Treinamento funcional em homens com deficiência androgênica / Functional training in men with androgen deficiency

Os sintomas da deficiência androgênica durante o envelhecimento masculino (DAEM) são eviden-ciados, a partir dos 40 anos, sendo que a atividade física (AF) pode atenuar esse processo. O objetivo desse estudo foi analisar a influência de um protocolo de treinamento funcional na AF habitual em homens com DAEM. Participaram 20 homens de 40 a 59 anos (média de idade de 49,63 ± 4,65 anos), sendo 11 do grupo experimental e nove do grupo controle. Foram coletadas informações por meio de um questionário autoaplicável, dividido em três seções: características gerais e clínicas; AF ­ IPAQ (versão curta) e sintomas do envelhecimento masculino pela "Aging Male Symptoms Scale (AMS)". Na análise dos dados, utilizou-se a estatística descritiva (média, desvio padrão e frequência simples) e inferencial (Exato de Fisher e Anova two way com medidas repetidas com teste de com-paração de Sydak). O grupo experimental apresentou um aumento médio significativo no tempo de caminhada, em minutos por semana (265 ± 53 minutos; p = 0,013), atividades moderadas (138 ± 21 minutos; p = 0,004), moderadas + vigorosas (209 ± 24 minutos; p < 0,001) e total (474 ± 48 minutos; p < 0,001) em comparação ao grupo controle. Um protocolo de treinamento funcional e a motivação da prática de AF foi eficaz para o aumento do tempo de prática de AF em homens com DAEM

The symptoms of androgen deficiency in the aging male (ADAM) affect men from the age of 40, and in this context it is noted that the practice of physical activity (PA) can help in this process. Thus, the objective of this non-randomized clinical trial was to analyze the influence of a functional training protocol on habitual PA in men with ADAM. Twenty men aged 40 to 59 years (mean age 49,63 ± 4,65 years) 11 of the exper-imental group and 9 of the control group. Data were collected through a self-administered questionnaire divided into three sections: sociodemographic and clinical characteristics; Physical activity - IPAQ (short version) and symptoms of male aging by aging male symptoms scale (AMS); In which men responded in the pre and post-intervention, after being allocated into experimental and control groups. Statistical analysis was descriptive (mean, standard deviation and simple frequency) and inferential (Fisher exact, Anova two way tests with repeated measurements and Sydak comparison test). The experimental group presented a significant mean increase in walking time, in minutes per week (265 ± 53 minutes, p = 0.013), moderate (138 ± 21 minutes, p = 0.004), moderate + vigorous activities (209 ± 24 minutes; p <0.001) and total (474 ± 48 minutes, p < 0.001) compared to the control group. A functional training protocol and motivation for the practice of PA was effective for increasing the practice of AF in men with DAEM

Nivel de información sobre el síndrome de declinación de la función testicular en el envejecimiento masculino / Level of information on the declining testicular function syndrome in male aging

Introducción: el síndrome de declinación de la función testicular del hombre que envejece ha cobrado relevancia reciente, pero se asume que se conoce poco. Objetivo: identificar el nivel de información, en población y proveedores de salud, sobre este síndrome. Métodos: estudio descriptivo transversal, que involucró a 452 personas de población general, 109 médicos especialistas afines al tema y 406 de atención primaria. Se emplearon cuestionarios autoadministrados, estadísticas descriptivas y prueba chi2. Resultados: de la muestra poblacional 70,30 por ciento de las mujeres y 56,0 por ciento de los hombres reconocieron que el hombre experimenta un proceso equivalente al climaterio femenino; 64,04 por ciento no conocía los síntomas y 47,12 por ciento de los hombres mayores de 40 años señalaron edad de comienzo superior a la suya. De los especialistas afines, solo 10 habían oído hablar de todos los términos que se emplean para referirse al síndrome, 77,06 por ciento habían escuchado frecuentemente andropausia y 70,65 por ciento climaterio masculino; 27,52 por ciento dio definiciones incorrectas. De atención primaria, 28,57 por ciento no reconoció ningún término, 21,18 por ciento había escuchado frecuentemente andropausia y 19,95 por ciento climaterio masculino; 51,7 por ciento no definió correctamente el síndrome. El 74,14 por ciento no mencionó síntomas, 76,85 por ciento señaló contraindicaciones excesivas al tratamiento y 85,22 por ciento valoró su conocimiento como insuficiente. El nivel de información no se relacionó con edad, sexo o tiempo de graduado (p> 0,05). Conclusiones: la población, principalmente las mujeres, reconoce el síndrome, pero no domina sus manifestaciones. En médicos, con independencia de la edad, sexo o tiempo de graduado, la información se limita mayoritariamente a términos como andropausia y climaterio masculino; el dominio conceptual, del cuadro clínico y tratamiento, es insuficiente(AU)

