild osteopenia at both lumbar spine and femoral neck was observed in 15 out of the 20 (75%) M2Fs (BMD = 0.89 0.14
(mean standard deviation (SD)) g/cm2 versus 1.1 0.09, p < 0.001; lumbar T-score = 1.39 0.84 versus 0.5 1.10, p < 0.0005; femoral T-score = 1.12 0.76 versus 0.08 1.00, p < 0.05, respectively). No differences in plasma crosslink levels or in hormonal and biochemical parameters were found
between subjects.
Conclusions: Our results indicate that cross-sex hormone treatment of M2Fs, independently of serum testosterone levels, seems acceptably safe over a median treatment period of 15 years in a consistent population of subjects. A protective role for estrogens on bone seems to be present in a minority of
subjects.
Objective: Erectile dysfunction (ED) is often associated with a cluster of risk factors for coron... more Objective: Erectile dysfunction (ED) is often associated with a cluster of risk factors for coronary artery disease and
reduced endothelial function. Acute and chronic administration of oral sildenafil, a phosphodiesterase type 5 (PDE5)
inhibitor, improves endothelial function in patients with ED. Tadalafil (TAD) is a new PDE5 inhibitor with a long
half life that allows alternate day administration. Aim of the study was to evaluate whether chronic therapy (4 weeks)
with TAD improves endothelial function in patients with increased cardiovascular risk and whether this effect is
sustained after discontinuation of therapy.
Methods: We randomized 32 patients with increased cardiovascular risk to receive either TAD 20 mg on alternate
days or matching placebo (PLB) for 4 weeks. Patients underwent evaluation of brachial artery flow-mediated
dilation (FMD), nitrite/nitrate and endothelin-1 plasma levels at baseline, at the end of treatment period and after
two-weeks follow-up.
Results: At 4 weeks, FMD was significantly improved by TAD (from 4.2 3.2 to 9.3 3.7%, p < 0.01 vs.
baseline), but was not modified by PLB (from 4.1 2.8 to 4.0 3.4%, p = NS). At 6 weeks the benefit in FMD was
sustained in patients that received TAD (9.1 3.9% vs. 4.2 3.2%, p = 0.01 vs. baseline; 9.1 3.9% vs.
9.3 3.7%, vs. 4 weeks, p = NS) while no changes in FMD were observed in patients randomized to PLB. Also,
compared to baseline, a net increase in nitrite/nitrate levels (38.2 12.3 vs. 52.6 11.7 and 51.1 3.1, p < 0.05)
and a decrease in endothelin-1 levels (3.3 0.9 vs. 2.9. 0.7 and 2.9 0.9, p < 0.05) was found both at four and
six-weeks after TAD; these changes were inversely correlated as shown by regression analysis (adjusted R2 = 0.81,
p < 0.0001).
Conclusions: Chronic therapy with TAD improves endothelial function in patients with increased cardiovascular
risk regardless their degree of ED. The benefit of this therapy is sustained for at least two weeks after the
discontinuation of therapy. Larger studies are needed in order to assess the possible clinical implications of chronic
therapy with TAD.
![Research paper thumbnail of Corrigendum to “Hormonal supplementation and erectile dysfunction”[Eur Urol 2004; 45: 535–8]](https://attachments.academia-assets.com/46240733/thumbnails/1.jpg)
](![Research paper thumbnail of Corrigendum to “Hormonal supplementation and erectile dysfunction” [Eur Urol 2004;45:535–8]](https://attachments.academia-assets.com/46240726/thumbnails/1.jpg)
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European journal of endocrinology / European Federation of Endocrine Societies, 2015
Diabetes mellitus (DM) is associated with endothelial dysfunction, reducing nitric oxide-dependen... more Diabetes mellitus (DM) is associated with endothelial dysfunction, reducing nitric oxide-dependent vasodilation, and increasing production of pro-inflammatory factors, leading to an increased risk of long-term cardiovascular disease. As the effects of phosphodiesterase 5 inhibitors (PDE5i) on endothelial function have not been systematically investigated, we conducted a meta-analysis of available randomized clinical trials (RCTs). A thorough search of the literature was carried out. Relevant studies were considered according to RCT study design, enrollment of men with type 2 DM, chronic administration of PDE5i, and evaluation of endothelial function through both hemodynamic and endothelial inflammation-related parameters. Fifteen studies fulfilled the eligibility criteria but only six RCTs met the inclusion criteria and were analyzed for 476 diabetic men, 239 randomized to Sildenafil, and 237 to placebo respectively. Four RCTs evaluated flow-mediated dilation (FMD), demonstrating a ...
