Perceptions of and risk factors for andropause

Association of salivary testosterone levels during the post-awakening period with age and symptoms suggestive of late-onset hypogonadism in men

BACKGROUND

The lack of association between serum testosterone levels and symptoms suggestive of hypogonadism is a significant barrier in the determination of late-onset hypogonadism (LOH) in men. This study explored whether testosterone levels increase after morning awakening, likewise the cortisol awakening response (CAR) in the hypothalamic-pituitary-adrenal (HPA) axis, and whether testosterone levels during the post-awakening period are associated with age and symptoms suggestive of late-onset hypogonadism (LOH) in men.

METHODS

Testosterone and cortisol levels were determined in saliva samples collected immediately upon awakening and 30 and 60 min after awakening, and scores of the Aging Males' Symptoms (AMS) questionnaire were obtained from 225 healthy adult men.

RESULTS

A typical CAR (an increase in cortisol level ≥ 2.5 nmol/L above individual baseline) was observed in 155 participants (the subgroup exhibiting typical CAR). In the subgroup exhibiting CAR, testosterone levels sharply increased during the post-awakening period, showing a significant negative correlation with age, total AMS score, and the scores of 11 items on the somatic, psychological, and sexual AMS subscales. Of these items, three sexual items (AMS items #15-17) were correlated with age. Meanwhile, there was no notable increase in testosterone levels and no significant correlation of testosterone levels with age and AMS score in the subgroup exhibiting no typical CAR (n = 70).

CONCLUSIONS

The results indicate that the hypothalamus-pituitary-gonad (HPG) axis responds to morning awakening, and determining testosterone levels during the post-awakening period in men with typical CAR may be useful for assessing HPG axis function and LOH.

Prevalence of andropausal symptoms among Kuwaiti males

Andropause is a syndrome that usually occurs during men's midlife. It is associated with clinical short-term and long-term effects, as well as some physiological and psychological symptoms due to subnormal levels of testosterone serum. The objective of this study was to identify the factors that significantly contribute to the prevalence of symptoms that may be related to androgen deficiency. The study used a cross-sectional structured questionnaire and a sample of 214 Kuwaiti men aged 40 years and older. The questionnaire consisted of the sociodemographic characteristics of the participants and the Androgen Deficiency of the Aging Male Scale of Andropausal Symptoms. The results of the study indicate that Kuwaiti men who were 40 to 49 years old reported fewer symptoms than did Kuwaiti men aged 50 years and older, including deterioration in their ability to play sports, easily falling asleep after dinner, anger, and hot flushes (p < .05); and Kuwaiti men aged 50 years and older reported experiencing decrease in muscle strength, decrease in sport performance, sweating, loss of height, decreased libido, as well as falling asleep after dinner. For those aged 40 to 49 years, lower education levels, marital status, and employment status were significantly associated with the men's symptoms (p < .05). On the other hand, in the case of respondents aged 50 years and older, only education level was significantly associated with their symptoms (p < .05). This is a preliminary study that reports the prevalence of aging male symptoms among Kuwaiti men. The findings will offer insight into the necessary health care provisions to educate, treat, and provide information related to andropause for the general public.

More than half of the men in a Swedish population of men aged 55, 65 and 75 believe in 'a male climacteric'

AIM

Symptoms of late-onset hypogonadism (LOH) are often unspecific, and the existence of a male climacteric has been much debated. In this study, we investigate aging men's thoughts about, and beliefs, in a 'male climacteric'.

METHODS

A questionnaire was developed including background demographic data, symptoms possibly related to LOH and questions about men's thoughts and beliefs in a 'male climacteric'. All men, 55-, 65- and 75-years old, living in Linkoping, Sweden (n=1885) received the questionnaire.

RESULTS

One thousand three hundred fifty-six (72%) questionnaires were eligible for evaluation, 65.4% of the responders had heard of a 'male climacteric', and 42.2% believed it existed but only 3% had sought medical advice for these symptoms. More than half believed that a 'male climacteric' was related to decreased libido and less strong erections. Almost half of the men thought that decreased memory and/or dystymia and anxiousness were related to a male climacteric.

CONCLUSIONS

The majority of men have heard of a male climacteric, but only a minority had consulted a practitioner about their symptoms. More information and knowledge are needed, for the general population to better motivate men to seek medical advice and also for the health care professionals to better deal with the symptoms of LOH.