Introduction: declining testicular function syndrome of the aging man has gained recent relevance but it is accepted that little is known about it. Objective: to find out the level of information of the population and of the health providers on this syndrome. Methods: cross-sectional and descriptive study involving 452 people from the general population, 109 medical specialists related to this topic and 406 primary care physicians. Self-administered questionnaires, summary statistics and chi-square test were all used. Results: in the population sample, 70.30 percent of women and 56 percent of men admitted that man experiences a process similar to the female climaterium; 64.04 percent did not know the symptoms and 47.12 percent of men older than 40 years stated that this process occurred at an age above that of theirs. As to the related specialists, just 10 had heard about all the terms used to mention this syndrome, 77.06 percent had often heard the term andropause and 70.65 percent the term male climaterium, and 27.52 percent gave incorrect definitions. In the primary health care physician group, 28.57 percent did not recognize any term, 21.18 percent had frequently heard about andropause and 19.95 percent about male climaterium, and 51.7 percent did not give a correct definition of the syndrome. In the sample 74.14 percent did not mention any symptom, 76.85 percent pointed out excessive treatment contraindications and 85.22 percent assessed their knowledge as poor. The level of information was not associated to age, sex or time of graduation (p> 0.05). Conclusions: the population, mainly women, recognizes the syndrome but did not know well the symptoms. Regardless of age, sex or time of graduation, the physicians' information about the syndrome is mostly limited to terms such as andropause and male climaterium but they did not master the concept, the clinical picture or the treatment(AU)

Sintomas do envelhecimento masculino relacionados à atividade física e qualidade de vida_uma revisão sistemática / Aging male symptoms related to physical activity and quality of life: a systematic review

O objetivo desta revisão foi identificar artigos originais que relacionam a sintomatologia do envelhecimento masculino com a qualidade de vida e a atividade física. Esta revisão seguiu as recomendações do Preferred reporting items for Systematic Reviews and Meta-análise (PRISMA). Foram selecionados artigos de bases de dados Medline/PubMed, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde), e das biliotecas eletrônicas SciELO (Scientific Electronic Library Online) e Portal Periódicos da Capes, publicados nos últimos dez anos (janeiro de 2003 a fevereiro de 2013), em português, inglês e espanhol. As palavras-chaves utilizadas foram: atividade física, qualidade de vida e andropausa ou sintomas do envelhecimento masculino, presentes no título ou nos resumos dos artigos. Utilizou-se a escala proposta por Downs e Black, para avaliação metodológica dos artigos incluídos na revisão. Identificou-se 233 estudos; 43 preencheram os critérios de inclusão. A maior parte dos estudos foi realizado em países da Europa, para análise das variáveis utilizou-se medidas indiretas como questionários, medidas diretas e coleta sanguínea. Em 18 estudos relatou-se presença de sintomas do envelhecimento masculino; em cinco deles descreveu-se que a qualidade de vida foi afetada pelos sintomas. Apenas três estudos relacionaram a sintomatologia com a atividade física. Os sintomas do envelhecimento masculino podem estar associados a diferentes fatores, influenciando os todos domínios da qualidade de vida dos homens, sendo os sintomas sexuais os mais frequentes, seguidos dos somáticos e psicológicos. Embora a atividade física seja relatada como benéfica, neste período foram encontrados poucos estudos, havendo necessidade de pesquisas que relacionem essas variáveis...(AU)

The aim of this review was to identify original articles that relate the aging male symptoms with quality of life and physical activity. This review followed the reporting items Preferred recommendations for Systematic Reviews and Meta-analysis (PRISMA). Were selected articles from databases Medline / PubMed, LILACS (Latin American and Caribbean Health Sciences), and electronic biliotecas SciELO (Scientific Electronic Library Online) and Portal Journals Capes, published in the last ten years (January 2003 to February 2013), in Portuguese, English and Spanish. The key words used were: physical activity, quality of life and andropause or aging male symptoms, present in the title or summary of articles. Were used the scale Proposed by Downs and Black for methodological evaluation of the articles included in the review. It identified 233 studies; 43 met the inclusion criteria. Most studies were conducted in countries of Europe, to analyze the variables were used indirect measures such as questionnaires, direct measurements and blood collection. In 18 studies it was reported the presence of aging male symptoms; in five of them it has been described that the quality of life was affected by symptoms. Only three studies have related symptoms with physical activity. The aging male symptoms may be associated with different factors, influencing all domains of quality of life. The sexual symptoms were the most frequent, followed by somatic and psychological. Although physical activity is reported to be beneficial in this period, few studies have been found...(AU)

El deseo sexual en varones adultos mayores, su relación con la testosterona sérica y otros factores / Sexual desire in older men and its association with serum testosterone and other factors

