Diagnosis and treatment of sexual dysfunction in elderly men

Male sexual dysfunction refers to a phenomenon in which a man experiences difficulty at any stage during the process of sexual intercourse. In general, erectile dysfunction is regarded as the most representative form of sexual dysfunction, but various other diseases can also be categorized as male sexual dysfunction, including sexual arousal disorder, decreased libido, ejaculation disorder, and Peyronie's disease. Causes of sexual dysfunction include chronic diseases, such as diabetes, hypertension, dyslipidemia, and obesity. In addition, some medications, surgical procedures, and traumas can cause sexual dysfunction. However, aging is the most important cause of male sexual dysfunction. To diagnose and treat elderly patients who complain of male sexual dysfunction, it is first necessary to become familiar with the characteristics of sexual dysfunction in elderly men. The prevalence rates of metabolic syndrome, hypertension, diabetes, dyslipidemia, coronary artery disease, stroke, and depression are higher among elderly men than among younger men; furthermore, the elderly are at a higher risk for the development of kidney, hepatic, spinal cord, and neurological diseases. Notably, anti-hypertensive agents can affect erectile function in elderly men: sexual dysfunction may be severe or the response to treatment may be poor. For satisfactory treatment, spousal factors should also be considered.

Acute Myeloid Leukemia with the 11q23 Rearrangement in a Patient with Klinefelter Syndrome / 대한내과학회지

Klinefelter syndrome is usually characterized by eunuchoidism, gynecomastia, small testes, infertility, elevated gonadotropins, mental retardation, and a constitutional extra X chromosome. Several reports have suggested an association between leukemia and Klinefelter syndrome, although two cohort studies failed to show a clear association between the two. We report the first Korean case of acute myeloid leukemia with the 11q23 rearrangement in a 27-year-old man with Klinefelter syndrome.

Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy

Introduction: The relationship between Testosterone Replacement Therapy (TRT) and prostate cancer remains controversial. Most TRT studies show no change in prostate specific antigen (PSA) but some men do have PSA rise or develop an abnormal digital rectal exam (aDRE). Our objective was to examine the biopsy results of men with symptomatic hypogonadism before or during therapy. Materials and Methods: Data was extracted from our medical record on men with hypogonadism who had a prostate biopsy within the past 4 years done by 3 Urologists with guideline driven practice patterns. Results: 96 men were identified. Mean age at biopsy was 63 (range 40–85) and median PSA was 3.78ng/dL (0.5–662). Of the 61 men not on TRT, median PSA was 4.34 (0.5 to 662) and mean total testosterone 254 (191–341). There were 29 (47.5%) prostate cancers found (6 Gleason score 6, 13 Gleason score 7, 10 Gleason score 8 or 9). Of the 35 men on TRT, median PSA was 3.27 (0.5 to 13.7). The %PSA increase ranged from 2 to 251% (mean 93.5%). Mean total testosterone was 383 (146–792). Of the 14 men treated < 2 years, none had cancer. Of the 21 men treated 2 or more years 5 had cancer (2 Gleason score 6, 3 Gleason score 7). Conclusions: Men with hypogonadism and a clinical indication for biopsy often have prostate cancer, many high grade. No men with an initial PSA rise on TRT had cancer. Men on long term TRT should be monitored with PSA and DRE per guidelines.

