Aging Male Symptoms Research Articles

Physical activity level and self-reported musculoskeletal pain perception among older males

BACKGROUND AND OBJECTIVES: In light of the social and economic impact caused by pain and the evidences of benefits provided by physical activity to individuals affected by this unpleasant sensation, this study aimed at evaluating the prevalence of selfreported musculoskeletal pain and at determining its association with the level of physical activity of males aged 40 years or above, dwellers of the urban zone of the city of Pelotas-RS. METHODS: This is an observational, cross-sectional and population-based study. The level of physical activity was measured by means of leisure and commuting sections of the International Physical Activities Questionnaire, being classified as insufficiently active those with scores below 150 minutes/week. To evaluate pain self-perception, a question of the Aging Male's Symptoms Scale was used. Those reporting moderate, severe and intense pain were classified as having pain. RESULTS: The prevalence of pain self-perception was 27.0% (CI95% 22.7 - 31.3) and was significantly associated to the level of physical activity (p<0.001). Males performing 150 minutes/ week or more of physical activity had 60% protection against pain report as compared to those not reaching this cutoff point, being that this result was maintained significant even after adjustment for confounding factors (p=0.02). CONCLUSION: This study has shown that reaching physical activity recommendations may be a protection against musculoskeletal pain perception among studied males.

Testosterone Supplementation in Older Men with Low Testosterone Levels

As men age, their blood testosterone levels generally decline, often to levels in the low or low-normal ranges specified by commercial laboratories. Testosterone supplementation is being prescribed increasingly for such men, some of whom report “aging-male symptoms.” Although testosterone supplementation undoubtedly improves aging-male symptoms and sexual function in men who have overt primary or secondary hypogonadism, the value of supplementation in other men has not been established. A multi-institutional team conducted a randomized …

Efficacy and safety of testosterone replacement therapy in men with hypogonadism: A meta-analysis study of placebo-controlled trials.

The purpose of the present meta-analysis was to evaluate the efficacy and safety of testosterone replacement therapy in men with hypogonadism. A search was conducted for appropriate randomized controlled trials and the data from 16 trials were pooled. The intended primary outcome of the present study was to determine the efficacy and safety of testosterone replacement therapy. The current data demonstrated that scores for Aging Male Symptoms (AMS) were significantly reduced following testosterone replacement therapy, with a mean decrease in AMS score of 1.52 [95% confidence interval (CI), 0.72 to 2.32; P=0.0002]. Testosterone replacement therapy increased lean body mass [mean difference (MD), 1.22; 95% CI, 0.33 to 2.11; P=0.007], reduced fat mass in a non-significantly manner (MD, −0.85; 95% CI, −1.74 to 0.04; P=0.06) and significantly reduced total cholesterol (MD, −0.16; 95% CI, −0.29 to −0.03; P=0.01). No significant differences were identified in body weight (MD, 0.09; 95% CI, −1.13 to 1.31; P=0.89), body mass index (MD, 0.10; 95% CI, −0.62 to 0.82; P=0.78) or bone mineral density (MD, −0.01; 95% CI, −0.03 to 0.02; P=0.60). Average prostate volume increased (MD, 1.58; 95% CI, 0.6 to 2.56; P=0.002) following testosterone replacement therapy, but the levels of prostate-specific antigen (PSA) (MD, 0.10; 95% CI, −0.03 to 0.22; P=0.14) and the International Prostate Symptom Scores (MD, 0.01; 95% CI, −0.37 to 0.39; P=0.96) did not change. In conclusion, testosterone replacement therapy improves quality of life, increases lean body mass, significantly decreases total cholesterol, and is well-tolerated and safe for men with hypogonadism who are exhibiting PSA levels of <4 ng/ml.