Introducción: el deseo sexual cambia con el envejecimiento, la verdadera magnitud de estos cambios y los factores que los condicionan son aún objeto de debate. Objetivo: describir las características del deseo sexual en varones adultos mayores del municipio Plaza de la Revolución y su asociación con la testosterona sérica y otras variables. Métodos: estudio transversal descriptivo, con base poblacional. Participaron 510 varones de 60 años y más, sin limitaciones físicas o cognitivas, ni condiciones que causan hipogonadismo, seleccionados mediante muestreo estratificado polietápico complejo entre los residentes del municipio Plaza de la Revolución, en La Habana. Contestaron cuestionario anónimo autoadministrado, se recogieron datos del interrogatorio y examen físico, y se determinó testosterona sérica total. Se evaluaron aspectos del deseo sexual y factores con posible influencia sobre este; se analizaron estadísticas descriptivas y pruebas de chi cuadrado, Kruskal Wallis y regresión logística múltiple. Se cuidaron aspectos éticos. Resultados: la edad de los participantes fue entre 60 y 93 años (mediana 70). El 82,41 por ciento refirió cambios en su deseo sexual en relación con edades previas; de estos, 79,16 por ciento señaló disminución, 11,66 por ciento pérdida y 9,18 por ciento aumento. El 55,02 por ciento dijo tener nivel de deseo sexual medio, 44,53 por ciento lo experimentaban a menudo, y 4,25 por ciento nunca. El 71,22 por ciento refirió estar satisfechos o medianamente satisfechos con su deseo sexual. No se observó relación entre la testosterona sérica y los cambios en el deseo sexual, nivel o frecuencia actual (p> 0,05). La disminución del deseo sexual mostró asociación positiva significativa con la edad mayor a 80 años, disminución de la sensación de bienestar y consumo de medicamentos; y asociación negativa, con la actitud hacia la sexualidad (p< 0,05). La escolaridad, la ocupación, las creencias religiosas, el estado civil, el tiempo de relación de pareja, las enfermedades cónicas, los hábitos tóxicos, los ejercicios físicos, la socialización, el estado psicológico, la educación sexual, la importancia que le conceden a la sexualidad, o tener privacidad, no se relacionaron significativamente con la disminución del deseo sexual. Conclusiones: el deseo sexual cambia con la edad, predominantemente en sentido de disminución, pero la mayoría de los sujetos se sienten satisfechos o medianamente satisfechos, lo experimentan a menudo y en un nivel medio. La disminución del deseo sexual en los sujetos estudiados no depende de la testosterona sérica, y sí de otros factores biológicos, psicológicos y sociales(AU)

Introduction: sexual desire decreases with aging but the real scope of these changes and the factors unleashing them are still a topic under debate. Objective: to describe the characteristics of the sexual desire in older men from Plaza de la Revolution municipality and their association with serum testosterone and other variables. Methods: population-based descriptive and cross-sectional study which involved 510 men aged 60 years and older, who did not present either physical/cognitive handicaps or conditions leading to hipogonadism. They had been selected from the residents of Plaza de la Revolucion municipality in Havana through a complex multistage stratified sampling. They answered a self-administered anonymous questionnaire; their questioning and physical exam data were then collected and the total serum testosterone was determined. Several sexual desire aspects together with the possible influential factors were evaluated; the summary statistics in addition to Chi-square, Kruskall-Wallis's and multiple logistic regression tests were all analyzed. Moreover, ethical aspects were respected. Results: the age of the participants ranged 60 to 93 years (median of 70). In this group, 82.41 percent pointed out that their sexual desire had changed in comparison with earlier ages and from this percentage, 79.16 percent said their desire decreased, 11.66 percent stated it had disappeared whereas in 9.18 percent it had increased. The answers showed that the degree of sexual desire was medium in 55.02 percent of participants, 44.53 percent often felt it whereas 4.25 percent never had it. In the study group, 71.22 percent were satisfied or fairly satisfied with their degree of sexual desire. There was no association between the serum testosterone and the changes in the current degree and frequency of sexual desire (p> 0.05). The decrease in sexual desire showed significant positive association with the age older than 80 years, less sensation of wellbeing and lower consumption of drugs; however, it was negatively associated to the attitude towards sexuality (p< 0.05). Schooling, occupation, religious beliefs, marital status, length of time of a couple relationship, chronic diseases, toxic habits, physical exercising, socialization, psychological condition, sexual education, importance attached to sexuality or to privacy were not significantly associated with decrease of sexual desire. Conclusions: sexual desire changes with the age, particularly towards decrease, but the majority of older men are satisfied or fairly satisfied with it; they often feel it with medium degree. The decreased sexual desire in the studied subjects does not depend on the serum testosterone but it does on other biological, psychological and social factors(AU)

