Andropause: introducing the concept of 'relative hypogonadism' in aging males

Is it andropause?

In primary care practice, it is not unusual to encounter male patients in their 50s or older who report having loss of libido, erectile dysfunction, fatigue, and depression. Such signs and symptoms may signal an age-related decline in androgen levels, which commonly begins after age 40. However, psychologic problems and medical illness often confound the diagnosis. Drs Tan and Pu, who are currently conducting research on androgen deficiency, discuss the diagnostic difficulties of the physiologic phenomenon of andropause and offer a comprehensive approach to clinical assessment and laboratory evaluation.

The role and place of medicinal plants in the strategies for disease prevention

Medicinal plants have been used in healthcare since time immemorial. Studies have been carried out globally to verify their efficacy and some of the findings have led to the production of plant-based medicines. The global market value of medicinal plant products exceeds $100 billion per annum. This paper discusses the role, contributions and usefulness of medicinal plants in tackling the diseases of public health importance, with particular emphasis on the current strategic approaches to disease prevention. A comparison is drawn between the 'whole population' and 'high-risk' strategies. The usefulness of the common-factor approach as a method of engaging other health promoters in propagating the ideals of medicinal plants is highlighted. The place of medicinal plants in preventing common diseases is further examined under the five core principles of the Primary Health Care (PHC) approach. Medicinal plants play vital roles in disease prevention and their promotion and use fit into all existing prevention strategies. However, conscious efforts need to be made to properly identify, recognise and position medicinal plants in the design and implementation of these strategies. These approaches present interesting and emerging perspectives in the field of medicinal plants. Recommendations are proposed for strategising the future role and place for medicinal plants in disease prevention.

A Telfairia Occidentalis Seed-incorporated Diet May Be Useful in Inhibiting the Induction of Experimental Andropause

Background:

Andropause, a prevalent pathology of men, results from an imbalance in steroid hormone concentrations that often is associated with aging, and reduces the quality of life of the sufferer. This study investigates the usefulness of a diet containing 15% Telfairia occidentalis seeds in the inhibition of the induction of experimental andropause.

Materials and Methods:

Twenty male rats were divided into four equal groups. Rats in the test group received dihydrotestosterone and estradiol valerate (ratio 10:1) subcutaneously every other day for 28 days and were placed on the test diet. Those in control I received the hormones, but not the test diet. Rats in controls II and III received olive oil (vehicle) and were placed on the test diet and normal diet, respectively. Testes weights and relative weights, serum testosterone concentrations, and testosterone concentration per gram of testicular tissue were measured or determined in all rats using standard protocols. Data were analyzed and differences between means separated using one-way analysis of variance.

Results:

Rats in the test group had slightly larger mean relative testes weights compared to those in control I, though both were significantly (P<0.001) smaller than the values obtained in controls II and III, respectively. Rats in the test group had significantly higher (P=0.034) serum testosterone concentrations relative to the control I group 6.9(0.3) ng/ml vs. 4.7(0.1) ng/ml, while the testosterone relative to testes weight values (ng/ml/g) of the test group was 16.8(3.4), and for controls I, II, and III the values were 12.3(1.4), 5.5(0.4), and 4.6(0.7), respectively. The differences between the test and control groups were all significant (P=0.04 in control I, and <0.001 in controls II and III).

Conclusion:

The test diet resulted in a modest reduction of biochemical castration and an improvement in secretory capacity of the testes of the test rats, relative to the control group that received the hormones but was placed on a normal diet. T. occidentalis seeds-incorporated diet may be useful in inhibiting the induction of experimental andropause.

Complaint of insomnia as a predictor of aging symptoms in males at a men's health clinic

INTRODUCTION

Issues of men's health have been greatly researched by scholars in recent decades. At men's health clinics, many patients complain of both insomnia and aging males' symptoms (AMS). These symptoms might be influenced by biological, psychological or even social factors. The aim of this study was to investigate different aspects of the relationship between insomnia and aging symptoms.

METHODS

This cross-sectional study included 231 males from a men's health clinic. Participants completed a set of general data and screening assessments, including the AMS rating scale, insomnia severity index (ISI), Beck depression inventory-II (BDI-II) and Beck anxiety inventory Chinese version (BAI), to investigate the severity of aging symptoms, insomnia, depression and anxiety.

RESULTS

The ISI correlated significantly with the AMS scale, both with (partial correlation coefficient = 0.470) and without (r = 0.580) controlled variances of depression and anxiety. Using linear regression, aging symptoms were statistically predicted by the severity of the ISI, and a substantial proportion of the variance was explained (adjusted R(2) = 0.410). When all variables were included, this proportion rose to 55.3% (adjusted R(2) = 0.553).

CONCLUSION

We suggest that insomnia is a good predictor of aging symptoms across all age groups of men.

No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause'

BACKGROUND

The measurement of bioavailable testosterone (BT) or free testosterone (FT) levels is currently considered the gold standard for the diagnosis of androgen deficiency in elderly men. While the impact of age on circulating testosterone levels (total, bioavailable and free) has been strongly documented, the existence of seasonal variations in testosterone levels remains debated.

OBJECTIVE

We investigated whether seasonal variations in serum calculated free testosterone (cFT) levels may translate into variations in the prevalence of low testosterone levels. Diagnosis was on the basis of biochemical determinations and was cross-checked with the prevalence of clinical signs and symptoms of 'andropause', as assessed by the Androgen Deficiency in Aging Males (ADAM) questionnaire.

METHODS

The study recruited 5028 men aged 50 years and over from September 2000 to January 2003. Their serum FT levels were assessed and they completed the French ADAM test. Men were considered eugonadal when cFT was > or =70 ng/l. The ADAM test was scored as described originally. The prevalence of 'andropause', diagnosed by the two methods, was compared throughout the year, on a month by month basis.

RESULTS

The percentage of subjects with cFT levels below 70 ng/l increased significantly with age (P<0.001). Serum cFT levels (mean [SD]) varied significantly with the month of sampling (P<0.0001), the highest (88.1 [30.2] ng/l) and lowest (76.9 [28.0] ng/l) mean values occurring in April and in October, respectively. Conversely, the prevalence of testosterone deficiency (cFT<70 ng/l) reached a peak in October (45.7%) and a nadir in April (29.7%). Although the prevalence of 'andropause', based on the ADAM questionnaire, increased significantly with age (P<0.0001), no influence of the month of the year was noticed.

CONCLUSIONS

Our results confirm a progressive age-related decline in FT levels. The monthly variations in serum FT values, observed throughout the year, do not show a major seasonal rhythm in elderly community-dwelling males, since the magnitude of the variations (<15%) remains marginal. This slight variation may, however, have an impact on the number of elderly men diagnosed with Partial Androgen Deficiency in Aging Males (PADAM).