Testosterone replacement therapy improves the health-related quality of life of men diagnosed with late-onset hypogonadism

ObjectivesTo test the hypothesis that testosterone replacement therapy (TRT) improves the long-term health-related quality of life (HRQoL) of men with late-onset hypogonadism (LOH), as studies have shown that sub-physiological testosterone levels have a negative impact on psychological (e.g. mood, vitality, libido and sexual interest) and physical features (e.g. erectile function and physical strength), all of which contribute to a sense of well-being. Patients and methodsIn all, 261 patients (mean age 58years) diagnosed with LOH were treated with long-acting intramuscular testosterone undecanoate (TU) for up to 5years. Health quality indicators including the International Prostate Symptom Score (IPSS), the five-item version of the International Index of Erectile Function (IIEF-5), the Aging Males’ Symptoms (AMS) scale, and the percentage of patients reporting joint and muscle pain were measured at baseline and at each visit. The means were then plotted over time in parallel with mean total testosterone (TT) levels. ResultsBoth the mean IPSS and AMS scores fell significantly within the first 3months and the mean IIEF-5 score and TT levels increased within the first 3months. All four parameters continued to improve over the course of the trial. The percentage of patients reporting both joint and muscle pain decreased during TRT. ConclusionsThis prospective, observational and longitudinal analysis shows a clear improvement in both psychological and physical characteristics as physiological testosterone levels are reached and maintained contributing to an improvement in the HRQoL in men with diagnosed LOH.

Identification of late-onset hypogonadism in middle-aged and elderly men from a community of China

In this study, we investigated the essential criteria for late-onset hypogonadism (LOH) syndrome based on the presence of symptoms associated with low testosterone levels in Han Chinese men. Blood tests for total testosterone (TT) and sex hormone–binding globulin (SHBG) were performed, and the aging male symptoms (AMS) questionnaire was conducted in a randomly selected cohort composed of 944 Chinese men aged 40 to 79 years from nine urban communities. Three sexual symptoms (decreased ability/frequency of sexual activity, decreased number of morning erections, and decreased libido) were confirmed to be related to the total and free testosterone levels. The thresholds for TT were approximately 12.55 nmol l−1 for a decreased ability/frequency to perform sex, 12.55 nmol l−1 for decreased frequency of morning erections, and 14.35 nmol l−1 for decreased sexual desire. The calculated free testosterone (CFT) thresholds for these three sexual symptoms were 281.14, 264.90, and 287.21 pmol l−1, respectively. TT <13.21 nmol l−1 (OR = 1.4, 95%CI: 1.0–1.9, P = 0.037) or CFT <268.89 pmol l−1 (OR = 1.5, 95%CI: 1.1–20, P = 0.020) was associated with an increase in the aforementioned three sexual symptoms. The prevalence of LOH was 9.1% under the criteria, including all three sexual symptoms with TT levels <13.21 nmol l−1 and CFT levels <268.89 pmol l−1. Our results may improve the diagnostic accuracy of LOH in older men.

AB027. Testosterone deficiency of testosterone replacement therapy Mongolian men aged over 40 years old

Background and ObjectiveEarly detection of testosterone deficiency in middle aged and aging male improves their quality of life and prevents testosterone relating disorders. There is not enough evidence based study related testosterone deficiency syndrome and erectile dysfunction in Mongolia. Purpose of our study is investigating TDS and erectile dysfunction among men over 40 years old. We conducted questionnaires of AMS (Aging Male Symptom) scale and erectile function levels and forms of sexual function by IIEF-5 score. And we studied the relation of erectile dysfunction. To determine to testosterone deficiency by serum level of total testosterone less sensitive than free testosterone. To detect the testosterone deficiency syndrome in aging males with erectile dysfunction.Materials and MethodsA total of 309 males over 40 years of age enrolled this study. An approval of the Ethical Committee of MOH was obtained. Each participant was assigned to either an erectile dysfunction (ED) group or a control group depending on results of the IIEF-5 questionnaire. The ED group was further divided into three groups (moderate, severe and very severe) based on a level of ED. The total testosterone (TT) levels were determined in blood serum, using a competitive ELISA analytical system and free testosterone (FT) calculated as described by Vermeulen. Test samples were collected between 8:00-11:00 am. The biochemical diagnosis of TDS was based on ISSAM guidelines, particularly, if TT was ≤3.46 ng/mL or free testosterone FT was ≤0.072 ng/mL.ResultsED of moderate, severe and very severe levels were diagnosed in 199 (64.41%) out of 309 participants. There was an inverse association between an erectile function and age (r=−0.380, P<0.01). The average TT was 5.75±2.316 ng/mL and FT was 0.091±0.0084 ng/mL. Compared to the ED group, the control group had a higher TT level: 5.6440±1.177 ng/mL and 5.812±2.316 ng/mL respectively. In the control group the FT level was 0.061±0.0084 ng/mL whereas it was 0.041±0.0076 ng/mL in the ED group. Late onset hypogonadism detection by using calculated free testosterone was three times higher when using total testosterone. Testosterone replacement therapy improved erectile function, aging and reducing waist circumference and maintain testosterone in biological level.ConclusionsOur study showed that most of aging males had a moderate to very severe ED (64.55%). The level of TT (5.644±1.177 ng/mL) and FT (0.041±0.0036 ng/mL) was significantly lower in ED patients (P<0.05). The testosterone deficiency syndrome was detected in 24.27% of the ED group.

Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan

Objective: We investigated the effects of testosterone replacement therapy (TRT) on nocturia and general health among men with hypogonadism and nocturia.Methods: From our previous EARTH study population, 64 patients with a clinical diagnosis of nocturia (two or more times per one night) and hypogonadism, comprising the TRT group (n = 31) and controls (n = 33), were included in this analysis. The TRT group was administered 250 mg of testosterone enanthate as an intramuscular injection every 4 weeks for 6 months. All patients responded to the following questionnaires: International Prostatic Symptoms Score (IPSS), Aging Male Symptoms (AMS) score and Short Form-36 health survey at baseline and 6-month visit. These categories were compared based on changes from baseline to the 6-month visit between TRT and control groups.Results: At the 6-month visit, the TRT group had a significant decrease in IPSS question no. 7 and AMS question no. 4, whereas no significant changes were observed in the control group. Additionally, role limitation because of health program, vitality and mental health domains were significantly improved in the TRT group.Conclusions: Six-month TRT may improve nocturia, sleep conditions and quality of life among men with hypogonadism and nocturia.

Erectile dysfunction is a prognostic indicator of comorbidities in men with late onset hypogonadism

Introduction: The role of testosterone deficiency in erectile dysfunction (ED) is increasingly recognized; however, there is a need to clarify the nature of the relationship between ED and late onset hypogonadism (LOH).Aim: In this study, we sought to determine the correlators of ED severity amongst men with LOH.Methods: 130 patients diagnosed with LOH fulfilling the criteria of total testosterone ≤3.5 ng/ml (<12 nmol/l) and with an erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1–5) were enrolled for a subsequent trial of Testosterone Undecanoate. Demographic data were recorded at baseline.Main outcome measures: Subjects completed three standardised questionnaires to assess sexual health including International Prostate Symptom Score (IPSS), Aging Males Symptoms (AMS) and IIEF Sexual Health Inventory for Men (SHIM). Patients were stratified by ED severity with SHIM scores of 1–7 considered severe ED, 8–11 moderate ED and 12–16 mild to moderate. Serum testosterone, sex hormone binding globulin (SHBG) and lipids (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) were assessed along with plasma fasting glucose and HbA1c. Weight, BMI and waist circumference were also recorded.Results: A significant association was observed between severity of ED and mean weight (p = 0.000), waist circumference (p = 0.000), triglycerides (p = 0.009), total cholesterol (p = 0.027), HbA1c (p = 0.000), fasting glucose (p = 0.003) and AMS scores (p = 0.043). No significant differences were seen in testosterone fractions and SHBG levels between ED subgroups. A positive correlation existed between the prevalence of diabetes mellitus (type 1 and type 2) and ED severity in this cohort (p = 0.018).Conclusions: The descriptive data of our cohort show that increased severity of ED within LOH patients correlated with an increased waist circumference, hyperglycemia, hypertriglyceridemia, hyperlipidemia and a history of diabetes mellitus. Severe ED functions as a prognostic indicator of co-morbidities in men with LOH.