Sexual satisfaction in couples in the male and female climacteric stage / Satisfacción sexual en parejas durante el climaterio femenino y masculino / Satisfação sexual nos casais durante o climatério feminino e masculino

The objective was to describe the sexual life satisfaction of couples in the climacteric stage and determine whether there are differences between the perception of satisfaction and the sex life of each partner. We studied 142 couples obtained by stratified sampling of family health centers, Concepción, Chile. 66% of women and 84% of men reported being very or somewhat satisfied with their sex lives. Slight concordance was found between the responses of the partners in relation to satisfaction with their sexual life. Moreover, a slight degree of agreement was found between the sexual life satisfaction reported by women and their partners' perceptions of the women's sexual life satisfaction. Additionally, a slight degree of agreement was reported between the sexual life satisfaction reported by men and their partners' perceptions of the men's sexual life satisfaction. This study provides new information about Chilean couples in the climacteric stage in relation to self-reported sexual satisfaction and perceived satisfaction in couples.

O objetivo foi descrever a satisfação com a vida sexual dos casais no período do climatério e determinar se existem diferenças entre as percepções da satisfação com a vida sexual de cada membro do casal. Foram seleccionados cento e quarenta e dois casais por meio de uma amostragem estratificada dos centros de saúde familiar em Concepción, Chile. Sessenta e seis porcento das mulheres e 84% dos homens relataram ser muito ou moderadamente satisfeitos com suas vidas sexuais. Verificou-se uma leve concordância entre as respostas de cada membro do casal em relação à satisfação com a vida sexual. Também identificou-se um leve grau de concordância entre a satisfação com a vida sexual referida pela mulher e a percepção da satisfação com a vida sexual que seu parceiro tem dela. Da mesma forma, verificou-se um discreto grau de acordo para a referida pelo homem e a percepção da satisfação com a vida sexual que sua companheira tem dele. É oferecida uma nova informação a respeito dos casais chilenos no período do climatério, em relação à satisfação sexual autoinformada e a satisfação percebida no parceiro, evidenciando-se a diferença da percepção entre os casais.

El estudio describe la satisfacción con la vida sexual de parejas en etapa de climaterio, además de determinar si existen diferencias entre las percepciones de satisfacción con la vida sexual de cada miembro de la pareja. Se estudiaron 142 parejas, obtenidas mediante muestreo estratificado en centros de salud familiar de Concepción, Chile. Un 66% de mujeres y un 84% de hombres informaron sentirse muy o algo satisfechos con su vida sexual de pareja. Se encontró una concordancia leve entre las respuestas de cada miembro de la pareja, en relación con la satisfacción en la vida sexual. También, se encontró un grado de acuerdo leve entre satisfacción con la vida sexual informada por la mujer y la percepción de satisfacción con la vida sexual que su pareja tiene de ella. Asimismo, se reportó un grado discreto de acuerdo para la satisfacción con vida sexual referida por el hombre y la percepción de satisfacción con la vida sexual que su pareja tiene de él. Este estudio proporciona nueva información respecto a parejas chilenas en etapa de climaterio, en relación con la satisfacción sexual autoinformada y percibida en la pareja.

The Effect of Anthocyanin on the Prostate in an Andropause Animal Model: Rapid Prostatic Cell Death by Apoptosis Is Partially Prevented by Anthocyanin Supplementation

PURPOSE: To evaluate the anti-apoptotic effect of the antioxidant reaction of anthocyanin on the prostate in an andropause animal model. MATERIALS AND METHODS: Sprague-Dawley rats were divided into three groups (n=12 in each): control (Group I), andropause (Group II), andropause treated with anthocyanin (Group III). For induction of andropause, Group II and III underwent bilateral orchiectomy. Group III was treated with daily oral anthocyanin (160 mg/kg) for 8 weeks. After 8 weeks, the rats were sacrificed and their blood and prostates were examined pathohistologically and evaluated for oxidative stress and apoptosis. Oxidative stress was assessed by the activity of superoxide dismutase (SOD) and apoptosis in the prostate was identified by terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling assay. RESULTS: Group II showed markedly increased activity of SOD in serum over that observed in Group I, whereas the rats in Group III showed reduced oxidative stress compared to Group II. Despite no significant differences in prostate weight between Group II and III (p=0.078), the apoptotic index was significantly greater in Group II than Group I, and was significantly lesser in Group III than Group II. CONCLUSIONS: We suggest that the oxidative stress caused by low testosterone may be another inducer of apoptosis, and this apoptosis may partly contribute to the overall apoptosis of the prostate in the andropause animal model. Therefore, anthocyanin supplementation may contribute to preventing excessively rapid cell death by apoptosis in the prostate in an animal model of andropause.

