David J Handelsman

University of Sydney, Sydney, New South Wales, Australia

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Publications (513)2502.72 Total impact

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    [Show abstract] [Hide abstract] ABSTRACT: Research into gene expression enables scientists to decipher the complex regulatory networks that control fundamental biological processes. Quantitative real-time PCR (qPCR) is a powerful and ubiquitous method for interrogation of gene expression. Accurate quantification is essential for correct interpretation of qPCR data. However, conventional relative and absolute quantification methodologies often give erroneous results or are laborious to perform. To overcome these failings, we developed an accurate, simple to use, universal calibrator, AccuCal. Herein, we show that AccuCal quantification can be used with either dye- or probe-based detection methods and is accurate over a dynamic range of ≥10 5 copies, for amplicons up to 500 base pairs (bp). By providing absolute quantification of all genes of interest, AccuCal exposes, and circumvents, the well-known biases of qPCR, thus allowing objective experimental conclusions to be drawn. We propose that AccuCal supersedes the traditional quantification methods of PCR.
    Preview · Article · Dec 2016 · BMC Biotechnology
  • [Show abstract] [Hide abstract] ABSTRACT: Background & aims: Circulating testosterone is usually reduced in men with cirrhosis but there has not been a comprehensive analysis of androgen status or circulating estrogens. Little is known about associations between circulating sex steroids with aspects of health in this population. Methods: We report data from men with cirrhosis and low serum testosterone (<12nmol/L or calculated free testosterone <230pmol/L). Comprehensive circulating sex steroid profiles were measured by liquid chromatography-mass spectrometry and compared with age-matched controls. Relationships between sex hormone levels, severity of liver disease, biochemistry, and clinical outcomes were assessed. Results: Serum estrone and estradiol were significantly elevated in men with cirrhosis compared to controls (median 869.1pmol/L vs 133.8pmol/L and 166.7pmol/L vs 84.6pmol/L respectively). Serum estrone correlated with MELD score (correl +0.306, p<0.001), and inversely correlated with serum sodium (correl -0.208, p=0.004) and haemoglobin (correl -0.177, p=0.012). No such correlations were observed for estradiol. Serum testosterone levels inversely correlated with MELD score (correl -0.294, p<0.001), and positively with handgrip strength (correl +0.242, p<0.001), physical activity (correl +0.276, p=0.012), haemoglobin (correl +0.282, p<0.001), and serum sodium (+0.344, p<0.001)). Dihydrotestosterone inversely correlated with MELD score (correl -0.225, p=0.002) and shared similar significant relationships to testosterone. Conclusion: Low serum androgens and elevated serum estrone (but not estradiol) are associated with higher MELD and individual adverse health outcomes in cirrhotic cohort of men selected for low testosterone. Serum estrone may be a novel marker of ill health in this population. Whether low androgens are markers or mediators of ill health requires further investigation. This article is protected by copyright. All rights reserved.
    No preview · Article · Mar 2016 · Liver international: official journal of the International Association for the Study of the Liver
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The objective of this study is to examine associations between Hb levels and sarcopenia, low muscle strength, functional measures, and activities of daily living (ADL) and instrumental ADL (IADL) disabilities in older Australian men. Methods: Men aged 70 years and older (2005-2007) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 years (n = 1,367), and 5 years (n = 958). The main outcome measurements were walking speed, muscle strength, ADL and IADL disabilities, and sarcopenia using the Foundation for the National Institutes of Health criteria (low appendicular lean mass adjusted for body mass index < 0.789 and poor grip strength < 26kg). Analysis was performed using Hb levels as a continuous measure, unadjusted and adjusted by age, income, body mass index, measures of health, estimated glomerular function, inflammatory markers, and medication use. Receiver operating characteristic curve analysis was performed to determine a threshold of Hb for each outcome. Results: In cross-sectional and longitudinal analysis, for every 1g/dL increase in Hb, there was a significant reduction in risk of sarcopenia, slow walking speed, poor grip strength, inability to perform chair stands, and ADL and IADL disabilities in unadjusted, age-adjusted, and multivariate-adjusted analysis. The highest value of the Youden Index for Hb was 14.2g/dL for sarcopenia and grip strength, 14.5g/dL for walking speed, and 14.4g/dL for all other outcomes. Conclusion: Declines in Hb levels over time are associated with poor functional outcomes. The risks and benefits of interventions to increase Hb among older men warrant further investigation to differentiate whether this is an active contributor to age-related debility or a passive biomarker of it.