El síndrome de Pasqualini: hipoandrogenismo con espermatogénesis conservada

Pasqualini y Bur publican el primer caso de eunucoidismo con espermatogénesis conservada en 1950 en la Revista de la Asociación Médica Argentina. El síndrome de hipoandrogenismo con espermatogénesis incluye: (a) eunucoidismo bien definido, (b) testículos de volumen normal con espermatogénesis completa, llegando a espermatozoides maduros en una elevada proporción de tubos seminíferos, con células de Leydig indiferenciadas e inmaduras, (c) compensación funcional completa mediante la administración de gonadotrofina coriónica, mientras ésta se aplique (d) gonadotrofinas urinarias totales dentro de límites normales, y (e) esta definición fue ampliada con la actividad normal de las otras hormonas adenohipofisarias y la ausencia de malformaciones congénitas en la mayoría de los casos. En la fisiopatogenia del síndrome de Pasqualini, conocido también como síndrome del "eunuco fértil", se demostró primero la ausencia de hormona luteinizante (LH) en el plasma y orina de estos pacientes. El segundo gran avance fueron los estudios funcionales y genéticos que validaron la hipótesis de un déficit funcional de LH en estos hombres, extendido luego a las mujeres. Varios grupos, incluyendo el nuestro, demostrarían en estos casos una LH con diferentes grados de actividad inmunológica pero biológicamente inactiva, a partir de una o más mutaciones invalidantes en el gen LHB. Por último, la comprensión acabada del síndrome de Pasqualini permitiría revertir el fenotipo y la infertilidad de estos pacientes a partir de la utilización de gonadotrofina coriónica y las modernas técnicas de fertilidad in vitro. Este artículo es una revisión histórica y un homenaje a la memoria de Rodolfo Q. Pasqualini.

Pasqualini and Bur published the first case of eunuchoidism with preserved spermatogenesis in 1950 in Revista de la Asociación Médica Argentina. The hypoandrogenism with spermatogenesis syndrome included: (a) eunuchoidism, (b) testis with normal spermatogenesis and full volume, with mature spermatozoa in a high proportion of seminiferous tubes and undifferentiated and immature Leydig cells (c) full functional compensation through the administration of chorionic gonadotropin hormone, while hCG is administered (d) total urinary gonadotrophins within normal limits (e) this definition supposes the normal activity of the pituitary and the absence of congenital malformations in general. A first step in the understanding of the physiopathogeny of Pasqualini syndrome or the so called "fertile eunuch" syndrome was the absence of LH in plasma and urine of patients. The second breakthrough was the functional and genetic studies that validated the hypothesis of a functional deficit of LH in these men: it will then also be described in some women. Different groups including ours demonstrated in these cases a LH with varying degrees of immunological activity but biologically inactive in most of the patients, due to one or more inactivating mutations in the LHB gene. Finally, the full comprehension of Pasqualini syndrome allowed to reverse the hypoandrogenic phenotype and to restore fertility in these patients through the use of chorionic gonadotropin and the modern in-vitro fertility techniques. This article is an historical review and a tribute to the memory of Rodolfo Q. Pasqualini.

Congenital bilateral anorchia: hormonal, molecular and imaging study of a case

The aetiology of congenital bilateral anorchia is unknown. For many years there was speculation of an association between genetic factors and anorchia. We performed different tests in an anorchid boy, 2.5 years old, presented to us with micropenis and absence of both testes, in order to determine any possible factors contributing to the anorchia. Physical examination and hormonal, imaging, chromosomal, and molecular analyses of this case were performed. The basal FSH and LH levels were increased, and their increase in response to gonadotrophin-releasing hormone test was prolonged, while testosterone levels failed to increase after hCG administration. Ultrasonography of the pelvis and magnetic resonance of the abdomen were performed and failed to show any testicular tissue. Lastly, surgical exploration confirmed the absence of testicular structure. Chromosomal analysis revealed a normal male karyotype and molecular analysis did not reveal mutations or polymorphisms in the open reading frame of the SRY gene. Diagnostically, the lack of testosterone response to hCG stimulation is the hormonal hallmark of bilateral congenital anorchia. In addition, according to our case and previous studies, there is lack of association between genetic factors necessary for correct testicular descent and anorchia.

Diabetes Mellitus in Association with Klinefelter Syndrome / 대한내분비학회지

Klinefelter syndrome is the most common form of male hypogonadism. It is characterized by small, firm testis, gynecomastia, a variable degree of eunuchoidism, azoospermia, elevated gonadotropin level. Increased frequency of diabetes mellitus, breast cancer, empysema, chronic bronchitis, varicose vein, germ cell neoplasia occurs in Klinefelter syndrome. We report a 19 year-old male patient with diabetes mellitus in association with Klinefelter syndrome, which was confirmed by chromosome analysis. The patient is being treated with insulin for diabetes mellius and with testostrone replacement for Klinefelter syndrome.