Serum Total Testosterone Level and Identification of Late-Onset Hypogonadism: A Community-Based Study

PURPOSE: Late-onset hypogonadism (LOH) in aging males is a clinical and biochemical syndrome characterized by a decline in serum testosterone levels. LOH results in various physical and mental disabilities. We evaluated the relationship between serum testosterone levels and symptoms of LOH. MATERIALS AND METHODS: During an andropause screening program, we examined responses to the Saint Louis university androgen deficiency in aging males (ADAM) questionnaire and results on the International Index of Erectile Function (IIEF-5) in terms of clinical symptoms and evaluated serum total testosterone levels for a biochemical diagnosis of LOH in healthy community-living volunteers aged over 40 years. RESULTS: The mean age of the 534 men was 59.1 years (range, 40 to 79 years), and their mean serum testosterone level was 464.1+/-171.9 ng/dL. The serum testosterone level decreased significantly with age. There was a 92.5% positive response rate to the ADAM questionnaire. The percentage of patients whose serum testosterone level was 0.05). There was no significant correlation between IIEF-5 scores and serum testosterone levels. CONCLUSIONS: Among men over 40 years of age, 25.6% met the clinical and biochemical diagnostic criteria for LOH. There was no relationship between serum testosterone levels and symptoms of LOH.

Improvement of andropause symptoms by dandelion and rooibos extract complex CRS-10 in aging male

Many aging male suffer various andropause symptoms including loss of physical and mental activities. This study evaluated the putative alleviative effects of CRS-10 dandelion and rooibos extract complex (CRS-10) on the symptoms of andropause. The survival rate of TM3 Leydig cells (TM3 cells) treated with CRS-10 was measured based on typical physiological stress. After daily intake of CRS-10 for 4 weeks, the level of testosterone, physical activity and both the number and activity of sperm in older rats (18 weeks) were measured. Furthermore, thirty males were surveyed with AMS (Aging Males' Symptoms) questionnaire after intake of 400 mg of CRS-10. Overall, CRS-10 protected TM3 cells from serum restriction and oxidative stress via activation of ERK and Akt pathways. The level of testosterone and activation of spermatogenesis in rats were significantly enhanced. In addition, physical locomotion was markedly improved. Daily intake of 400 mg of CRS-10 improved the quality of life among agingmale respondents, according to a clinical survey using the AMS. The results indicate the potential of CRS-10 as a safe and efficacious natural substance for reducing or alleviating andropause symptoms.

Awareness of andropause in males: A North Indian study.

Background: According to the Indian census 2011, India has the largest population of the elderly. Very few studies have been carried out in North India to assess the awareness about andropause in men, which is why this study was conceived. Objectives: To assess the awareness about andropause and its treatment modalities among the men of Chandigarh. Materials and Methods: The present study was conducted at an Urban Health Training Center (UHTC-44 B) of Government Medical College and Hospital Sector 32, Chandigarh (GMCH) in male patients attending the outpatient department. This non-interventional individual cross-sectional study was carried out from August 2010 to August 2011 in men aged 40 years and above. Systematic, random sampling was carried out and the study sample comprised 757 men. The subjects were given pre-structured and pre-tested questionnaires that had questions pertaining to socio-demographic profile, ADAM scale, views about andropause, its treatment modalities, etc., Results: Out of the sample size of 757 men, subjects from the urban area (323; 43.1) were more in contrast to that of the peri-urban (41; 31.9) and slum areas (393; 259). Maximum number of patients belonged to the age group of 40-49 years (342; 26.3), followed by those in age group 60-69 years (141; 18.6). It was found that awareness about the term andropause was found only among 17 (2.2%) subjects, whereas the knowledge of a syndrome synonymous to that of menopause in females was even less 7 (0.9%) patients positive for andropause were found to increase with increase of age (40-49; 35.7, 50-59; 81.2, 60-69; 96.5). Only 123 (11.4%) had an idea about the treatment of andropause. The keenness to resort to treatment or seek medical advice was shown by 355 (47.3%). Subjects in the age group of less than 60 years resorted to injections (15; 4.7) and transdermal patches (6; 1.09) as testosterone-replacement therapy. Herbal medicines were especially taken by those subjects in the age group 60-70 years, (74.3%; 101). Conclusion: Awareness about andropause and its treatment modalities is less in men.