Prospective assessment of health-related quality of life in men with late-onset hypogonadism who received testosterone replacement therapy.

The objective of this study was to characterise the status of health-related quality of life (HRQOL) in Japanese men with late-onset hypogonadism (LOH) treated with testosterone replacement therapy (TRT). HRQOL in 69 consecutive Japanese men with LOH undergoing TRT for at least 6months was prospectively evaluated before and 6months after the initiation of TRT using the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8). All eight-scale scores except for bodily pain (BP) in the 69 patients at 6months after the introduction of TRT significantly improved compared with those before TRT; however, all scale scores except for BP in the 69 patients were significantly inferior to those in age-matched Japanese controls irrespective of the timing of SF-8. Multivariate analyses of several parameters revealed that both age and Aging Male Symptom (AMS) score had an independent impact on mental health (MH), despite the lack of an independent association between any score and the remaining factors examined. TRT appeared to significantly improve the status of HRQOL in men with LOH; however, even after the introduction of TRT, HRQOL associated with MH remained significantly impaired in elderly men and/or those with a high AMS score.

Diagnosing andropause

Testosterone levels’ decrease with age is now well documented. Indeed 20% of healthy men over 60 and 30–50% over 80 years of age have levels under the reference range. Low testosterone levels are not sufficient to diagnose age related male hypogonadism or “andropause”. Andropause diagnosis requires the presence of both low testosterone levels and clinical symptoms. Depending on the study, several cut-offs have been used in order to define low testosterone levels. The use of free testosterone as a more specific marker in cases where Sex Hormone Binding Globulin (SHBG) alterations are suspected has also been a matter of discussion. Several questionnaires have been elaborated in order to help andropause diagnosis, such as the St. Louis Androgen Deficiency in the Aging Male (ADAM) questionnaire and the Aging Male Symptom (AMS) rating. Although sensitivity was quite satisfying for both the ADAM and the AMS (88% and 96% respectively) specificity was low (60% and 30% respectively). Scores on both questionnaires reflected testosterone levels even less with higher age.

Screening of late onset male hypogonadism with ADAM and AMS scores and impact of cognitive functions

Objective: To screen men presenting late onset hypogonadism with the conjunction of ADAM (Androgen deficiency of the Aging Male) score and AMS (Aging Male's Symptoms) score and measure its impact on cognitive function.

The Efficacy of Combination Treatment with Injectable Testosterone Undecanoate and Daily Tadalafil for Erectile Dysfunction with Testosterone Deficiency Syndrome

Both testosterone therapy and chronic treatment with phosphodiesterase type 5 inhibitors (PDE5Is) have positive effects on the histology of penile corpora and erectile function. However, few clinical studies have evaluated the efficacy of combination therapy with both testosterone replacement and chronic PDE5Is. This study was designed to evaluate the efficacy and safety of combination treatment with long-acting injectable testosterone undecanoate (TU) and a once-daily tadalafil 5 mg for erectile dysfunction with testosterone deficiency syndrome. Sixty patients were consecutively enrolled and followed for 36 weeks. Thirty patients were randomly assigned to group I and received 1,000 mg of parenteral TU on day 1, followed by additional injections at weeks 6 and 18 with on-demand tadalafil 10-20 mg during the 30 weeks of treatment. The remaining 30 patients received the same dose and schedule of TU as group I, and were prescribed once-daily tadalafil 5 mg during 30 weeks. Serological tests were performed, and the International Index of Erectile Function (IIEF), Aging Males' Symptoms (AMS) questionnaires, and Global Assessment Question (GAQ) were administered to the patients. Total IIEF and AMS scores were significantly improved during the 30 weeks of treatment in both groups. When IIEF scores were compared between the two groups, group II showed better symptom scores than group I at weeks 6 and 30. A similar pattern was observed when comparing AMS scores between the groups. At week 36, changes in IIEF and AMS scores that indicated worsened symptoms compared with week 30 were observed in both groups; group II showed better symptom scores than group I. On the GAQ, the ratio of patients reporting improvement in erectile function was significantly higher in group II than group I. The combination of long-acting injectable TU and once-daily tadalafil 5 mg produced a significant improvement in erectile function. Moreover, the improvement in erectile function was well maintained, even after the cessation of treatment.