International journal of andrology, 2002
Penile pharmacotesting (PPT) with alprostadil (PGE1) represents the most common diagnostic approa... more Penile pharmacotesting (PPT) with alprostadil (PGE1) represents the most common diagnostic approach to male erectile dysfunction (ED). A positive response - i.e. normal erectile rigidity of sustained duration - is presumed to exclude venous or arterial pathology with enough accuracy. To test this assumption we compared PPT vs. flowmetric results obtained by colour-duplex Doppler ultrasound (CDDU) in patients (pts) undergoing diagnostic evaluation for ED under conditions of maximal cavernous relaxation. A total of 195 non-consecutive impotent pts were diagnosed after dynamic CDDU as non-vasculogenic (NOR), or having arteriogenic (AR), veno-occlusive (VO) or mixed (MX) ED. Maximal erection obtained after PPT was scored as: type-1 (full tumescence - no sustained rigidity, angle on the abdominal plane >90 degrees), type-2 (sustained partial erection, valid for intromission, angle=90 degrees) and type-3 (sustained full erection, angle <90 degrees). Comparing PPT with flowmetric res...
Page 1. Vol. 13 N. S2 Giugno 2006 Direttori Scientifici / Editors in Chief Edoardo S. Pescato... more Page 1. Vol. 13 N. S2 Giugno 2006 Direttori Scientifici / Editors in Chief Edoardo S. Pescatori (Modena), Paolo Turchi (Prato) Direttore Responsabile / Managing Editor Vincenzo Gentile (Roma) Board Editoriale / Editorial Board ...
Background: Cross-sex hormone treatment in male-to-female (M2F) transsexuals appears reasonably s... more Background: Cross-sex hormone treatment in male-to-female (M2F) transsexuals appears reasonably safe. Little is known about its long-term use. The aim of our study was to evaluate the effect of long-term high dose estrogens, plus the antiandrogen cyproterone acetate, on bone composition and on biochemical/hormonal parameters in M2F transsexuals.
Methods: A retrospective analysis was performed on 45 young M2Fs (mean age 39.5 years; body mass index (BMI) = 22) receiving estrogens (previously 100 mg ethinyl estradiol, now 2–4 mg oral estradiol valerate/day or 100 mg transdermal estradiol/day) plus the antiandrogen cyproterone acetate 100 mg/day. Data were retrieved from 20 subjects after reassignment surgery (mean hormonal treatment duration
15.6 years). A complete hormonal and biochemical assessment, as well as bone biochemical markers (parathyroid hormone (PTH), calcium, phosphorus, alkaline phosphatase and plasma pyridinoline crosslinks), were evaluated. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry
(DEXA).
Results: All subjects had suppressed serum testosterone levels (mean = 0.57 nmol/l), whereas serum estradiol levels were within the supraphysiological range (mean = 880 pmol/l). A mild osteopenia at both lumbar spine and femoral neck was observed in 15 out of the 20 (75%) M2Fs (BMD = 0.89 0.14
(mean standard deviation (SD)) g/cm2 versus 1.1 0.09, p < 0.001; lumbar T-score = 1.39 0.84 versus 0.5 1.10, p < 0.0005; femoral T-score = 1.12 0.76 versus 0.08 1.00, p < 0.05, respectively). No differences in plasma crosslink levels or in hormonal and biochemical parameters were found
between subjects.
Conclusions: Our results indicate that cross-sex hormone treatment of M2Fs, independently of serum testosterone levels, seems acceptably safe over a median treatment period of 15 years in a consistent population of subjects. A protective role for estrogens on bone seems to be present in a minority of
subjects.
Objective: Erectile dysfunction (ED) is often associated with a cluster of risk factors for coron... more Objective: Erectile dysfunction (ED) is often associated with a cluster of risk factors for coronary artery disease and
reduced endothelial function. Acute and chronic administration of oral sildenafil, a phosphodiesterase type 5 (PDE5)
inhibitor, improves endothelial function in patients with ED. Tadalafil (TAD) is a new PDE5 inhibitor with a long
half life that allows alternate day administration. Aim of the study was to evaluate whether chronic therapy (4 weeks)
with TAD improves endothelial function in patients with increased cardiovascular risk and whether this effect is
sustained after discontinuation of therapy.