Andropause and the development of cardiovascular disease presentation more than an epi-phenomenon / 老年心脏病学杂志（英文版）

Andropause refers to a generalized decline of male hormones, including testosterone and dehydroepiandrosterone in middle-aged and aging men. This decline in hormones has been associated with changes such as depression, loss of libido, sexual dysfunction, and changes in body composition. Aging has been associated with an abundance of concomitant diseases, in particular cardiovascular diseases, and although andropause is correlated to aging, a causal relationship between reduction of androgens and the development of chronic diseases such as atherosclerosis and heart failure has not been convincingly established yet. On the other hand, increasing data has emerged that revealed the effects of low levels of androgens on cardiovascular disease progression. As an example, low levels of testosterone have been linked to a higher incidence of coronary artery disease. Whether hormone replacement therapy that is used for andropausal men to alleviate symptoms of male menopausecan halt progression of cardiovascular disease, remains controversially discussed, primarily due to the lack of well-designed, randomized controlled trials. At least for symptom improvement, the use of androgen replacement therapy in andropausal men may be clinically indicated, and with the appropriate supervision and follow up may prove to be beneficial with regard to preservation of the integrity of cardiovascular health at higher ages.

Short term testosterone replacement therapy improves libido and body composition / Reposição de testosterona a curto prazo melhora libido e composição corporal

OBJECTIVE: To assess the efficacy and safety of testosterone replacement in males with late-onset hypogonadism compared to hypogonadal men without replacement, and controls, during six months. METHODS: We assessed, through ADAM, AMS, IIEF-5 and SF-36 questionnaires, and through clinical and laboratorial examinations, 62 patients divided into three groups: 17 hypogonadal males (HR) used intramuscular testosterone every three weeks; 14 hypogonadal males (HV) and 31 non-hypogonadal males (CV) used oral vitamins daily. RESULTS: When compared to others, HR group obtained libido improvement assessed by ADAM 1 (p = 0.004), and borderline sexual potency improvement assessed by IIEF-5 (p = 0.053), besides a decrease in waist circumference after eight weeks (p = 0.018). The remaining parameters did not differ between the groups. PSA and hematocrit remained stable in those using testosterone. CONCLUSION: Six months of testosterone replacement improved sexuality and body composition, with prostatic and hematological safety.

OBJETIVO: Avaliar a eficácia e a segurança da reposição de testosterona em homens com hipogonadismo tardio comparados a hipogonádicos sem reposição e controles, durante seis meses. MÉTODOS: Mediante os questionários ADAM, AMS, IIEF-5 e SF-36, foram feitos exame clínico e laboratorial em 62 pacientes divididos em três grupos: 17 hipogonádicos (HR) usaram testosterona intramuscular a cada três semanas; 14 hipogonádicos (HV) e 31 não hipogonádicos (CV) usaram vitaminas via oral diariamente. RESULTADOS: Comparado aos demais, o grupo HR obteve melhora da libido avaliada pelo ADAM 1 (p = 0,004) e melhora limítrofe da potência sexual avaliada pelo IIEF-5 (p = 0.053), além de diminuição da cintura a partir da oitava semana (p = 0,018). Os demais parâmetros não foram diferentes entre os grupos. PSA e hematócrito se mantiveram estáveis nos que usaram testosterona. CONCLUSÃO: A reposição de testosterona durante seis meses melhorou a sexualidade e a composição corporal, com segurança prostática e hematológica.

Laboratory diagnosis of late-onset male hypogonadism andropause / Diagnóstico laboratorial do hipogonadismo masculino tardio (andropausa)

OBJECTIVES: To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). METHODS: Total testosterone (TT), SHBG and albumin were measured in 216 men aged 52-84 years. The laboratorial definition of LOH was two values of calculated free testosterone (cFT) <6.5 ng/dl, according to Vermeulen's formula. RESULTS: At the first blood test, cFT was <6.5 ng/dl in 27 percent of the men. Laboratorial LOH (confirmed by two tests) was present in 19 percent, but TT levels were low in only 4.1 percent. Age influenced TT (p=0.0051) as well as BMI; 23.5 percent of patients > 70 years and 38.9 percent of the obese men who had TT within the reference range were, in fact, hypogonadal. CONCLUSION: Especially in obese men and in those > 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.

OBJETIVOS: Avaliar os fatores que influenciam o diagnóstico laboratorial do hipogonadismo masculino tardio. MÉTODOS: Avaliamos 216 homens entre 52 e 84 anos. O diagnóstico laboratorial foi definido como dois valores de testosterona livre calculada (TLC) <6,5 ng/dl, segundo a fórmula de Vermeulen, a partir das dosagens de testosterona total (TT), SHBG e albumina. RESULTADOS: Na primeira dosagem, a TLC foi <6.5 ng/dl em 27 por cento da amostra. Hipogonadismo laboratorial (confirmado por duas dosagens) esteve presente em 19 por cento, no entanto a TT foi baixa em apenas 4.1 por cento dos homens. A idade influenciou a TT (p=0.0051) bem como o IMC; 23,5 por cento dos homens > 70 anos e 38,9 por cento dos obesos com TT dentro dos níveis de referência eram, na verdade, hipogonádicos. CONCLUSÃO: Especialmente em homens obesos e nos > 70 anos a dosagem de SHBG é importante para calcular TL e diagnosticar o hipogonadismo.