MP71-16 GENERATION DIFFERENCE ON THE ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND LATE-ONSET HYPOGONADISM SYMPTOMS: ANALYSIS OF 1398 HEALTHY YOUNG AND ELDERLY ADULTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-16 GENERATION DIFFERENCE ON THE ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND LATE-ONSET HYPOGONADISM SYMPTOMS: ANALYSIS OF 1398 HEALTHY YOUNG AND ELDERLY ADULTS Hiroshi Kiuchi, Tetsuji Soda, Kentaro Takezawa, Shinichiro Fukuhara, Yasushi Miyagawa, Akira Tsujimura, Tetsuya Takao, and Norio Nonomura Hiroshi KiuchiHiroshi Kiuchi More articles by this author , Tetsuji SodaTetsuji Soda More articles by this author , Kentaro TakezawaKentaro Takezawa More articles by this author , Shinichiro FukuharaShinichiro Fukuhara More articles by this author , Yasushi MiyagawaYasushi Miyagawa More articles by this author , Akira TsujimuraAkira Tsujimura More articles by this author , Tetsuya TakaoTetsuya Takao More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2629AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aging is known to affect sexual, psychological and physiological functions including lower urinary tract symptoms (LUTS). Recent data suggested that severity of LUTS was associated with that of late-onset hypogonadism (LOH) in elderly men. However, information on the association in young adults is limited. In this study, we evaluated the relationship between LUTS and LOH symptoms in young and elderly adults. METHODS This study included 1398 healthy men ≥20 years; 130 in 20□fs, 519 in 30□fs, 399 in 40□fs, 268 in 50□fs and 82 in 60□fs. LUTS was assessed using I-PSS questionnaire and LOH symptoms was evaluated using Aging Male's Symptoms (AMS) questionnaire with higher score indicating more severe symptoms. LUTS was diagnosed as I-PSSS ≥8. Severity of LUTS was defined by I-PSS-QOL as follows; 0-1 as mild, 2-3 as moderate, and 4-6 as severe. Generalized additive models were used for statistical analysis. RESULTS Total I-PSS score increased with age: LUTS was observed in 3.1% in 20's, 2.7% in 30's, 7.8% in 40's, 15.3% in 50's and 22.0% in 60's (p for trend <0.01) (Fig.1). Mild LUTS was found in 751(54%), and moderate LUTS in 556(40%), severe LUTS in 91(7%). Severity of LOH symptoms increased with increasing LUT severity in any years of age. Moreover, young adults with severe LUTS had more severe LOH symptoms than elderly adults (36.3 vs. 28.5, p<0.05) (Fig. 2); they reported higher psychological and physiological sub-score than elderly men, whereas they reported lower sexual score. CONCLUSIONS Both young and elderly adults with severe LUTS have severe LOH symptoms, but young adults with severe LUTS were more likely to have severe LOH symptoms than elderly adults. Therefore, urologist should take care of hypogonadism symptoms other than LUTS when young adults are presented with LUTS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e918 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroshi Kiuchi More articles by this author Tetsuji Soda More articles by this author Kentaro Takezawa More articles by this author Shinichiro Fukuhara More articles by this author Yasushi Miyagawa More articles by this author Akira Tsujimura More articles by this author Tetsuya Takao More articles by this author Norio Nonomura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD16-04 ALTERATIONS OF HEMATOGENESIS AND BONE MINERAL DENSITY AFTER DUTASTERIDE TREATMENT IN AGED PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical & Non-Surgical Therapy1 Apr 2015PD16-04 ALTERATIONS OF HEMATOGENESIS AND BONE MINERAL DENSITY AFTER