Uric Acid in a Male’s Life

Uric acid (UA) has important functions in the body, primarily as an antioxidant that protects cells from damage caused by free radicals. Uric acid (UA) is the end product of purine metabolism contained in many foods and formed naturally in the body. The normal level of this indicator, which also depends on the gender and age of patients, contributes to the stable functioning of the kidneys and prevents the accumulation of UA salts in the joints. Serum UA levels are an important medical indicator that may indicate the presence of certain diseases, such as gout and cardiovascular disease. Excessive production of UA and decreased renal excretion are the main causes of hyperuricemia. Excessive production of UA and its decreased renal excretion are the main causes of hyperuricemia. Notably, hyperuricemia is reported to be the second most common metabolic disease worldwide after diabetes mellitus (DM). In the United States, a nationwide survey showed that the prevalence of hyperuricemia is significant: 20.0% of females and 20.2% of males. A recent report from China showed that the prevalence of hyperuricemia increased steadily from 8.5% to 18.4% from 2000 to 2017. There is currently no consensus on the critical values of UA that are associated with additional risks and on the values that require mandatory prescription of urate-lowering therapy (ULT). The main differences are, in particular, in the gender difference in the threshold value of UA in blood serum in males and females. The standard value of hyperuricemia in most studies is 357 μmol/L (6 mg/dL) for females and 416.5 μmol/L (7 mg/dL) for males. Factors that impair the breakdown of UA are known to include overweight, alcohol abuse, and stress. High levels of UA in the blood can reduce life expectancy by several years, especially for men. Sex hormones play a significant role in the metabolism of UA. However, the data on the effect of male sex hormones on the UA level are not as straightforward, as studies have shown varying results regarding the relationship between the total testosterone level and the UA level. The question of whether male hormonal status can independently influence the UA level, as in the case of female sex hormones, remains open. UA affects almost all major sperm parameters. There are conflicting data on the effect of UA on the prostate gland (PG). There is a potential causal relationship between higher genetically predicted levels of UA and an increased risk of prostate cancer. Studies have also shown a relationship between hyperuricemia and androgenetic alopecia, diabetic retinopathy, heart failure, and other nosologies in males. The issue of correction of asymptomatic hyperuricemia remains a traditional one, given the various potential organ and system damage, the recommendations of leading rheumatology Guidelines, and the side effects of ULT, despite encouraging data on the absence of clinically significant adverse effects on sperm quality and reproductive hormones in males. Asymptomatic hyperuricemia is associated with many somatic diseases, the onset and progression of chronic kidney disease, and in terms of the evidence base, requires only the use of lifestyle modification measures. The expert consensus on the diagnosis and treatment of patients with hyperuricemia and high cardiovascular risk in the 2023 update and the Austrian Society of Rheumatology and Rehabilitation for patients with gout and hyperuricemia in 2022 provided nutritional and lifestyle recommendations, including cherries (Montmorency variety), which can lower the UA level. Lifestyle modification with certain dietary measures, especially in males, may be the most important and cost-effective factor to be used in asymptomatic hyperuricemia and gout. A strong commitment to their implementation guarantees improved control of UA metabolism values, inflammatory symptoms, reduced risk of damage to various organs and systems.