Risk of late-onset hypogonadism (andropause) in Brazilian men over 50 years of age with osteoporosis: usefulness of screening questionnaires / Risco relativo de hipogonadismo tardio (andropausa) em brasileiros com mais de 50 anos com osteoporose e a utilidade de questionários de triagem

OBJECTIVE: To analyze the relative risk of late-onset hypogonadism in men with osteoporosis and the usefulness of screening questionnaires. METHODS: We correlated the Aging Male's Symptoms (AMS), Androgen Deficiency in Aging Male (ADAM) and International Index of Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone density, paired by age and ethnicity). RESULTS: Hypogonadism presented in 25 percent of the osteoporotic and in 12.2 percent of normal bone density men (OR 2.08; IC95 percent: 1.14-3.79) and was associated with ADAM first question (low libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels. CONCLUSION: Hypogonadism was 2.08 times more prevalent in osteoporotic men. The symptom that best correlated with late-onset hypogonadism was low libido (ADAM 1 positive).

OBJETIVOS: Avaliar o risco relativo de hipogonadismo tardio em homens com osteoporose e a utilidade de questionários de triagem. MÉTODOS: Correlacionamos a pontuação dos questionários Aging Male's Symptoms (AMS), Androgen Deficiency of the Aging Male (ADAM) e International Index of Erectile Function (IIEF-5) com dosagens de testosteronas em 216 homens entre 50 e 84 anos (110 com osteoporose e 106 com densidade óssea normal, pareados por idade e etnia). RESULTADOS: Hipogonadismo ocorreu em 25 por cento dos osteoporóticos e em 12,2 por cento dos com densidade óssea normal (RR 2,08; IC95 por cento: 1,143,79) e esteve associado à pergunta 1 do ADAM (diminuição de libido, p = 0,013). Testosterona total < 400 ng/dL associou-se a AMS > 26 (p = 0,0278). Disfunção erétil, avaliada pelo IIEF-5, não se correlacionou com dosagens de testosteronas. CONCLUSÃO: Hipogonadismo foi 2,08 vezes mais prevalente em homens com osteoporose e esteve associado à diminuição da libido (ADAM 1 positivo).

Efficacy and Safety of Testosterone Gel in Korean Men with Late-onset Hypogonadism: A Prospective, Fixed-dose, Placebo-uncontrolled, Open-label, Multicenter Study / 대한남성과학회지

PURPOSE: We evaluated the efficacy and safety of transdermal 1% testosterone gel in Korean men with late-onset hypogonadism from Aug. 2004 to Dec. 2005 in a prospective, fixed-dose, placebo-uncontrolled, open label, multicenter study. MATERIALS AND METHODS: From the 5 urological centers in Korea, a total of 87 male patients older than 40 years who were diagnosed with late-onset hypogonadism with serum testosterone lower than 350 ng/dl or serum free testosterone lower than 73.5 pg/ml were enrolled. Among the 87 enrolled 68 patients completed the daily application of 1% testosterone gel according to the standard consumer guidelines for the full 12-week period. We compared the data at baseline and at 4, 8, and 12 weeks follow-up using the Aging Males' Symptoms (AMS) scale, the International Index of Erectile Function (IIEF)-15, the International Prostate Symptoms Score (IPSS), and the serum levels of total and free testosterone and prostate specific antigen (PSA). RESULTS: The mean age of the patients was 56.5+/-12.7 years. The total scores for the AMS scores at baseline, 4, 8, and 12 weeks were 43.5+/-12.2, 36.6+/-12.3, 33.8+/-11.2, and 34.2+/-11.0, respectively (p<0.0001 vs. baseline). Total and free testosterone levels at baseline were 259.8+/-119.4 ng/dl and 50.5+/-24.7 pg/ml, and at 12 weeks were 594.5+/-376.6 ng/dl and 139.5+/-110.7 pg/ml, respectively (p<0.0001 vs. baseline). IIEF scores increased from 34.7+/-8.5 at baseline to 43.2+/-8.7 at 12 weeks (p<0.0001). There were no significant changes in serum PSA levels. The most commonly reported adverse events were acne and itching at the site of application. The majority of adverse events were mild, reversible, and short in duration. CONCLUSIONS: Testogel(R) showed highly effective clinical and biochemical recovery with good tolerance in Korean men with late-onset hypogonadism.