DUTASTERIDE TREATMENT IN AGED PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA Kenichi Mori, Shinsuke Mizoguchi, Yasuhiro Sumino, Fuminori Sato, Naoki Yoshimura, and Hiromitsu Mimata Kenichi MoriKenichi Mori More articles by this author , Shinsuke MizoguchiShinsuke Mizoguchi More articles by this author , Yasuhiro SuminoYasuhiro Sumino More articles by this author , Fuminori SatoFuminori Sato More articles by this author , Naoki YoshimuraNaoki Yoshimura More articles by this author , and Hiromitsu MimataHiromitsu Mimata More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1288AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testosterone maintains bone mineral density (BMD) and hematogenesis in men. Therefore, hypogonadism can decrease BMD and hematogenesis. Because most patients with benign prostatic hyperplasia (BPH) are aged persons, there is a possibility of hypogonadism in aged BPH patients. Dutasteride administration for BPH can increase blood levels of testosterone; however, it is not known whether BMD and hematogenesis are altered after dutasteride administration. Therefore, the effects of dutasteride on BMD and hematogenesis in patients with BPH were investigated. METHODS Sixty-four patients with BPH, who were taking 0.5 mg dutasteride daily for a year, were investigated retrospectively. All patients were concomitantly taking alpha-blockers, and two patients were treated with anticholinergic drugs. BMD, prostate volume (PV) and blood hemoglobin (Hb), hematocrit (Ht), total cholesterol (T-CHOL), HDL cholesterol (HDL), and free testosterone (FT) levels were examined before and after dutasteride administration. BMD was investigated using dual-energy X-ray absorptiometry. The questionnaires such as International prostatic symptom score (IPSS), Overactive Bladder Symptom score (OABSS) and Aging Male Symptoms rating scale (AMS) were also evaluated. RESULTS Median age and FT levels prior to the treatment were 77 years old and 5.4 pg/mL (ranged from 9.1 to 3.9 pg/mL), respectively. Post-treatment PV, IPSS and OABSS were significantly decreased compared with those of pre-treatment (P<0.05). Post-treatment Hb and Ht levels were significantly increased compared with those of pre-treatment (P<0.05). Post-treatment BMD was also significantly increased compared with that of pre-treatment (P<0.05). Furthermore, T-CHOL levels were significantly decreased after a year, whereas HDL levels were significantly increased compared with pre-treatment values (P<0.05). Post-treatment FT levels (mean: 6.4 pg/mL) were significantly increased, and AMS was significantly decreased compared with pre-treatment values (P<0.05). CONCLUSIONS In this study, most patients had hypogonadism, evidenced by the mean baseline FT level at 5.4 pg/mL. Thus, dutasteride administration might be effective for the treatment of BPH patients with hypogonadism because dutasteride administration could increase FT blood levels, which leads to improve not only hematogenesis, but also and BMD. Furthermore, improved daily living activity evidenced by increased AMS can also contribute to the improvement of lipid metabolism and BMD. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e331 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenichi Mori More articles by this author Shinsuke Mizoguchi More articles by this author Yasuhiro Sumino More articles by this author Fuminori Sato More articles by this author Naoki Yoshimura More articles by this author Hiromitsu Mimata More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Are andropause symptoms related to depression?