    No preview · Article · Mar 2016 · The Journals of Gerontology Series A Biological Sciences and Medical Sciences
  • Jaesung Peter Choi · Yu Zheng · David J Handelsman · Ulla Simanainen
    [Show abstract] [Hide abstract] ABSTRACT: PTEN (phosphatase and tensin homolog) deletion induces uterine pathology while androgen actions via androgen receptor (AR) support uterine growth and thereby may modify uterine cancer risk. We hypothesized that the androgen actions mediated via uterine glandular epithelial AR could modify PTEN deletion-induced uterine pathology. To test our hypothesis, we developed uterine glandular epithelial specific PTEN and/or AR knockout mouse models comparing the uterine pathology among wild-type (WT), glandular epithelium specific AR inactivation (ugeARKO), PTEN deletion (ugePTENKO) and the combined PTEN and AR knockout (ugePTENARKO) female mice. The double knockout restricted to glandular epithelium showed that AR inactivation enhanced PTEN deletion-induced uterine pathology with development of intraepithelial neoplasia by 20 weeks of age. In ugePTENARKO, 6/10 (60%) developed intraepithelial neoplasia while 30% developed glandular hyperplasia whereas only glandular hyperplasia (3/10, 30%) were observed in ugePTENKO uterus. No uterine pathology was observed in WT (n=8) and ugeARKO (n=7) uteri. Uterine weight was significantly (p=0.002) increased in ugePTENARKO [374±97mg (mean±SE)] compared with WT (97±6mg), ugeARKO (94±12mg) and ugePTENKO (205±33mg). ERα and P-AKT expression was modified by uterine pathology but did not differ between ugePTENKO and ugePTENARKO, suggesting its expressions are not directly affected by androgens. However, PR expression was reduced in ugePTENARKO compared to ugePTENKO uterus suggesting PR expression could be regulated by glandular epithelial AR inactivation. In conclusion, glandular epithelial AR inactivation (with persistent stromal AR action) enhanced PTEN deletion-induced uterine pathology possibly by down-regulating PR expression in the uterus.
    No preview · Article · Mar 2016 · Endocrine Related Cancer
  • [Show abstract] [Hide abstract] ABSTRACT: Aim: To describe the age at which the geriatric syndromes and frailty become common in community-dwelling men. Methods: The Concord Health and Ageing in Men Project involves a population-based sample of 1705 community-dwelling men aged 70 and over from a defined geographic region in Sydney. Data were obtained by physical performance tests, clinical examinations, and questionnaire to determine the prevalence of the following conditions by five-year age group. Results: Poor mobility, recurrent falls, urinary incontinence, dementia and frailty phenotype were all uncommon (less than 10%) in men in their 70s, but the prevalence of each of these conditions exceeded 10% in men aged 85-89. The prevalence of Frailty Index-defined frailty, multimorbidity, polypharmacy and instrumental activities of daily living dependence was constantly high in all age groups. Conclusions: The different health-care needs of the 'old old' aged 85 years and older should be accounted for in health service planning.