Awareness and knowledge of andropause among Chinese males in Hong Kong

This is a pilot study that explored the awareness and knowledge of andropause among Chinese males in Hong Kong. The study employed a structured questionnaire and a convenience sample of 500 individuals at the age > or =40 years participated in the survey. A total of 397 (79.4%) of the respondents were identified as andropause-enlightened, 88.2% of whom believed that andropause was a natural aging process. Mass media was the main source of andropausal information. The andropause-enlightened respondents had poor knowledge with the mean knowledge score of 5.94. The majority identified irritability (72.5%), loss of energy (66.5%), and loss of libido (60.7%) as symptoms. Less than half of the andropause-enlightened respondents expressed that andropause could be treated and only 34 knew testosterone replacement therapy as a treatment. The present findings underscore the need for provision of health education to increase the knowledge of andropause among adult males.

Prevalence of symptoms possibly related to PADAM, in a Swedish population aged 55, 65 and 75 years

OBJECTIVES

With age there is an average decline in the concentration of biologically active testosterone. It is still controversial if this leads to a clinically relevant deficit, "partial androgen deficiency of the ageing man" (PADAM). Our objective was to investigate the prevalence of a series of symptoms possibly associated with PADAM in an assumed normal-population of older men.

METHODS

We developed a questionnaire including items about symptoms possibly associated with PADAM as well as background data covering demography, medical history, mood status, medication, castration therapy, as well as smoking, exercise and alcohol habits. The 10 items of the ADAM-questionnaire, designed to predict low bio-available T, were also included. The questionnaire was sent to all 1885 men 55, 65 or 75-years-old, living in Linköping, Sweden.

RESULTS

We identified a number of symptoms that differed significantly (P < 0.01) between age groups, e.g., "increased abdominal circumference", "decrease in muscle strength and/or endurance", "decreased libido", "less strong erection" and "lack of energy". From factorial analysis we found that the symptoms co-varied in four different groups.

CONCLUSION

The prevalence of a number of symptoms differed significantly between age groups, but we cannot infer that there is a causal connection between an average age-dependent decline in testosterone function and these symptoms. There are several other ways to interpret these results like the existence of concurrent somatic and/or mood disorders or ageing as such. For this purpose further studies including measurements of testosterone concentrations relating to the findings of this study have to be performed.

Erectile dysfunction in smokers: a penile dynamic and vascular study

In this study, we aimed to determine the hemodynamic mechanisms through which cigarette smoking, as an independent risk factor, induces erectile dysfunction (ED). We performed a standard ED evaluation that included history; a physical exam; and serum glucose, testosterone, and prolactin levels. We then excluded ED patients with abnormal androgen profiles and patients with ED risk factors other than smoking. A total of 109 ED patients entered the study, including 71 current smokers and 38 nonsmokers. All patients then underwent extensive evaluation, including nocturnal penile tumescence and rigidity (NPTR) monitoring with Rigiscan, followed by pharmacopenile duplex ultrasonography (PPDU) and redosing pharmacocavernosometry (RPC). Results of the above tests were compared in the smoker and nonsmoker groups. We also performed receiver operating characteristic (ROC) curve analysis to determine which diagnostic parameter is most affected by cigarette smoking. The 4 most significant variates served as input features for a logistic regression model, designed to predict smoking. The average age for smokers and nonsmokers was 44.3 and 51.2 years, respectively (P = .02). Eighty-six percent of smokers had abnormal NPTR testing compared with 55% of nonsmokers (P = .02). The average peak systolic velocity (PSV) was 26.8 and 31.2 cm/s for smokers and nonsmokers, respectively, and this difference was not found to be statistically significant (P = .19) in this study. On performing RPC, an abnormal maintenance flow (MF) of >5 mL/min was detected in 89% of smokers and in 47% of nonsmokers, and the difference was significant (P < .01). With the use of smoking as the outcome, the ROC area of different diagnostic parameters was as follows: 0.79 for penile base rigidity, 0.58 for PSV, and 0.77 for MF. A logistic regression model that used the 4 most significant variates as input features yielded a ROC of 0.857. The results of NPTR testing in our smoker and nonsmoker groups indicated that ED in smokers is mainly of organic etiology. On the basis of the PPDU findings and the higher incidence of abnormal MF in the smoker group and its relatively high ROC value, we concluded that dysfunction of penile veno-occlusive mechanisms plays a substantial role in the development of ED in smokers.

Symptom experience in Australian men and women in midlife

OBJECTIVE

To compare the experience of vasomotor, psychological and somatic symptoms in Australian men and women in midlife, to investigate whether symptoms often attributed to endocrine changes in midlife are associated with health and psychological well-being, and to evaluate their relationship to menopausal status in women.