Andropause is a middle-age condition in which men experience changes in their physical, spiritual and emotional health. The association between andropause and psychological symptoms such as depression are not very clear yet. The objective of this study was therefore to determine the association between the 'Aging Males Symptoms Scale' (AMS) and depression. A cross sectional study was conducted among 521 old men. To collect data, the AMS and the Patient Health Questionnaires 2 and 9 were used to screen depression, in addition to questions on background and fertility. Multiple linear regression analysis was used to assess the association between andropause symptoms and depression. Based on our results and the AMS score, 51.5% of the study population had clinical symptoms of androgen disorder, 3.7% of which had severe symptoms. There was a strong correlation between the AMS score and depression. Depression, diabetes, cigarette smoking and spousal age retained their significant associations even after entering the relevant demographic, anthropometric, smoking and disease variables in the multivariable model. As a positive predictive factor, depression had the strongest association with AMS. Based on our results, there is a direct association between andropause symptoms and depression, where the increasing AMS score corresponds with the severity of depression. Our results show the need of screening for depression when evaluating andropause symptoms.

The prevalence and correlates of the positive Androgen Deficiency in the Aging Male (ADAM) questionnaire among psychiatric outpatients: a cross-sectional survey of 176 men in a general hospital in Taiwan.

IntroductionThe Androgen Deficiency in the Aging Male (ADAM) questionnaire is widely used to screen for late-onset hypogonadism. The positive response to the ADAM questionnaire (positive ADAM) has been associated with depression and poorer quality of life in a number of studies. It is unclear whether there is any value of the ADAM questionnaire in psychiatric populations. In this study, we aimed to determine the utility of the ADAM questionnaire in a convenient sample of male psychiatric outpatients.MethodsOne hundred and seventy-six men (mean age: 54.3 years; standard deviation: 10.7 years; range: 40–80 years) completed the ADAM questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Aging Males’ Symptoms (AMS) scale. Anxiety was defined as a HADS anxiety subscore ≥8; depression as a HADS depression subscore ≥8; and moderate/severe impairment of health-related quality of life (HQoL) as AMS ≥37. ADAM, anxiety, and depression was used to model the moderate/severe impairment of HQoL.ResultsOne hundred and sixty-four (93%) men had positive ADAM. Positive ADAM was associated with a lower body mass index (P<0.05) and moderate/severe impairment of HQoL (P<0.001), but was not associated with anxiety or depression (P>0.05). Positive ADAM was associated with five symptoms of the AMS scale: “decline of one’s feeling of general well-being”, “depressive mood”, and three sexual symptoms. In regression analysis, positive ADAM was associated with increased risk of moderate/severe impairment of HQoL (unadjusted odds ratio 20.1, 95% confidence interval 3.77–372, P<0.01), which remained significant with covariates of anxiety and depression (adjusted odds ratio 15.6, 95% confidence interval 2.52–309, P<0.05).ConclusionThe ADAM questionnaire can be used to screen the sexual symptoms but not depression/anxiety in male psychiatric outpatients. Positive ADAM may indicate moderate/severe impairment of HQoL.

Effects of testosterone treatment on glucose metabolism and symptoms in men with type 2 diabetes and the metabolic syndrome: a systematic review and meta-analysis of randomized controlled clinical trials.

The effects of testosterone treatment on glucose metabolism and other outcomes in men with type 2 diabetes (T2D) and/or the metabolic syndrome are controversial. To perform a systematic review and meta-analysis of placebo-controlled double-blind randomized controlled clinical trials (RCT) of testosterone treatment in men with T2D and/or the metabolic syndrome. A systematic search of RCTs was conducted using Medline, Embase and the Cochrane Register of controlled trials from inception to July 2014 followed by a manual review of the literature. Eligible studies were published placebo-controlled double-blind RCTs published in English. Two reviewers independently selected studies, determined study quality and extracted outcome and descriptive data. Of the 112 identified studies, seven RCTs including 833 men were eligible for the meta-analysis. In studies using a simple linear equation to calculate the homeostatic model assessment of insulin resistance (HOMA1), testosterone treatment modestly improved insulin resistance, compared to placebo, pooled mean difference (MD) -1·58 [-2·25, -0·91], P < 0·001. The treatment effect was nonsignificant for RCTs using a more stringent computer-based equation (HOMA2), MD -0·19 [-0·86, 0·49], P = 0·58). Testosterone treatment did not improve glycaemic (HbA1c) control, MD -0·15 [-0·39, 0·10], P = 0·25, or constitutional symptoms, Aging Male Symptom score, MD -2·49 [-5·81, 0·83], P = 0·14). This meta-analysis does not support the routine use of testosterone treatment in men with T2D and/or the metabolic syndrome without classical hypogonadism. Additional studies are needed to determine whether hormonal interventions are warranted in selected men with T2D and/or the metabolic syndrome.