    No preview · Article · Mar 2016 · Australasian Journal on Ageing
  • [Show abstract] [Hide abstract] ABSTRACT: Context: The dynamic temporal relationship between changes in serum reproductive hormones and mortality in men has not been reported. Objective: To examine the relationship between progressive changes in circulating reproductive hormones over time with all-cause and cause-specific mortality in older men. Design, setting and participants: Community-dwelling men aged 70 years and older from CHAMP study were assessed at baseline (2005-2007, n=1705), 2-years (n=1367) and 5-years follow-up (n=958). Main Outcomes and Measures: At all three time-points, testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and SHBG, LH, and FSH were determined by immunoassay and free testosterone (cFT) was calculated according to Sartorius. Mortality was ascertained through the state death registry. Statistical modeling was by General Estimating Equations (GEE) with Poisson regression. Results: Serum T over time (relative risk (RR) per 1 SD decrease in concentration: 1.18, 95%CI:1.05-1.32), DHT (RR:1.17, 95%CI:1.05-1.32), E2 (RR:1.46, 95%CI:1.30-1.63) as well as cFT (RR:1.27, 95%CI:1.13-1.41) were associated with all-cause mortality. After adjusting for multiple covariables, the decline in serum T (RR:1.17, 95%CI:1.03-1.32), DHT (RR:1.17, 95%CI:1.03-1.32) and cFT (RR:1.13, 95%CI:1.08-1.19) remained significantly associated with all-cause mortality. Similar relationships were observed for cancer, but not cardiovascular mortality. Progressive decline in serum E2 levels remained significantly associated with all-cause (RR:1.49, 95%CI:1.31-1.69), cancer (RR:1.82, 95%CI:1.45-2.28) and cardiovascular (RR:1.37, 95%CI:1.13-1.66) mortality even after adjustment for covariables. Serum E1, LH, FSH and SHBG were not associated with all-cause, cancer, or cardiovascular mortality. Conclusion: Dynamic temporal changes in serum T, cFT, DHT and E2 (but not E1, LH, FSH, SHBG) in older men are associated with all-cause and cause-specific mortality in distinct patterns.
    No preview · Article · Mar 2016 · Journal of Clinical Endocrinology & Metabolism
  • No preview · Conference Paper · Mar 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Context: Lower testosterone (T) is associated with poorer health outcomes in older men, however, the relationship between T, dihydrotestosterone (DHT) and estradiol (E2) with cardiovascular disease (CVD) in younger to middle-aged men remains unclear. Objectives: We assessed associations between endogenous sex hormones with mortality (all-cause and CVD) and CVD events, in a cohort of men aged 17-97 years. Participants and methods: Sex hormones were assayed using mass spectrometry in 2,143 men from the 1994/5 Busselton Health Survey. Outcomes to December 2010 were analysed. Results: Of the 1,804 men included in the analysis, mean age was 50.3±16.8 years and 68.9% of men were aged <60. Mean follow-up period was 14.9 years. There were 319 deaths, 141 CVD deaths, and 399 CVD events. Compared to the full cohort, men who died had lower baseline T (12.0±4.4 vs 13.6±4.9 nmol/L), free T (181.9±52.9 vs 218.3±63.8 pmol/L) and DHT (1.65±0.64 vs 1.70±0.72 nmol/L), but higher E2 (64.0±32 vs 60.1±30.2 pmol/L). After adjustment for risk factors, T was not associated with mortality (adjusted HR=0.90, 95% CI 0.79-1.04; p=0.164 for every increase in 1 SD of T), CVD deaths (adjusted HR=1.04, 95% CI 0.84-1.29; p=0.708) or CVD events (adjusted HR=1.03, 95% CI 0.92-1.15, p=0.661). No associations were found for free T, DHT or E2. Results were similar for men older and younger than 60 years. Conclusions: In predominantly middle-aged men, T, DHT and E2 do not influence mortality or CVD outcomes. This neutral association of hormones with CVD contrasts with prior studies of older men. This article is protected by copyright. All rights reserved.
    No preview · Conference Paper · Mar 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Context: Although androgen status decreases with ageing in unselected men, the contemporaneous relationship over time between circulating hormones and androgen-sensitive outcomes has not been reported. Objectives: To investigate the temporal relationships between age-specific androgen status and muscle (mass, strength), hemoglobin and prostate-specific antigen (PSA). Design, setting and participants: Men aged 70 years and older from CHAMP study were assessed at baseline (2005-07, n=1705), 2-years (n=1367) and 5-years follow-up (n=958). Main Outcomes and Measures: At all assessments, serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by LC-MS/MS, and serum SHBG, LH, and FSH by immunoassay together with calculation of free testosterone (cFT). Muscle mass, strength of upper (hand grip) and lower (walking speed) limbs, hemoglobin and prostate size (serum PSA) were measured. Results: Serum hormones showed longitudinal, within-man decreases in serum T (-2.6%/yr), DHT (-2.6%/yr), E1 (-3.2%/yr) and cFT (-2.8%/yr) but increases in serum E2 (2.6%/yr), SHBG (1.3%/yr), LH (1.9%/yr) and FSH (1.8%/yr). Significant positive correlation was observed between changes in serum T with muscle mass, strength and hemoglobin but not with PSA across the three time-points. Changes in serum DHT, cFT and E1 had significant correlation with muscle mass, strength and hemoglobin, but not with PSA. Conclusions: These extended observational data are consistent with the impact of reduced androgen status on some somatic features of male ageing. However, they do not exclude reverse causality or independent effects of ageing on both androgen status and androgen-sensitive outcomes.