METHODS

A cross-sectional, correlational, population-based study based on self-report questionnaires. Participants comprised 451 men and 766 women, aged between 39 and 65, from urban and rural South Australia, who responded to invitations to participate, or who volunteered to participate following media releases. Outcome measures used comprised a 47-item symptom checklist of current presence and severity of vasomotor, somatic and psychological symptoms experienced by men and women during midlife, and measures of health and psychological well-being.

RESULTS

The majority of men and women reported that they were not 'bothered' by vasomotor, psychological and somatic symptoms. For those symptoms in which men and women differed significantly, women generally reported being more 'bothered' than men, although the pattern of association between symptoms and measures of health and psychological well-being was the same for both men and women. Items from all three symptom clusters were independently related to menopausal status.

CONCLUSIONS

Health and psychological well-being play a role in the genesis of symptoms experienced by men and women in midlife. Both men and women experience similar symptoms, although women are more distressed by them signifying support for a menopausal syndrome in women. The finding of an independent relationship between menopausal status and psychological and somatic symptoms, in addition to the vasomotor symptoms, contradicts the narrow-estrogen hypothesis of climacteric symptoms.

Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse

OBJECTIVE

To report a case of symptomatic hypogonadism induced by the abuse of multiple steroid preparations that was subsequently reversed by clomiphene.

DESIGN

Case report.

SETTING

University-affiliated andrology practice within family practice clinic.

PATIENT(S)

A 30-year-old male.

INTERVENTION(S)

Clomiphene citrate, 100-mg challenge for 5 days, followed by treatment at same dose for 2 months.

MAIN OUTCOME MEASURE(S)

Clinical symptoms, androgen decline in aging male questionnaire, total T, FSH, LH.

RESULT(S)

Reversal of symptoms, normalization of T levels with LH surge, restoration of pituitary-gonadal axis.

CONCLUSION(S)

Clomiphene citrate is used typically in helping to restore fertility in females. This represents the first case report of the successful use of clomiphene to restore T levels and the pituitary-gonadal axis in a male patient. The axis was previously shut off with multiple anabolic steroid abuse.

Effects of natural products and nutraceuticals on steroid hormone-regulated gene expression

BACKGROUND

There is an increasing trend in the use of complementary and alternative therapies to treat or prevent hormonally dependent pathologies. Methods determined whether several of these natural products and nutraceuticals, commonly taken for hormone-related effects, possess steroid hormone activity. The agonist and antagonist estrogenic, androgenic, and progestational activities of 20 natural products and nutraceuticals were assessed using an in vitro tissue culture indicator system. Two steroid-regulated proteins (pS2 and prostate-specific antigen [PSA]) were quantified, using ELISA-type immunoassays, as markers of agonist and antagonist activity.

RESULTS

Four of the products tested, two isoflavone preparations, Promensil and Estro-Logic, chamomile, and grapeseed extracts, were found to have weak estrogenic agonist activity, with the latter two also demonstrating weak progestational activity. Several of the products tested exhibited antagonistic (blocking) activity, including antiestrogenic activity by Prostate-Ease, wild yam root, and dong quai, and antiandrogenic activity by dong quai, Promensil, and rosehips.

CONCLUSIONS

Several of these natural products demonstrate weak steroid hormone activity.

Is smoking a cause of erectile dysfunction? A literature review

Erectile dysfunction is common, and its prevalence increases with age owing to age-related diseases of vascular, hormonal, neurogenic and psychogenic factors. A literature review was undertaken to explore the impact of smoking on erectile dysfunction. The literature review of 18 studies revealed the detrimental effect of smoking on erectile function. Smokers were 1.5 times more likely to suffer erectile dysfunction than non-smokers. Men may be unaware of the effect of tobacco on erectile function. This literature review presents strong reasons for stopping smoking, and highlights the need for education within a comprehensive smoking cessation programme. All men should be offered smoking cessation treatment which includes nicotine replacement therapy and continued support. Randomized controlled trials are needed to explore the effect of smoking and smoking cessation on erectile dysfunction.

Conservative treatment of erectile dysfunction. 1: Anatomy/physiology

This is the first of a three-part article addressing whether physiotherapy involving pelvic floor muscle exercises is efficacious as a first-line treatment for erectile dysfunction (ED). In this, the first part of the article, the prevalence of ED and associated risk factors are considered after which the anatomy of the penis and the physiology of erection are outlined. This provides background for the second and third parts of the article which review the outcomes of published clinical trials investigating the treatment and prevention of ED, and assess the evidence for pelvic floor exercises relieving ED.