Effect of testosterone replacement treatment on constitutional and sexual symptoms in type 2 diabetic men: need for rules.

In a recent publication, Gianatti and colleagues investigated the effect of testosterone treatment in obese, aging men with type 2 diabetes (T2D) with mild to moderate symptoms, a modest reduction in testosterone levels, mild to moderate aging male symptoms, and erectile dysfunction.1 The authors could not show any significant improvement in constitutional or sexual symptoms in this group of men. This randomized double-blind, parallel, and placebo-controlled trial among other critically emphasizes the increased testosterone prescriptions worldwide and together with other corroborating or contradictory studies awakes the need for guidelines in the androgen replacement treatment.

Effect of testosterone treatment on constitutional and sexual symptoms in men with type 2 diabetes in a randomized, placebo-controlled clinical trial.

The objective of the study was to assess the effect of T treatment on constitutional and sexual symptoms in men with type 2 diabetes (T2D). This was a randomized double-blind, parallel, placebo-controlled trial. The study was conducted at a tertiary referral center. Men aged 35-70 years with T2D, a hemoglobin A1c less than 8.5%, and a total T level less than 12.0 nmol/L (346 ng/dL) with mild to moderate aging male symptoms and erectile dysfunction. Eighty-eight participants were randomly assigned to 40 weeks of im T undecanoate (n = 45) or matching placebo (n = 43). Constitutional symptoms using the aging male symptoms (AMS) score, sexual desire (question 17 AMS score), and erectile function (International Index of Erectile Function-5). T treatment did not substantially improve aging male symptoms [mean adjusted difference (MAD) in change over 40 weeks across the T and placebo groups in AMS total score, -0.9 (95% confidence interval [CI] -4.1, 2.2), P = .67] or sexual desire [MAD in question 17 AMS, -0.3 (95% CI -0.8, 0.2), P = .17]. Although compared with placebo, erectile function in men assigned to T was reduced [MAD in International Index of Erectile Function abridged version 5, -2.0 (95% CI -3.4, -0.6), P < .02], there was no significant difference between baseline and 40-week International Index of Erectile Function abridged version 5 scores if both groups were analyzed separately. At baseline, symptoms were worse in men with depression and microvascular complications but did not correlate with T levels. In this trial, T treatment did not substantially improve constitutional or sexual symptoms in obese, aging men with T2D with mild to moderate symptoms and modest reduction in T levels typical for the vast majority of such men.

Correlates of low testosterone in men with chronic spinal cord injury.

Although high rates of serum testosterone deficiency have been reported in men with spinal cord injury (SCI), its determinants and attributes are not yet established. The aim of this study was to recognize, among putative determinants and attributes of androgen deficiency, those significantly associated to low testosterone after adjustment for confounders recognizable in men with chronic SCI. A biochemical androgen deficiency (total testosterone <300ng/dL) was exhibited by 18 of 51 patients (35.3%). Significant correlates of testosterone levels were as follows: weekly leisure time physical activity (LTPA) explored by the LTPA Questionnaire for people with SCI, body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides and sexual symptoms, explored by the aging males' symptom (AMS) questionnaire. At the multiple linear regression analysis, among putative determinants of low testosterone, only weekly LTPA and BMI exhibited a significant association with testosterone levels, explaining 54.2 and 9.0% of testosterone variability respectively. At the linear regression models, among various putative attributes of androgen deficiency, only lower sexual desire and, at a lesser extent, higher HOMA-IR, exhibited significant associations with lower testosterone levels, after adjustment for BMI, age, comorbidities and weekly LTPA. In conclusion, poor LTPA, high BMI and low sexual desire are independent predictors of low testosterone in men with chronic SCI. This is relevant to clinical practice, as all these features are routinely assessed in rehabilitation settings for SCI. As poor LTPA and high BMI are modifiable life-style related risk factors, prospective studies could clarify whether life-style modification could increase the level of testosterone and improve the low sexual desire, relevant clinical attribute of low testosterone in men with SCI.