    No preview · Article · Feb 2016 · The Journal of Clinical Endocrinology and Metabolism
  • [Show abstract] [Hide abstract] ABSTRACT: The aims of this work were to define the role of androgens in female wound healing and to develop and characterize a novel wound-dressing with anti-androgens. Androgens retard wound healing in males, but their role in female wound healing has not been established. To understand androgen receptor (AR)-mediated androgen actions in male and female wound healing, we utilized the global AR knockout (ARKO) mouse model, with a mutated AR deleting the second zinc finger to disrupt DNA binding and transcriptional activation. AR inactivation enhanced wound healing rate in males by increasing re-epithelialization and collagen deposition even when wound contraction was eliminated. Cell proliferation and migration in ARKO male fibroblasts was significantly increased compared with wild type fibroblasts. However, ARKO females showed a similar healing rate compared to WT females. To exploit local anti-androgen effects in wound healing, while minimizing off-target systemic effects, we developed a novel electrospun polycaprolactone (PCL) scaffold wound dressing material for sustained local anti-androgen delivery. Using the anti-androgen hydroxyl flutamide (HF) at 1, 5 and 10 mg/ml in PCL scaffolds, controlled HF delivery over 21 days significantly enhanced in vitro cell proliferation of human dermal fibroblasts and human keratinocytes. HF-PCL scaffolds also promoted in vivo wound healing in mice compared to open wounds but not to PCL scaffolds. This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2016 · Wound Repair and Regeneration
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    David J Handelsman · David F Gerrard · Alvin Matsumoto
    Full-text · Dataset · Jan 2016
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    [Show abstract] [Hide abstract] ABSTRACT: Context: Advancing age is accompanied by accumulation of ill-health and shortening of chromosomal telomeres signifying biological ageing. Testosterone (T) is metabolised to dihydrotestosterone (DHT) by 5|ga-reductase (SRD5A2) and to estradiol (E2) by aromatase (CYP19A1). Telomerase preserves telomeres, and T and E2 regulate telomerase expression and activity in vitro. Objectives: To establish whether circulating T or its metabolites DHT or E2, and single nucleotide polymorphisms (SNPS) in SRD5A2 or CYP19A1 associate with leucocyte telomere length (LTL) in men. Participants and methods: Early morning serum T, DHT and E2 were assayed using mass spectrometry, and SRD5A2 and CYP19A1 snps and LTL analysed by PCR in 980 men from the Western Australian Busselton Health Survey. LTL was expressed as the T/S ratio. Results: Men were aged (mean±SD) 53.7±15.6 years. LTL decreased linearly with age, from T/S ratio 1.89±0.41 at <30 years to 1.50±0.49 at 70 to <80 years (r=-0.225, p<0.0001). After adjustment for age, DHT and E2 were positively correlated with LTL (DHT r=0.069, p=0.030; E2 r=0.068, p=0.034). The SRD5A2 rs9282858 polymorphism was associated with serum DHT but not with LTL. Three dominant alleles of CYP19A1 were each associated with lower serum E2 and shorter LTL: rs2899470 T (E2 59.3 vs 68.6 pmol/L, p<0.0001; T/S ratio 1.54 vs 1.62, p=0.045), rs10046 C (60.5 vs 68.1 pmol/L, p=0.0005, 1.54 vs 1.62, p=0.035) and rs700518 A (59.9 vs 68.9 pmol/L, p<0.0001, 1.54 vs 1.63, p=0.020). A single copy haplotype C/T/I/A/T rs10046/rs2899470/rs11575899/rs700518/rs17703883 (52% prevalence) was associated with both lower E2 and shorter LTL. Conclusions: In men, serum DHT and E2 correlate with LTL independently of age. Aromatase gene polymorphisms include 3 dominant alleles which are associated with both lower serum E2 and shorter LTL. E2 influences telomere length in vivo thus warranting further studies to examine whether hormonal interventions might slow biological ageing in men.