The Relationship between Serum Total Testosterone and Clinical Symptoms of Late-onset Hypogonadism in Aging Males / 대한남성과학회지

PURPOSE: Late-onset hypogonadism(LOH) in the aging male is a clinical and biochemical syndrome characterized by a decline in levels of serum testosterone, and results in various physical and mental disabilities. We aim to evaluate the relationship between serum testostosterone levels and symtpoms of LOH. MATERIALS AND METHODS: As part of an andropause screening program, we examined ADAM questionnaires, IIEF-5 scores, and total serum testosterone levels among healthy volunteers aged over 40 years. RESULTS: The mean age of the 409 men was 59.8 years(range 40~89), and the mean serum testosterone level was 471.5+/-180.2 ng/dl. The serum testosterone level decreased significantly in correlation with age. There was a 92.5% positive response on the ADAM questionnaire. Among patients whose serum testosterone was less than 350 ng/dl, the ADAM questionnaire was positive in 23.7%(n=97). The mean serum testosterone level for men with a positive or negative ADAM questionnaire was 469.2+/-181.8 or 489.2+/-170.5 ng/dl, respectively; this difference was not statistically significant (p=xxx). There was also no significant correlation between IIEF-5 scores and serum testosterone levels. CONCLUSIONS: Among men over 40 years of age, 23.7% met the clinical and biochemical diagnostic criteria for late-onset hypogonadism, and there was no relationship between serum testosterone levels and symptoms of late-onset hypogonadism.

Combination Therapy of Androgen Replacement and Alpha-blockers in Patients with PADAM and Severe LUTS / 대한남성과학회지

PURPOSE: Severe LUTS (lower urinary tract symptoms) have been considered to be a contraindication to ART (androgen replacement therapy) in PADAM (partial androgen deficiency in aging male) patients. But increasing numbers of patients presenting with PADAM have also LUTS due to the enlarged prostate. We investigated the effect of ART to the prostate in whom LUTS are controlled with alpha-blockers. MATERIALS AND METHODS: Of those patients who visited our clinic for PADAM symptoms and had decreased serum levels of total testosterone( <2.8 ng/ml, Biodata, Italy), men with severe voiding symptoms(IPSS 20~35) were recruited. Oral androgen(testosterone undecanoate 160 mg/day) and doxazosin(2~4 mg/day) were administered. IPSS score, prostate volume by TRUS, and serum PSA were assessed. RESULTS: A total of 25 patients were enrolled. Mean patient age was 63.5(51~89) years and median duration of follow-up was 754 days. Initial prostate volume by TRUS was 34.50+/-10.22 ml. Voiding symptoms evaluated by IPSS score improved significantly from 24.12+/-2.54 to 14.64+/-6.01(p <0.01). Serum PSA level showed no significant change from 1.20+/-0.54 ng/ml to 1.30+/-1.05 ng/ml. CONCLUSIONS: PADAM patients with severe voiding symptoms could be treated with a combination of androgen therapy and alpha-blockers. Further studies with longer follow-up would be required to confirm our results.

The aging male project.

With an increasing life expectancy and a decreasing reproduction rate, the population structure changes. A Jenapharm R & D program investigates the endocrinology of aging men. In men, a decrease in production of sex steroids and other hormones with age can be observed. The typical patterns of daily rhythmicity become less distinct. This is part of a very complex picture in which not only isolated hormones are involved, but also the influence of hormones on each other. Many factors from the external and intemal environment mediated by neurotransmitters constantly affect the highly sensitive hormonal balance. Therefore, aging has also been defined as "the gradual dysfunction of homeostatic processes". Declining testosterone (T) levels are involved in 'andropausal' symptoms in men: loss of libido, erectile dysfunction, insulin receptor resistance, obesity, osteoporosis, disturbances of lipid metabolism, myocardial and circulatory disturbances, impaired well-being and mood. Data are derived from studies in hypogonadal men treated by T replacement. In such parients under T treatment libido increases, fat mass decreases, muscle strenth, bone mineral density and erythropoesis increase. Whether the symptoms of andropause in aging men could successfully be treated by T substitution remains to be investigated. Negative effects of T, especially on the prostate and the cardiovascular system, are under discussion. There is increasing evidence that low T levels seem to be a risk factor for both the prostate and the cardiovascular system. Jenapharm's new testosterone undecanoate formulation for intramuscular injection can be administered every three months. T levels remain within the physiologic range. No supraphysiologic peaks occur. In women, estrogens have beneficial non-genital effects. Studies concentrate on synthetic estrogens for men without feminizing properties such as gynecomastia and reduced testicular size. Several derivatives of 17- alpha estradiol have been synthesized some of which show selectivity for the central nervous system. CNS effects have been demonstrated in female and male animals. Cardiovascular protection by estrogens has been shown in animal and human studies. Atherosclerotic plaque size was reduced after estrogen injections in cholesterol-fed rabbits. Phytoestrogen-fed monkeys had lower total cholesterol and LDL cholesterol and higher HDL cholesterol. Apart from atherosclerotic lesions, coronary artery vascular reactivity was improved. Some of these experimental findings were confirmed in human studies in postmenopausal women with and without estrogen treatment. Whether all of the described estrogenic effects can be seen in men remains to be investigated.