Significance of Testicular Size and Plasma Hormone Levels in Infertile Males / 대한비뇨기과학회지

For the evaluation and management of male infertility, measurements of testicular size (volume) and plasma hormones (FSH, LH and testosterone) have been considered as very important procedures besides the routine examinations of history, physical examination, laboratory works including semen analyses and testicular biopsy and special studies. A total of 99 infertile males with small testes which were less than 1Oml in volume was subjected to the assessment of plasma FSH, LH and testosterone levels. They were divided into 6 study groups; such as Group I. Control: 28 men with normal semen parameters and plasma hormone values. Group II. Oligospermia: 12 patients with sperm density of less than 20 X 10 6/ml. Group III. Testicular azoospermia: 22 patients with testicular biopsy of better than germ cell arrest. Group IV Sertoli cell only syndrome: 25 patients proved by testicular histology. Group V. Klinefelter`s syndrome: 30 patients proved by karyotype studies. Group VI. Eunuchoidism: 10 patients proved by laboratory and physical examinations. The results obtained in this clinical study were as follows (Table 1): Testicular sizes were decreased in Groups IV. Sertoli cell only syndrome, V. klinefelter`s syndrome, and VI. Eunuchoidism. Plasma LH levels were increased in Groups IV. Sertoli cell only syndrome, and V Klinefelter`s syndrome. Plasma FHS levels were increased in Groups IV. Sertoli cell only syndrome, and V. Klinefelter`s syndrome. The long-term hormonal therapy with high doses of human chorionic gonadotropin and human menopausal gonadotropin combined with testosterone was applied to a total of 216 infertile patients with small tests (less than 10ml in volume) for 12 months (range: 3-24 months). Semen parameters were improved in 10 patients who were severe oligozoospermia before the treatment and spermatogenesis was induced in 14 patients who were azoospermic before the treatment following the hormonal therapy. In conclusion, an infertile male with small testis (less than 10ml, should be adequately evaluated before declaration of final diagnosis of sterility.

A Case Report of Klinefelter's Syndrome / 대한비뇨기과학회지

The Klinefelter's syndrome is characterized by azoospermia, gynecomastia, a variable degree of eunuchoidism elevated urinary gonadotropins, atrophic testis and hyalinization of the seminiferous tubules in which Leydig cells were preserved. Reviewing some world literatures, we have reported a case of Klinefelter's syndrome associated with right inguinal hernia in 22 year-old Korean male.

Hormonal Therapy on Eunuchism and Eunuchoidism / 대한비뇨기과학회지

The writers, herein, report clinical findings and results of hormonal therapy applied on 10 eunuchs and 35 eunuchoids for the 10-year period from 1960 to 1969. The clinical findings of these subjects are summarized in the tables 1~4, and the results of the treatment, in table 5. Seven anorchisms in 10 eunuchs lost their testes and scrotum by dog bites and the remaining 3 cases, by industrial injuries. Ten cases of eunuchs and 8 cases of hypergonadotropic eunuchoids were given intramuscular injections of testosterone depot "MIRO-DEPO" (Hanil Pharm. Mfg. Co.), 100 mg every 10 days for 6~12 months. The remaining 27 cases of hypogonadotropic eunuchoids were administered injections of human chorionic gonadotropin "PUBEROGEN" (Tong-A Pharm. Mfg. Co. Tomoda Pharm. Mfg. Co.), 1,000 I.U. every 3 days combined with the testosterone depot, 100mg every 15 days, for 6 to 12 months. Improvements of male secondary sex characters such as sex hair growth, voice change, enlargement of penile size and masculine fat distribution were observed three to six months after the treatments. Such improvements were found in 90 per cent of eunuchs, 96 per cent of hypogonadotropic eunuchoids and 80 per cent of hypergonadotropic eunuchoids. Two of the hypogonadotropic eunuchoids were proved to become fertile (fertile eunuchoid) with long-term treatment of Puberogen.