    Full-text · Article · Jan 2016 · The Journal of Clinical Endocrinology and Metabolism
  • [Show abstract] [Hide abstract] ABSTRACT: Aims: To describe the natural history of non-neurogenic overactive bladder (OAB) and urgency incontinence in community-dwelling older men. Methods: A representative sample of 1,705 community-dwelling men aged 70 and older in a defined geographic area of Sydney, Australia, had their urinary symptoms assessed using the International Prostate Symptom Scores (IPSS) and the International Consultation of Incontinence Questionnaire (ICIQ) at baseline, 2-year follow-up, and 5-year follow-up. Four hundred and eighty-eight men without neurological diseases or prostate cancer during follow-up, or history of urological treatment at baseline were included in the analysis. Urgency incontinence was defined as leakage of urine occurring more than weekly in the above-defined population. OAB was defined as either urgency or urgency incontinence according to 2002 International Continence Society consensus. Results: Of the men with OAB at baseline, 29% received treatment for OAB or benign prostatic enlargement over 5 years. Of the remaining men, 33% had sustained remission at 2-year and 5-year follow-ups without treatment. Of the men with OAB at 2-year follow-up, remission rate at 5-year follow-up was 53% in men without OAB at baseline and 27% in men with OAB at baseline (P = 0.23). No statistically significant difference was found in baseline characteristics between men with sustained remission and men with persistent symptoms. Conclusions: One in three older men with non-neurogenic OAB had sustained remission of symptoms without medical or surgical interventions. No significant predictor of sustained remission was identified. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.
    No preview · Article · Jan 2016 · Neurourology and Urodynamics
  • David J. Handelsman
    No preview · Chapter · Jan 2016
  • [Show abstract] [Hide abstract] ABSTRACT: To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men. Cohort study. Sydney, Australia. Community-dwelling men aged 70 and older (N = 1,705). Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death. Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI) = 1.06–1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI = 1.30–2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI = 1.60–4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions. Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.
    No preview · Article · Jan 2016 · Journal of the American Geriatrics Society
  • Y. Lam · L. Leece · S. Yuen · D. Handelsman · R. Karas · M. Ng
    No preview · Article · Dec 2015 · Heart, Lung and Circulation
  • Y. Lam · L. Leece · D. Handelsman · M. Ng
    No preview · Article · Dec 2015 · Heart, Lung and Circulation
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    David J Handelsman · David F Gerrard · Alvin M. Matsumoto
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To review the doping status of dehydroepiandrosterone (DHEA) for female athletes with adrenal insufficiency within the framework of Therapeutic Use Exemption (TUE) applications for this proandrogen, which is included on the World Anti-Doping Agency (WADA)'s Prohibited List. Data sources and main results: Current knowledge of adrenal pathophysiology with a focus on the physiological role and pharmacological effects of DHEA in female athletes including placebo-controlled clinical trials of DHEA and consensus clinical practice and prescribing guidelines. Conclusions: Because there is no convincing clinical evidence to support the use of DHEA replacement therapy in women with adrenal failure, a TUE for DHEA is not justified by definite health benefit for either secondary or primary adrenal failure. This is consistent with the 2014 update of the US Endocrine Society guidelines, meta-analyses of DHEA treatment in women with or without adrenal failure, current WADA TUE guidance document for adrenal insufficiency and recent case law of WADA's Court of Arbitration for Sport.