Methods: We randomized 32 patients with increased cardiovascular risk to receive either TAD 20 mg on alternate
days or matching placebo (PLB) for 4 weeks. Patients underwent evaluation of brachial artery flow-mediated
dilation (FMD), nitrite/nitrate and endothelin-1 plasma levels at baseline, at the end of treatment period and after
two-weeks follow-up.
Results: At 4 weeks, FMD was significantly improved by TAD (from 4.2 3.2 to 9.3 3.7%, p < 0.01 vs.
baseline), but was not modified by PLB (from 4.1 2.8 to 4.0 3.4%, p = NS). At 6 weeks the benefit in FMD was
sustained in patients that received TAD (9.1 3.9% vs. 4.2 3.2%, p = 0.01 vs. baseline; 9.1 3.9% vs.
9.3 3.7%, vs. 4 weeks, p = NS) while no changes in FMD were observed in patients randomized to PLB. Also,
compared to baseline, a net increase in nitrite/nitrate levels (38.2 12.3 vs. 52.6 11.7 and 51.1 3.1, p < 0.05)
and a decrease in endothelin-1 levels (3.3 0.9 vs. 2.9. 0.7 and 2.9 0.9, p < 0.05) was found both at four and
six-weeks after TAD; these changes were inversely correlated as shown by regression analysis (adjusted R2 = 0.81,
p < 0.0001).
Conclusions: Chronic therapy with TAD improves endothelial function in patients with increased cardiovascular
risk regardless their degree of ED. The benefit of this therapy is sustained for at least two weeks after the
discontinuation of therapy. Larger studies are needed in order to assess the possible clinical implications of chronic
therapy with TAD.
European journal of endocrinology / European Federation of Endocrine Societies, 2015
Diabetes mellitus (DM) is associated with endothelial dysfunction, reducing nitric oxide-dependen... more Diabetes mellitus (DM) is associated with endothelial dysfunction, reducing nitric oxide-dependent vasodilation, and increasing production of pro-inflammatory factors, leading to an increased risk of long-term cardiovascular disease. As the effects of phosphodiesterase 5 inhibitors (PDE5i) on endothelial function have not been systematically investigated, we conducted a meta-analysis of available randomized clinical trials (RCTs). A thorough search of the literature was carried out. Relevant studies were considered according to RCT study design, enrollment of men with type 2 DM, chronic administration of PDE5i, and evaluation of endothelial function through both hemodynamic and endothelial inflammation-related parameters. Fifteen studies fulfilled the eligibility criteria but only six RCTs met the inclusion criteria and were analyzed for 476 diabetic men, 239 randomized to Sildenafil, and 237 to placebo respectively. Four RCTs evaluated flow-mediated dilation (FMD), demonstrating a ...
International journal of andrology, 2002
Penile pharmacotesting (PPT) with alprostadil (PGE1) represents the most common diagnostic approa... more Penile pharmacotesting (PPT) with alprostadil (PGE1) represents the most common diagnostic approach to male erectile dysfunction (ED). A positive response - i.e. normal erectile rigidity of sustained duration - is presumed to exclude venous or arterial pathology with enough accuracy. To test this assumption we compared PPT vs. flowmetric results obtained by colour-duplex Doppler ultrasound (CDDU) in patients (pts) undergoing diagnostic evaluation for ED under conditions of maximal cavernous relaxation. A total of 195 non-consecutive impotent pts were diagnosed after dynamic CDDU as non-vasculogenic (NOR), or having arteriogenic (AR), veno-occlusive (VO) or mixed (MX) ED. Maximal erection obtained after PPT was scored as: type-1 (full tumescence - no sustained rigidity, angle on the abdominal plane >90 degrees), type-2 (sustained partial erection, valid for intromission, angle=90 degrees) and type-3 (sustained full erection, angle <90 degrees). Comparing PPT with flowmetric res...
Page 1. Vol. 13 N. S2 Giugno 2006 Direttori Scientifici / Editors in Chief Edoardo S. Pescato... more Page 1. Vol. 13 N. S2 Giugno 2006 Direttori Scientifici / Editors in Chief Edoardo S. Pescatori (Modena), Paolo Turchi (Prato) Direttore Responsabile / Managing Editor Vincenzo Gentile (Roma) Board Editoriale / Editorial Board ...