    Full-text · Article · Dec 2015 · Clinical Journal of Sport Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: Background/Aims The longitudinal relationships of within-individual hormone and anthropometric changes during puberty have not ever been fully described. The objectives of this study were to demonstrate that 3 monthly urine collection was feasible in young adolescents and to utilise liquid chromatography-tandem mass spectrometry assay methods for serum and urine testosterone (T), estradiol (E2) and luteinizing hormone (LH) in adolescents by relating temporal changes in urine and serum hormones over 12 months to standard measures of pubertal development. Methods A community sample of 104 adolescents (57 female) was studied over 12 months with annual anthropometric assessment, blood sampling and self-rated Tanner staging and urine collected every 3 months. Serum and urine sex steroids (T, E2) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and LH by immunoassay. Results A high proportion (92%) of scheduled samples were obtained with low attrition rate of 6.7% over the 12 months. Urine hormone measurements correlated cross-sectionally and longitudinally with age, anthropometry and Tanner stage. Conclusion We have developed a feasible and valid sampling methodology and measurements for puberty hormones in urine, which allows a sampling frequency by which individual pubertal progression in adolescents can be described in depth.
    Full-text · Article · Nov 2015 · PLoS ONE
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Depression in older men has been associated with low circulating testosterone concentration but data from prospective studies are limited. Methods: We conducted a prospective longitudinal study in a community representative cohort of 3179 older men free of clinically significant depressive symptoms at baseline. The main objective of this study was to determine if low serum testosterone, dihydrotestosterone and estradiol concentrations are associated with the development of depressive symptoms. Incident depression was assessed with the Patient Health Questionnaire and via an electronic health record database (The West Australian Data Linkage System). The main exposures of interest were serum testosterone, dihydrotestosterone and estradiol measured by liquid chromatography-mass spectrometry and calculated free testosterone in baseline blood samples (collected between 2001 and 2004). Results: One hundred and thirty five men (4.2%) developed depression over a median follow up time of 9.4 years (range 8.4-10.9). Men with incident depression were older (median age 77.7 vs 76.1 years, z=-3.82, p=0<0.001) and were more likely to have cardiovascular disease (43.0% vs 32.6%, χ(2)=6.32, p=0.012) and diabetes (22.2% vs 13.2%, χ(2)=8.95, p=0.003). Low serum total testosterone (<6.4nmol/L) was associated with incident depression (HR 2.07, 95%CI 1.17-3.68) and this remained significant after adjustment for relevant potential confounding factors (HR 1.86, 95%CI 1.05-3.31). Low serum dihydrotestosterone, estradiol and calculated free testosterone were not associated with risk of depression. Conclusions: Low serum total testosterone, but not calculated free testosterone, was associated with incident depression in this sample of older men.
    No preview · Article · Nov 2015 · Psychoneuroendocrinology

Publication Stats

14k Citations
2,502.72 Total Impact Points

Institutions

  • 1981-2015
    • University of Sydney
      • • ANZAC Research Institute
      • • Centre for Education and Research on Ageing
      • • Discipline in Obstetrics and Gynaecology
      • • Institute of Criminology
      Sydney, New South Wales, Australia
  • 2001-2014
    • Sydney Orthopaedic Research Institute
      Sydney, New South Wales, Australia
    • University of Turku
      Turku, Varsinais-Suomi, Finland
  • 2006-2011
    • Concord Repatriation General Hospital
      Sydney, New South Wales, Australia
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      • Department of Medicine
      Torrance, CA, United States
  • 2001-2010
    • Concord Hospital
      Concord, New Hampshire, United States
  • 2009
    • National Measurement Institute
      Sydney, New South Wales, Australia
  • 2004-2009
    • University of Melbourne
      Melbourne, Victoria, Australia
    • University of Helsinki
      Helsinki, Uusimaa, Finland
    • Austin Health
      Melbourne, Victoria, Australia
  • 1986-2009
    • Harbor-UCLA Medical Center
      • Department of Pediatrics
      Torrance, California, United States
  • 1980-2009
    • Royal Prince Alfred Hospital
      • • Division of Endocrinology
      • • Department of Medical Oncology
      • • Department of Molecular and Clinical Genetics
      • • Department of Surgery
      Camperdown, New South Wales, Australia
  • 2007
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
  • 1986-2007
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2005
    • University of Vic
      Vic, Catalonia, Spain
  • 2002
    • Liaoning Research Institute of Family Planning
      Feng-t’ien, Liaoning, China
  • 2000
    • The Endocrine Society of Australia
      Sydney, New South Wales, Australia